Would you ask for a referral to an allergy specialist in this situation? (long, sorry)

[suiledonn]

DD1 (3.4) has had eczema since she was 2 months old and a history of wheeziness and chest infections since around that time resulting in a diagnosis of asthma at 19 months. She reacted to egg at 12 months and we had allergy tests done (skin prick and blood) when she was 14 months. Those tests were postive for an egg allergy (mild to moderate) and nothing else. We saw a consultant immunologist for this, privately and it was very expensive. He advised to keep her egg-free.
Since she was hospitalised for her asthma we are under the care of a paediatrician. Because of her ongoing problems (eczema, asthma, constipation and tendency to have a lot of allergic type skin reactions) the paed. suggested having her allergy tests done again.
We got the results yesterday - strong allergy to grass, moderate to dust mites and then low level sensitivity to egg, dairy and wheat.
We had a lot to discuss with the paed and dd was anxious to leave so I feel I didn't ask enough questions.
He said as the food sensitivity is low he would not recommend removing them from her diet at this stage. She has been on an egg-free diet since the first diagnosis.
Not sure what to do now. The paed. is not an allergy specialist so maybe we should see someone to discuss the implications of the food allegies. I never asked if they could suddenly get worse or if we could see an imporvement in her conditions if we took them out of her diet. Her asthma is controlled by a preventer inhaler and her eczema comes and goes although she did have a bad time this summer, due to the grass allergy I presume. Her constipation seems to be resolving and she is not taking medication for this now.
Would you look for a referral to an allergy consultant in this situation?
Sorry for the long post - needed to see it in black and white to get it straight in my own head.

Also, meant to add we are no longer in a position to go to the private immunologist. Would have to wait for a referral.

Hi suiledonn,

I am not an allergy expert by any means, but when my DS was allerfy tested it was actually done by the paediatrician. It could be that your paediatrician is the allergy specialist iyswim...

Could you ring his secretary and ask if he could ring you for a chat, or make another appointment to see him and go with a list of questions? Doctors don't mind this at all, particularly those who work with kids and are used to parents needing to ask them lots of stuff! Good luck with this.

if you are up for it I'd suggest a two trial of dairy and wheat free then reintroduce dairy, followed by wheat a week later. I'd try her with well cooked egg as egg allergy is often outgrown.

Paediatricians, even those with an interest in allergy, aren't as good as an allergy specialist. But as you aren't describing classic allergy symptoms if food is a problem it's more likely intolerance than alelrgy. For intolerances exclusion and reintroduction give you much more information.

If you can't face a GF/CF diet (which is hard) try giving her Peptizyde enzymes and switch from cows milk to goats milk.

Thanks for the replies. Still thinking about it for now.

She had a definite egg allergy - hives around the mouth within minutes of eating egg when she was younger and swollen puffy eyes. Not sure if I am ready to risk the egg yet as it causes her eczema to flare up.

DH would like to exclude dairy and wheat to see what happens. He was dairy and wheat-free for years as a child and he grew out of his problems. I would have to do some research and plan it properly though as dd1 has a very small appetite and is not a good eater. She doesn't eat much bread/wheat based foods but dairy is very important in her diet.

My ds has multiple food allergies (some severe) and I have spent a lot of time with consultants so know a little about the subject.

A lot of the current thinking with allergies seems to be linked to toleration. DS was eating soya and peas quite happily but his RAST test showed an increasing level of allergy to it. We cut them out of his diet (on advice from paed cons) it didn't make any difference to his eczema problems but when we tried to reintroduce them he reacted immediately. His dairy allergy also rocketed up once we had cut it out but he always showed an immediate reaction when he was exposed to it so it was obvious it had to be excluded from his diet.

The immunologist we subsequently saw explained if you remove something from the diet that is being tolerated, the body loses the ability to tolerate it quite quickly. If you see the latest peanut research this would back up the theory.

So it is possible that a mild allergy could increase if you cut out the allergen. Although it could still be outgrown over time of course.

Hope this hasn't made things even more complicated for you but thought it was worth a mention.

Thanks Bilbomum. That is something to think about.
This whole allergy thing is so difficult to deal with. It comes from my DH's side of the family so I have no experience of it before dd1 came along.

The research on toleration is great and one of the reasons I keep feeding my child foods they test positive for but do not react to. However a child with eczema and wheeziness may not be tolerating all foods.

With gluten if there is a problem and you continue to feed it the problems can get worse because the gut lining can be damaged. The ability to tolerate dairy depends on the villi in the gut being undamaged. Removing dairy or substituting with goats milk frequently does help eczema but sometimes dairy is a secondary problem to wheat intolerance. There aren't easy tests for intolerance problems.

Have experience of a child with dairy allergy apparently tolerating soy then having a severe allergic reaction when it was removed and reintroduced. But a few years on they have no food issues at all.