questions on peanut allergy and anaphylaxis - any advice appreciated

[skinnygirlfat]

hello all,

my dd was diagnosed with cow's milk protien allergy at 6 months which she outgrew at 1 year. at the appt to confirm this, the doc asked me if there was any other allergies i was concerned about. the most obvious one i could think of was peanuts. they tested her and said she was positive.

the dietition we saw at the time was sceptical, saying that it was usual for dd to be tested under these circumstances and that most kids would test positive for peanuts at such a young age. she advised us to continue we were and to avoid giving nuts directly but not to be too worried regarding things which might contain them.

we have been fine for the past year and dd has never knowingly eaten peanuts nor had a confirmed allergic reaction. she has eaten nut free mouthfuls of my very nutty cereal though and had many things that may contain traces of them.

she's now 2 years and we had a follow up appt a couple of weeks ago. she was tested for a variety of nuts all of which came back negative apart from peanut.

we've been advised to avoid all nuts and products that might contain them. docs said that they didn't think we'd need jext pens but gave them to us as i'm of a panicky dispostion.

i feel a bit lost now as i fully expected to be told she was over the allergy (or at least that it wasn't severe) and am quite worried (see above!). i have been researching online but am finding it hard to make sense of everything so would REALLY apprecaite it if there is anyone out there who can answer some of my questions -

1. dd has only ever had a skin prick test. i don't know what the result was at 1 year but her 2 year test resulted in a wheal measuring 7mm. docs said that the measurement is not an indication of severity but that anything over 5mm is considered a postive reaction. i am confused by this as surely it must give some indication if to get smaller than 5mm would mean you are not considered allergic? am i misunderstanding? can anyone tell me what a wheal of 7mm might mean?

1. is a RAST a blood test? what does it show and should i request one?

1. is there any test that can determine the severity of an allergy? my husband & his family have various mild allergies - he to peanuts though is only makes his mouth a bit itchy. is it probable that dd could be the same?

1. under what circumstances is an oral challenge considered?

1. i have heard sensitisation mentioned a lot but am confused by what it means. i never ate peanuts during pregancy but had peanut butter on toast pretty much every day whilst breastfeeding (for 14 months). is sensitisation a good or bad thing?

1. how can i determine how vigilant we need to be? we haven't been overly careful for the past year and dd has definitely been around nut products with no problems. everything seems to contain nuts! what are your thoughts on food which state that they do not contain nuts but they cannot guarentee that their ingredients don't??

1. is every reaction different? is it true that can they get worse?

1. how can docs say that they don't think jext pens would be needed? surely that suggests they have some thoughts on the severity?

1. last question is on anaphylaxis. in oct, my nephew gave dd a bite of a cereal bar shortly before boarding a long haul flight. i took the bar away as soon as i saw and label read "may contain traces of peanuts". it's the only thing dd has ever had which specifically states peanuts. she did not react, we had an 8.5 hour flight, followed by 5 hours at home before she had an bad turn. paramedics said she had suffered a febrile convulsion but she's had 2 before and this presented differently, we saw a consultant afterwards who agreed & there is a bit of a question mark over what it was though they swayed toward some kind of convulsion. i mentioned cereal bar to paramedics, a&e staff & consultants and none thought it relevant but am obv playing over in my mind now. can a person have an delayed anaphylatic reaction? i am unfamilar with the scale of anaphalaxis so please excuse me if this sounds silly but is it possible for a person to come round without the use of an adrelanine shot or is one always required? dd looked like she was choking, her shoulders were rounded and heaving but with no sound. it was like she was trying to be sick but had forgotten how to. her eyes where open but unfocused. i thought she wasn't breathing, we turned her upside down and hit her back and she vomited three times. she was conscious but took some time to get back to her normal self. there was no rash or swelling (is there always with anaphylaxis)?

if you are still reading, thank you!

any advice would be much appreciated.

Please look at www.allergyni.co.uk. The person in charge is Maureen Paul who is very well versed in allergies and can help with your questions. Good luck

Don't panic because it's a peanut allergy, my DD has one and only gets a skin rash

Also the size of the weal produced in allergy test has no correlation to the severity of the allergy..obv if it's positive there is an allergy but 10 mm doesn't show a more severe allergy than 7mm IYSWIM.

Also anaphylaxis is pretty immediate, not delayed like that I think

Above all don't panic because of the fact peanut allergies CAN be severe, not all are

hello,

happy new year and thank you both for your responses.

Ilovejellysweets i will contact maureen, thank you.

FanjoForTheReindeerJumper thanks for your posts. that's what i am struggling with, not knowing how she would react. how do you know that your dd would only get a skin rash? i am terrified that mine will ingest peanut in some form and react worse each time, i really don't feel like i understand things properly.

dd gets a bit blotchy quite often and sometimes after eating food but i have never really worried before as nothing seems to bother her. now i am watching her like a hawk. she ate a cheesey biscuit/dip thing the other day (which she's had lots of times) and went a bit red - i thought i was going to have a panic attack. she was fine of course and i know i sound over dramatic but i just feel very on edge about the whole situation.

i'm also scared that she might have a febrile convulsion and i will panic and confuse with anaphylaxis or vice versa. i know i am sounding like a lunatic now and need to calm down - am usually level headed (honest!). i think it's linked in to having had 2 miscarriages in the last 6 months and now just feel so overprotective of dd. i just wish there was a way of knowing how serious her allergy is. would a blood test help?

thanks again

I wish I could reassure you by saying that there was some way of knowing how severe an allergic reaction will be but sadly allergies are notoriously unpredictable and there is no way of knowing how severe a reaction will be. In fact, each reaction is different, sometimes better, sometimes worse. RAST tests are indeed blood tests and are often used in conjunction with skin prick tests as a 'tool' to try to assess whether or not a person is allergic to something but they are no more accurate than skin prick tests and do not give a clear indication of how severe a reaction is likely to be. Food challenges conducted in hospital are considered the 'gold standard' for assessing whether or not an allergy has been outgrown but can be very stressful especially when they 'fail' (believe me, taking your child to hospital, making them eat something you're pretty sure they're allergic to and making them deliberately very ill is no fun) and are not generally done simply because an allergy is suspected. I know that the fear feels overwhelming right now and the not-knowing makes it really difficult but you will get used to it (to some extent at least!). It's all about managing the risk. It's impossible to completely eliminate the risk (short of living in a protective bubble!) so you need strategies for avoiding risk and most importantly for dealing with reactions if and when they occur - this is called a care management plan. You can discuss this with the consultant or allergy nurse if you have access to one or you can write your own plan with help from organisations like Anaphylaxis Campaign. A plan would normally include what signs and symptoms to look out for, what medication to give in which circumstances (eg Piriton for a mild reaction such as hives, adrenaline injection for more severe reaction involving breathing difficulties etc), where the medication is kept & who has access to it, what to do next (eg how long to monitor the child, whether or not to call an ambulance etc), and how often the plan should be reviewed.
I really do understand how scared and confused you are feeling right now but you are not alone and this MN forum is a great source of advice and support.

Hi
My first bit of advice is to contact the Anaphylaxis Campaign who are generally brilliant and can help and give all sorts of advice.
I'm allergic to nuts myself though so here's my thoughts on your questions:

1. Not sure about this one I?m afraid

1. A RAST test does involve taking blood, to then test if it produces certain antibodies in response to allergens. Allergy specialists will do this for you but you?ll need a referral to one I think

1. No good test will tell you how severe it is or will remain. An allergy can be mild and remain mild, or can start mild and become more severe quickly. If allergic, bets to avoid.

1. If you think your little one?s allergic, I wouldn?t consider this under any circumstances unless an allergy specialist does it in controlled environment. Do not attempt at home

1. Sensitisation relates to when a child first becomes exposed to a potential allergen but it can happen any time and to be honest while people go on about it, I don?t know that it?s been proven to make much of a difference in terms of whether a child will develop an allergy or not.

1. You mention that dd has eaten nut products and has only tested positive to peanuts. It?s worth knowing that a large proportion of the people who are allergic to peanuts are only allergic to them and not tree nuts, and vice versa. Some are allergic to both. Peanuts are legumes, not technically nuts, so it?s very possible to be only allergic to them and fine with all other nuts. It may be that you only need to be vigilant in relation to them but not other nuts.

In terms of the ?may contain? warnings, that?s a bit of a judgement call. I?m allergic to both peanuts and tree nuts and have definitely reacted to traces in food that technically didn?t contain nuts. I?m highly allergic to tree nuts though so traces will trigger a reaction in me. They may not in your child.

1. My reactions got worse over time. I was diagnosed as a baby with nut allergy but only went into anaphylactic shock when I was 17, having had one or two reactions a year. It got progressively worse. This is not the case with everyone though, and some people don?t get worse. Some get worse quickly. It?s irritatingly unpredictable.

1. Is this advice from a GP or specialist? My advice is to see an allergy specialist (not dietician).

1. The only time I?ve heard of delayed anaphylaxis is in exercise-induced anaphylaxis in which a person eats an allergen but only reacts if they take exercise shortly afterwards. I?m afraid I don?t know much about febrile convulsions. Anaphylaxis doesn?t always have a rash but her mouth would probably have swelled up to a point you?d have noticed. I?m afraid I can?t say if this was anaphylactic shock but it doesn?t sound like it and the paramedics obviously didn?t think it was.

Hope that helped!