or Connect
Mothering › Mothering Forums › Mom › Women's Health  › Allergies › Advice for First Visit to Allergist...
New Posts  All Forums:Forum Nav:

Advice for First Visit to Allergist...

post #1 of 8
Thread Starter 
Hello all - I would love some advice as we prepare for our first visit to the allergist. Here is a summary of what is going on with my 7 month old DS:

Reflux @ 2 months treated with Zantac at first, now on Prilosec. Eczema moderate to severe also started @ 2 months treated with a skin care regime of topical hydro cream (applied once every three to four days because I am so reluctant to use it) and various lotions/ointments, etc, applied several times a day. The severity of the eczema ebbs and flows - some days he looks great, then in a matter of minutes he flares up, is itching and miserable. He also has a persistent cough with occasional wheeze. He is really miserable and seems to be in pain a lot of the time.

He is breastfed and I have tried an ED (milk, soy, egg, fish, nut) and we are fairly sure there is a milk allergy. I have eliminated all dairy and soy at this point which as helped but not eliminated the eczema by any means. We started solids at 6 months 1 week. He seemed to have a reaction to carrots and pears. But has been ok with squash, peaches, apples, avocado, rice cereal. He has fallen off the growth chart, going from the 50th percentile at birth to less than the 5th percentile.

Oh - and he as a twin sister who has no skin/reflux or respiratory issues whatsoever.

We have a visit to the allergist next week and I am trying to educate myself as to what we should expect. According to our doctor there is nothing that can be done about allergies in infants, no testing is reliable and we just have to wait for his immune system to outgrow everything.

So...what should I expect, what should I demand? We cannot continue with him being so miserable. His only relief is when we give him Benadryl - which I hate doing but sometimes it is the only way to stop him from scratching his skin off.

Also, any advice for surviving the 72 hours before the visit when, per instructions, we can't give him anything to help relieve the itch/pain? Thanks in advance for any insight. I really appreciate all the info I learn from this site
post #2 of 8

The waiting without anything to treat the itch before allergists is so horrible.

I would soak affected parts in warm water (you in tub with him perhaps) and very lightly towel off leaving lots of moisture on the skin then you lotion him lightly with a regular lotion (low allergen...for my son we did vanicream or calendula by california baby as he didn't react to those). Let it "soak in" and then follow up with a very heavy layer of the lotion or, better yet, a thick cream type. I did aquaphor.

That's a huge growth drop. We did that too with my other son who was a refluxer. His reflux wasn't adequately controlled. Is your son still in reflux pain you think? marci kids has a site with dosage of PPI's. Make sure he's dosed correctly for weight and three times a day (very important). That might make all the difference.

It's also possible you're dealing with eosinophilic esophagitis. You'd need a scope to rule that out or in and making diet changes can affect the accuracy of the scope (if the diet helps the scope is clean when really there is an issue). I've heard of breastfeeding moms drinking the special formula for their kids so even if it is EE it doesn't mean the end of breastfeeding necessarily (though at times the child is truly healthier without because they just can't tolerate the allergens).

If he's dosed properly on PPI's and still having reflux pain I think you need a pediatric GI well versed in EE.

Allergy testing under two is not as accurate as over two unfortunately but you might get lucky (don't assume negative means he's negative...). Many allergists would say 7 months is too young for environmental allergies to be contributing (like dust or pet or pollen) as he's not had enough time for exposure to trigger immune response. That leaves foods.

If allergy testing isn't helpful I'd try a really formal rotation diet to try to pinpoint reactions while you eliminate the most common triggers (dairy, gluten, soy, corn, egg I believe) or an elimination diet. Hopefully someone with experience breastfeeding and doing that can help. Most gluten free stuff is nut contaminated I discovered so you have to be careful with that aspect--I can give you a list of safe from nuts gluten free stuff and related if you want. However, as I said, you don't want to change tons of stuff and then not be able to accurately test for EE which I think he needs if the growth or reflux issues continue. They can biopsy for celiac at that time too.
post #3 of 8
Quote:
Originally Posted by sbgrace View Post
It's also possible you're dealing with eosinophilic esophagitis. You'd need a scope to rule that out or in and making diet changes can affect the accuracy of the scope (if the diet helps the scope is clean when really there is an issue). I've heard of breastfeeding moms drinking the special formula for their kids so even if it is EE it doesn't mean the end of breastfeeding necessarily (though at times the child is truly healthier without because they just can't tolerate the allergens).
If this is true, then how is EE really any different from food intolerances, if the EE "goes away" if you're off the foods? And I'm not being snarky. I really want to know. Because I hear EE more and more, yet it "sounds" like food intolerances. So what's the difference?

Quote:
If he's dosed properly on PPI's and still having reflux pain I think you need a pediatric GI well versed in EE.
Personally, I would rather have a GI well versed in food intolerances, because if the reflux is still there, she may still be eating trigger foods (like gluten and corn, or actually could be anything). I guess I'm saying I'd want one supportive of elimination diet vs. formula and meds.

Quote:
Allergy testing under two is not as accurate as over two unfortunately but you might get lucky (don't assume negative means he's negative...). Many allergists would say 7 months is too young for environmental allergies to be contributing (like dust or pet or pollen) as he's not had enough time for exposure to trigger immune response. That leaves foods.
Allergy testing isn't that accurate under two and they're more likely to do a RAST, when a skin prick is usually more accurate. Eczema can be from either food allergies or food intolerances (or environmental allergies, but as sbgrace said, it's more rare at that age). Though I've heard of a bunch of kids that reacted to pets before age 2. With reflux, I'd say food intolerances is more likely than food allergies.

Quote:
If allergy testing isn't helpful I'd try a really formal rotation diet to try to pinpoint reactions while you eliminate the most common triggers (dairy, gluten, soy, corn, egg I believe) or an elimination diet. Hopefully someone with experience breastfeeding and doing that can help. Most gluten free stuff is nut contaminated I discovered so you have to be careful with that aspect--I can give you a list of safe from nuts gluten free stuff and related if you want. However, as I said, you don't want to change tons of stuff and then not be able to accurately test for EE which I think he needs if the growth or reflux issues continue. They can biopsy for celiac at that time too.
I don't know that a rotation diet would help when BFing, because it takes about 4 days (or more) to clear out of breastmilk, so the baby would be getting the same things all the time, unless you did a block rotation. Dairy, gluten, soy, and corn are the top 4 intolerances, but any food can cause any symptom. Two of my kids were on reflux meds before we figured out the trigger foods. www.reflux.org also has discussion boards where the people talk about a lot of food intolerances. I saw on there once about a special pillow that keeps them mostly upright when sleeping too.

Have you taken out all "hidden" dairy and soy, including soybean oil and lecithin, and look at all your supplements/meds as well? My DS would react to "vegetable" (soybean) oil in a vitamin, even if it was about the 15th item in the list. So some kids have very low thresholds.

I would go to the allergy doctor and keep an open mind. It is possible that you'll have some things identified. However, I would not end there since it could be food intolerances. I'd see a GI who comes recommended by someone. And I'd also seek out an osteopath or someone who does craniosacral work, since they can help with reflux as well. Start a food journal if you haven't already.

Have you already tried changing laundry detergents? Remember to look at all the creams you're putting on him for trigger ingredients, since things are absorbed by the skin.
post #4 of 8
Thread Starter 
Thanks! Great and helpful infomation in your replies, I really do appreciate it.

We are going to begin the workup for EE in April, I think. DS has seen a pediatric GI who prescribed the Prilosec and who we are schedule to see again in early April. He prescribed the Prilosec twice a day, not three times a day, so maybe we need to change that?

"Allergy testing under two is not as accurate as over two". That is a huge disappointment. I guess I am confused too, because how do people know when their baby is allergic? (I feel like I am reading and hearing all of the time "my child is allergic to X" and the child is under two.)

I think sbgrace, that you are right that I need to do a more rigorous and dedicated rotation diet. I think I may try to find someone to help me plan that, because I am having a hard time figuring out what I will be able to eat.

kjbrown92, I totally agree about finding a GI supportive of an elimination diet, but I have just not come across one yet. It feels to me like the doctors I have seen are quick to dismiss BF and have me turn to formula.

Thanks for the advice on makeing it through the 72 hours before his allergy visit. I will be taking your advice on the warm baths with lotion as a possible way to relieve the itch.
post #5 of 8
I found a GI who was supportive of food intolerances after the fact. I'd already done the elimination and figured out the foods, but my friends kept telling me I couldn't possibly have figured it out myself and it couldn't possibly be nutritious for her to only be on 20 foods, and I had to have a doctor look at her. So the ped recommended a GI doctor that I hadn't seen before (had seen a different one with my DS). I brought along all my food journals and told her the foods that she was on and all her symptoms. The GI said it was a very healthy, balanced diet. It was great that I had documented everything, and call her if I needed anything when I started to add things back in after at least 6 months off all the trigger foods. I don't know how much help she would have been while I was doing it though. If you tell us what part of the country you're from, maybe someone here has a good doc recommendation for you! With allergy tests, there can be a lot of false positives from what I understand, and since they don't test intolerances at all, there's always that angle. skin pricks are supposed to be more accurate than the RAST, but a lot of doctors do the RAST because it tests for a lot of foods at once.

If you're doing the rotation diet to prevent new allergies from forming, that's one thing. If you're trying to do it to determine the allergies, and it's a regular 4 day rotation, and you're BFing, I doubt it will help, since the allergens stay in your system for more than just a day. So if you have cantaloupe on day 1, it's still in your milk on day 2, 3, and 4, and then you eat in on day 1 again, so it's basically there the whole time. So it depends on why you want to do the rotation. We do it to prevent new ones from forming, and we've been on it for almost 2 years.
post #6 of 8
Kathy,
If food is causing eosinophils to build up and damage the esophagus you'd be dealing with EOS disease. Whether it's an allergic reaction or intolerance reaction (I'd lean to allergic given those eosinophils but that's not proven) doesn't really matter I don't think. The key are those eosinophils numbers. And I guess you're thinking why does it matter if it's EOS if you can remove the foods and the kid does better? I'd say it matters because, in my understanding, you can eliminate foods and think symptoms are improved but still have that internal damage going on. You see that when you scope. Many kids with this really need a rest period from all allergens (not just the foods a person might ID via obvious reactions or the top intolerances) to really heal. I've not met many at all that had a clean scope after pulling top allergen foods out. And there are kids who really improved health and growth wise when that rest happened. We pulled all major triggers (allergy and intolerance) out of my son's diet. When he was still having growth and reflux problems they did scope. It didn't have enough EOS to be dx'd but then we were stuck wondering if he really did and removing those things lowered those and if they were safe to add in again.

In our case and the case above you're talking a baby who has such severe reflux pain they are failure to thrive. My son was spitting up blood. He dropped off the scale and while we corrected the damage causing the blood he was fearful to swallow, kept not growing, and remained in pain.

I think what you have in your mind picture wise is different than my experience?
I'm really wondering about my Caleb and EOS disease (in the lower parts, not esophagus) but because of the metabolic issues we have I don't feel we can safely scope him. And while I've removed problem foods I'm left wondering what's going on inside him and if it's responsible for some stuff I'm seeing. I wish we could safely scope the kid.
post #7 of 8
Quote:
Originally Posted by sbgrace View Post
Kathy,
If food is causing eosinophils to build up and damage the esophagus you'd be dealing with EOS disease. Whether it's an allergic reaction or intolerance reaction (I'd lean to allergic given those eosinophils but that's not proven) doesn't really matter I don't think. The key are those eosinophils numbers. And I guess you're thinking why does it matter if it's EOS if you can remove the foods and the kid does better? I'd say it matters because, in my understanding, you can eliminate foods and think symptoms are improved but still have that internal damage going on. You see that when you scope. Many kids with this really need a rest period from all allergens (not just the foods a person might ID via obvious reactions or the top intolerances) to really heal. I've not met many at all that had a clean scope after pulling top allergen foods out. And there are kids who really improved health and growth wise when that rest happened. We pulled all major triggers (allergy and intolerance) out of my son's diet. When he was still having growth and reflux problems they did scope. It didn't have enough EOS to be dx'd but then we were stuck wondering if he really did and removing those things lowered those and if they were safe to add in again.

In our case and the case above you're talking a baby who has such severe reflux pain they are failure to thrive. My son was spitting up blood. He dropped off the scale and while we corrected the damage causing the blood he was fearful to swallow, kept not growing, and remained in pain.

I think what you have in your mind picture wise is different than my experience?
I'm really wondering about my Caleb and EOS disease (in the lower parts, not esophagus) but because of the metabolic issues we have I don't feel we can safely scope him. And while I've removed problem foods I'm left wondering what's going on inside him and if it's responsible for some stuff I'm seeing. I wish we could safely scope the kid.
I guess for me it sounds the same as gluten intolerance vs. celiac disease. Either way you have to take out gluten, so why does it matter? You had said that if you take out the food triggers than you don't see anything on the scope, which led me to believe that it could be controlled by diet, so then I don't see why the specific "diagnosis" matters, when the treatment is the same. However, if the treatment isn't the same, then it does matter. And if the scope only shows one part of the body that may be affected, and other parts may be affected while that part doesn't show it, then it makes a difference. So far on the things I've read, it just sounded like food allergies/intolerances to me, so I've remained confused.

And I wonder what the difference would have been if my kids had been scoped. The GI for DS never mentioned scoping (though they did an upper GI, check for some flap issue I think) and the GI for DD2 said she knew she'd find damage in the gut, so she didn't want to scope. Both my kids are off 30-40 foods that trigger them from up all night screaming to relux meds when they were younger to "folliculitis" to eczema to vomiting to constipation/diarrhea/stomachaches. But if they are symptom free off those foods, what would be the "benefit" of a scope or a diagnosis of EE?

Determining the foods is the hard part, no matter what age, and what the symptoms are.
post #8 of 8
I think it matters because there can still be damage going on though maybe less severe. That damage could be because of foods still consumed (kids can be reacting to all of them until a rest allows healing) or it could be from enviromental allergies. Beyond that the way a person knows they pulled all the foods they need to pull for healing is scoping again. You can't do that if you don't know you have it in the first place. My understanding from when we scoped Andrew was that they also treat with meds but maybe that was just our GI.

I don't think anyone is debating anywhere that this is allergic in nature. I think that's the current understanding and kids with other allergy responses (hay fever, asthma, etc.) are known to be more likely to have EOS. And in my opinion if a kid's reflux clears with removal of allergens and flairs when you put them back in I would certainly be thinking EOS...that's the hallmark. That improvement did not happen with Andrew (though we left gluten, soy, corn, dairy, citrus, nuts, etc. etc. out for him for two years) and he's not my allergic kid. I now think we were dealing with metabolic rather than allergy related food issues as well as muscle tone and delayed gastric emptying from that metabolic condition we weren't aware of at the time. But for a long time we didn't know if the foods we had pulled (and didn't see a change other than weight gain but the scope was ok so....) could be safely added back. I don't know if that made any sense.

But in the OP's case we're talking about an allergic baby with uncontrolled reflux and failure to thrive. I think it would be prudent to do a scope and see if EOS is behind the issues so the baby has a chance to feel good and grow well. Andrew will never be the size he would have been and I believe he still has emotional impacts from pain in infancy. I just don't think waiting and pulling things and playing with meds (which is what we did as I didn't know better and our ped. messed up) is the way to go for the OP. I wish I could go back and redo us. So I'm glad the OP is looking at EOS and scopes because that makes me think they are in competent medical hands (we were not).

I don't know if any of that made sense as we all have a stomach virus and I'm sleep deprived to put it mildly. But I do think if you're dealing with EOS you want to know. At this point if Caleb wasn't likely carrying the same metabolic condition (which can be worsened or triggered by anesthetic) I would see a GI to see if he's got EOS. I may anyway.
New Posts  All Forums:Forum Nav:
  Return Home
  Back to Forum: Allergies
Mothering › Mothering Forums › Mom › Women's Health  › Allergies › Advice for First Visit to Allergist...