What do you make of these test results

[tinytalker]

I've just had my dd's blood results back. We know she is allergic to cats, dogs, rabbits and horses (through experience and skin prick testing) which was confirmed with the blood test. Cats - Grade 2 kua/L 2.29, Dog - Grade 3 kua/L 9.08, Horse - Grade 4 kua/L 49.6, Rabbit - Grade 3 5.91
We had a query regarding pine nuts which was negative BUT hazelnut came back as a Grade 4 allergy! kua/L 29.1
The weird thing is she can eat nutella without a problem!!?? All other nuts were negative too.

What do you think?
A weird anomaly or what?
Anyone else have any experience of blood test results that might help me make sense of this?

I have spoken to the referring Professor but you know how they have a way of confusing you plus I always come away forgetting to ask half the questions I intended.
He did say he didn't think an oral challenge was suitable at this moment. What does that mean?!

Tinytalker, I think they normally won't consider an oral challenge unless the blood test result is grade 3 or lower, as higher than this is indicative of a probable (but not necessarily definate) clinical reaction - this could be why she is testing positive but isn't getting a reaction. If I were you I'd stop giving your dd nutella and switch to a nut-free chocolate spread instead, as I think it's probably not worth the risk with a nut allergy.

Well my child with nut allergy has a grade 3 positive blood tests for a food that they can even eat raw. We've gone on feeding it to them as we want to make sure they maintain tolerance.

In your place I'd ask for a food challenge since all other nuts were negative. Tests aren't infallible, clinical experience is more important.

Yes, the clinical reactions though usually come at >grade 3. As I say though, it only indicates a probable, not a definate reaction. DS1 has just dropped to grade 3 for eggs and they are now considering an oral challenge, which they wouldn't do previously.

Thanks for your replies.
Sorry to be dozy, but is an oral challenge a diagnostic test or a treatment to reduce/cure allergic reactions?
Academic Mum - Do you mean Grade 4 is too high a reaction for the challenge to be safe/pleasant for the child?

I was told that the test only indicate the probabilty of a reaction and the higher the level the higher the probablity and more severe the reaction.

An oral challenge means giving food to be eaten and see what happens. Eg Ds milk allergy oral challenge program we are hoping for in aug 1 drop cows in cup soya, 2 drops cows in soya, 4 drops cows in soya. It is way of testing for a reaction without overloading and getting the very severe reaction. A tiny bit will invoke a smaller reaction.
A way of assessing if safe to consume.

MY SON HAD A BLOOD TEST DONE AND HE WAS A GRADE 6 FOR PEANUT ALLERGY. DO YOU THINK THEY WOULD CHALLENGE IT?

Actually i think they would wrap him bubble wrap and place in a sterile room to avoid contact

Above grade 4 is likely to induce a reaction and thus could /probably be dangerous. We had an anaphaltic shock from milk just prior to bloods being level 4 but it took a fair amount to do so (about 4oz baby formula).

tinytalker, don't be too sure that your DD has no problem with nutella - she might have some low-grade grumbly gut issues, tiredness etc.

I have a friend who had a wheat (not gluten, wheat) allergy diagnosed - she had been suffering with grumbly guts, headaches, tiredness, general lethargy and not feeling right. Stopped wheat and started to feel better; then a few weeks later got carried away by the smell of fresh-baked bread and ate a half-baguette in one sitting --> face, throat and eyelids swelled alarmingly, rash on neck and chest, felt appalling and had dreadful guts.
Whilst being on wheat continually, her bod had been grumbling along on it; after it was removed, the bod heaved a sigh of relief and relaxed - so when it was re-introduced (oral challenge, if you like) - her bod went NOOOOOOOooooo!!! Iyswim.

So - if you do decide to remove it from her diet on the basis of these test results, be careful of re-introducing it.

chunkybutt - they will not risk a food challenge with your child while their result is that high. If skin prick tests showed a declining wheal size then they might consider a food challenge when they got below a certain level. Unfortunately children don't generally outgrow nut allergy when the test results are that high.

AcademicMum where does the above grade 3 come from? We were told thresholds considered posititve are different for different types of foods.

OP food challenges start with rubbing the food on the skin of the arm, then the face, then the lip, then trying a taste and gradually increasing the amount. It's labour intensive so they can't afford to do many and they normally only do them if the child has declining skin prick tests. Children can be quite nervous about them if they have had previous reactions to the food but unless there is a reaction (and they don't do them if that's likely) they aren't unpleasant.

We are grade 2 and told this was still to high to reintroduce milk - go figure.

Now, I dont KNOW this and am only speculating but I can see why there would be a difference between milk and e.g. hazelnuts - the milk protein is hugely more available to be absorbed than the nut protein, because (obviously) milk is liquid and has a massive surface area; whereas nuts need to be chewed or chopped very finely (or ground) to allow the digestion of the protein to be anything like as easy.
So maybe the allergenic potential is looked at alongside ease of digestion?

Very wise words thumbwitch

It could also be that they are hoping he will grow out of it as he is 4 so just still in the region of growing out. We have a patch test repeat in summer. Last result was very close to call. But if he does pass this he will be milk free for rest of life

Thumbwitch - that's an interesting story about your friend, that helps explain why the specialist said let her have small amounts of Nutella from time to time.
And perhaps you're right about not being so sure she's ok with Nutella, maybe that could account for her consistently bad allergic shiners (black eyes) and stuffy nose!
I think I will cut her back on the Nutella but let her have it once a month maybe.

I can't remember what level the blood results were for dd but her most severe reaction was always to egg which I remember had a 'moderate' grading rather than severe. It was always her worst pin prick reaction too.

They place a lot more emphasis on those food challenge tests which really are the gold standard for seeing how a child will react.

DidEinstein'smum, don't lose hope. Dd failed her milk challenge tests a few times before she passed them!

fingers crossed that your ds will

and yes tiny, too true about the allergic shiners. You may even find she has more energy if you cut it out.

Allergies are such odd things aren't they.

The above grade 3 is what we were advised from our consultant. DS1 has just dropped to grade 3 for eggs and has been booked for an oral challenge. He is grade 4 for peanuts and cashews and grade 5 for most tree nuts and he said anything above grade 4 is more likely to give a clincal reaction. Nothing is guaranteed though, so someone who has had only a mild reaction one time, may have a severe reaction the next time, whereas someone who has had a severe reaction may not have a severe reaction on the next occassion. (Hope that makes sense, I'm having a bad day today).

My dd is now 11.5 yrs. What do you think are the chances of her growing out of it? She's had multiple allergies since about age 2yrs.
AcedemicMum - How long between tests, when there was a drop in grade? Did he have any treatment or did you do anything specific to cause a reduction in allergic response?

tinytalker, the length between tests, I don't know. I suspect it probably depends on the allergy as some are more likely to be outgrown than others. Egg and milk are some of the most likely to be outgrown, so I think we are just lucky that ds1 seems to be outgrowing it. Nuts are less likely to be outgrown, though I've heard that there are some densensitisation methods, I don't know anything about them (I only heard about it from my BIL who is anaphylactic for peanuts and couldn't undergo desensitisation because his allergy was too strong, but he can go anaphylactic with even just the smell from someone next to him eating peanuts!!!).