UPDATED: an Allergist has answered your questions

[DrAdamFox1]

My name is Dr Adam Fox,

I am a paediatric allergist and I will be coming to Mumsnet on May 23rd to try and answer all your allergy-related questions. The MNHQ video team will record my answers, which will be posted back into this thread.

I have worked in this field for over 15 years and was one of the founders of the children's allergy service at Guy's & St Thomas' Hospitals. I am a trustee of Allergy UK and currently President of the British Society for Allergy & Clinical Immunology. I see thousands of children's with allergies every year so will do my best to answer pretty much anything allergy related!

A huge thank you to you and Prof Lack for helping my son.

We've been advised to give DS nuts (a variety of nuts in differing quantities) to help prevent allergies. Should this be common guidance? A few of my NCT groups are scared to give nuts even in the form of nut butters.

Hello everyone!

We are very excited to have Dr Adam Fox join us next Thursday.

Please ask any allergy related questions you've got and we will do our best to get around to answering as many as possible.

Great. How long do you think it will be until some of the patches to prevent peanut allergy currently going through clinical trials in the US are available on the NHS?

Off track (slightly) but any tips for cholinergic urticaria? I have had it since I was 11, and tried every med possible. I take 40mg cetirizine. They said my only other option was immunosuppressants but I have autoimmune neutropenia so not an option

Oh my goodness this is amazing!!!

I’ve been in contact with both yours and Prof Lack’s secretarial teams to discuss a private appointment for my DS, as our nhs care (or lack thereof) just isn’t giving him what he needs.
I guess my biggest question is what is the current guidelines for adrenaline autoinjector prescriptions for children with multiple food allergies and asthma together? My son suffers from both. He has had 2 previous episodes of anaphylaxis (after exposure to cows milk), but our dietician, GP and consultant refuse to prescribe adrenaline autoinjectors until we submit to a hospital milk challenge It would appear that until we submit to their bullying tactics, they are barring my DS from any further treatment or support with his allergies (7 in total!).

Oh fantastic! Thanks for doing this!

I have a 7 month old baby. I suspect he has allergic colitis. He has struggled with his digestion since he was 1 week old, is very irritable, and has copious amounts or mucus in every nappy (never visible blood though!). I have tried increasingly severe elimination diets and even on a strict TED the symptons remain (though less severe). He was originally suspected of silent reflux and was on ranitadine for 4-5 months.

My questions-

1. Should we try an amino acid based formula? At the moment he is breastfed with just a little bit in the way of solids.
2. We started weaning at 6 months. Should we stop giving him solids until we've worked out what is affecting him or just push through?
3. What long term effects are related to inflammation of the gut? If we don't work this out, but just wait it out instead, is he likely to outgrow it or will he have a permanently damaged gut?

My son is 13, and, in the words of his paediatrician, "a very allergic boy". Food and environmental allergies to all sorts, carries epipens, etc. Has severe asthma, eczema, hayfever, keratoconjunctivits, etc.

However, he's now steroid dependant and takes daily hydrocortisone, and is also on immunosuppressants (methotrexate) to treat his eczema. What effect are these likely to have on his allergies? Does it mean he's less likely to have an anaphylactic reaction (I'm not going to feed him stuff, obviously, but, for eg, if he got stung by a bee), or will it make no difference?

He seems to develop a new allergy every year or so, is this likely to carry on forever (what will he eat!) Or is it a childhood thing?

He doesn't get allergy tests anymore, last time his total IgE was over 5000, which meant we got loads of false positives to things he eats all the time, he has his IgE checked every so often but it's always sky high, so RAST tests are pointless. He reacted to the negative control on his last lot of skin prick tests too. Why is this? What makes the IgE so high? Does that have any implications for the likelihood of a reaction?

Hi, my nearly 3yo is ana to peanuts, also allergic to pine nuts sesame and raw egg, diagnosed at 1yo after a reaction at 10mths. We've been told to avoid all nuts, however we were told this may also increase likelihood of developing allergies to other nuts. We've had very little advice from our allergy clinic (!)... so we started introducing walnuts into his diet (just a tiny amount in his porridge ) then were told to stop this by our GP as technically we were doing a "food challenge" unsupervised. I read that introducing nuts ought to be on a daily basis and that introducing it and then reintroducing it after a few months can increase likelihood of developing an allergy to it - is this true? Therefore, Should we continue introducing other nuts in his diet on a daily basis now that we have already started? We last gave walnuts about 2 months ago, no reactions.

Also, I have a 6mth old and have just started weaning but due to my sons allergies I've decided to stay clear of known allergens until she is tested with a spt when she is 10mths old. As her first contact to allergens will be at the spt, are they likely to come up negative, as I was told allergies develop after a second contact, not the first contact? If so, will she likely develop allergies if I then introduce allergen foods after the spt? Thanks in advance.

My 25 month old son has CMPA and we're currently trying to work our way through the milk ladder.

He can now tolerate products on step one of the ladder, so anything with milk baked into it like biscuits and scones etc. The next step however, milk added into something and then baked in the oven, is going badly because it's still too much for him and he has some form of a reaction with each try. We've tried 3 times to date.

We know to wait a while between his last reaction and trying him on the next stage again but how long would you say we have to wait? One dietitian told us 6 months, a paediatrician said 2 months and an allergist told us 2 weeks or until he's stopped reeling from his reactions. We're averaging 3 months at the moment. His eczema often flares when he reacts badly and that can take 6 weeks or so to settle and the rest of the time spent waiting is me being unsure when to try again, but also being reluctant to because I don't want to keep making him suffer, especially unnecessarily.

Thanks in advance.

Thanks so much for this.

My son (8 weeks old) Has recently been diagnosed with CMPA and due to this I have a few questions relating to allergies -

• Are there any stats available that show the age children tend to outgrow a CMPA? In your experience what is the average age?
• Is he more likely to have allergies to the other main allergens now due to this diagnosis? Not sure if it’s relevant but there’s no allergies in either side of the family. I have asthma and his older sister has keratosis pilaris rubra facei (A minor skin condition) Does that make him more likely to have food allergies?
• Rather than introduce allergens to him during the weaning process, is it possible to just pay privately for a skin prick test or is it better to simply introduce the allergens during weaning and hope for the best?!
• What are the current guidelines for introducing allergens? Can they be introduced from 6 months or is it best to wait until a bit older?
• My main concern would be a nut allergy and i’d like to introduce nuts as soon as possible. Besides peanuts, what other nuts should be introduced?

My little girl had her jabs day before yesterday and it has come up in a massive red mark and the size off the red mark has doubled since yesterday. And she showing clear signs off distress.

Yay! I really hope you can answer my questions as I’m struggling to find the correct person to ask.

My daughter is now 3. We breast feed at first but had to combination feed at 1 week when I was diagnosed with spesis and put on lots of IV antibiotics. By 6 weeks we gave up breast feeding. She always struggled with feeding both breast and bottle but this settled down a bit when her to tongue tie was cut and she was put on Rantitadine for reflux. At 7 months she was put on lactose free diet by GP as a result of continued foul smelling, very loose stools and vomiting. Some improvement of symptoms. At 11 months a NHS paediatric dietician said it was CMPA and she went dairy free. Since then her weight percentile has increased to met her height percentile and she only been able to manage step 1 of the milk ladder.

My question is about her new sibling due in July. What are the chances of the new baby having CMPA? Did the antibiotics I took last time have an impact? Should I go dairy free in preparation for breast feeding? I’m worried baby will have CMPA and we will struggle to breast feed and professionals will not listen again when I say something is not right. All advice eagerly welcomed.

Thanks

Oh also, are therr any tests that will help us work out what his intolerances are? Paediatrician has suggested a fructose intoleterence breath test. What are your thoughts on MRT or ALCAT tests... do they actually work? They are very expensive so I don't want to waste money but if we get some answers I'm willing to try...!

Hi, thanks for doing this. I have an nut allergic 4 year old who reacted to cashew and pistachio on the skin prick (we carry and epipen), but not other nuts. Since then she has had swelling of the lips when eating products containing other types of nuts. Is it likely she has developed an allergy to those? I was thinking it could be cross contamination. Would it be worth getting skin prick done again? I don’t want to restrict her diet to avoid all nuts unless we have too. I have weaned my 2nd child early with all the major allergens (inc peanuts) but I have yet to give him any other type of nuts because I’m nervous, is it best to bite the bullet and introduce them earlier?

Hi, my 13yo DS is due to start immunotherapy at St.Thomas' for grass and tree pollen allergy later this year, for which we are truly grateful as from march til September he is a complete recluse.

We have noticed that his oral allergy syndrome is getting worse (he is allergic to nuts and has epi-pen) bizarrely his worst reaction to date was raw celery where he couldn't speak.

Anyway, he very much misses things like cherries/plums etc, esp at this time of year. Is there a risk of anaphylaxis from this or is oral allergy just annoying rather than life-threatening?

It is also so hard to get it taken seriously, people just think he's trying to shirk eating fresh things which is so not the case.

Thank you!

@surreygirl we are having similar issues with my 6mo although we have had regular frank blood as well. Thought we were getting somewhere by adding lactase (colief) to every single breast feed.

NHS consultant disinterested, didn't check with red book at last appointment and therefore didn't notice he's lost 300g in 1 month having gained nicely up to now. Considering private options at the moment - just started weaning onto solids, some is going in but clearly not much.

My daughter is 4 and is allergic to egg white and yolk, peanuts, cashew nuts and pistachios. She has ana symptoms and we carry 2 Epi Pens but still unsure of when I should use them. She gets hives, coughing, vomit and itching around her throat but we have never used the pens because after she vomits, she starts to get better.
Also, will she still grow out of an egg allergy even though she has nut allergies too? Thank you.

What do you think about immunotherapy for management of allergies? What is the likelihood and timescale for it becoming widely available on the NHS?

At the moment, the peanut immunotherapy is only available to patients age 16 and under. Do you think this will change in the future?

Hi, my 11-year-old daughter was diagnosed
with peanut allergy at the Evelina Children's Hospital aged 9 months when she came to be assessed for the LEAP study. She returned to the Evelina for a peanut challenge aged 5, which she failed (ie still allergic).

She's had no further testing or contact with our local hospital team since then, but we have antihistamine and emerade on repeat prescription. Is it worth getting her retested at some point? If so, what age would you suggest and what kind of retesting? Or is it unlikely she'll grow out of it?

She did also have eczema, milk & egg allergy but grew out of those aged 2 or 3.

Thank you!

I have a 7-year old with CMPA. Regular - every few months - attempts at milk ladder but always get a reaction (diarrhoea, severe stomach cramps) at step 1. He used to be ok, but he’s been really upset about it recently. What’s the chance of him growing out or at least tolerating it better? And second question: how often is it sensible to try milk products, given that it always leads to him having a few days off school and he’s hugely disappointed when it doesn’t work? Thanks!

Marking place

Is there any work being done to find ways to 'treat' milk allergies in the same way there has been for peanuts?

My 12 yo DD has a severe milk allergy (carries an epipen) which I doubt now she will ever grow out of but would be good to know if at some point we could live without the fear of accidental exposure.

Also, what can be done to raise awareness of ALL food allergies? There is so much misinformation on these boards particularly when people start discussing food allowed at school. You can guarantee someone will come on saying 'imagine what it would be like if a child had a nut allergy....... milk allergies are rarely serious blah blah blah'. It's so frustrating!

I have teenagers wth oral allergy syndrome too. We have been advised that it is unlikely to develop into anything worse, (eldest also reacts to cashews/pistachios, but not anaphylactic) so they are fine to eat what they want and put up with the consequences. The eldest gets frustrated by how little fruit she can eat and still enjoy it (like above poster sometimes gets a very sore mouth / throat after celery) - any tips for modulating these reactions?

Any pointers for trying the milk ladder with a school aged child? I cannot keep her off for 48hrs every time she reacts (d&v usually) not can I take this time off work. This leaves me with the only option if the long summer holidays.

Previously I managed to get her halfway point the ladder before a reaction that took three weeks to clear, she had just started nursery then and I was sahm.

Is it likely that now she's 2years older to be more or less successful? Or the same? How many children never outgrow CMPA? If indeed it is that and not lactose.. how would we know difference when she's not ever had tests?