reaction to brazil nuts, GP has referred us, what now?

[MummyPig]

Hi everyone, ds2 had a reaction to brazil nuts last week - choking, swollen eyes, itchy rash around face, neck and legs. We didn't take him to A&E and the reaction subsided after about an hour or so. I am kicking myself because at the time I didn't put two and two together. We were in a forest on a hot day and I thought each symptom was caused by a different thing, but we are now fairly sure it wasn't the heat, suncream or some kind of reaction to pollen or grasses.

Anyway, I have seen the GP who has referred him to a paediatrician at the local hospital. Ds2 is already seeing the paed for reflux, which I suspect is not in our favour as they probably won't treat this as a new case. Our next scheduled appt with him isn't until September. I would really like them to do RASTs but I am told by the receptionist that ds2 would only be given an appt for these if the GP specifically requested them - and he wasn't very specific about what he was requesting when he spoke to me, so I suspect he's just said 'the mum thinks he had an allergic reaction, can you look at him' or something along these lines.

Anyway, this is a long way of saying that although we have a referral I think it will be a while until we have any definite diagnosis. So what should I do in the meantime? I'm certainly not going to be offering him any nuts myself and his childcare providers aren't supposed to use nuts in any case. But I'm considering writing a letter to both the nursery and the childminder outlining what has happened and saying that if he shows any sign of being unable to breathe, they call an ambulance. Does this sound right? It's certainly what I would do, as I'm really worried now that the next time he reacts it could be far worse.

Any other advice would be welcomed.

[bluejelly]

Worth having some antihistamine medicine in the house-- you can get it from the chemists. My dad had an allergic reaction to a wasp sting (similar to what you describe) and it worked brilliantly.

[MummyPig]

Thanks bluejelly for reminding me. On the day in question we went off to nearest chemists and bought a bottle of Piriton. I shall also ask the childcare providers to have some handy.

[mell2]

Oh MummyPig very sorry to hear about your ds reaction to brazil nuts. I would definitely go back to gp and ask for a RAST. I had taken my ds to GP a couple of times with swollen eyes that had come up at school, it was only when a brazil nut touched his lips and he had a reaction that the GP sent him for RAST.

If your ds has RAST and it is positive to nuts at least he will be prescribed an epi pen and then you can still keep your appointment in September with the paed.

Good luck.

[wherethewildthingsare]

Mummypig - don't feel bad, it took me till adulthood to find out I was allergic to walnuts and hazelnuts (funnily I am fine with peanuts and brazils!). You are right to be cautious and think about an epipen. RAST is also worth doing - I thought I was allergic to cats but it turned out to be dust mites.

[Heartmum2Jamie]

I'm really sorry to hear that your ds had a reactions to brazil nuts mummypig. I agree that they should run a RAST to find out if he is allergic to any other nuts/foods. My ds is allergic to all my 3 types of nuts...pistachios, walnut mix and I can't remember the other one (not that it matters as have no intention of giving him any nut!)

I do have a question too. Should you automatically be given an epipen with a nut allergy?? We don't have one, but we don't know what type of reaction we are looking at, as he's never been "nutted"! He reacts with hives/welts to milk & eggs, suffers gastrically with soya & wheat. He has touched a nut and didn't get any skin based reaction that we noticed. I think that I would rather have an epipen just in case and hope that I never have to use it.

[mell2]

I agree Heartmum2jamie that it is better to have an epipen and hopefully never have to use it.

I was under the impression that if you are allergic to nuts you should be prescribed with an epipen. My ds's RAST test did show him to be highly allergic to a variety of nuts. I was told by the paed allergist that there is no way of knowing if my ds would have an anaphylactic shock but the epipens were his insurance.

I went through a very hard time when he was first diagnosed but the paed allergist told me that at least i know and carry epipens.

[MummyPig]

Thanks everyone for your kind words of support. I am calling one of the receptionists at the hospital tomorrow because she said she would find out what the GP has actually asked for. So if he hasn't asked for a RAST I shall go back (and ask to see a different GP).

It's particularly annoying because we have milk and soya intolerances in the family, which both boys seem to be growing out of, so I thought I could see the end of checking labels. No such luck, eh? And I have been breastfeeding ds2 for so long partly to minimise any other reactions - but nut allergies seem to be for life, so I can't do much now that he has one. Not that I'm planning to stop bf any time soon, though, now we've come this far I'm going to leave it up to him.

[Elliebean]

Hi mummypig sorry to hear about your ds2. I must be really naive but can you tell me what a RAST test is. My dd 15mths old has a milk alergy only discovered at 7months when i tried to stop bf.
I have had no support from GP or referrals, I only found out about epipens when the nursery asked if she had one. But GP told me dd was too young for one.
I think I had better go back and start asking some more questions. It seems unless you press them nothing is offered!
Good luck with your call to the receptionist!

[MummyPig]

In an allergy, the body reacts to certain cells or molecules as if they were dangerous foreign bodies (antigens), and mounts an immune response to them - producing the typical allergic reactions like hives, vomiting etc. . The immune reaction only occurs if the blood contains specific antibodies for these specific antigens, and among them is one called ImmunoglobulinE, or IgE.

RAST is a blood test that shows if the body has IgE antibodies for particular antigens. It's not 100% certain, possibly 90% but only in the sense that if it doesn't show a reaction, there's about a 90% certainty that the child is unlikely to have an allergy to whatever is being tested. It's also only as good as whatever they choose to test - with ds1 our dietitian unhelpfully forgot to put milk or soya on the list, and instead he was tested for a variety of things including 'white beans' (whatever those are supposed to be - perhaps haricots?) so I am still not absolutely certain whether his reaction to soya is an intolerance or an allergy.

The other common test for food allergies is a skin prick test, which some specialists believe is better than a RAST, but they may not work if the allergic reaction is localised, for example in the gut rather than in the skin. (This bit of information is taken from the book 'The Complete Guide to Food Allergy and Intolerance' by Jonathan Brostoff and Linda Gamlyn, which is my 'bible'. Incidentally, both of the authors will be at the Allergy Show in London this weekend.)

Food intolerances do not show up on either of these tests, and this appears to have contributed to many doctors' refusal to believe that they are 'real' (despite the experiences of many parents). I believe the only real way you can determine a food intolerance is by doing an exclusion diet, but even if you find a medic who believes you, you are unlikely to find someone who will support you through this process (at least in my experience) which leads to many parents going through it alone, or with the 'virtual' support of other parents on the internet.

Apologies if this sounds a little like an essay, I'm currently studying human biology with the OU and my last essay was on the immune system! My study is motivated by wanting to become a nutritionist, and this in turn is motivated by the experiences my ds1 has been through (even before ds2's reaction to brazil nuts). Hence another reason I'm kicking myself for not having recognised the reaction when it happened. Just goes to show the difference between academic knowledge and 'clinical' experience!

By the way, if you want more info on the difference between food allergy and intolerance, Allergy Uk do some good factsheets. I believe children more often have an intolerance than allergy to cow's milk, so I'm wondering if this might be so in your dc's case - although of course you may have investigated it fully at the time so I'm not making any assumptions.

there's more info on allergy tests on \link{http://www.bbc.co.uk/health/conditions/allergies/testing_index.shtml#skin-prick_test\this BBC Health page}

[MummyPig]

In an allergy, the body reacts to certain cells or molecules as if they were dangerous foreign bodies (antigens), and mounts an immune response to them - producing the typical allergic reactions like hives, vomiting etc. . The immune reaction only occurs if the blood contains specific antibodies for these specific antigens, and among them is one called ImmunoglobulinE, or IgE.

RAST is a blood test that shows if the body has IgE antibodies for particular antigens. It's not 100% certain, possibly 90% but only in the sense that if it doesn't show a reaction, there's about a 90% certainty that the child is unlikely to have an allergy to whatever is being tested. It's also only as good as whatever they choose to test - with ds1 our dietitian unhelpfully forgot to put milk or soya on the list, and instead he was tested for a variety of things including 'white beans' (whatever those are supposed to be - perhaps haricots?) so I am still not absolutely certain whether his reaction to soya is an intolerance or an allergy.

The other common test for food allergies is a skin prick test, which some specialists believe is better than a RAST, but they may not work if the allergic reaction is localised, for example in the gut rather than in the skin. (This bit of information is taken from the book 'The Complete Guide to Food Allergy and Intolerance' by Jonathan Brostoff and Linda Gamlyn, which is my 'bible'. Incidentally, both of the authors will be at the Allergy Show in London this weekend.)

Food intolerances do not show up on either of these tests, and this appears to have contributed to many doctors' refusal to believe that they are 'real' (despite the experiences of many parents). I believe the only real way you can determine a food intolerance is by doing an exclusion diet, but even if you find a medic who believes you, you are unlikely to find someone who will support you through this process (at least in my experience) which leads to many parents going through it alone, or with the 'virtual' support of other parents on the internet.

Apologies if this sounds a little like an essay, I'm currently studying human biology with the OU and my last essay was on the immune system! My study is motivated by wanting to become a nutritionist, and this in turn is motivated by the experiences my ds1 has been through (even before ds2's reaction to brazil nuts). Hence another reason I'm kicking myself for not having recognised the reaction when it happened. Just goes to show the difference between academic knowledge and 'clinical' experience!

By the way, if you want more info on the difference between food allergy and intolerance, Allergy Uk do some good factsheets. I believe children more often have an intolerance than allergy to cow's milk, so I'm wondering if this might be so in your dc's case - although of course you may have investigated it fully at the time so I'm not making any assumptions.

there's more info on allergy tests on \link{http://www.bbc.co.uk/health/conditions/allergies/testing_index.shtml#skin-prick_test\this BBC Health page}

[MummyPig]

Oh dear, apologies for posting my essay twice .

Time for me to go downstairs and talk to dp now rather than staying on mumsnet all night.

[Elliebean]

Thanks mummypig for the info. Unfortunately we know my dd has an allergy. when I weaned her I put formula milk in with some carrots until then she had only had breastmilk. Her lips swelled and there were red patches around her mouth. The GP said to try feeding her just milk but I didn't like the sound of this so I asked the health visitor she suggested putting milk on dd's arm. When I did this it looked as though I had put boiling water on her!!
No one else in the family has anything like this so it was a shock and I gained alot of info from the nusery when dd started there at 8mths.
Anyway thanks for your help I am off to surf the net to get some info ready to tackle the GP when I ask for a referral. Good luck with the o.u btw. I did a law degree part time attending the uni 2 nights a week, but I admire o.u students because I wouldn't have the stamina to do distance learning. keep up the good work thanks again.EB