Peanut allergy - what level of anaphylaxis?

[Joni13]

My son (3.5) recently had a reaction to peanut. He got hives round his mouth after eating a small amount earlier in the year, so was referred for a skin prick test which the clinic said was negative... we were then sent to do a home introduction to peanut. My husband did this while I was at work, and they finished the last dose (tbsp) at around 12 with no reactions. By the time I got home from work around 4 my son had developed a few hives on torso, was suddenly coughing a lot, stuffy runny nose, rubbing his eyes and I thought his voice sounded 'thick'. We gave him cetirizine but then I got worried and called 999 and they told us to administer his epipen (he has one for a dairy allergy). The ambulance arrived shortly after and seemed a bit baffled and unsure that it was an allergic reaction (all his vitals, incl chest, heart rate etc were normal). However over the hour that they stayed with us his hives spread to cover his body, so we were brought into a&e to be monitored. By the time we got there however, the hives had almost all cleared up.

He clearly has is allergic, but has anyone else experienced this type of reaction? All the medical professionals (incl clinic) appear to agree it's 'odd'.
I'm not sure what I'm looking for, but I'm very anxious about this new diagnosis, much more so than the milk, so I guess I'm wondering whether this would have been a 'severe' reaction or not. Grasping at straws a bit, I guess.

Didn't want to read and run. My son had a similar reaction when we found he was allergic to pistachios. Wheezing coughing, puffy eyes and hives again when we reached the hospital the hives had nearly disappeared, he was diagnosed as anaphylactic to pistachios but then it did come up very clear on the skin prick test.

The coughing, wheezing etc is classed as severe as it affects breathing.

That's very concerning if they said he wasn't allergic!! Hopefully you get more tests asap!

We did a peanut challenge in hospital. The first few bits were OK but when we got up to a teaspoon she was coughing and unwilling/unable to take cetirizine. Epipen was given. Over the next hour hives appeared everywhere and a second epipen was given. So it happened more quickly than your ds but it sounds similar. We now take an epipen out with us and have another set at school. I think a peanut allergy is much easier to deal with than dairy. People take it seriously and labelling is good.

You need a referral back to a decent allergy clinic where they administer not just skin prick, which is unreliable, but also IGE blood tests. My children were referred to the Evelina allergy clinic which runs both. One of them had multiple allergies including peanut; she began growing out of allergies and had a negative skin prick to peanut age 4. A consultant suggested she could then try a "food challenge" in hospital under supervision, but when he checked her blood results, said in fact she will never grow out of peanut. The blood test can tell you which protein the allergy is to (there are three in peanuts) as well as lots of other things a skin prick can not. Go back and get him checked again but demand the blood tests as well. You can also request any other food challenges happen under medical supervision in hospital (standard, at Evelina)

@SparklesandRainbows thank you. Sorry to hear your son is allergic to pistachio. We're realising there are certain nuts my son hasn't tried yet, so we're going to have to carefully go through those now... which I'm v anxious about!

It's more like histamine intolerance that comes on a few hours after eating - hives can be one presentation. If it is that, it's not an allergic reaction. Peanuts can do it but so can other foods that are high in histamine. A food diary would be useful to see if he reacts to other foods.

@wtftodo thank you - yes we're down in Cornwall unfortunately, I've been reading about Evelina which sounds really good. We were told at his next follow up (likely in 2 years time) they'll do a blood test, but it seems mad to me we have to wait that long... I think I'll go back to them and ask to have it sooner.

@CrunchyCarrot ok this is v interesting, I hadn't heard of histamine intolerance.... however my husband used pretty much a whole punnet of strawberries to encourage my son to eat all the peanut butter that morning (he doesn't like it) and I had read that they are high in histamines, so I had wondered if they'd had something to do with it, as it seemed so odd that he had no reaction to all the doses of peanut all morning...

That's definitely anaphylaxis. His voice changes are classified as anaphylaxis in section A.

www.bsaci.org/wp-content/uploads/2024/02/BSACI-AllergyActionPlan-2018-EpiPen-form.pdf

No. It's definitely anaphylaxis.

Our daughter has a milk allergy. Negative to peanuts, but we were unsure if a previous exposure was linked to a reaction. Under clinic supervision we completed a peanut food challenge, and as we were feeling good and about to leave, during the last set of observations, she came out in spots/hives in new as well as usual places, and quickly developed swollen/colour around eye and the itching and irritability began.
We are now waiting for a call back and told not to give peanuts for now until we've spoken to her consultant.

This is classed as allergy, it's not the level for anaphylaxis to be given though. They'll probably prescribe anti histamines for you to have at home. I assume the allergy clinic will be advising you as to your next steps with the peanut allergy? What were the results on the skin prick test? My dd2 has peanut allergy but needs epi pens for anaphylaxis, ask any more questions if you have them happy to help 😁

*previous negative skin prick test for peanuts

And paramedics really don't understand "non standard" anaphylaxis presentation.

They told me off for using the epipen and were not going to take my son to hospital until I said he often had biphasic reactions.

He ended up being kept in overnight and administered adrenaline twice during the night.

Nonsense. It is anaphylaxis. www.bsaci.org/wp-content/uploads/2024/02/BSACI-AllergyActionPlan-2018-EpiPen-form.pdf

I've seen my dd2 with anaphalxisis it's more than a stuffy nose and a cough, I literally thought she was going to die. I meant the op no harm just trying to help

Anaphylaxis can present in a variety of ways including fainting or sleepiness/lethargy, as per my child's medical action plan, issued by the hospital, which is packed with her emergency meds.

We were also told emphatically by the hospital that there is no such thing as a mild peanut allergy, or an anaphylactic allergy, etc. They explained while the skin prick and blood tests can tell you how likely someone is to react to any given exposure, it will not tell you how severe that reaction may be. Illness, exercise, tiredness, etc etc can all affect whether a reaction occurs and how severely. You can go from a very "mild" reaction to a severe, life threatening reaction. This apparently is particularly true (and unpredictable) for some allergens - peanut, cashew - than others.

Hope this helps, OP. Please call your clinic and ask for a quicker follow up due to developments, or ask GP for a new referral.

I've seen both my DC with anaphylaxis. DD presents as mostly changes to her voice and coughing. An allergy specially administered the epipen and said it was anaphylaxis .

DS goes grey and floppy.

www.bsaci.org/wp-content/uploads/2024/02/BSACI-AllergyActionPlan-2018-EpiPen-form.pdf

The change in voice would ring alarm bells for me too, I have a DC with a peanut allergy and I would have given the epipens for that.

I'd try get an appointment with the specialist and ask for bloods, but honestly you're already dealing with anaphylaxis to milk, peanuts will be a walk in the park!

You can get a second (biphasic) reaction but it is unusual that he didn't appear to have a first reaction at the time of eating.
I was told by A&E doctor that when the allergen reaches the small intestine this can cause a second reaction. I wonder if that is what happened and he just reacted much more seriously then?

I agree, it is more likely to be the peanuts but you can get anaphylaxis from histamine intolerance. They are called non-immune anaphylaxis.

I have had 2, possibly 3! I had a battery of tests after the first anaphylaxis which didn't show any allergies. The food diaries prior to all three reactions showed high histamine foods and no common allergen, I'm not sure if the third was anaphylaxis but it did require a 999 call and O2, antihistamines and steroids to manage it. Since then I have followed a low histamine diet and have avoided any severe reactions.

Can I ask what the blood levels were? My daughter had a level of 6 when she was tested at six months, and although her skin prick has reduced each year we haven't been offered a peanut challenge yet.