Allergy Test / Skin Prick Test - how to prepare?

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Greyhound
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04 Dec 2008, 9:47 am

Tell them it might hurt - don't say that it won't. I hated it in hospital recently when they said things wouldn't hurt and they did.


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Last edited by Greyhound on 04 Dec 2008, 3:38 pm, edited 1 time in total.

leechbabe
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04 Dec 2008, 3:07 pm

The peanut test did react, it came up about half the size of the hazelnut. Enough to be significant. The doc wants to do the challenge because she is worried Heidi will have a worse reaction if exposed to the actual peanut.

I'm a bit hazy on the specific details because by the second consult to find out results and get our info both girls had reached their endurance limit. Heidi was doing her bang crash into the couch thing and Annie was whining.

The doctor gave me a bunch of handouts to read and I'm hoping to sit down with them today.



EvilTeach
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07 Dec 2008, 12:04 pm

Educate yourself good.

Peanut and peanut oils are in a lot of food products.

I'm glad it went well.
It is good to know what the allergies are.



leechbabe
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09 Dec 2008, 6:27 pm

EvilTeach wrote:
Educate yourself good.
.


Working on it. I have such a huge pile of books I'm trying to read. Only just finished "Autism's False Prophets" and have a Temple Grandin one to read next.

Always seems to be something new to learn :?



annotated_alice
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10 Dec 2008, 1:12 pm

Hi Leechbabe,

Glad the testing went well. My sons have multiple anaphylactic allergies. We've been through the skin testing many, many times (along with RAST tests as well), not fun. We usually bribe with a new Bionicle, which we call a "bravery gift".

I agree with EvilTeach, that educating yourself is essential, but since you seem like the type to do your "homework" anyway, I'm sure it goes without saying. I don't have time for book/website recommendations right now (on my way out the door to a Christmas concert), but let me know if you want them and I'm happy to pass along info.

It's a steep learning curve and a scary new world at first, when you discover that common foods can make your child sick or even be lethal, but after awhile it becomes business as usual, although I'm sure us parents always have higher adrenaline levels than average! I still jump out of my skin every time the phone rings when they're at school...luckily it's usually just behaviour issues to deal with and not an allergic reaction. :lol: :roll:

The combination of AS/ADHD etc. and serious allergies can be particularly challenging especially as they get older, since kids with anaphylaxis need to be even more responsible, careful and dependable than other kids, not less so.

Anyway, best of luck to you and your girls. I hope the challenge is successful and that the allergies do not turn out to be serious, but if they do, I'm sure you'll all do great with managing them. :)



leechbabe
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11 Dec 2008, 4:01 am

Thank you annotated_alice, I will probably take you up on that offer after Christmas. I'm just too overwhelmed keeping Heidi calm in the pre-Christmas build up to do much of anything else. I hugely appreciate the offer though.



leechbabe
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12 Dec 2008, 3:26 am

We are booked in for the Peanut Challenge mid January. I got all the hospital admission forms in the mail today.

Also info about how the test is conducted. Double blind placebo something technical or other.

I have to take in some smooth peanut butter and also another food like spaghetti sauce. You give both the foods to Nurse A, she mixes a little peanut butter into the spaghetti sauce and gives it to Nurse B who then feeds the mixture to your child. Thing is sometimes Nurse A just gives Nurse B plain spaghetti sauce with no peanut butter in it. This is so the child can't panic over eating nuts and cause a psychological reaction, and so neither the parent present or Nurse B can imaging a negative reaction.

Sounds like a very sound way to do the test and minimise chance of false positives.

One problem, Heidi wont eat foods that touch - which means sauces in all forms. She likes to know exactly what she is eating. I rang and explained this but the lady on the phone was adamant this is the only way the test would be done.

So I'm going to have to practice with Heidi over the next 4 weeks eating spaghetti sauce.



Mage
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12 Dec 2008, 9:09 am

Can you use yogurt with chocolate syrup mixed in instead? Enough chocolate should cover the peanut butter taste and color fine.



annotated_alice
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12 Dec 2008, 10:03 am

It's funny that they would insist on spaghetti sauce, especially since it's a new food for Heidi. How will the allergist know 100% that she isn't reacting to something in the sauce? Or just sensitive to the acidity in tomatoes (our allergist once told us that many children can get redness around their mouths from tomatoes even though they aren't allergic)?

Food challenges are done here, with just the food. There is no attempt to disguise it, and really you could taste peanut butter in anything anyway. I guarantee a child could tell the difference between PB spiked sauce (yuk!) and plain sauce, so the logic behind preventing a psychosomatic reaction seems faulty. Besides then you can never be 100% positive that any reaction occurring isn't due to an ingredient in the added food, not the challenge food. You could end up with a false positive.

When giving the challenge with just the suspected allergen, there is definitely the possibility of the child's fears about the food affecting the symptoms they present, but the same fear will be there no matter what you mix the potential allergen with, if the child is old enough to understand the concept of the challenge. And while anxiety can cause upset tummy, breathlessness, flushed face etc., it is not likely to cause hives, swelling, severe breathing difficulties, severe vomiting etc. as anaphylaxis would. If the doctor is in any doubt about whether a symptom is due to anxiety or a reaction the challenge can simply be halted for a time, while the child is observed carefully and has a chance to relax. It will quickly become apparent whether it is nervous illness or the real deal. We had to do this when my son was challenged for peanut. He began complaining that his throat "felt hot" at one point, but didn't show any other symptoms. The allergist observed him for about an hour, no new symptoms presented and we continued with the challenge.

I would try to talk to someone different at the allergist's office. I am very leery of the whole idea of mixing the challenge food with another food (particularly a multi ingredient sauce!) as far as clarity of results, but if they insist on doing it that way, you should at least be able to use a familiar food that your daughter has had many times recently (so you 100% know she isn't allergic to it) and something that she likes so that you and she aren't faced with the horrible task of trying to force her to consume quantities of something she hates on the challenge day. That would just be insanely stressful!

We have really discovered on our own journey that not all allergists are created equal. If you don't end up feeling really comfortable and happy with your doctor's knowledge and methods, I would see someone else for a second opinion.

Hope it all goes well.



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12 Dec 2008, 10:12 am

Just reread and realized the double blind method is more to prevent the parent or nurse from letting the knowledge that the peanut is being administered affect their observations, rather than the child's own anxiety. (I am a chronic mis-understander! :wink: ) But I still think the logic is faulty. You will know that peanut is being administered at some point, you will be really stressed out anyway and the symptoms of a serious allergy are not easily overlooked or misconstrued. Oh well, I still think they should give you some flexibility on choosing a placebo food that won't be in conflict with your daughter's particular needs.



leechbabe
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12 Dec 2008, 3:32 pm

I agree whole heartedly about the tomato based sauce not being an appropriate medium. Many of my nieces and nephews react to tomato and I'm suspecting the rash my girls got around their faces from trying hotdogs recently was due to the tomato sauce on the hotdog.

Really like the yogurt idea and the Soy Life blueberry yogurt should at least disguise the colour. Might test out making some chocolate custards at home and see if I can get something with a strong chocolate flavour that Heidi will eat.

But Heidi is just so incredibly sensitive to tastes and flavours that I don't know if she would accept something she was used to at home that had a slightly different (peanut added) flavour at the hospital.



EvilTeach
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12 Dec 2008, 5:13 pm

You need to perform the study exactly as they tell you, or the results will be invalid. This is not the time to start creating new statistical methods. Yes, it will be hard on you and your daughter. I am sure you are up to the challenge.

Practice with your daughter, with a variety of sauces, in the size of the dose she will be getting, so it becomes a routine task. Issue a reward for each time she takes the dose.

Practice, so it will go smooth at the hospital.



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12 Dec 2008, 5:53 pm

Evilteach,
This is a ABSOLUTE test! There ARE NO statistics involved! Adding other ingredients, ESPECIALLY ones she may react to CAN make the test WORTHLESS! That is a given.

leechbabe,

Hotdogs are NOTORIOUS for having a LOT of things in them. She COULD have had a simple reaction to the nitrites, or seasonings, or may be alergic to the pork that might be in them, or even steroids, hormones, or antibiotics that might have been fed to the animals. For the hotdogs, I would suggest giving her a PLAIN piece of the hotdog she reacted to. If she reacts, try a hebrew national. THEY are supposedly FAR more likely to be pure. If she reacts, it certainly shouldn't be worse. She MIGHT not react at all.

Then again, you might be right about the tomatoes. On the BRIGHT side, if she returns to normal, the alergy is likely MINOR, and shouldn't be much of a concern. PEANUTS, on the other hand, ARE all around you, and can practically aerosolize THAT can, at it's worst, inflame the lungs, and stop breathing. That IS unlikely though, so wait until the challenge.

That DOES explain why they want her in the hospital though. It is UNLIKELY for people as a group but, for some people, is is all but a GIVEN! Your goal is to find out which group she is closest to. If it is the first, she can be simply a little careful, or not care. If it is the second, DON'T fly on SWA(that still gives out nuts), and make sure she doesn't get exposed elsewhere.

I wish you both the best.



leechbabe
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12 Dec 2008, 9:43 pm

I'm going to keep trying with tomato based sauces as well but I need to have a back up plan if Heidi's dislike of tomato based sauces continues. I'm also going to call back the allergist rooms and ask about using the chocolate custard instead.



leechbabe
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15 Jan 2009, 3:45 am

We did the peanut challenge at the hospital today.

All went very smoothly.

Heidi had refused to eat breakfast in the morning, then we went to Hays Paddock in Kew for a 3 hour play before heading over to the hospital.

To prepare Heidi I simply told her we were going to the hospital to eat spaghetti - we've been practicing eating spaghetti since Christmas and she has done well at it. I brought her own bowl and spoon from home and the tinned alphabet spaghetti from Heinz (Heidi loves the word-getti, as she calls it).

As I was expecting her to eat at the hospital at 1pm I hadn't given her lunch, that combined with no breakfast and 3 hours play made for a very hungry and very lethargic little girl.

We got admitted to the hospital, Heidi got a little "Cabrini Nurse" teddy bear. Given a seat in the post op recovery lounge - Heidi had a big comfy reclining chair, I got to sit on an instrument of torture.

First up was smear of peanut butter on her lips.

No reaction so 30 min later she got 1/8th teaspoon of peanut butter mixed into some spaghetti sauce.

Again no reaction so 30 min later she got 1/4 teaspoon of peanut butter mixed in spaghetti sauce.

Almost immediately she got hives all around her mouth.

Challenge over.

They waited to see what would happen next, within 10 minutes she was scratching her head and there were more hives.

So give her some zyrtec and wait some more.

Hives disappear, scratching stops, no vomiting.

Heidi can eat - she'd not had breakfast or lunch, it was 3pm, she was hungry.

She ate two whole tins of spaghetti and there was no vomiting or diarrhea so we were allowed to go home.

Can keep peanut butter in the house but Heidi is not allowed to eat it. We have to keep utensils used for peanut butter separate from all others and wash in boiling water. Also wash hands, face and brush teeth after eating. Seems like a lot of work and just easier not to have it around.

A relief that it is not an anaphylactic reaction and the rash shows up pretty quick and disappears just as fast when treated with zyrtec.



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15 Jan 2009, 11:51 am

So, she had no reaction to the peanut butter alone, but then a reaction to the peanut butter/spaghetti mix? Sounds like she's allergic to whatever's in the spaghetti sauce to me.

Don't take these tests too seriously, I don't see a whole lot of good science behind it. Peanut allergies are extremely rare, and if she's never had a reaction to peanuts in the past then I wouldn't worry about a possible positive from the prick test.

IMO hives are nothing to worry about anyway. I would break out in hives every single day if I didn't take my zyrtec. I'm not willing to live in a bubble just to avoid taking zyrtec every day. You should just be very grateful your daughter does not have any serious allergies, keep zyrtec on hand, and not worry about all this avoiding peanut butter and any utensil that has ever touched peanut butter nonsense.