Skin Patch Test Questions- updated for results - Mothering Forums

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#1 of 11 Old 10-27-2007, 12:25 AM - Thread Starter
 
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I'm looking into skin patch testing for my 9 month dd and I would love to hear from all you mamas that went through this with your dc's.

*How old was your dc when s/he was tested?
*What was the exact procedure? Does it always take 72 hours?
*How uncomfortable was the test for your dc? Were you able to go about your daily routine as normal or were the patches an all encompassing distraction? I've heard that they can take an antihistamine to relieve the itching, but doesn't that intefere with the test?
*How is the skin "read" and what kind of data do they collect... measurements? descriptions?
*How accurate and specific were the results? In otherwords, once you elminated the positive allergens and later challenged them, how many of them were actually triggers?

Thanks for your help!!

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#2 of 11 Old 10-28-2007, 07:57 PM
 
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I think patch testing can be very valuable for certain conditions. However 9 months is really young to be doing any kind of skin testing. Have you found a doctor who will do this for you?

*How old was your dc when s/he was tested?
3 years old

*What was the exact procedure? Does it always take 72 hours?
I brought in pure samples of food. THey were prepared and put on special metal discs and taped to her back for 48 hours. I removed them at home and then we went in the next day for them to be read.

*How uncomfortable was the test for your dc? Were you able to go about your daily routine as normal or were the patches an all encompassing distraction?
They got itchy for her and we could not bathe her during that time. Removing the tape was so painful that I'm not sure if we will be doing any more patch testing for awhile.


I've heard that they can take an antihistamine to relieve the itching, but doesn't that intefere with the test?
I was told no antihistamines for a week before the test and during the test.

*How is the skin "read" and what kind of data do they collect... measurements? descriptions?
They wait to see if, after food is removed, there is still a red spot 24 hours later. They will judge it based on how big it is and how swollen it appears to be.

*How accurate and specific were the results? In otherwords, once you elminated the positive allergens and later challenged them, how many of them were actually triggers?

My dd has a condition that is not your typical food allergy. It's called EE and the only sure way to see if foods are bothering her are to do biopsies of her esophagus. Some doctors have seen that in about 60% of people with EE you can find *some* of the triggers through a combination of patch and prick testing. In abouth 30% of people they don't react at all to skin testing but if they go on an elemental formula (does not trigger allergies) for a month their EE will improve, showing that their symptoms were obviously food-based.

Here is a pic of my dd's back with tape and discs on
http://i68.photobucket.com/albums/i2...a/PICT1345.jpg

Here it is right after removal
http://i68.photobucket.com/albums/i2...a/PICT1359.jpg

Here's her back after about an hour
http://i68.photobucket.com/albums/i2...a/PICT1361.jpg

The only one that showed a reaction was the patch middle right (rice) and it's very mild. It actually faded so much the next day that they considered a very small reaction or just an irritant. This test was to see if she was allergic to rice because she had been reacting to it with her tummy pain and vomiting. The other foods I had suspected were okay. Sure enough the rice was the only one that had any reaction at all. It was enough proof for me to remove rice from her diet. I let her have carrots, potatoes, and broccoli and then we did a biopsy of her esophagus a few weeks later, and those foods were found to be safe for her (no inflammation). At the time she was on only elemental formula plus those three foods.

Here's a patch test photo I found on the internet that shows strong positives.
http://www.karger.com/gazette/67/Ring/images/ring_6.jpg

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#3 of 11 Old 10-28-2007, 11:24 PM
 
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How old was your dc when s/he was tested?
She was about 15 months

What was the exact procedure?
We went in on a Tuesday and they put bits of pureed food into little metal discs and then taped them to her back.

Does it always take 72 hours?
we were told to take the patches off at home Thursday morning and she went into the office Friday morning fo them to be read.

How uncomfortable was the test for your dc? Were you able to go about your daily routine as normal or were the patches an all encompassing distraction?
They really didn't seem to bother her at all! No bathing though so she was pretty icky by the time we took them off- lol

I've heard that they can take an antihistamine to relieve the itching, but doesn't that intefere with the test?
We were told none the week before the test

How is the skin "read" and what kind of data do they collect... measurements? descriptions?
They measure the reaction on a scale od 0 to 2+ I think - I can't remember. Basically, they look for how red and raised the bumps are. A pos. reaction looks a bit like poison ivy.

How accurate and specific were the results? In otherwords, once you elminated the positive allergens and later challenged them, how many of them were actually triggers?
We found out that my DD's strongest reaction was rice!! We never thought to cut it out. Plus she had a mild reaction to corn. Her colon is MUCH better since we cut out these two triggers! She reacted a little to everything (including the tape) but we started with the obvious positives as far as elimination. Her GI didn't want to go nuts and cut out things that she didn't really need to have out of her diet. So far, so good! The testing isn't 100% accurate, especially when they are young!

Here are pictures of my DD's back with that patches and then 12 hours after they were removed.

http://i12.photobucket.com/albums/a2...l6941/back.jpg
http://i12.photobucket.com/albums/a2.../patchtest.jpg
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#4 of 11 Old 10-29-2007, 01:56 PM - Thread Starter
 
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Thank you for responding so thoroughly! Yes, I have found a doctor that is willing to do that test on a 9 month old, but I have to travel 3 hours to see her (she's at a teaching hospital in Houston). I have yet to speak directly to her to make sure that such a journey would be fruitful. The nurse I spoke with said that they would be very limited by the size of my dd's back and may only be able to test up to 10 foods. I suppose we could do the top allergens minus the fish/shellfish since we're vegetarian (dairy, egg, gluten, soy, peanuts, corn, tree nuts) giving us 3 other foods to choose (sounds like we should do rice!).

According to the clinical studies that I've read, the patch test is supposedly the most accurate and specific test for infants and children under 2. The prick and RAST were pointless for my dd because I could already tell that she doesn't have an immediate response to anything. And the constant recommendation I get from other allergists to see a dermatologist for TRUE testing is annoying. She doesn't have contact allergies that I am aware of. Wouldn't contact allergies manifest where the allergen touched her?

Anyway, I would love to hear from more of you that have gone through this! Thanks again for responding!!

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#5 of 11 Old 10-30-2007, 09:59 AM
 
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Quote:
Originally Posted by Jaimee View Post
According to the clinical studies that I've read, the patch test is supposedly the most accurate and specific test for infants and children under 2. The prick and RAST were pointless for my dd because I could already tell that she doesn't have an immediate response to anything.

ITA about the accuracy of the patch testing! My DD had both blood and skin prick tests and had perfect results even though we could see in her colon she had SEVERE allergic collitis! The patch testing finally gave us a direction to go in.... The problem is that non-IGE related allergies are not seen by many doctors as "real" allergies. It's sometimes a battle...sigh.

Anyway, good luck. I hope you get some answers!
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#6 of 11 Old 10-30-2007, 11:00 PM - Thread Starter
 
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Originally Posted by trtl6941 View Post
ITA about the accuracy of the patch testing! My DD had both blood and skin prick tests and had perfect results even though we could see in her colon she had SEVERE allergic collitis! The patch testing finally gave us a direction to go in.... The problem is that non-IGE related allergies are not seen by many doctors as "real" allergies.
I am so happy to hear you say this because it really makes me feel like I'm heading in the right direction. So often I feel like I'm fighting a losing battle. Allergists and even well meaning friends constantly tell me that "she'll grow out of her eczema" and I should stop trying so hard. Or even worse, that most eczema is not food related and I should just treat it topically since her negative prick and RAST results indicate that her eczema triggers are unknown. How stupid is that? They tested like 7 things. Are there only 7 allergens in the world? :

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#7 of 11 Old 11-01-2007, 02:59 PM - Thread Starter
 
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for more responses!

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#8 of 11 Old 11-07-2007, 12:15 PM
 
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We are headed to the allergist in two weeks for skin testing too. My youngest is around 10 months. His Rast came back that he is allergic to NOTHING yet he had a violent reaction to green beans at 7 months, projectile vomiting and full body hives. And eczema at 8 months to either soy or potatoes..

I'll ask about the patch testing instead of the prick. I was also told to bring the food and he would eat some there and be observed.. so I guess we will be there a few hours.. oh joy..
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#9 of 11 Old 11-08-2007, 01:30 AM - Thread Starter
 
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I'll ask about the patch testing instead of the prick. I was also told to bring the food and he would eat some there and be observed.. so I guess we will be there a few hours.. oh joy..
Well, reaction trumps any test, so I suppose there's no more convincing way to prove an allergy! It just seems like you shouldn't have to subject him to a uncomfortable reaction in the doctor's office. Do you keep a food diary? Perhaps this could be sufficient evidence for your doc.

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#10 of 11 Old 11-09-2007, 01:19 AM
 
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Evan was 12 mos when we had the patch testing done. He tested + to wheat, soy, pea, and slightly to dairy I think. I'll see if I can find the pic and post it. He was only tested for 6 things. Our allergist said he's never seen a child react on the test that did not have an EOS disorder (like pp dd), but afaik he does not have that disorder, but possibly still have gluten issues. His patches didn't take up hardly any of his back, not like the other posters have showed so it didn't bother him at all. He had to wear his for 48 hrs and then we read the results are 24hrs after we took them off. We didn't go back in so I told the nurse the results over the phone and took pics since it did end up she didn't write down everything I said so the pics helped at our next appt. When we had this done, we were already off all solids and on rx formula only so I can't say how accurate they were that way, but we knew going in he had problems w/ all of those foods. It appears I erased the pics or have them hidden somewhere in the computer really well.

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#11 of 11 Old 12-13-2007, 12:18 AM - Thread Starter
 
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We traveled to Houston on early Friday morning to have dd allergy tested at Texas Children's Hospital. The hospital is very impressive... new, clean, and spacious. But it's a teaching hospital so we had to go through everything twice- once with a fellow and once with the doctor. Inbetween we waited and waited and waited. We were at the hospital a total of 5 hours. Dd was bored and tired, dh and I were starving and tired. It was a very long day.

First we discussed what foods would be tested. We had brought several foods (per request of the doctor) that we suspected and that they didn't have at the hospital. Unfortunately we were only able to use 3 of these because of the size of dd's back. In total 9 foods were tested: egg, milk, wheat, soy, corn, tomato, almond, rice, and peanut (and 2 controls: histamine and saline). They had special ordered small disks to put the food on so that we could test more foods- usually the disks are the size of quarters, but hers were the size of a watch battery. The foods were made into pastes and applied to the disks, which were stuck on a piece of medical tape. The tape was then placed on her lower back where it remained for the next 48 hours. Dd didn't mind this process at all.

The doctor felt that it was important to limit the number of foods tested so that her upper back remained open for further prick testing. She wanted to test several contact/inhalant allergens as well. These included cat, dog, 2 kinds of dust (including cockroach), and a mold mix. Previously when we had dd prick tested for foods she didn't even notice. This time the nurse really dug the pricking instrument into her skin, making her bleed and scream. It was pretty terrible, but over quickly and she fell asleep in my lap for the next hour, not even waking 20 minutes later when the nurse came in to measure the results. Dd was negative for all of these allergens.

On Sunday we removed dd's patches and thought that the skin looked uniformly pink from pulling the tape off, but not irritated from the actual allergens. As instructed we didn't wash her during this time, so she got pretty dirty. However, her eczema actually improved drastically over the weekend. The patches of skin that had been open and oozing (no steriods allowed 2 weeks prior to testing) were completely closed and fading. We are not sure what caused this, but it could have been the lack of bathing or the humidity. We are planning on bathing her less often to see if this helps.

On Monday we took dd back in to the hospital to have her patches read. Fortunately we were not there for nearly as long this time! Her back had faded and both of us thought that none of the allergens had reacted. We were wrong! She tested ++ (strong positive) to wheat and + (weak positive) to egg and corn. All the rest were +/- (doubtful). It wasn't just the reddness that mattered, but also "infiltration" and papules- in otherwords, they could feel the positive reaction. The doctor's official recommendation is wheat elimination for 2 weeks followed by a three day challenge* (if her skin clears). If the skin doesn't clear, she recommends ending the elimination and treating with steroids, creams, etc. Our plan is to start the elimination after the holidays so that I can enjoy some great food for a few weeks. If her skin doesn't improve, I will consider also eliminating egg and corn for 2 weeks after that. I am still determined to find a way to control her skin without steroids.

Check out a picture of her back from each day here.

I asked the doctor: if her skin doesn't improve with these food eliminations and since she tested negative to common inhalants (via the prick), what would she put her money on? Like our previous allergist she said she's really too young for pollen allergies. She also said that contact allergens (like detergents, etc.) almost always manifest where the skin is touching the irritant, not in localized patches like dd's eczema. You can see where this is going... Basically she said, "we aren't very smart." She never answered my question.

I have to admit that I'm excited at the prospect of a positive result, but I am fully aware that it could be a false positive. I'm also not looking forward to a wheat-free diet, but it's a limited time. So, there you have it! Bring on the eggs and dairy (for now...)

*I want to point out that the doctor told me in order to challenge a delayed allergy you must eat the food each day for three days. A reaction should appear within this 72 hour period, but if your dc is ebf it may take as long as 5 days! I did not know this when I was challenging previously. Rrrrr...

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