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.

[orangehead]

Sorry forgot to add one thing. Although his main symptoms now are diarrhea and bloating he regularly vomits, but not normal vomit but very small amounts. This seems to happen when he runs about, it does not seem to bother him although he says it is very hot. Thanks again

[cariboo]

p.s. could you please confirm that peanuts are not actually nuts but legumes? Again, thanks

[ilovemydog]

Hello Dr Fx,

I have peanut allergy (epipen type) and was told not to eat peas, nor to give them to babies (DD - 2 and DS - 8 months)

Is this over reacting?

Are peanuts and peas related?

Am I asking too many questions?

Is Elvis still alive?

[cariboo]

Hello lovemylab... yes, peas are related to peanuts. Love, Dr Foxglove

[cariboo]

(May I just apologise for that complete breach of etiquette & good taste? I'm an idiot & I'll shut up now)

[tatt]

Hi

Do you think desensitisation will work on adults? My teenager has severe nut allergy -how likely is it that desensitisation programmes will be established at locations other than Cambridge?

I've read that dehydration increases histamine levels. Do you think this could be a factor in exercise induced anaphylaxis?

Anecdotally anaphylactic reactions on planes are more severe - any research on this? Again could dehydration be a factor?

Paediatricians argue that consultant allergists are unnecessary and can even be harmful. My experience of both paediatrician and consultant allergist is that the latter is far better informed and hence more helpful. What's your view / how can the number of allergy specialists be increased?

How do we train gps better?

[VeniVidiVickiQV]

[Litchick]

Hi there.
My DD (AGED 9) was recently diagnosed as allergic to peanuts.
Do you think there is any merit in trying a desensitisation prog?
Many thanks

[twocutedarlings]

Hi there,

12 months ago my daughter (just 4 years old) had and allergic reaction to what we believe was prawns her face swelled like a balloon (she couldnt even open her eyes) and her body (mainly around her joints) was covered in hives. Thankfully it didnt effect her breathing and after a manic trip to A&E we were sent home with pieriton and all has been fine since.

The doctor we saw at A&E advised us to give her a couple on months to recover and to give her prawns again to see if she reacted again . Rightly or wrongly i chose not to take his advice a we have avoided all shell fish ever since.

I realise that it is important to find out for definate, so what would your advice be? should i go our GP and ask for her to refered for test or should we give her prawns and see ?

[athomeagain]

I wonder if it would be possible to answer a few questions for us that our local specialist seems unable to?

Our three year old daughter has been diagnosed for well over a year as anaphylactic to eggs, peanuts, walnuts and sesame.Her latest skin prick test showed level 5 reactions (the same as the control) .She has also reacted to items in the park that people have been eating on and to people touching peanuts and then her.

At the moment we are being extra cautious with absolutely everything that she touches and we are not eating anything that cannot be assured to be safe.

It seems that other people are quite happy to eat 'unsafe' foods but not to let their child have them.Even eating them next to them,as in a bag of nuts and also foods that may contain.

Do you have any suggestions as to what we should be doing? We have read a piece of research that says that if we were to eat, drink and clean our teeth after eating something with an allergen in it then we would be unlikely to contaminate her with that allergen.

We are also concerned by ingredients in things that she might use rather than eat (e.g. paint, playdoh)or in fact in products that we might use (e.g. shampoo or body lotion and especially anything that may linger on the skin) and we tend to shy away from letting her use things until we have confirmed that they are safe or checked the labels. Do you have any suggestions in this regard? How likely would a reaction be if any of the allergens were present in tiny amounts in these types of products?

How likely are children to cross contaminate each other?

This also runs for us when we go out to eat: At the moment we are taking our own food all the time for all of us as we know that it is safe. It was suggested to us that we should wipe the tables with anti-bac wipes where we eat to ensure that there is the lowest possible chance of an allergen being present. Do we need to go this far? If the table was 'cleaned' by the establishment prior to us using it would it be likely that allergens would remain? Do you have any suggestions as to how we should deal with the nursery?

At the moment all our Specialist has told us is that we need to be 'sensible' in our approach. We are finding that simple word quite difficult to put into practice as 'sensible' seems to us to be to make as sure as we can that she does not come into contact with the allergens and therefore avoids another reaction.

Overall our lives are ruled by places were no one is eating or facepainting ,playing with dogs,using animal foods etc and this is affecting the whole household.

Do all of the things she is allergic to sustain the same amount of risk ie if someone were to eat a sandwich containing mayo next to her and then hold her hand is this a real risk,we ask as we have moved her away from children in the park because of situations just like this.

We really would appreciate your help as we need to have some direction as to what we should be doing that would take account of the current medical evidence.

We have recently been told that she will only have an anaphylactic reaction if she ingests the food that she is allergic to and not if she touches it. Is that right? What will destroy the proteins for nuts and eggs? Is soap and water enough? So, if she touches a food that might contain her allergen if she then washes her hands will that prevent her ingesting even traces of it and thereby prevent an anaphylactic reaction?

With thanks and confusion!

[DrAdamFox]

test

[thesockmonsterofdoom]

Hi there Dr Fox,
My 5 year old has all the symptoms of coeliacs disease, and has no symptoms when she does not comsume any glten, the symptons return immediatley if gluten is consumed.
She had a blood test for Coeliacs which was negative and is not having any further tests as it is very obvious, Is it possible to have Coeliacs disease but test negative for it or could she just have a severe gluten intolerance.

[thesockmonsterofdoom]

sorry, also dd wets herself a lot, I have always wondered if this could be related?

[GeraldineMumsnet]

Hello, Dr Fox's just getting settled in and looking through your questions, so we'll get going in about 10 minutes. He's prepared some answers to quite a few of the questions that you've already posted.

[SuperSillyus]

Oh brilliant to find this today! My questions have been covered by others and I'm really interested to see what's said.

[DrAdamFox]

Hi,
Thanks very much to Mumsnet for inviting me along - I regularly get mums in clinic telling me about what they have read on the site so it's great to be involved. I will try my best to answer as many questions as I can.
Adam

[bythepowerofgreyskull]

sorry in comparison to others a minor question..

Dr Fox - my 2 year old son is a fussy eater.. but when he eats eggs which he enjoys he has no problems with his digestive system but he gets hives if the egg touches the outside of his mouth only on the area where the egg touches.
SHould I stop giving him eggs or is this nothing to worry about? Thanks

[DrAdamFox]

Dear Cariboo - lots of people are asking about desensitizing and it is a really hot topic for allergist. The idea is to change the underlying immune response to an allergen by exposing the allergic person to lots of it either by injections or squirted under the tongue. It works really well for pollens eg in hayfever but is still v experimental in foods and only shoul dbe done as part of a clinical trial. Results look promising in some studies but it is a fair way off being widely available. Injection immunotherapy to nuts is most definitely dangerous and definitely a bad idea.

[DrAdamFox]

savoycabbage ? the ?traces of nuts? issue is a very individual thing and depends on lots of factors. For some families, where the kids have had very severe reactions or reaction to very small amounts, only complete avoidance will do. However, this is not the same for everyone. It is important to appreciate what the labels mean as they are over misinterpreted. ?May contain traces? foods usually are nut free but there is a small chance they may contain significant amounts of nut - enough to cause a reaction. Some mums tell me their kids ?can?t be that allergic because they eat the ?may contain? foods and are OK? ? of course this is giving them a false sense of security as in fact they have simply been tolerating food with no nuts in at all. For most nut allergic kids we support a risk assessment approach ie if the child is well, supervised and with their emergency medication available, then it would be reasonable to have ?may contain? foods. However, if they are not well ie bit wheezy, in a strange environment, unsure where their piriton is, then it would be best to play it completely safe.

[DrAdamFox]

Dear hellish - RAST tests (now called Specific IgE tests) are really useful for diagnosing immediate allergies (although unlike skin tests, you have to wait a few days for the results). They have to be interpreted with care in the context of the clinical history, otherwise they can lead to over-diagnosis of allergies that aren?t really there. Unfortunately they are of v limited value for delayed allergies. I think I?ve touched on the 'may contain' issue already. Anxiety though is a big problem for some families (but surprisingly not for some families). Different things help for different families but spending time with other families in the same situation who have found good ways to cope can really
help. The Anaphylaxis Campaign runs excellent days for kids and teenagers, which really help show how food allergies should not be a barrier to living a normal life. Sometimes, a psychologist can help work through issues too. As for the ?challenge? programmes ? I know these are offered in some alternative clinics but please be careful as they can be dangerous. There are ongoing trials looking at desensitisation but this has to be very closely monitored and hopefully may prove to be a useful technique ? it is still early days so please don?t try this at home.

[DrAdamFox]

Thanks flowerbud. Anyone with an immediate type food allergy (which is what you are describing here) could potentially have an anaphylactic (ie life-threatening) reaction but these are very uncommon in egg allergy. There is a lot of debate about which kids should have epipens prescribed, although some consensus is emerging following the publication of a ?position paper? from the European Academy of Allergy. Generally, Epipens or Anapens are given to kids who have both a food allergy plus a history of asthma (a major risk factor for having severe reactions) or food allergy that has caused a severe reaction in the past. Personally, I think prescribing an Epipen is an
individual decision to be made by the parent and family together. Whilst I would always give one to any one with either of the above criteria, other factors may also influence the decision ie what the child is allergic too (nuts are more likely to cause bad reactions), distance from medical care, age of child (teenagers are most at risk of severe reactions) plus anxiety ie if the parents can?t sleep for worrying that they don?t have epipens, then it makes sense to prescribe them. However, this needs to be combined
with a discussion about the real risks of severe reactions which are fortunately uncommon. Of course, if you do get an epipen it is essential that you are shown properly how to use it. Just to mention that it is very common for 2 year olds to struggle to eat enough egg for the food challenge and things often don?t get resolved until they are 3.

[DrAdamFox]

dear by the powerofgreyskull - egg allergy is really common (approx 2% of kids) but you are correct that this doesn't sound like this. A fair number of kids, often those with eczema, get redness around their mouths but are absolutley fine when they eat the food. It sounds like this is the case and i agree yu shouldn't cut eggs out of his diet - life is hard enough with a fussy eater!

[bythepowerofgreyskull]

thanks, he does have minor levels of eczema..

(but that is probably because I have it as do most of my family)

do you believe diet has alot to do with eczema?

[DrAdamFox]

dear sockmonster - diagnosing coeliac disease is very tricky without gluten inthe diet for approx 3 months as the screening tests will be negative as there is no inflammation to detect. This is hard as you want to make your child sick by putting them on gluten. However, some kids can get a transient gluten hypersensitivity that they may outgrow so at approx 7-8 years it is important to confirm the diagnosis of coeliac disease before committing to a livelong diagnosis. Obviously, if attempting to reintroduce gluten makes them sick, you probably have your answer but if you were able to persevere to get the TTG blood test or even better an endoscopy & biopsy (the gold standard test) then that is the ideal.