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!

Thanks in advance for your time and any advice you can give. Apologies if this is long.

My 13 month old boy is allergic to several things. He hates eating and gags on anything past stage 2. He was big for his age, both weight and height wise until weaning, falling further behind and is now ftt. I can't help think this is due to lack of food intake and wondering if his issues with eating are allergy related. Lots of foods make him itch a day later and some are serious ige.

Do you have any advice on encouraging a toddler this age to eat and how we work through the allergy skin issue (breastfeeding is making this more complicated with the delayed reactions and I already have a severely restricted diet as does he).

Do you think persisting with small amounts of the delayed reaction foods will help his body learn to tolerate these foods or make matters worse?

Do you recommend a food challenge on dairy where the skin prick is a 10mm wheel and hives on skin contact (following severe reaction to a drop of milk in the mouth). My dietician still thinks he could potentially eat yoghurt.

Thank you in advance.

Thanks for this. I'm an adult with anaphylaxis. Do you think immunotherapy will ever be available for all the major food allergens?

And are some people just too allergic for immunotherapy, full stop?

I saw you @DrAdamFox1 last year at guys with my two year old daughter. Thank you so much for all your help

My daughter is 9, allergic to CMPA, eggs and nuts.
I'm curious about the immunotherapy treatment.

A friend's daughter underwent it in Canada, and is no longer allergic to peanuts.

I enquired at my daughter's last appointment with our allergy specialist, and she implied it was expensive (and not available in the NHS), and made it sound dangerous/not worth exploring.

What is your view in this.

Also interested in immunotherapy for hayfever/dust mite allergies. My daughter is constantly stuffed up, despite using piriton every night before bed, except during hayfever season where she has antihistamines prescribed twice a day.

I have a few questions

One of my children has a hazelnut allergy, but also reacts (breathless) to grass pollen and other pollen (silver birch trees - from our observation). He gets diarrhoea if he eats plants from the deadly nightshade family. Are these things linked?

There’s a history of allergy in the family - two kids with nut allergy and overlap between two kids with allergy to pollens and grass. But there’s also a history of Tourette syndrome in two of the kids with allergies. Is there a link between Tourette’s and allergies.

I know there’s a big emphasis on carrying epipens. But in my experience of children having severe reactions- but not collapsing in anaphylaxis- prednisolone has been invaluable along with high doses of anti-histamine. Is there not an argument for allergy sufferers carrying at least 12 tablets of prednisolone along with epipens for emergencies.
I’m asking because the steroids I carry saved my sons life last year in Croatia. I’m not sure the epipen was the right treatment and didn’t use it. He was obviously having a severe reaction to hidden nuts (facial oedema/ vomiting) - but not in anaphylaxis. Steroids and anti-histamine stopped the allergic response and saved him.

Hi
My son was diagnosed with nut allergies by you at The Portland. He had a small 4mm welt to walknuts.
On repeat test 1.5 yrs later at my local NHS hospital he was recorded as having no reaction to walnuts.
Now however, less than two years later he's had two reactions to walnuts. One skin reaction from handling and a few days later severe cramps from eating.
Is it possible that he'd outgrown the allergy in the few years in between I was there some mix up in the recording of his results?

Hi.

I have a 5 month old baby who we're planning on starting on food at 6 months. My husband has a severe allergy to anything from the pea and bean family (anaphylactic shock) plus minor reactions to other foods as well as testing positive for allergies on a skin prick test for other foods which he has never eaten.

I know that if there are allergies in a parent, a child is more likely to develop them. My son is exclusively breast fed, and I have been following the advice given by various health care professionals to eat all these items during pregnancy and whilst breast feeding to expose the baby to potential allergens. Is there anything I should be doing when I introduce food?

Hi. My 11 year old daughter has mouth breathed since a toddler. She has permanently inflamed nasal passage and our GP says she has nasal polyps. We have used varying nasal sprays but the most recent have her a rash. I gave her cetirizine but when she woke up her eyes and her lips had swelled up. Nothing too extreme, but red and swollen. She has been referred to Ent but no appointments until August! We have been given different drops to try. Sge is clearly sensitive to something. I have multiple allergies to foods and medication, but this has been put down to thyroid(hashimoto thyroiditis) & menopause - ideopathic angioedema . Is there a hereditary condition that I may have passed on? Many thanks.

Thank you for taking the time to do this. I have a 9 year old daughter who seems to be allergic to grass / tree pollen from around April until July as she comes out in excema on her face and joints when playing outside. We reduce the impact with cream so this isn't a huge issue.

Last year in Croatia, however, she ate cherries and immediately came out with red itchy skin around her mouth and neck. We gave her piriton and it settled down quickly - so, no more cherries. Then in France in august she ate a nectarine and had a similar reaction.

From google it sounds like she may have a birch pollen allergy. We are currently waiting an appointment to see an allergy specialist but the appointment isn't until October and I am wary of letting her eat any of the fruits on the birch pollen allergy list now - someone said that allergies often take 3 occurrences before they have a severe effect.

So my concern is, is this a serious allergy or just an annoying skin rash? Is there anything going on inside her body or is it all on the skin? Could she have a far more life threatening reaction the next time she reacts to a fruit?

Thank you for your help

Thank you for doing this.

My DS (3.5) is allergic to cows milk, eggs, nuts, sesame and pine nuts. He has asthma and his eczema is under control. He carry's around epi pens but has never had full anaphylaxis (although we have it in the family). We cannot get him past stage one of the milk ladder. He gets swollen lips, hives and itching with anything more than the digestive biscuit. What are the chances of him outgrowing the cows milk allergy anytime soon? I have heard that if he isn't making progress on the ladder by three, then it's likely to persist until adulthood.

Thank you.

30not13 we were told by our dietician when we questioned if it could be a reaction to lactose rather than CMPA to give some lactose free yoghurt and see if there is a reaction.

Have you asked school about milk ladder and your daughters reaction? DD’s nursery is very good although we tend to give the next level at the start of the weekend. We were also told by the dietician that when DD reacted to stop dairy until all symptoms disappeared but to then go back to the step that she could tolerate so you are never starting it again.

My 9 month old son reacts (via my breast milk) to dairy, soya, egg, beef, wheat, peppers and orange. I plan to try the first step of the milk ladder directly when he turns 1. What order would you recommend that I try to introduce the foods again? Does it matter? Many thanks for your time

To add to my earlier post, talking with my eldest today, with the inevitable seasonal uplift in her oral allergy symptoms, she is again having trouble with, of all things, lettuce. A palm sized piece of iceberg lettuce at lunch at school recently left her with red swollen lips, she described walking out with her hand over her mouth in embarrassment.

Pythonesque when DS is bad (is now) he goes hyperreactive and reacts to so much. We've had the lettuce reaction too, especially the 'white' heart but, rocket too. At other times of year when he's not so reactive he can eat it with less of a problem

I have a 18 week old with suspected cmpa non ige - I am dairy free > 6 weeks but persistent mucus stools. Other GI sx and No failure to thrive—— is persistent mucus ok In the long term or should I really exclude other food ie is it essential that mucus stops in absence of other symptoms? Thanks in advance

My daughter (15) was diagnosed with a peanut allergy at age 4. We've been avoiding peanuts since then, as advised.

She has recently had a skin prick test which revealed she was also now allergic to walnuts and hazelnuts.

The doctor told us that she should try to eat walnuts and hazelnuts to increase her tolerance.

Why is it that she has to avoid one allergen (peanuts) and not the others?

Secondly, has there been any trials of the immunotherapy on adults and if so was it successful?

Thank you so much.

is it true that the level/size of reaction on skin prick tests has no bearing on how severe the reaction will be? My DS has had anaphylactic reactions to beans and lentils, and has had positive results on skin prick tests to various nuts, but has never actually eaten them so I don’t know how severe a reaction may be!

Also, what is the likelihood of future siblings having allergies when my DS has them (to lentils, beans, nuts, eggs, sesame), and can anything be done to minimise the risk during pregnancy?

Thanks

Hi,
My little girl is allergic to Dairy, eggs, soya, tomatoes, flax seed, spinach, white fish, most legumes (except peas) plus many more I am still discovering. I breastfed her till she was two and the only way I ever achieved baseline was to do a Ted, which nearly broke me. Weaning has been a nightmare and rather than things getting better, she seems to react to more, rather than outgrowing anything. Her allergies are all non-ige except for white fish, which she was fine with for months before having a severe reaction and being covered in hives, instant burning diarrhoea etc. However, all her spt’s have come back clear.
I believe there must be an underlying problem for her to react to so many foods. I have suggested a histamine intolerance to my dietitian, but was made to feel like a google warrior. Where do I go from here? I don’t feel like her allergies are taken seriously because her weight gain is good, mainly due to my high diligence and the fact I breastfed her so long. She spends so many of her evenings in so much pain with her tummy, throwing up in her bed, awful nappy rash, periods of insomnia. I really want to help her. She is now so scared to eat any new foods, her diet is very limited. I was under a consultant and am now under a registrar. The only suggestion I have been given is to keep doing what I’m doing and keep trying new foods, but I don’t think this is getting to the bottom of her underlying issues. Your advice would be hugely appreciated. Thanks in advance.

Thank you doctor for all the work you do!
My son is 15 years old and has cmpa. He had it from birth,and went into anaphylactic shock at 5 months when we were diagnosed and issued with epipen. At that point in time he was allergic to multiple foods,all of which have fallen away except for the milk protein allergy. We are not in the uk. Do you believe that he will still grow out of it? Would immunotherapy help him? His last reaction was just before Christmas when he ate some chocolate by mistake (we picked up some chocolate that had very similar packaging to a safe chocolate that he had eaten before).

Thank you Dr Fox for your time.

With the experience of DC2 having multiple ana allergies, plus some non IgE, when DC3 was showing similar symptoms at around 2-4 weeks, I modified my diet until 3 months age (her, not me) but then followed the early feeding protocol used in the EAT study. She had a rocky month or two but now eats everything.

However, she is below 20th centile for height, which is very short compared to her family. DC2 was below 7th centile until I identified his last non IgE food issue; he's now about 75th centile, still with a few allergies (some he has grown out of). DC2 has mainly gut issues if not ana.

Should I look into potential food / gut issues for DC3? I don't want to be doing any long term damage. I have recently left the UK and allergy care here is not exactly cutting edge.

Separately, please can you share your experience of the EAT results with these parents here .... I am a firm convert and seriously hoping a few people here will save a lifetime of allergies in their children.

There are so many serious allergy questions here, that I feel a bit silly posting this, but my daughter (aged 5) has been coming out in severe hives for over 6 weeks now, affecting her whole body and neck, but not face. We have no idea what is causing it but suspect an allergy to biological washing powder as I'd switched at about the same time this started. It could also be our dogs, dust or pollen - or perhaps it's a new intolerance to a food group? How do we figure it out?

She reacts badly to all insect bites, with dramatic oversized bites, red skin and welts but is not 'allergic' to them (no problems breathing or eczema etc). The hives she has had recently look like white welts where she's scratched her skin, on top of large patches of red skin. I've switched back to non-bio washing powder but it's taking time to wash through everything again and the hives still occasionally flare up, making me question if it is something else. Piriton helps as does hydrocortisone cream but she complains of it being extremely itchy. Do I need to start a food diary or is there an easier way of testing what is triggering it? Many thanks in advance.

Hi
My little boy took a IGE reaction (swollen eyelids rash on face) when he was 7 weeks old suspected artificial colourings as family history but I also had peanuts that day. I have had peanut butter today (had multiple times since his birth) and no reaction so far. He's not had another reaction since the first episode.

We have been on the waiting list for allergy tests at a private clinic but it's not cheap am I better waiting for weaning in order to try at home and also see if there are other allergens? He is now 16 weeks old.

I've been told they can test but I need to provide the colouring but I've no idea which one it was family history is to yellow, orange, red, green and caramel.

I have a 12 month old daughter with egg and peanut allergy. Peanut confirmed with skin prick test, egg confirmed from ingestion and follow up skin prick test. My daughter is due to start daycare soon, and I’m just terrified she will come into contact with an allergen, especially as she may be allergic to further items. She has had random hives over the last month. Just the one and just every so often.
The latest was today on her face. I’m so confused as she hasn’t eaten anything she hasn’t before. I’m still breastfeeding and don’t eat any of her allergens and pretty much eat what she eats.
She has no other symptoms (well stuffy nostril the last week or so and it’s runny today).
Is there a way we can test for multiple allergens in one go? A blood test or something? Is there a way of telling how severe the allergy is? Especially as she has not invested nuts. This hit and miss method of her reacting to something and trying to narrow it down and being scared to give her new foods is a really anxious way of living. It feels like everything is unknown and I constantly check her for hives, I’m scared of people touching her, after another hive today I don’t think I can let her be at daycare with all this unknown so I’m faced with having to leave work.

Note: We have not been issued with an epi pen as thank goodness she has only reacted with hives, eczema, redness and a little lip swelling once. We use Chlorphenamine (prescribed).
She is not due to see the allergist for a follow up until the end of next year.

Many thanks in advance
Kristen

Hello
A minor issue compared to the other posters but still I am unable to get a proper advice elsewhere.
I just would like to ask if steroid eye drops and steroid nasal sprays can be used together for a prolonged period of time. My child has severe seasonal conjunctivities (with prick test being negative) from April to August for the last 7 years. She was under ophtalmologist's care initially but after several years was discharged to GPs care, who is prescribing steriod drops to be used as per the scheme suggested by ophtalmologist so the symptomps can be kept under control. Last few years she also has nasal swelling during the spring -summer and again steroid spray was recommended by GP. Oral antihistamins are not effective at all and no symptomps between September and March. I am concerned that steroids are used for about five months of the year - is it a safe way to manage the condition, considering that it is a child who is growing, should she be reviewed by ophtalmologist due to potential eye pressure issues or by any other specialist (allergist had also discharged us after two blood tests and prick tests were negative for indications of allergic reactions). Are there any therapies that can be tried (privately too, if needed) to make her more tolerant to spring summer season?
Thank you so much for your time answering the questions on this thread.

Hi Dr Fox- thanks for taking time to read my question. My son was diagnosed with multiple food allergies (milk, egg, all nuts, sesame, lentils) through skin prick and blood tests at 1 year old. He also had severe eczema from around 6 months. We have been strictly avoiding these since then (he was exclusively breastfed). A repeat blood test at age 2 confirmed he was still allergic to all these above, with blood test showing high ige levels in general and we were given epi pens.

However, we've never had a reaction other than eczema and hives. On two separate occasions he accidentally had yoghurt and raw egg batter and did not seem to have a
reaction (maybe other than delayed eczema). In his 2-year skin prick test he pretty much came up with small welts for most things such as soya which he consumes in abundance in his diet with no problem. Despite our request, the consultant did not offer us an oral food challenge for milk and egg due to his high ige numbers (eg all nuts ranging from 30 to 80) and I am too nervous to try this at home.

My son is 3 now and I'd like to understand if false positives are possible in these tests and what the next course of action should be here. We don't like the fact that he has a very limited diet.

Other relevant information
-No history of food allergies/asthma in our families, but my husband has urticaria
-His eczema improved from severe at 6 months to very mild now
-Ige numbers fell in between the two tests

• heat and pressure to skin triggers small hives

Appreciate any insigh