Food Allergy

First appointment with an allergist. What to expect? **Updated**

moosebaby2011moosebaby2011
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edited November 2013 in Food Allergy
This is my first post on the allergy board. A little background:

My DS is 22 months old. Back in June he broke out in hives after having been exposed (accidentally) to tree nuts. Since DH and I were fairly confident that we knew the source of the problem, and we already avoid tree nuts in our house (DH reacts to them as well, albeit he vomits rather than getting hives), after speaking with our pedi we declined allergy testing. Neither of us really wanted to put our baby through that if it weren't absolutely necessary, and given DS's reaction was not of the life-threatening variety our pedi was fine with this decision.

This Saturday when DS woke up he had hives on his torso that have gotten progressively worse over the past couple of days. The reaction is pretty much identical to the one he had back in June (location of the hives, pattern, etc) only this time I have no idea what could have caused the issue. I spoke with our pedi this morning and got a referral to an allergist. Our appointment is on Friday.

According to the allergist's office, the appointment will last a couple of hours and will involve a complete physical and some skin testing, but beyond that I have no idea what to expect. Do any of you have some advice to share for a nervous mom?

Thanks so much.

**Update** DS's hives cleared up by Tuesday. On Wednesday he came down with a fever and vomiting, which made DH and I suspect that the hives were DS's immune response to exposure to a virus, which is a pretty common thing. Despite that (and because of the previous reaction) we elected to keep the appointment with the allergist, which was today. They did the plastic-type scratch testing, so no needles which was a relief for me. The results were inconclusive. He had a couple of mild reactions that the allergist strongly suspects were false positives because they didn't make a lot of sense based on DS's history and the fact that they were doing scratch testing on a wiggly toddler. To give you an example, DS's strongest reaction of a 2/3 was to sesame, which is something that he has eaten many, many times (the kid loves hummus which is chock full of tahini) without having a reaction. So, worst case scenario is that he is allergic to something that he wasn't tested for, but it seems more likely that DS gets hives in response to virus exposure and this is not food allergies at all.

Thank you again to all of you that responded.

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Re: First appointment with an allergist. What to expect? **Updated**

  • The physical will be the usual weight and BP check done at the Dr. office. Then they may or may not use something to numb the skin on his back. They don't do this at all for adults because the skin prick tests really is just that, skin pricks. It's no big deal, but our allergist offered this for DS when he was 15 months. In hindsight, based on how he was reacting, I should have declined the numbing just to speed up the procedure. DS went absolutely ballistic as soon as they put him on the scale and it didn't stop until we left the office. The numbing cream took about 30 minutes to start working.

    Then they prick the skin with different allergens. Hopefully your allergist doesn't test for too many because it is unnecessary and there is a very high false positive rate with the skin tests. Talk to your allergist about this if some of the results surprise you. Real life reactions to foods trump the test results. You'll sit around waiting while the skin reacts and then they'll come in and record any reactions. You'll probably also get his blood drawn for a blood test. It is used in conjunction with the skin test to verify the results.

    ***Make sure you get an Epi Pen prescription!*** Or the Auvi Q injector prescription. You can go to their websites for a coupon that covers the prescriptions co-pay. (Awesome!) Your allergists office should also have these coupons to hand out. Make sure you get one! Free stuff!

    Your ped is an idiot. The first few allergic reactions usually get progressively worse. DS's allergist is very worried about what his 3rd and 4th reactions will be like. That ped was incredibly negligent to brush off a TN reaction as not life threatening and incredibly ignorant to assume all reactions would be just as mild. Seriously, I'm seeing red and couldn't even respond when I read this yesterday. I can't believe someone in the medical field could be that uninformed. TN and PN allergies are much more likely to result in a life threatening reaction than many other allergies. MUCH more likely.

    Please, please, please educate yourself more on TN allergies. I realize your DH has TN allergies so he thinks he knows how to handle them. I have TN allergies, too. Thing is, they know more about food allergies now than when we were kids, and they are learning so much more every day. I have learned so much since DS's reaction and it turns out a lot of what I thought I knew was very outdated. Please take your DS's reaction as a chance to educate your family about FA. Your DH needs an epi-pen, too. Use his allergies to set a good example for your son about how to handle FA.

    http://www.foodallergy.org/
    http://www.foodallergy.org/anaphylaxis
    http://www.kidswithfoodallergies.org/resourcesnew.php
    http://snacksafely.com/2013/08/allergic-living-lessons-from-a-teen-food-allergy-tragedy/
    http://peanutfreeparenting.wordpress.com/2012/06/30/danger-of-delayed-allergic-reactions/
    Managing tree nut (me), peanut & egg (DS) allergies.

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  • Also, it would be a good idea if both you and your DH were at this first appointment if at all possible. Don't leave without a Food Allergy Action Plan. You can google that to get an example. It's an easy reference for care providers about what steps to take for which symptoms. Remember that Benadryl, while often recommended to treat an allergic reaction, does nothing to prevent or treat an anaphylactic reaction. It's to provide comfort after getting hives or another mild reaction.
    Managing tree nut (me), peanut & egg (DS) allergies.

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  • @Starbuck128: Thank you for the response. If it puts your mind at ease at all, it wasn't our regular pedi who we initially spoke with about DS's reaction. It was an NP who did his 18 month check-up while our pedi was on medical leave. She gave us the contact information for several area allergists but left the decision up to us. When I spoke to our actual pedi on Monday she was a bit more forceful about the issue.

    I'll talk to DH about an epi pen for himself. He's obviously been dealing with his TN intolerance for many years and the only reaction he's ever had has been vomiting, but it certainly couldn't hurt to take extra precautions in the event that his symptoms worsen.
     
    What worries me most about all of this is that I am no longer convinced that DS has a TN allergy. Yes, his first reaction was after he ate bread that contained TN's, but the second reaction was almost identical to the first and I am positive that he didn't have anything containing TN's this time around (SAHM and hadn't given anything new). Having him react to something when I have no idea what the cause could be makes me extremely nervous. 
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  • Totally agree with PP.  Nut allergies are serious and they do worry more about the future exposures.  My DD tested positive for PN after breaking out in hives when she was given peanut butter.  It wasn't consider a "major" reaction and her score is 3 (out of 6) which puts her in the "moderate" range.  This basically means nothing because they can't guarantee her the same reaction next time.  She currently tests negative to TN but note that there are alot of cross reactions between TN/PN so if he is TN allergic, you'll want to avoid PN most likely as well.  We currently avoid TN even though she doesn't seem to be allergic to them.  

    Also, it sounds like he could have more than one allergen.  If it wasn't TN this time, it could have been something else.  Even more reason to get to the allergist ASAP.
  • I had the skin tests done after I developed all sorts of allergies after my pregnancy with DS. HOnestly, the "pricks" don't hurt at all. The worst part for me was they made me lie on my stomach for 20 minutes while the testing took place. Both of my kids have had the skin testing done as well. DD had it around 9 mo and actually fell asleep while waiting for the nurse to come read the results, so she obviously wasn't very phased. Bring toys, snacks, and before you know it the 20 minutes wil be over. The nurse gave my DD a tongue depressor and latex glove puppet (she drew a face on it) and it distracted her and made the time fly.
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  • Agree with PPs. DS "only" had a hive reaction the first time he was exposed to peanuts. We had him tested and was told he was positive for peanuts but negative for tree nuts. Then he went into anaphylaxis after a cookie with walnuts (no peanuts). Dr said he still doesn't think he's allergic to tree nuts but it was likely cross contaminated with peanuts and his reaction is getting worse. So you may think he didn't have nuts but sometimes it's hard to know for sure. Plus it can become life threatening with more exposures. Now we just avoid all nuts and anything processed at a plant with nuts.

    Good luck at your appointment. You're doing the right thing. Knowledge is power!
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  • Skin testing isn't conclusive. I test positive for a shellfish allergy on a skin test, but I have been eating shrimp all my life and have so far never had a reaction. Did they test for tn allergies?
    LilySlim - (VMOr)

  • @rissa06: Yes, they did a skin test for tree nuts with little or no reaction. At that point the allergist didn't feel that further testing (i.e. blood) was necessary. We're to follow up in a year, but so far everything has been absolutely fine.
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  • Thanks for posting this b/c we go in for allergy testing on Monday. Great knowledge to have prior to our visit.
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                           Willa 10/27/12
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