Please help me think through allergy issues

[Trillian]

A few months back I posted about my DS's reaction to nuts. After the initial emergency appointment, we went to an allergist, he read the blood test (but didn't give me the results), said he tested positive for "a lot of things," and that he would run skin tests to narrow it. Well, the skin tests he said were invalid because he didn't react to the histamine control. However, he still reacted to pistachios (and walnuts in the blood test) and grass in the skin test, so to eliminate nuts from his diet and come back in a year.

 

During the appointment I told him he was gluten free because of digestive issues and that he had been helped greatly by the change in diet. Randomly, when he asked about pets, we also told him that he had Madagascar Hissing Cockroaches (this is going somewhere).

 

Yesterday, his face turned bright red, and all day, inside or not, no changing, so I e-mailed for the blood test results; all I can say is it looked like an allergy response as opposed to something from the weather or whatever. According to the blood test results, he tested positive for wheat (not mentioned despite what I told him about going gluten free), soy, peanuts, and cockroaches in addition to the information we've already been given. Now, I know the skin test is supposed to be more accurate, but if he said himself it wasn't valid, I'm wondering how much weight to give the blood test (and will happily get rid of the cockroaches :-) ).

 

Yesterday he had a soy based pasta before his face turned red, so we've decided to try a soy elimination and see if there's any change.

 

Has anyone had this experience? Where the skin test was not helpful but the blood test still gave useful information? I don't want to chase my tail too much, but I don't want DS to be sick either. Except for the nuts and grass, the allergens were all level 2.

 

Thanks,

[sbgrace]

For food allergy tests there is a high risk of false positives. But there is an equally high risk of false positives in skin or blood tests. So I'm not sure what the allergist was doing and why he didn't follow up better with the blood results you did have. The skin, if no histamine control, is pretty useless imo.

 

Am I understanding, though, that you had wheat, soy, peanut, and cockroach positives on the blood RAST testing? Then the skin test had no control but positives on a couple of nuts. Is that right?

 

The foods could be false positives still. Usually they will ask about suspected reactions to the positive foods (did he have any--did you suspect nuts as an allergen for example?). If you don't know of reactions the gold standard would be an in office food challenge to see if they are allergens or not. Reactions are the best indicator. It gets tricky, though, when dealing with possible anaphylactic things like nuts and peanuts.

 

There is a ton of cross contamination with tree nuts and sesame (sesame has a shared protein with pistachio and cashew) in gluten free items (prepared foods like cereals and and similar as well as staples like flours; Rob's Red Mill gluten free for example is run on shared lines with tree nuts though they do have warnings). I would want to know if he's eating tree nuts without reaction in his gluten free stuff. Also, was his blood test for those nuts negative? Because false negatives are much more unlikely. He may not be allergic to nuts if I'm reading correctly.

 

Beyond that you have a positive blood test for soy and a potential soy reaction now, correct? I'd want to follow up on that along with the nut thing. The wheat sounds like a moot point given he's gluten free anyway. There's no way I'd food challenge that one given he's doing well gluten free.

 

The cockroach is an environmental and false positives with environmentals are far less common. The allergists we've worked with seem to take environmental allergy test results at face value.

 

It really sounds like you need a new allergist.

[Dana]

My son had a skin test that didn't tell us much of anything. His back just swelled up pretty much all over with milk the largest. We didn't test nuts with a skin test; he'd already had anaphylaxis to cashews. The blood test was more useful later on. We know he tested positive to egg on the blood test, so we're being a bit more careful with them, but he can tolerate them in baked goods, so we're continuing to use them in baking.

I also asked for a copy of the bloodwork numbers. That's been nice to have as well.

 

But for us, skin test, not useful. Blood test, slightly useful. Gold standard is still food challenge (and he's still highly allergic to dairy in baked goods *&%*$& ).

 

I'd likely use your results to get rid of the roaches if you want them gone & I'd be looking for a different allergist. I'm definitely getting my questions answered if I'm having you treat me or my child.

[Trillian]

i'm sorry. I'll try to be more clear. He had an anaphylactic (sp?) reaction to, we believe, hazelnuts. He tested positive to walnuts in the blood test (the only nuts tested for) and pistachios on the skin test (he tested for multiple nuts and this was the only one that was positive). However, the histamine control didn't react in the skin test, so the allergist said the skin test wasn't valid. He still said to trust that he was allergic to nuts since we had the experience and two test results. I am ordering all the gluten free flours from King Arthur because they are nut free. We're being quite careful that he isn't getting any cross contamination as far as the nuts go.

 

So, it sounds like we should stick with trying a soy elimination and asking for another referral to a different allergist.

 

Thanks for helping to sort it out.

[Dana]

Our allergist has said that even if you're only allergic to some nuts, the cross-contamination issues are such that we were told to avoid all nuts.

 

Good luck!

Allergies stink!

[Tess in the Burbs]

Get a new Dr. Mine has a sheet that they mark when skin testing that is diuble copies and she gives me the copy to take home. I then get an action plan for every single allergy.

 

We have seen 4 allergists over the years. All did skin test then the RAST tests.

 

 

i did have one guy ready to fly me to see Dr wood to convine me the reactions aren't a true allergy- only nutcase we have seen. He didn't believe in kids food allergies ;-|

 

Get a better dr who communicates until you know all the answers to your questions

[vonfirmath]

Did you go directly to an allergist? Or did you get your doctor to refer you there?

[Trillian]

The urgent care referred us. We're with Kaiser. Now that we're "in" with the allergist we could self-refer, but to get a new allergist, I would have to go to the primary care. Since we had an emergency situation, the urgent care referred us.

[MomatHWTK]

Our first allergist seemed to only address or care about the peanut allergy. As it turned out, DS had a TON of allergies and they didn't all show up with skin testing. We did a full elimination (very extreme so you probably won't have to do that). We were told by lots of folks that blood tests have false positives and I believe they probably do for most kids, but for our son he really did have that many allergies! Over time he's been able to outgrow and add some foods back and we are actually supposed to be getting a RAST(specialized blood test) to see if he can trial a few more foods.

 

You do need a more dedicated and detail oriented allergist IMO. Some of them are just so used to "eliminate nuts" and the problem is solved that they don't seem to want to do the real detective work. (Or at least that's how I felt when we got no help from our first allergist!)

[Reya]

I have low-level food-based false positives to several things. The environmental allergens are accurate, however.