NoPeanutsPlease is an independent blog.

All views, opinions and conclusions are solely those of the author and do not imply endorsement or recommendation by any other party.

Wednesday, January 31, 2007

The Verdict Is In

Today we finally had our appointment with the allergist. It was kind of strange. We were virtually certain that our daughter is allergic to peanuts and egg whites, so going into the appointment were assuming that this would basically be an exercise in parental thoroughness with little new knowledge to be gained.

We started out by presenting our food allergy 'episodes' to the doctor in a random fashion. We of course started with the Boxing Day anaphylaxis scare, but could not say for sure that it was peanuts. There were numerous other suspected nut reactions as well as four egg white episodes, one of which presented swelling and shortness of breath and seemed to be a milder form of an anaphylactic reaction.

The doctor informed us that we would use a skin prick test to determine confirm these allergies and to determine whether other allergies were present.

After doing a considerable amount of research, I was aware of the fact that skin prick tests are far from 100% reliable and often are best used in order to confirm a suspected allergy vs being used as a means to identify allergies on an exploratory basis.

I also was aware that these tests only determine incidence of the allergy with no ability to gauge severity.

Given that we were quite certain of the egg white allergy and had reason to strongly suspect a peanut allergy, we were able to narrow the field. The allergist administered a skin test to seven sites. Four (wheat, corn, walnut, cow's milk) were done using an actual skin prick but the higher risk allergens (peanut, egg, flu vaccine) were applied topically without breaking the skin.

The result was not surprising. Our daughter developed hives to peanut and egg white despite not even having a break in the skin. All others came back negative.

The verdict was in: peanut and egg white are the culprits and based on our experience, we are fairly certain that both allergies cause anaphylaxis.

We were so sure that this would be the outcome of testing that our daughter has actually been wearing a Medic Alert bracelet for anaphylaxis to peanut and egg for three weeks now. I figured it was best to err on the side of safety despite knowing that in cases where parents suspect a food allergy only 39% of those allergies are confirmed via testing. Hmm, too bad we were not in the 61%.

Though the events of today were anti-climactic and confirmed what we already 'knew', it is definitely better to know. At least now we are sure what we are up against.

The challenge is that avoidance is your only real solution. There is no cure. There is nothing that this well-trained medical professional is able to do beyond telling us to avoid the allergens. No peanuts. No eggs. It must frustrate allergists to having nothing better to offer.

Though disappointing on one level to have the allergy confirmed, it is definitely better (and safer) to know. It is also promising to know that the majority of children will outgrow their egg allergy. As noted by Auckland Allergy Clinic, "about 80% of children with milk and egg allergy will outgrow their allergy by the age of five but only about 20% of peanut-allergic kids will outgrow their allergy." Maybe we'll be lucky and find ourselves within the 20% who outgrow peanuts and the 80% that outgrow eggs, though the apparent severity of her allergy does reduce the likelihood somewhat.

It was also a relief to learn that the food allergy is restricted to peanut and egg white. It is 'very rare' for people to have an allergy to more than one or two foods, so the negative result for the other allergens was comforting.

So there it is ... now we know.



The Cookbook Junkie said...

I'm surprised your doctor did an SPT after your child already had an ana episode. They wouldn't do it for my son but his last bad reaction was inhalation (not just a whiff of PB but I baked salted peanut cookies - probably the worst thing I could have done I know now) so that was probably why they were more cautious.

Peanuts, egg white and milk allergies commonly go together. My son also tested mildly allergic to milk and egg whites but he drank tons of milk before the tests and ate things with eggs too. I avoid anything too eggy but still give him the milk and things made with egg.

The new, young allergist was really trying to pressure me into an egg challenge but I just think my son is too young to communicate the milder symptoms of a reaction so I said no. He eats things with egg, he's had flu shots the past 2 or 3 years (after the egg white dx I had to get the shot under observance in two parts in the allergists office).

NoPeanuts said...

I know ... I was also surprised that we did a peanut test! Apparently if the skin is not broken it should not cause anaphylaxis but I was pretty wary of the test - consider me shellshocked from Boxing Day! The peanut only resulted in two smallish wheals at the specific site of the liquid ... scary to see any reaction but it was relatively minor.

As for the eggs, I am not sure how old your son is but we were advised to avoid eggs entirely until she is 5. They will not even test until then. I would also be wary of an oral challenge without a negative skin test - that would be scary.

It does seem that if eggs are cooked into something our daughter is fine though she experiences seemingly random flashes of eczema on her back which could be related.

You raise an interesting point on milk going hand in hand with peanut and egg allergy. She did not test positive to a milk skin test yesterday but perhaps that is the cause of her eczema flashes. Maybe we should try goat's milk or something else for her (?) ... is your son able to drink soy or goat's milk?