first appointment with consultant - what to expect

[bakedalaska]

My daughter has been referred for a suspected egg allergy. I am pretty sure it was the (well-cooked) scrambled egg I fed her, as she had eaten everything else before with no reaction. After about 5 minutes she developed a raised blotchy rash on her face, vomited, then turned pasty white with very bloodshot eyes and started passing out. She didn't seem to have any trouble breathing. NHS direct sent an ambulance but by the time we got to the hospital she'd vomited most of it up and was a much better. The dr on duty at the hospital acted like we were pests for bringing her in.

Our appointment is the week before we go on hol. I would like to know how serious this is and what else she is allergic to.

Is it realistic to expect to find get this from our first appointment?

Also the consultant is a paediatrician. Is that right or should it be an allergy specialist?

[Chandra]

Sorry to hear you have going through that. I would recommend that you write down the exact sequence of what happened during the reaction. Unfortunately allergists are ridiculously scarce, so the probabilites of your child seeing one are remote, specially if you live in the north of England. However, some paediatricians have "an interest" in allergies (which means they know a bit more about them and some are willing to administer allergy tests). We have seen one of them sometime around may, were told they will call us to test in a few weeks but months have passed without hearing from them . If the paediatrican can't help, your GP can bypass the specialist and order the tests himself, you will have to pay them but they cost around £8 per item tested so worth pushing for one. Tatt posted a memo from the Parliament some time ago which explained how GPs could do this, if you check the archives you may be able to find it.

HTH.

[princesspeahead]

yes they can do a skin patch test for egg and other things immediately.
where in london are you? one of the best allergy specialists is a general paed at chelsea & westminster (then runs private allergy clinics at the cromwell as well). His name is Markiewicz (sp??!).
hopefully if you have been referred to the consultant he will have an interest/specialism in allergies, but I think it is a fair question to ask of him at the start.

[princesspeahead]

ps just for your info another good one is gideon lack, who does nhs clinics at st mary's paddington adn private out of the portland. but he is an allergy specialist, not a general paed.

[bakedalaska]

thanks Chandra and PPH

PPH, our appt is with Markiewicz. I am so glad to hear that he is well respected.

What is the significance of the sequence of reactions? They kept asking my husband whether he was sure the rash appeared after she vomited. I wasn't in the room because I was washing the scrambled egg pan, of course.

[Chandra]

They can measure the intensity of the reaction or bring up other possible scenarios in case egg is not the main culprit.

[mymama]

bakedalaska hope all goes well with your allergy appointment. My ds2 is allergic to eggs (managed to find out before he ever ate one). I would avoid all egg products prior to your appt in case of another reaction which could be more severe. You can search the net for egg allergy for further info. Various sites also have lists of other names for egg in products such as albumenetc. hth

[tatt]

I'm sorry you're going through this. What you are describing sounds like anaphylactic shock. You were very sensible to take her to hospital but a junior doctor may not know enough about allergy to know that you can get anaphylactic shock without obvious breathing problems. Although it normally does involve the throat swelling that doesn't always happen.

Its the second exposure that triggers the reaction so it could be something she'd eaten before, or traces of egg in something else previously.

On our first visit we had skin prick tests and a blood test. Ask for a local anaesthetic for the blood test if it isn't offered and for anti-histamine cream to be applied ince the skin prick tests are over as they aren't pleasant. Take something to distract your child and if you can a voice recorder to remind yourself later what the consultant said.

Until you have a diagnosis avoid all egg and carry liquid antihistamin with you. There is a website where you can download translations saying I have an egg allergy in different languages, it would probably be safest to find it now.

Athough ideally everyone would see an allergy specialist there are good doctors with an interest, depends who trained them

[princesspeahead]

oh good! he looked after my son at birth and for 3 years after until we moved out of london (he has a congenital problem, not an allergy problem). he is quite quiet and you have to ask your questions rather than him telling you everything you may want to know all at once (IYKWIM) but very good and respected and a father of 4 or 5 I think! But his private practice is ALL allergy related, he is an expert in that field.Seriously I'm sure you are in teh right place with him. Good luck and let us know how you get on?
Good luck

[princesspeahead]

oh good! he looked after my son at birth and for 3 years after until we moved out of london (he has a congenital problem, not an allergy problem). he is quite quiet and you have to ask your questions rather than him telling you everything you may want to know all at once (IYKWIM) but very good and respected and a father of 4 or 5 I think! But his private practice is ALL allergy related, he is an expert in that field.Seriously I'm sure you are in teh right place with him. Good luck and let us know how you get on?
Good luck

[SueW]

Do all the best paeds have lots of children? My daughter's paed ocns is fantastic - he listens to parents and child and has a great way with everyone, is much admired and respected throughout the hospital and by all his patients' families I've met. A website devoted to a child he'd operated on sung his praises and he got a mention in a professional journal I read recently for the way he had dealt with a child where the mother had had nothing but problems elsewhere - she'd driven 250 miels to see him.

Anyway, he has 4 kids, apparently

[bakedalaska]

Thanks for the tip about the translations, tatt. They even had Portugese. I already had the liquid antihistamine recommended by the A&E dr but hadn't thought to carry it around.

There is so much to worry about, I am trying to figure out what is vigilance and what is obsessing. Today at lunch a cute little girl carrying around an egg sandwich (egg mayo all over her face and hands) came over to see DD, who was in her buggy. She kept trying to touch DD's face and arms. After a few jumpy minutes my husband took her out of the cafe.

I can't wait to meet Markiewicz.

[tatt]

You're unlikely to get an anaphylactic reaction to skin contact (don't like to say never to anything ) but anything that goes on a child's skin can end up in their mouth. Its sensible to be vigilant and wipe off any contact with egg until she's tested. You need an alcohol based wipe or soap, water alone doesn't remove all traces of peanut so I guess it wouldn't remove egg either.

Should have said that if she has an anaphylactic reaction the throat will be swelling but she may collapse from the blood pressure problem before her breathing is severely affected. Its the internal swelling that is the problem according to the video I saw Friday.

[foxinsocks]

We had Markiewiez (not sure of spelling) for dd who has an egg allergy and a milk allergy (now outgrown).

I think he thought I was a bit of a nutter because by the time our appointment came, she had outgrown problems she had with other food (white fish, chicken, peas) and she was much better! First of all, he did a blood test (which revealed that egg was the only 'true' allergy) - this took a while to return. Then he did skin prick tests (which again revealed egg as the only food one) so then he did a milk challenge which she failed (came out in a rash). We didn't see him for 6 months, did another milk challenge, she passed and that was that!

He wasn't too worried about the egg (even though her skin prick test revealed a massive allergy) as I assured him the reaction was only hives, vomiting (v similar to your dd's reaction) and I was sure it hadn't affected her breathing (this is their main concern) so we were signed off from him.

Definitely go in with loads of questions - I forgot to ask him to pin prick test her for peanuts and I probably won't be able to get another appointment now. You have to be proactive with him but he has a fantastic manner with the kids. Dd was pin pricked by him and she did not move/cry/complain because he was SO gentle (they don't need anaesthetic cream for that).

The blood tests aren't great though so be prepared for that!

[princesspeahead]

he is nice isn't he fox, but definitely more comfortable with kids than with adults I found. Not great on eye contact! interested to hear what he finds....

[bakedalaska]

Nuts and egg are both fatty, so I imagine neither would be washed off with water alone. Alcohol probably cuts the grease.

I will probably come off as a bit of a nutter too Fox. I usually get pegged as a geriatric overprotective mum, which has about an ounce of truth. When you say the blood test took a while to return do you mean hours or days?

[tatt]

unfortunately its more likely to be weeks than days but for most people skin prick tests are a pretty good indication. If your child was passing out they won't think you are over reacting. If it happens again then you need to get antihistamine into them fast. If its just vomiting then that's less of a problem. They'd still think you needed to have tests but its not an emergency.

At our allergy clinic I believe they skin prick all children for peanut unless you tell them your child's safe with it. Childre with one allergy often have others. Guess that's one of the differences in seeing an allergy consultant and not one with an interest.

[bobbybob]

I haven't eaten eggs for 2 years because I was bfing ds. I had some out at a cafe at the weekend, and ds did react although only mildly.

[foxinsocks]

blood tests took a few weeks I think (can't quite remember because it was a while ago). We had to go to the GP to get the results and I can remember the look on the GP's face - she was so delighted that I had been 'proved wrong' (as I had insisted dd was allergic to loads of things but the blood test only showed egg). As it happens, she failed the milk food challenge (done later at the hospital) so she did still have a problem with that. Once the blood results came through, we were given another appointment with the consultant to do the skin prick tests. Once the skin prick tests were done, they asked me if I wanted a food challenge for egg but I said no because I was happy to just avoid it and also dd had had things like sausages, cakes which had cooked eggs in and not had a massive reaction (I think in your position I would be tempted to go for the food challenge).

I'm not sure how old your dd is - we saw Markiewiecz when dd was around 2 and by the time she was 2 and a half, she had outgrown the milk allergy. I think he may not have automatically tested for peanuts because of her age. There's no need to give them nuts at this age anyway.

Markiewiecz is a leading allergy specialist but he does do other stuff as well (because he does NHS and private work).

My problem (and I was certainly classed as a nutter) was that when dd was weaned onto solids she had dreadful trouble with loads of foods. I never actually thought she was properly allergic to all of them, but I avoided the foods because I knew they caused her problems (hives, bad stomach). I had to go to the GP for something else and when she asked about dd's diet and I told her the foods we were avoiding, she went mad and told me I had no right to limit her diet (dd was already on hypoallergenic formula)!! I really think she thought I was a complete loon.

The annoying thing was that once we saw the consultant, she had outgrown most of the food issues (other than milk and egg) but I had them all tested just to be sure. Honestly, if I could have taken a picture of the look on the GP's face - it was almost 'yet again, I'm faced with another middle-class mad woman who decides to put her dd on some weird diet'. I could have punched her lights out! I'm sure dd's problems were just because of an immature digestive system (she had a hernia, reflux all sorts of other digestive problems) and once she got old enough, things evened out.

The egg allergy is not surprising for us as dh has a chicken and egg allergy so I wouldn't be surprised if she doesn't outgrow it though a lot of children do.

[foxinsocks]

sorry for that rant!

hope the appointment goes ok - let us know.

[princesspeahead]

my dd and one of my ds's has also been to see Prof Harper at GOSH for ezcema (he is a Paed Derm) and he interestingly said that although a fair number of young children had a milk allergy, they usually grew out of this and it was rare to find a milk allergy in children much over 2.5.

[foxinsocks]

I can believe that - in fact, I didn't want a referral to the consultant at the time because even I thought she would outgrow her problems (because it was so obvious that her digestive system had trouble) - but as she had had 2 UTIs she got a standard referral anyway and the allergy one got lumped on top!

It's amazing that Markiewicz sees so many different problems (as well as his special interest in allergies). I have enough trouble keeping up with new developments in accountancy and that's hardly mindblowing stuff!

[bakedalaska]

I suspect DD has at least one other allergy. She often has a mild rash around her mouth and ruddy cheeks after meals but I haven't been able to figure out what causes it. It may be wheat or cheese.

I intend to ask him to test for nuts, or at least peanuts, and soy too. DH is part Chinese and his family eats a lot of Chinese food with soy and nuts. I have been worrying about what foods the grandparents will try to feed DD when they come to visit in Oct. Their attitude towards the allergy is puzzling. They don't appear to take it seriously.

I have plenty of regrets about my own diet. When I was pg I was quite 'relaxed'. I generally avoided raw eggs and fish but when I went to Japan and was served sushi, I ate it. I also had the occasional ice cream. Nuts I didn't even think about, just gobbled them down. Whilst bf too. DD is 14 months old now. I still bf her a little bit mornings and evenings but really she is all but weaned.

I don't mind your rant Fox. I find my GP difficult too.

[bakedalaska]

What to expect ? Well, not much. Dr Markiewicz was sick so we saw a registrar. From DD's reaction, she thought it was a mod/severe reaction to eggs. They took blood to test for egg, nuts, peanuts, soy and sesame. She said only the consultants could do the skin prick test, so that didn't happen. She told us to carry around chlorphenamine. She referred us to a dietician, who she said would see us by tomorrow. Dietician can't see us until mid-october. Blood tests to be ready in mid-October, a few days after the dietician's appt. So no joy before holidays anyway.

I learned more on mn than at the allergist's office.

[foxinsocks]

oh noooooo, how annoying! I was looking forward to seeing what you thought of him! Did they book you in for skin prick tests?

[bakedalaska]

I was really looking forward to meeting him after hearing so much about him. I had told DH all about him and he was v curious and well impressed by my grapevine. No skin prick tests were ordered so far as I am aware. She said it took a consultant to order them. I'm not even sure whether our next appt is with the consultant or back to the registrar. No offence to her but I hope it's Markieweicz