Should my toddler have an EpiPen after sesame and egg allergy tests?

[Ela00]

My 2 year old son recently had skin prick test for a bunch of possible allergies, because he was getting fairly regular skin rashes but I couldn’t pin point what it was. Until I gave him mayonnaise for the first time and he projectile vomited, then i suspected egg (but he also has had egg lots of time and seemed to be fine).
His skin prick test to egg was 3mm, so that seems to make sense to me, ie its on the borderline of being positive. Most egg he tolerates ok but it seems less cooked either gives him mild hives or makes him vomit.

However the surprise came with the sesame score of 11mm. I had thought he was having regular sesame at nursery in hummus (only now did I find out they use sesame free hummus). I feel so awful, I did give him sesame when he was weaned at 6 months but only a handful of times before he started refusing it, then when I thought he was eating it at nursery I was relieved that it was regularly in his diet (however I now know that not to be the case).
the doctor told me to remove sesame from his diet and he will review in 9 months. However on reflection, surely he should have given us an epi pen? I am now incredibly anxious as (unlike egg) I have absolutely no idea what his reaction will be. Just that 11mm score is a lot higher than he scored for egg!
any advise appreciated?

to top it off, my son now seems to have had a hives reaction to peanut butter, when I also thought he was ok with that 😥 (they didn’t test him for nuts in the hospital, so now another thing to worry about).

Only a doctor can advice you.

I would avoid peanut for now as a child with egg allergy is twice as likely to be allergic to peanuts. The doctor should have told you this. Did they do a blood test as well or recommend a food challenge for sesame? The skin pricks give an indication but they are not an exact science.

are you starting the egg ladder with him? With an existing tolerance to baked egg it would be a good idea to read up on it but you usually do this on the advice of a dietician.

Did you see an paediatric allergy specialist? What you have posted makes me think not.

As a PP said, only a doctor can advise you, but when I asked about an EpiPen for my DD (she was 4 months old at the time of diagnosis, so a lot younger), they said they wouldn’t prescribe it if the symptoms were vomiting or hives, as that’s not anaphylaxis. I was given cetirizen instead (an antihistamine like pirotin).

Yes I’d defo be wary of peanut as there is often a link between peanut and sesame
I’m not sure without having a reaction if they do give out epi pens my dd2 has epi pens for peanut and seseame but she’s eaten both and reacted so we know she needs them. The allergy team would surely prescribe it if it was needed but 11mm does seem quite big
I found my dd2 last allergy skin prick test but they didn’t give us the mm size just a number from 0-10, she’s 8put of 10 for sesame which is suspected anaphylaxis and 9 out of 10 for peanut which is confirmed anaphylaxis

I sat in the waiting room of the local children's A&E and gave my son various potential allergens. That helped relax me.

If he had shown a severe reaction, not just a small skin swelling then he’d have been offered an EpiPen. You already said his reactions haven’t been anaphylactic in nature (that’s just restricted breathing not full on shock) so there’s nothing to indicated the need for a pen.

I have to carry EpiPens for peanuts and latex and a host of other random and more rare things as they make me wheeze and a blood test suggested the likelihood of a severe reaction. I was told if the bloods didn’t suggest the likelihood of a severe reaction they wouldn’t have bothered. I’d just carry liquid piriton /chlorephenamine (not piriteze /cetirizine) at all times as it works really fast if there are problems and you can give extra doses in emergencies (but always check with a GP or specialist this is ok first)

Thanks everyone for replying! I think my worry is that I don’t know what sort of reaction he would have if he had sesame accidentally. Yes with egg it’s a skin reaction but sesame I have no idea, and with such a high score I would suspect it would be worse (although I know that’s not always the case).
the doctor also did give me an egg ladder to introduce types of egg gradually but told me to strictly remove sesame (so it seems he thought the same, ie reaction could be worse) seems scary to me that I need my son to have an anaphylactic reaction before proscribing us a an epi pen, esp is doctor suspects it might be a severe reaction and he does have asthma inhalers already too.

I will push to see the consultant again sooner, at the moment our next appointment isn’t until November. But he’s now had a peanut reaction with hives and his voice went hoarse until I gave him Piriton, so maybe this now counts as potential anaphylactic :(
again he seemed ok with peanut butter at weaning stage, so was a bit of a shock when this happened from eating 1/4 toast.
It feels a scary place to be at the moment, neither myself or DP have any allergies so just trying to learn and understand how I should be advocating for my son.

Hoarseness is anaphylaxis. It’s on my DC’s allergy plan as one of the airway signs (A from the ABC of anaphylaxis - look up allergy plans online to see). I’m really surprised they didn’t give you an EpiPen based on that. My DC has an anaphylactic allergy to wheat and they got their EpiPen after wheezing from eating it - although it took an appointment after the fact with an allergy specialist for that to be recognised.

If I were you, I would go back to your GP with that and point out that it’s a pretty classic sign of anaphylaxis and ask where to go from there. I would also research the links between asthma and anaphylaxis - part of why my DC is on their brown inhaler (their triggers are illnesses and pollen) is because uncontrolled asthma is a risk factor for more severe anaphylactic reactions, and there’s also obviously the reaction trifecta of asthma, eczema and allergies.

It’s a lot to take in, but we’ve had the best results by going in well prepared with NICE guidance and knowing the interactions between conditions.

Please be aware, as well, that antihistamines are NOT considered a proper treatment for anaphylaxis because they don’t work quickly enough to arrest the reaction (I know, because my DC’s allergy plan is first step cetirizine, then EpiPen if they start wheezing, and the cetirizine didn’t prevent the wheezing from coming on), so if your son eats something and goes hoarse again, you really need to call an ambulance and say you think he’s experiencing anaphylaxis. I know it’s scary and it feels like an overreaction, but it isn’t. I’m not scaremongering. This is the advice we received from our specialist.

When DD was under the allergy clinic we were told we could bypass the GP is we thought something significant needed investigation. It might be worth phoning and asking to speak the consultant's secretary to mention the hoarseness and ask if he needs to be seen quicker than Nov.

With dd it wasn't the hives they were worried about, it was the coughing and the fact that she became very sleepy. (She was 2 1/2 when diagnosed). They said that was epi pen worthy.

To give you hope though, she reacted strongly to the tests all through childhood and early teens and they told us it was incredibly unlikely she'd grow out of it. Then the very last one her reaction more than halved and they said she could face a food challenge which she passed.

Ask the dr for bliid test allergy tests and go by those results. My son reacted to everything that was fresh fruit and veg , then cooked, and could barely eat anything. I was pushing cereal bars on him and thank god re flat out refused as his results came back with 17 various food allergies with multiple nuts and seeds included. He now has a diagnosis of oral allergy syndrome and even with multiple nut allergies he’s never been given a EpiPen. He’s very careful and only eats “safe” food and has managed fine for the last decade.

Yes, try to go back to the consultant sooner. Strictly avoid sesame and peanut until then.
They will prescribe an epipen if they think the airways are compromised (hoarseness would indicate this). Or perhaps the GP can prescribe? Check with them anyway.

Your son may have stopped taking the sesame from you for a reason at 6 months (eg tingly mouth) so don’t feel bad about that OP.