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Posted by eggallergymom
- May 01, 2013, 07:09:21 PMIt did have yeast extract, Eragon. Not sure if it matters or not, but I do bake bread (with yeast) every week here at home, and she eats that with no issues.
Thanks, everyone, for your perspectives! We are going to see another allergist and get a second opinion on the broth challenge, and the likelihood of this being a true allergy. Even if there is something there, given her reaction and the low number, hopefully we could treat that as more of a sensitivity; not seek out chicken for her, but not be as careful as we have to be about egg.
Thanks, everyone, for your perspectives! We are going to see another allergist and get a second opinion on the broth challenge, and the likelihood of this being a true allergy. Even if there is something there, given her reaction and the low number, hopefully we could treat that as more of a sensitivity; not seek out chicken for her, but not be as careful as we have to be about egg.
Posted by eragon
- May 01, 2013, 03:50:28 PMwe have had outgrowing to cooked and then raw egg, and had the raw egg come back. possible also to cooked but not 100% sure. son avoids.
had mildish dog allergy that changed dramatically at 7, then dropped down again at about 12ish. I think....
in a nut shell, individual peoples allergies are just that individual.
as for the broth, did it have yeast extract in it?
had mildish dog allergy that changed dramatically at 7, then dropped down again at about 12ish. I think....
in a nut shell, individual peoples allergies are just that individual.
as for the broth, did it have yeast extract in it?
Posted by CMdeux
- May 01, 2013, 03:15:36 PMFWIW, our allergist said the same thing "just avoid them." I'm pretty sure he didn't TRULY understand what that meant, or even understand to what level "avoidance" can go.
I feel SO lucky that we've had two very very good allergists who both have understood this in highly pragmatic terms. I don't know how we'd have gone through the past decade without them.
I will also add that as awesome as our first pediatric allergist was (and there are people here who see her-- she's GREAT), she really didn't seem to understand the human, day-after-day side of this very well.
I feel SO lucky that we've had two very very good allergists who both have understood this in highly pragmatic terms. I don't know how we'd have gone through the past decade without them.
I will also add that as awesome as our first pediatric allergist was (and there are people here who see her-- she's GREAT), she really didn't seem to understand the human, day-after-day side of this very well.
Posted by YouKnowWho
- May 01, 2013, 03:03:21 PMI get so frustrated when drs tell you to just avoid.
To this day, I still don't think the dr understood why I was crying when she told me DS1 was "allergic" to wheat, rye, barley, oats, rice, corn, egg, soy, dairy, peanuts and tree nuts so we should avoid.
Same dr told me not to worry about shared lines/facilities and told me to make him drink Gatorade because she had a corn allergy as well - she holds up the bottle with HFCS in it.
Sadly, she was a true MD, not a naturopath.
To this day, I still don't think the dr understood why I was crying when she told me DS1 was "allergic" to wheat, rye, barley, oats, rice, corn, egg, soy, dairy, peanuts and tree nuts so we should avoid.
Same dr told me not to worry about shared lines/facilities and told me to make him drink Gatorade because she had a corn allergy as well - she holds up the bottle with HFCS in it.
Sadly, she was a true MD, not a naturopath.
Posted by rebekahc
- May 01, 2013, 09:35:44 AMOne other thing to consider is the PPV (positive predictive value). The PPV is the kU/L at which 95% of patients will show clinical allergy symptoms to a food. It varies widely between foods.
Predictive of challenge outcomes for:
Positive (95% chance of reacting)
Milk 32 kU/L
Soy 65
Egg 6
Wheat 100
Peanut 15
Codfish 20
Negative (95% chance of NOT reacting)
Milk 0.8 kU/L
Soy 2
Egg 0.6 (90% NPV)
Wheat 5
Peanut <0.35 (85% NPV)
Codfish 0.9
So, who knows what the PPV and NPV for chicken is - maybe it's like wheat
.
It's important to remember that RAST numbers can only predict the likelyhood (or not) of a reaction and in no way correlate with the severity of the allergic response. So, any RAST number for egg over 6 kU/L is pretty much equal.
My advice on the chicken would be to not change what you're currently doing. If she hasn't reacted to eating at Chipotle, then I'd continue until/unless you have a reason to stop going. Since the broth was a one time deal, I think it's definitely worth getting a second opinion on how much (if any) chicken avoidance is necessary.
Predictive of challenge outcomes for:
Positive (95% chance of reacting)
Milk 32 kU/L
Soy 65
Egg 6
Wheat 100
Peanut 15
Codfish 20
Negative (95% chance of NOT reacting)
Milk 0.8 kU/L
Soy 2
Egg 0.6 (90% NPV)
Wheat 5
Peanut <0.35 (85% NPV)
Codfish 0.9
So, who knows what the PPV and NPV for chicken is - maybe it's like wheat
. It's important to remember that RAST numbers can only predict the likelyhood (or not) of a reaction and in no way correlate with the severity of the allergic response. So, any RAST number for egg over 6 kU/L is pretty much equal.
My advice on the chicken would be to not change what you're currently doing. If she hasn't reacted to eating at Chipotle, then I'd continue until/unless you have a reason to stop going. Since the broth was a one time deal, I think it's definitely worth getting a second opinion on how much (if any) chicken avoidance is necessary.
Posted by eggallergymom
- May 01, 2013, 09:03:07 AMJanelle--my daughter used to be really hivey (also had lots of eczema) but that's improved as she's gotten older. Her seasonal allergies now manifest in really itchy, red eyes, that tickly throat, and asthma. Her asthma is still pretty mild at this point, though. I think it's entirely possible that she reacted to something else in the broth (a seasoning), or that she just noticed the throat tickle more at that point. But the positive to chicken on the RAST panel is interesting and worth exploring, I think, because she hasn't had any other false positives.
I will admit to being something of a RAST rookie because she's only ever tested positive to egg yolk and egg white, and she has the ana history to go with those, so it all made sense. We haven't done the bloodwork much because of the allergist's position that this was likely a lifelong allergy, anyway. So I have no familiarity with RAST numbers that aren't spectacularly high. I have read that there isn't necessarily a correlation; that kids with relatively low RAST values can still anaphylax, and some people with high RAST numbers don't. We haven't seen that in her, of course. She is very sensitive to egg. My fear was that the chicken number might bloom into a more spectacular allergy. I wasn't sure if those lower level RAST numbers tended to stay fixed at a lower level, or if they grew. I suspect it works both ways.
Thanks again, everyone!
I will admit to being something of a RAST rookie because she's only ever tested positive to egg yolk and egg white, and she has the ana history to go with those, so it all made sense. We haven't done the bloodwork much because of the allergist's position that this was likely a lifelong allergy, anyway. So I have no familiarity with RAST numbers that aren't spectacularly high. I have read that there isn't necessarily a correlation; that kids with relatively low RAST values can still anaphylax, and some people with high RAST numbers don't. We haven't seen that in her, of course. She is very sensitive to egg. My fear was that the chicken number might bloom into a more spectacular allergy. I wasn't sure if those lower level RAST numbers tended to stay fixed at a lower level, or if they grew. I suspect it works both ways.
Thanks again, everyone!
Posted by aggiedog
- April 30, 2013, 10:23:27 PMI'll add that dd, who has had a spectacular contact anaphylaxis to PN's, recently began getting "itchy mouth" to certain tree nuts. Her formerly negative RAST's to those TN's are now level 1 and 2 positive. We "avoid" but I'll admit I don't go near the extent I did with PN's. (Dd did OIT for PN's, so lifestyle-wise, we don't avoid those anymore.) I don't talk to chefs, I don't call companies, I don't read ingredients in the school lunches. I do read labels when grocery shopping and I do avoid bake sale/church picnic desserts. And I obviously don't feed her things I know contains those nuts. Her allergy seems to be very mild for these, and so I can't seem to muster the same level of obsessive compulsiveness I had for PN's. FWIW, our allergist said the same thing "just avoid them." I'm pretty sure he didn't TRULY understand what that meant, or even understand to what level "avoidance" can go.
Posted by Janelle205
- April 30, 2013, 07:01:12 PMI think that I'd probably get a second opinion. To me, the 'just avoid it' comment seems to be coming from someone who has no idea what it is really like to manage a non-top 8 allergen. With only a mild reaction to the chicken broth, I'd want to know for sure. Plus, given that it would eliminate one of your safe restaurant options, that's another reason that I'd want to be sure - I recently had to eliminate one of mine, and it's a pain. While I realize that past reactions don't predict future reactions, it is quite possible to react spectacularly to one thing and very mildly to another. I react quite spectacularly to tiny traces of apple, but on the other hand, if I eat something with eggs in it, I just get a few hives and perhaps an eczema flare.
Your signature says that she has seasonal allergies - is she 'hivey' in general? Any chance that the chicken broth reaction could have been environmental that just happened to occur when eating?
On the occupational side of things, my doc thinks that my egg allergy might have developed in this way, since I developed an allergy to feathers concurrently. I eat chicken with no problems though. At the time, I was working extensively and closely with educational and rehab birds of prey. (So hey, maybe I'm allergic to hawk or owl meat...but I guess I'll never know.)
Your signature says that she has seasonal allergies - is she 'hivey' in general? Any chance that the chicken broth reaction could have been environmental that just happened to occur when eating?
On the occupational side of things, my doc thinks that my egg allergy might have developed in this way, since I developed an allergy to feathers concurrently. I eat chicken with no problems though. At the time, I was working extensively and closely with educational and rehab birds of prey. (So hey, maybe I'm allergic to hawk or owl meat...but I guess I'll never know.)
Posted by eggallergymom
- April 30, 2013, 05:48:01 PMOccupationally exposed, huh? No, no moonlighting at chicken farms or poultry processing plants here. 
And no, she's never shown any sort of RAST positive to anything but egg. The reaction to the broth was very, very different than the reaction she has to egg. The last ana episode with egg, she felt the tingly lips, mouth and throat right away, but it progressed really quickly to anaphylaxis. The broth reaction was very mild; no hives or digestive stuff, either.
So maybe it's time for a second opinion? Chicken is in so many things, and it does sound even trickier than an egg allergy to manage in some ways. Anecdotally, I've mentioned this to three people today, and all three of them said, "I didn't know you could even be allergic to chicken!" I don't doubt that people are, but I'd love it if we could limit our allergy adventures to egg.
Thanks, everyone! This site is a godsend. Off to make a list of additional questions, and check in with my friend whose son has a great allergist in town.
And no, she's never shown any sort of RAST positive to anything but egg. The reaction to the broth was very, very different than the reaction she has to egg. The last ana episode with egg, she felt the tingly lips, mouth and throat right away, but it progressed really quickly to anaphylaxis. The broth reaction was very mild; no hives or digestive stuff, either.
So maybe it's time for a second opinion? Chicken is in so many things, and it does sound even trickier than an egg allergy to manage in some ways. Anecdotally, I've mentioned this to three people today, and all three of them said, "I didn't know you could even be allergic to chicken!" I don't doubt that people are, but I'd love it if we could limit our allergy adventures to egg.
Thanks, everyone! This site is a godsend. Off to make a list of additional questions, and check in with my friend whose son has a great allergist in town.
Posted by CMdeux
- April 30, 2013, 04:24:52 PMYeah... "just avoid chicken" seems kind of... er... crazy... but that is just me. It really is EVERYWHERE, so avoidance of that one is no picnic. It's not covered under FALCPA and it's going to be nightmarish to get info on USDA (non-FDA) products. Even worse in some ways that sesame/sunflower avoidance.
The only people who seem to have both allergies are occupationally exposed and develop chicken-feather-egg syndrome or whatever it'd called.
I mean, the reaction that you describe seems more mild/subjective than anything else. Could have been thermal/aeroallergen load/spicy/salty/who knows what.
I'm especially suspicious since your DD's other KNOWN allergies are really, really, REALLY high RAST values and that one is so low.
Does she have a history of low positive RAST to any other things? If so, then I'm even more suspicious. We've been here, let's just say, with sesame. Which we finally challenged.
The only people who seem to have both allergies are occupationally exposed and develop chicken-feather-egg syndrome or whatever it'd called.
I mean, the reaction that you describe seems more mild/subjective than anything else. Could have been thermal/aeroallergen load/spicy/salty/who knows what.
I'm especially suspicious since your DD's other KNOWN allergies are really, really, REALLY high RAST values and that one is so low.
Does she have a history of low positive RAST to any other things? If so, then I'm even more suspicious. We've been here, let's just say, with sesame. Which we finally challenged.
Posted by aggiedog
- April 30, 2013, 03:51:02 PMQuoteI talked to my daughter's allergist today and he said that he is not comfortable doing a food challenge with homemade broth, given her history of anaphylaxis, that reaction to the broth, and her RAST results.
Had she had chicken prior to the reaction to broth? Has she had any since? I'm in no way discounting the allergist's opinion, but at the same time, I think it is very easy for the doctor to say "just avoid it" than it is to actually live it, YKWIM? If she's had some since, or lots prior, I'd consider really asking for a food challenge before eliminating a major source of protein and flavoring (for packaged foods.)
Posted by eggallergymom
- April 30, 2013, 03:46:01 PMNo, it was store-bought broth. I called the manufacturer and asked all of the right questions, and was told it was produced on a line that did not handle any egg products. It was the only kind of broth I'd ever bought, as everything else had cross-contamination warnings once you called. I talked to my daughter's allergist today and he said that he is not comfortable doing a food challenge with homemade broth, given her history of anaphylaxis, that reaction to the broth, and her RAST results. He said the safest plan is to add chicken to her list of allergies and foods to avoid. We are going to do some additional testing with other poultry as well. The upside is that my daughter was virtually a vegetarian anyway. The downside is that she loves Chipotle, which was one of the two restaurants we trust, as our local Chipotle doesn't have any breakfast offerings or eggy foods. But given all of the chicken all over the place there, I am not as comfortable there now. Which leaves the vegan place, which she loves, too.
Posted by lakeswimr
- April 29, 2013, 09:28:18 PMWas it homemade broth? Some broth has eggs in it.
Posted by eggallergymom
- April 29, 2013, 08:00:08 PMThanks, CM. I REALLY needed to hear that. 
I have been feeling pretty dejected about these numbers, and have been trying to figure out how to frame this up for her.
The broth challenge at the allergist's is a good idea. I can ask him about that tomorrow.
I have been feeling pretty dejected about these numbers, and have been trying to figure out how to frame this up for her. The broth challenge at the allergist's is a good idea. I can ask him about that tomorrow.
Posted by CMdeux
- April 29, 2013, 07:44:50 PMI wouldn't be too worried about the number itself, honestly.
The possible reactivity, though... THAT would worry me, and I'd probably be asking to do an in-office challenge with plain chicken broth (home-made, so no salt/seasonings).
My DD's egg numbers peaked at about 92? 93? Something like that. I just remember laughing hysterically, I was so dejected. I think she was about 8 at the time.
Fast forward to 12yo, though, and the numbers were down. WAY down. Under 10. So we did a baked egg challenge, which I never in a million years thought she'd pass. But she did. At a very low level, admittedly. I think we started dosing her at about 1/60th of an egg in a WELL-baked mini-muffin. After two years of up-dosing, we're up to about 1/20th of an egg. She is definitely still allergic, but her tolerance is high enough for it to be reasonably safe to eat in many restaurants now, which definitely was NOT the case four years ago. We don't think that she's ever going to be "not allergic" but maybe she can kind of live somewhat normally-- like a person who "only" has a peanut allergy, YK?
I know how you feel.
The possible reactivity, though... THAT would worry me, and I'd probably be asking to do an in-office challenge with plain chicken broth (home-made, so no salt/seasonings).
My DD's egg numbers peaked at about 92? 93? Something like that. I just remember laughing hysterically, I was so dejected. I think she was about 8 at the time.
Fast forward to 12yo, though, and the numbers were down. WAY down. Under 10. So we did a baked egg challenge, which I never in a million years thought she'd pass. But she did. At a very low level, admittedly. I think we started dosing her at about 1/60th of an egg in a WELL-baked mini-muffin. After two years of up-dosing, we're up to about 1/20th of an egg. She is definitely still allergic, but her tolerance is high enough for it to be reasonably safe to eat in many restaurants now, which definitely was NOT the case four years ago. We don't think that she's ever going to be "not allergic" but maybe she can kind of live somewhat normally-- like a person who "only" has a peanut allergy, YK?
I know how you feel.