Webchat with consultant paediatric allergist Dr Adam Fox, Tues 18 Nov, 12.45pm

[GeraldineMumsnet]

We're delighted that top children's allergist Dr Adam Fox has agreed to come on to Mumsnet to answer queries about all things allergic. Please post any advance questions here, particularly if you're not able to make it on the day.

hi
my 1 year old has a lymphatic malformation and also suffers from unexplained rashes like hives,often bizarely when he has eaten a new food but then seems ok on subsequent occassions. should he get'raft' (hope speling is ok) testing as suggested by a nurse? is there any connection between an abdominal lymphangioma (half was surgically removed a month ago) which is obviously in the immune system kind of, and allergies? i would e VERY grateful for you opinion as we are not getting very far, and his rashes arre very itchy!

As a childminder with a 60ft Walnut Tree in my back garden, how worried should I be about undiagnosed nut allergies in children?

Also we are advised not to feed a child any of the below foods first (ie the parent should):
egg
Shellfish
strawberries
Kiwi

Are there any others we should avoid? or is this advise ill thought out?

Hi Dr Fox

• How useful are RAST tests?

• Should we continue avoiding "May contain traces of.."products ? ( 6r old anaphylactic reaction to peanuts')

• Have you any ideas on how to deal with extreme anxiety in children who suffer life threatening allergies?

• What do you think of 'challenge' type programs to lesson the degree of allergy?

Thank you very much

Hello Doctor Fox

I have a high sensitivity to dairy products which caused me to sneeze constantly and feel very congested until I elimiated them from my diet about 10 years ago. I haven't been able to reintroduce cow's milk products although I am ok with sheep and goats' cheese, milk etc.

My daughter (11 months) has had a runny nose her whole life and constantly has her mouth open. The only time her nose was clear was after she had a tummy bug where she didn't keep anything down for a few days.

I'm thinking about switching her to a dairy-free formula and completely cutting out dairy to see if it makes a difference, but I'm worried about how to make sure she has enough calcium and would appreciate some guidance before I start messing about with her diet.

She only has goats butter and cheese so far but seems to get very snotty / sneezy the more she has.

I'd be very grateful for any advice on how to manage her diet and still give her enough nutrients. How long should I cut the dairy out for and at what point do I re-introduce it?

Thank you!

Hello Dr Fox.

Same question as Suzi2 and TheOldestCat I think. Although the LEAP study is ongoing, what is your hunch as to what it might find? I know that we can only really wait for the data for concrete answers, but thought you might have a feeling on the subject?

Thank you.

Hello

I have 2 daughters - my elder daughter (aged 4) is autistic, and has benefitted from a gluten and dairy free diet (Sunderland protocol)

i have kept my younger daughter (now 21 months old) largely (99%) gluten and dairy free, as advised when trying to avoid autism triggers.

I suspect my elder daughter may have a corn intolerance too - how might I go about finding out if this is the case? i am reluctant to fiddle around with her diet too much, as she is a very fussy eater.

My younger daughter rarely produces formed stools. She has not been tested for coeliac, as she is already gluten free. Her current paediatrician (she is FTT, and weighs 18lb at 21 months) dismisses my concerns as "toddler diarrhea". I think this is too simplistic.

How can I go about finding out what might be irritating her bowels? On a Bristol Stool Scale rating, her stools are type 7 95% of the time. Something must be wrong, but no-one will take me seriously. What can I do?

Dr Doctor Fox
My 5 year old son has a very 'spotty' face - a bit like goosebumps/small spots, particularly on his cheeks. Forehead and chin OK. Wondered if this may be due to an allergy? Rest of skin on his body is nice and smooth and normal. Wondered if it may be cows milk allergy (as intolerant of this when a baby) but don't want to cut it out his diet. Do you think I should see a local doctor maybe.
In good health otherwise, just looks very unsightly.

Mnay thanks

Dear Dr Fox
My 12 year old son occasionally gets a large swelling lip after eating an apple (he uses this as a good excuse not to eat them!) and sometimes complains of mouth/lip tingling with other fresh fruits such as tomatoes. He's also had a couple of major lip swellings after eating red-coloured ice lollies. I read recently that allergies giving rise to this type of reaction in the mouth should be investigated because of the risk of more serious reactions in the throat. Would be grateful for your thoughts on that.

Hello

My 2 yr old daughter has a severe reaction to egg, established from a skin prick test at 6mths old due to severe eczema(She has never eaten egg)
we were advised she could be anaphylactic.
Egg challenges in hospital have failed as she would not eat the cake containing egg.
I have been refused an epi pen, can I insist on having one, considereing the advice I have been given?

Thank you

Sorry, forgot to add, she has had subsequent skin prick tests 6mthly and the reaction is still as bad.

Thank you

Dear Doctor Fox,

my five year old daughter has a peanut allergy. We have been avoiding products containing traces of peanuts on advice of our consultant. Is this still the right thing to do?

I find the probiotic situation confusing as there are so many different strains. Is there a type of probiotic we could be giving her which may better than others?

Should you avoid nuts when you are pregnant?

Do people call you Dr Foxy?

My 5yo son was diagnosed with a peanut allergy at age 3 after getting a rash after touching peanuts. He hasn't been tested for other nuts and at the moment I am too scared to give him any. After his diagnosis he has had one reaction in which he vomited and went very gray but recovered quickly.

His peanut allergy is Grade 3. He doesn't have any other food allergies afaik. He has a viral induced wheeze and has had one skin reaction to elastoplast. He doesn't have hayfever or pet allergies etc.

Does he have a realistic chance of outgrowing his allergy? Is there anything I can do to help him outgrow it. He is taking Udo?s Choice Junior Blend Probiotics daily. Is there any real evidence that probiotics help? I was wondering if taking antibiotics whilst breastfeeding has contributed towards my son being allergic.

I am currently pregnant with my third child. My second child (3yo) has no known allergies. Should I be avoiding peanuts and treenuts or will that make it worse? I don't have any allergies but my husband does and both of our siblings do.

What are your thoughts on the desensitisation study at addenbrookes hospital and the Chinese medicine study at Johns Hopkins/Mount Sinai?

Dear Dr Fox

My questions relate to the potential protective effects of breastfeeding with regards to atopy and food allergy.

From your research and case experience is there any evidence to suggest that the longer an infant is breastfed the lower the risk of them becoming atopic or allergic to foods?

If yes for food allergy, could this possibly be due to minute food molecules in breastmilk that effectively 'teach' the immune system not to react to them later when the child eats the food?

So...is there merit in eating as wide a range of foods as possible whilst breastfeeding (inc nuts)?

Many thanks

Hello, Ds (5 years old) has a considerable number of allergies diagnosed: Peanut, egg, wheat, almond, hazelnut, shrimps, house dust mite, grass, dairy, soya, fish (excepting white fish), kiwi and bananas. He is also intolerant to other meats, fruits and vegetables.

All these allergies have been diagnosed by RASTs, and corroborated by skin prick tests.

He carries an epipen, and has been in a restricted diet for 3 years, his yearly reviews show that he is developing more allergies than he is outgrowing.

Is there anything that could be done for him other than avoidance of the allergens? I worry there may come the day when it will be imposible to keep his nutitrion up to a good standard. He already seems quite small and thin for his age.

Many thanks

What's your advice on routine immunisations - MMR etc - for children with allergies? Should they have them, in your opinion? Should parents exercise more caution if their child has allergies, or a genetic disposition towards coeliac disease, for example?

Dear Dr Fox,
do you have any helpful suggestions re house dust mite allergy? this is the principal casue of my DD's excema (she is now 17)
I have found the routines proposed -eg on the Channel 4 programme a few years ago totally impractical for most families especially if parents work outside the home/have other children etc- what would be your priorities?
and, to follow on, what advice for young people when they leave home, to live in college residences etc?
She also has peanut allergy and so far very diligent about carrying her epipen...but I can't remind her when she has left home!
thanks
MLE

Hello Dr Fox,

What are your thoughts on a recent study which suggests that by delaying DTP vaccination to 4 months the risk of developing asthma is significantly lowered?

Thanks in advance.

beachcomber - I am delaying them to 3 months with the support of my health visitor - I understand that the reason for lowering them was purely due to uptake when mothers returned to work earlier (before SMP payment times were lengthened). I will be interested in the response......

My question is related to dust mite allergies too.

My 3 year old has always been an extremely poor sleeper - to the extent that we have had an inpatient sleep study done when he was 2 and a half to check for apnoea.

When I gutted his room due to threadworms and scrupulously cleaned, he slept better for a few nights.

How would I go about getting tested for dust mite allergy and is it necessary? Or do I just stop being a domestic slattern

What are your tips for dust mite free sleeping?#
thanks

Hello Dr Fox

My son is allergic to cephalosporins for surewe found out when he had to be given it intravenously and his face and neck swelled immediately. We don't know for sure, but his allergist thinks he's allergic to penicillin too, on the basis of a little pinprick rash (not hives) he developed as a baby when he was given penicillin, plusthe doctor tells me--there's a crossover between penicillin and cephalosporin allergies.

The allergist recommends we not to bother with tests to determine if he has a penicillin allergy, as he almost certainly does.

(1) In your opinion, is a penicillin test advisable?
(2) What are his options if he is unlucky enough to need intravenous antibiotics again at some point?
(3) He can't tolerate erythromycin: he gets a lot of pain in stomach, and sickness too. So what are his options orally?

This is a big source of worry for me and I hope you'll have time to address my questions. (My allergist is busy and mostly unavailable.)

Hello Dr fox, My second son was a very healthy baby. But from around 8 months old starting suffering from severe vomiting and diarrhea and severe bloating of the stomach. I introduced solids into his diet around 6 months. We were constantly at the doctors,who kept fobbing us off. After about a year and a half of exactly the same symptoms he was finally referred to the hospital. All blood tests came back normal. They decided to just review him every few months. Over the next few months the vomiting eased, perhaps occuring once a month but the diarrhea was still severe and meant that potty training was very difficult as he had little control. I got so fed up that I took him for private allergy tests that came up he was intolerant to wheat but everything else ok. I immediately took him off wheat and all his symptoms cleared up no more diarrhea or bloating. When we returned to the hospital I told them and they were very pleased but said to keep him off wheat for a few more months then reintroduce in order to see if it was just an intolerance or coeliac. When we did reintroduce the wheat he seemed ok for a few months but then slowly started getting the symptoms back. Back at the hospital the were uncertain if to do bowel biopsy and said to stay on the wheat and see how he was next time. The next visit we were back to square one but the vomiting not as bad as when he was younger. An xray showed impaction and he was put on movicol. He has been on the movicol for 9 months it seems to help for a few weeks then he get bad again, so they up it and it helps for a few weeks and he is bad again so they change it again etc etc. I dont feel the movicol is getting to the root of the problem. About 3 months ago I took him back off the wheat but this time it has made no difference. So I am very confused. He is 5 and 1/5 and he is constantly being sent home from school due to him soiling himself. The last couple of months he has all of a sudden developed ecezma. There is also a history of coeliac in my family. Sorry this is so long but I dont know where to go from here, do I push for a bowel biopsy? He is getting to the age where he is going to made fun of at school for him soiling himself, they also make fun of his swollen tummy. Any advice would be greatly appreciated.

Hello Dr Fox. Is it possible, and safe, to desensitize an adult peanut allergy sufferer? Thank you!