Need your experience with peanut/tree nut allergies, please, please...

[sammymama]

Hi Mamas,

I reached out a few days ago and didn't get many replies; I have a little more info now and I'm so hoping more of you who have experienced this issue can take a moment to share your stories with me.

My dd (now 2) was born at home, had only a few vaxes, EBF for 8 mos (still BF 6-8x/day now), had a very slow and individual introduction to foods, eats only organic foods.  She's only had a handful of illnesses, nothing ever affecting her respiratory system (she even had RSV once and it was ridiculously mild).  Through the course of introducing new foods, a handful of them would cause her to get tiny little red pin pricks around her mouth where the food had sat (cashews, cottage cheese, tomato soup/sauce).  I told her ped, she said it was probably just a sensitivity and she would grow past it.

About a month ago DD suddenly had 2 allergic reactions to dogs - 1 after getting licked in the face and the other just after walking into a house with 3 dogs.  Due to this our ped recommended the RAST test.  It showed a moderate number for dogs, and a very high number for cats (we live with 2 huge, hairy Siamese and she's never had a reaction to them).  It also showed very low numbers for peanuts (0.77) and other tree nuts (the highest was a 5).  Based on that we were sent to a pediatric allergist, whom we saw today and had a skin prick test done.

My DD had the biggest reaction to cashews, with a 12mm weal.  Next were other tree nuts around 6-8, dogs around 8-11, and cats at 3-4.  Based on this the doctor told us to get rid of our cats, have my parents get rid of their cat (we stay over there often), and told me my DD was officially allergic to all peanuts and tree nuts... even though she has eaten ALL OF THEM (except straight pistachios) with no issue or reaction, save for those small red spots after cashews one time several months ago.  She told us to eliminate all of those things and look out for anaphylaxis.

In general this doc had a terrible "bedside" manner; she volunteered practically no information, answered my questions in clipped sentences, and when she realized she'd run out of dittos, she told me to go to a website and print out the info myself.  Otherwise we were sent on our way with a million questions - I was literally following her into the hall, still trying to get more information from her after she decided we were done (after spending - literally - about 7 minutes in the room with us).

So here are my biggest questions, ones that I'm hoping other moms have encountered and have advice on:

- How is it possible that my DD has this suddenly dire allergy, despite never reacting to any of these nuts?  (Yes, I ate them while I was preggers and BF - something the doc told me today probably contributed to my daughter's allergy.)

- What about the notion that both of these tests provide 50-60% false positives?  And that the blood test is a better predictor of food allergens and the SPT a better indicator environmental allergens?  If that were the case, shouldn't it be considered that my DD is FINE with nuts since her blood numbers were low and she's never reacted to those foods, and that she may in fact have an allergy to dogs b/c she had a big weal AND already reacted to them??

- How would we ever test to know that my daughter had "outgrown" these allergies?  I mean, if she doesn't react to these foods now, what good would a "food challenge" do down the line?  And for retesting her blood, if she doesn't eat or come in contact with any of these foods for a year, wouldn't that alone affect her blood levels?

- What about the cats?  If she has been around the cats this long with no issues, does that mean she's "gotten used to" them?  Or, as the doc today suggested, does it mean she will be used to them while she lives with them, but if she were to ever leave for awhile (vacation, college, etc), and then came back into contact with a cat she could suddenly get adult-onset asthma?!

- How would my otherwise totally healthy kid with minimal toxin exposure suddenly become part of the 1-2% of children with a peanut allergy?  My husband is allergic to cats.  That is our only family history.

Thank you so much for reading this far and I really do appreciate any thoughts you may have.

Sammy

[SweetSilver]

I agree about the doc.  Allergists are pretty cautious about nuts and peanuts.  It's very common for them to ask you to eliminate nuts for the time being if they tested positive for one-- or even a severe reaction to anything since young kids commonly add on allergies once they show a tendency.  But that's not what your doc is telling you.  Bottom line: challenges are the gold standard, regardless of the numbers.  Yes you should be wary since she already has allergies (my dd developed a wheat allergy around 3yo).  You might even want to put nuts, peanuts, shellfish and fish off her diet for a little.  These have the high anaphylaxis risk.  But if you are not seeing a reaction, then, for now, she is clear.  How you manage the possibility of new allergies developing is up to you and your comfort level.  Get an EpiPen, just in case.  (BTW some challenges are best done in the doc's office, like peanuts and cashews and shellfish.)

     Regarding the cats: we keep our bedroom pretty sparse and absolutely free of cats.  Get yourself a HEPA filter vacuum-- one with lots of attachments so you can vacuum your couch too.  The couch is trouble in our house since the kids jump on it and read bedtime stories on it.  Our family seems fine.  It seems your allergist is overreacting a bit.  It seems that you should be able to trust her implicitly with something so important.  Hopefully you can get a new referral.  

[NYCVeg]

We go to one of the best pediatric allergy practices in the country (dd has very severe, very extensive food allergies, including peanuts, tree nuts, wheat, eggs, fish, and many others), and our doctor has always insisted that real-life trumps the test results. Dd came back negative to fish three times, despite clearly reacting to it--massive hives all over her face within minutes of eating. Our doc has said specifically that if you pulled a dozen people off the streets and tested them for various allergies, many of them would come back "positive," despite the fact that they have no problems with the foods. He strongly advises NOT testing for any food until the child has actually had a reaction to it. 

Nut allergies ARE among the most volatile and unpredictable, so, while you may be perfectly comfortable keeping nuts in her diet, I would definitely have an Epi-Pen on hand, just in case.

As for the pets...again, this has to do with your comfort level. Dd is allergic to dogs and my parents have a dog. Generally, she just got runny nose, some sneezing, maybe a few hives. Since she seemed to tolerate these symptoms well, we didn't think anything of it. Then, however, we realized that the low level reaction to the dog primed her for more serious food reactions. We were at my parents about a year ago and dd had a severe reaction to wheat flour (she didn't eat it--it was just in the air because my mom had been baking earlier in the day). We think that, without her immune system being "primed" by the dog, she might not have reacted so strongly. Since then, we take much greater precautions around the dog. My parents generally send him to a sitter and have the house cleaned before we come to visit. If your dd doesn't seem to react to the cats, I think getting rid of them would likely be unnecessary, but I definitely agree with the PP about getting HEPA filters and being very diligent about cleaning hair and dander.

Family history and exposure are only part of the allergy puzzle and no one really has answers as to why some kids get food allergies. I have no allergies at all; my dh has some seasonal allergies, no foods. Dd had a birth center birth, ZERO vaxes, was bf for 19 months, EBF until 6.5 months, then had a very slow introduction to solids (she was mostly uninterested, so in her first year she had very little beyond breastmilk, avocado, banana, and some other fruits). She is still allergic to everything under the sun. There are plenty of people who do everything "right" and still end up with severely food allergic children and plenty of people who do formula, early solids, lots of processed foods, full vax, etc. and have kids with no allergies at all. The factors involved here are very complex and not very well understood.

Above all, I would get a new allergist!

[AllergicChild]

I'd suggest getting a second opinion from another allergist. Interpreting RAST and skin prick test results aren't the only way to determine allergies. Past history has been important for our family. My son is now 15 years old with multiple life threatening food allergies; mild asthma, eczema, severe pet allergies and environmental allergies. I created a website, AllergicChild.com, that might be helpful to you. Please visit us and read "Our Story of Food Allergies."