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#1 of 18 Old 11-04-2013, 10:11 PM - Thread Starter
 
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My 3 year old had the skin prick testing done and ended up testing positive for egg yolks, coconut, cumin, apples, pork and beef. Does the size of the reaction correlate to the severity of the allergy? Is the skin prick test reliable? Seems like a lot of allergies...


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#2 of 18 Old 11-05-2013, 07:36 AM
 
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I found the skin prick test to be reliable for my daughter and I.  But it's not perfect by a long shot, and many people find it unreliable.  Nice answer, huh?

 

The next step, now you have the results, is to do a challenge and a food diary.  I would start with the pork and beef, separately.  Or the egg yolks.  Then lastly the coconut and cumin/apples.  You could eliminate all at once and add back one at a time.  For the egg yolks, I would try eggs that are in well done baked goods.  Sometimes the result is different.  That's just how I would do it, though.  

 

I have found re: my tests, were that the results regarding positive/negative reaction were spot on for the protein foods, but the numbers/reaction were up to interpretation.  In my experience, the first number (indicating the size of the welt) had a stronger correlation to reactions than the second number (size of the red area).   But that's just my experience with my test.  

 

The fruits and vegetables were almost completely useless in my test.  My list included grapes, blueberries, garlic, mushrooms, green peppers, strawberries and pineapples.  Only the pineapple reliably gives me a mild reaction.  Coconut showed nothing, but it gives me incredible gas so I avoid it.  Grapes sometimes make my tongue tingle badly, sometimes not and same for the strawberries.  I can eat a bunch of strawberries off the same plant, and one day have no trouble, then I grab one the next day and get a reaction.  Go figure.  Garlic and mushrooms and green pepper give me flushed cheeks and indigestion--except when they don't.  And blueberries?  The highest reaction on the test gives me nothing noticeable physically.  Hm.  Out of everything on the test....hm.

 

But out of the huge list of foods, there are only a few that I entirely avoid due to the intensity of reaction.  Many can sneak in occasionally and it's no big deal.  But I am an adult, and it's easy to pay attention to physical symptoms, and I can judge when I can have a tiny sliver of cheesecake at a party or a piece of birthday cake with eggs.

 

I mention all this so you can have an idea of what a positive allergy test might mean in real life.  But first, you need to challenge the foods, because that is the "gold standard".  


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#3 of 18 Old 11-05-2013, 11:41 AM - Thread Starter
 
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How do I know if he has a reaction though..at 3 he can't really communicate if his mouth tingles or something and I doubt if he tells me every time his tummy or head hurts. :(


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#4 of 18 Old 11-05-2013, 12:12 PM
 
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That does make it harder, for sure.  I would say look for redness, swelling (can be subtle), especially around sensitive places like the lips.  Look to see if he rubs his mouth, "scratches" the roof of his mouth with his tongue.  Look for redness around the anus.  Removing the foods from his diet for a while then reintroducing them will help make these reactions more obvious to you both.  

 

But in the end, with kids you never know 100%.  Once dd grew up some, she said that carrots made her mouth tingle.  Rest assured that if the reaction is subtle, you don't have to worry about it.  Yes, it might be better going without those foods, but it's not going to send him to the ER, and those allergens are also probably not the reason he might lose sleep every night or anything else obvious.  In the end, if you don't see something, it is safe stay in the diet, regardless of what the test says.  


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#5 of 18 Old 11-05-2013, 12:42 PM - Thread Starter
 
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Thanks, I feel much better talking to someone who's been there. He has had a rash around his mouth for months so I guess I should eliminate everything until the rash goes away before reintroducing?


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#6 of 18 Old 11-05-2013, 04:02 PM
 
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What was the reasoning for testing to begin with?  A positive test result is only 50/50 on being an actual allergy.  If there wasn't a known reaction, they suggest not testing because of this. 

 

The size of the test result DOES NOT correlate to how bad/serious a reaction will be. 

 

Did your Dr. give you epi pens and an action plan?

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#7 of 18 Old 11-05-2013, 04:25 PM - Thread Starter
 
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He had/has a rash on his face, especially around his mouth..redness on the bottom..behavior symptoms (anxiety, picking at his skin, meltdowns, etc), not acting like himself and chronic tummy issues.


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#8 of 18 Old 11-05-2013, 05:03 PM
 
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That would be enough to get a test in my book, though others would disagree.  I am fine with the course of action I took.

 

You can eliminate all at once and reintroduce one at a time (only introducing the next food after a decent trial period), or, if eliminating everything all at once is hard, do each one separately.  If he is young, and it looks like your list is fairly easy, I would lean towards doing it all at once.  Eliminate long enough so that, hopefully, the rash and redness disappear, then reintroduce one at a time.  Some symptoms you won't notice disappearing so much as returning when you add the food back.  I know that doesn't seem to make sense, but you'll see what I mean--especially regarding moods.  Both dd and I had moods associated with some of allergens, and those connections were hard to notice until accidentally or purposefully ingesting something.  

 

A bridge to cross only if you get there: If, for some reason, the rash and redness persist well after elimination, that could mean something else causing trouble that didn't appear on the test, either because they didn't test for it, or because the results were unreliable.  Reintroduce the tested foods, keeping a food diary, and then continue with the diary, trying to pinpoint the actual cause with other foods.  I wouldn't eliminate anything until you have a good idea what to start with, which is why I like testing.  Again, cross that bridge only if you get there.

 

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The size of the test result DOES NOT correlate to how bad/serious a reaction will be.

Not sure what you mean by bad/serious, but certainly there is some correlation.  When one result is a 3/2 (baseline), another is a 4/35 and another is 32/54, you can bet there is a correlation to the *intensity* of the reaction.  Does not indicate whether it is *dangerous* and calls for a trip to the ER.


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#9 of 18 Old 11-05-2013, 05:49 PM
 
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Not sure what you mean by bad/serious, but certainly there is some correlation.  When one result is a 3/2 (baseline), another is a 4/35 and another is 32/54, you can bet there is a correlation to the *intensity* of the reaction.  Does not indicate whether it is *dangerous* and calls for a trip to the ER.

 

No. It doesn't mean anything. There are people who's numbers are extremely high and they *may* get a hive or nothing at all. There are people with very low numbers that have anaphylactic reactions to the offending food.

 

 

If he's been eating those foods, I would be very hesitant to remove them for a rash on his face and tummy issues.  I would perhaps do trials because it does sound like something is going on but not a "true" allergy IF there is no reaction or it's a delayed reaction.  Again, do you have Epi pens now? 

 

Again, current recommendations is that in the absence of a reaction within a certain time frame that is significant, there shouldn't be testing as the results are really unreliable.  Why were those the foods they tested for?  Coconut, pork and beef are all very unusual allergies so I'm wondering why those were what they decided to test for.

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#10 of 18 Old 11-05-2013, 05:58 PM
 
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If he's been eating those foods, I would be very hesitant to remove them for a rash on his face and tummy issues.  I would perhaps do trials because it does sound like something is going on but not a "true" allergy IF there is no reaction or it's a delayed reaction.  

 

DD's most intense (though not dangerous) allergy is to wheat, prime symptoms are rashes on face and anus and huge mood swings.  She is a devil on just the tiniest bit of wheat.  

 

So, I guess we just disagree on the OP's situation.  

 

The OP's son was probably tested for quite a few things.  I agree, including cumin on a 3yo allergy test is a bit surprising, as is a test extensive enough to include the Big 8 plus apples, coconut and other things.


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#11 of 18 Old 11-05-2013, 06:17 PM
 
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I'm not here to argue about this. The standards are to not test if there isn't a KNOWN and IMMEDIATE (within 2 hour) reaction. What you have done and choose to do are completely up to you. *I* would never pull a food and say my kid is allergic in the absence of a reaction. 

Living with allergies is hard so I would never pull things without a really really really good reason. Again, we all make our chooses but I would hate for others to life the "allergy" life if they don't need to.

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#12 of 18 Old 11-05-2013, 06:28 PM
 
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Have you considered having a blood test done (IGg)?  From my knowledge this is more to test food sensitivities, considered different from allergies.  Like the PP, many times things aren't considered "allergies" if there isn't an immediate reaction, but sensitivities can take a longer time to show up, but have a significant effect on gastrointestinal and immune health.  Maybe you could do the combination, and if there is overlap, concentrate on those things. 


 
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#13 of 18 Old 11-05-2013, 06:50 PM - Thread Starter
 
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I had no idea there was so much controversy! ;) I can't remember everything they tested for but here's what I remember: soy, wheat, oats, rye, almonds, peanuts, coconut, milk, sweet corn, white potato, oranges, apples, strawberries, cumin, cinnamon, several types of fish, beef, pork, chicken. There was probably 20 pricks.

When I called the PCM originally it was because he was acting like he was possessed and I had no idea what was wrong with him. He was acting like his autistic brother almost. We did a blood test and the only thing that tested positive was a sensitivity to chocolate. The prick test did show an extremely mild reaction but the dr said it was so milk it could be irritation caused by the prick itself.


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#14 of 18 Old 11-05-2013, 07:22 PM
 
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The scratch tests and blood are not 100% accurate, for example, DS has tested negative 3x, once to scratch testing, and twice to blood tests, but is absolutely clinically allergic to wheat, with symptoms showing up within minutes and confirmed by our allergist in spite of negative test results.

 

I don't know if you a aware, but in addition to scratch testing there is the delayed reaction testing which will help identify allergic reactions that are delayed by 4-72 hours, often those which are hard to determine even with food eliminations, because of how long it takes for symptoms to appear.  This kind of delayed response allergy (clinically, Type 4) is based on T-cell mediated reactions rather than IgE or IgG reactions, and is, unfortunately, not commonly offered.  This is my DD, now 18 months; we were on an elimination diet for 2 months, and only figured out about half her allergies.  When things were getting better but not totally resolved, we sought out the pediatric allergy specialist and through delayed testing found 18 allergies total.

 

I really hope your little one is feeling better soon.  Food allergies are so tough!!!

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#15 of 18 Old 11-14-2013, 03:51 PM
 
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So here is my info, as a woman with multiple food allergies who has had to carry an epipen since I was three, a nurse, and the mother of 2 kids with food allergies.

 

There are people who do not react to a scratch test, but still are allergic to an item.  Since the scratch test is done with a distilled version, it might not show up.  For example, I am not allergic to beef, but I am allergic to sulfites and many antibiotics, so I have had multiple allergic reactions to beef since cows are fed abx over a long period of time and non-organic meats are washed in a sulfite solution as a preservative.

 

I have never experienced a false positive scratch test, but yes the size of the hive or whelp does indicate the level of allergy.  Most docs I know use a scale of 0-4 with zero being no reaction and 4+ being a large reaction.  Anything with a 3 or 4 reaction would probably show an immediate reaction, something with a level of 1, might not have a noticeable reaction.

 

My allergist explained it to me like this.  Your body is a bucket, and every time you encounter an allergen (something you are allergic to), it drops histamine into your bucket.  Somethings, like coconut, dump a lot of histamine, and you have a bad reaction very quickly.  Other things like peas and pecans, just drop in a little histamine.  You might not notice a reaction, but if you bucket is already partly full from the environment (like the dust, mold, & dog dander at your aunt's house), that one slice of pecan pie might be enough to overflow your bucket and result in a big reaction.

 

So as a child, my mom just avoided the things I was allergic to and tried to remedy my environment (no carpet, no curtains, no dogs, HEPA filters).  As I got older I learned the things that I could tolerate, like occasionally having peas, but only in the winter when there is no pollen or mold in the air.

 

I am not a fan of the try it again after you have had a reaction approach.  I would recommend eliminating it all until your child is better able to communicate symptoms, since they can vary by child and by allergen.  I have also experienced that the more you are exposed to something the worse the allergic reaction becomes.  If it becomes a huge problem, or is life-threatening, you can discuss allergy shots (for desensitization).  I have done the shots, and it has helped me a lot, DS and DD both have a single food allergy, although they both had anaphylactic reactions.  Since they do not have a lot of problems with environmental allergens, we have chosen not to test or do shots at this time.


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#16 of 18 Old 11-15-2013, 07:29 AM
 
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I have never experienced a false positive scratch test, but yes the size of the hive or whelp does indicate the level of allergy.  Most docs I know use a scale of 0-4 with zero being no reaction and 4+ being a large reaction.  Anything with a 3 or 4 reaction would probably show an immediate reaction, something with a level of 1, might not have a noticeable reaction.

 

 

The size of the hive/wheal and the 0-4 grading DOES NOT indicate if or how bad a reaction is going to be. There are people with a 1 hive and .23 blood tests score who are anaphylactic to something and others with a 4 and 1.7 blood tests who have no reaction to a food.  While there are false negatives, the number for that is about 10% while the false positives is more in the 50-80% range. 

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That's why it's important to challenge the foods.  A 3yo will not be able to accurately describe what's happening, but if you are not noticing anything from your POV, then you can assume it's safe to keep the food in.

 

Even though we are discussing allergies, there is really, in my mind, 2 issues.  One is acute allergic reactions.  These are dangerous.  You keep them out of your child's diet to keep them out of the hospital.  You carry an epipen.  

 

The second is chronic.  These allergies can make people feel crappy, tired, moody, can create chronic inflammation, and chronic digestive problems similar to an intolerance.  They are not emergent, but they can have a profound effect on one's life.  You have more leeway in determining what to keep in and how much, depending on how you feel.  Some you will keep out as thoroughly as you would an acute allergen because the reaction is extremely unpleasant, and in kids this can translate into moodiness and rages and lethargy.  Others you can include in slightly different forms (baked egg or milk), in small amounts, or on occasion.  

 

I mention this to put the allergy test in perspective.  You cannot sit on the test results alone.  You must observe.  Sometimes the reaction is obvious (like my daughter's dairy allergy) and sometimes it's less obvious.  If it's obvious, chances are your test was just a clinical confirmation of what you knew already.  If it is less obvious, then likely it's not emergent.  If you cannot make a definitive connection, then you can assume it is safe to keep the food in the child's diet, despite the results of the test.  Food challenges are the gold standard, it is always said, and it's true.

 

In the end, my daughter's allergist is the one I trust the most on this issue.  If he sees reason to challenge certain foods, then I do.  I trust his professional assessment of my daughter's test results.  He also understands the limits of the test.  If I tell him that a certain challenge didn't turn up anything obvious, he trusts my observations.  

 

There should be nothing about testing you can't ask your allergist about.  


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#18 of 18 Old 11-18-2013, 03:15 PM
 
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How do I know if he has a reaction though..at 3 he can't really communicate if his mouth tingles or something and I doubt if he tells me every time his tummy or head hurts. :(

 

All of the things that led you to getting the test would be the things you'd be looking at to see if they continue to exist or disappear (or appear again during a challenge).  Also, changes in diaper output (assuming he's still in diapers--toilet output if he's trained)

 

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A bridge to cross only if you get there: If, for some reason, the rash and redness persist well after elimination, that could mean something else causing trouble that didn't appear on the test, either because they didn't test for it, or because the results were unreliable.  Reintroduce the tested foods, keeping a food diary, and then continue with the diary, trying to pinpoint the actual cause with other foods.  I wouldn't eliminate anything until you have a good idea what to start with, which is why I like testing.  Again, cross that bridge only if you get there.

 

I think testing gives you a good jumping off point for doing more probing by way of tracking logs, removal and challenges.  I don't think that testing is the only way to know what to start with for removal, but yeah--I wouldn't just grab something out of the hat.  Start with the stuff that was on the testing as "problematic" and go from there.  Tracking logs are a huge help in nailing down others.  Agreed--they don't test for everything and the reaction could be to something that wasn't tested for.  If you need a tracking log, pm me and I can send you one.

 

 

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If he's been eating those foods, I would be very hesitant to remove them for a rash on his face and tummy issues.  

 

Actually, if he's having reactions, it's possible that it's BECAUSE he's eating those foods, no?  If he's been eating those foods and the test came up with a reaction to them, for me (and btw, I'm seriously NO fan of testing) that would be a definite reason to at least eliminate and challenge to do a more definitive rule out.

 

 

 

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That's why it's important to challenge the foods.  A 3yo will not be able to accurately describe what's happening, but if you are not noticing anything from your POV, then you can assume it's safe to keep the food in.

 

Agreed that challenging the foods is critical.  I tell my clients to save it for a weekend and put a bit of it at every meal with their kids so that if it's a low level intolerance, they hit the threshold of reaction quicker.

 

 

FWIW, there is a LOT of arguing about which test is most accurate and which test tells what.  I've been involved in that world for 9 years (both as a struggling parent trying to find my way and then as a practitioner and attending training aimed at licensed medical practitioners) and there is STILL no definitive answer for it.  Even if you got the IgG blood testing it could come up with nothing.  Some even do IgA blood testing.  The list goes on.  Removal and challenge is by no means convenient but it is the be-all-end-all for knowing what's causing a reaction (and that was our first immunologists words, not my opinion).


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