False positives vs. skin tests.

[Frosted Crunch]

Okay you guys were so helpful on my Ds's thread, that i'm going to enquire about dd now. Dd is 4. She's got a chicken issue. She eats it, and with out fail 4 hours later she vomits it.

Here's her sheets:





She doesn't carry/need an epipen the allergist said.

I'm curious about the PB allergy though. he said that it's not a 911 go home and rid the house of PB, but to just watch her with it. Well, why would they mark it an 'allergy' then?

[CMdeux]

At four, you need to know whether or not your child is peanut allergic.  That kind of advice might be appropriate for some allergens (egg, milk, etc.  obviously not everyone can do that, but some people with those allergies can do fine that way)... but NOT for peanut.  Peanut allergy carries a huge liability for anaphylaxis; about 30%.

You've been given advice to "sort of" avoid, and no recommendations on treating a reaction.  With a peanut allergy... that is not current best practices.

I'd schedule an in-office food challenge.  Because the advice you've been given is useless in a childcare or school setting.  If she is allergic, you need to know.  So will any other adults that have care of your child.

As for the chicken... no idea.  Is it possible to have reactions that are only GI and are delayed so significantly?  Sure-- it's possible.  It's also possible that it's an intolerance rather than an IgE-mediated allergy, or that it has been coincidence of some kind if it's only been a handful of times and this is a 'barfy' kind of kid.  KWIM?

 

[rebekahc]

Ok, not a medical professional, but here are my thoughts.  Your DD's skin seems pretty reactive - she had no 0*0 spots.  My assumption would be that makes her more likely to have false positives.  Statistics say 50% of positives are false and I would assume it's at least that with your daughter.

Why did you have her tested?  Has she ever shown reactions to foods other than chicken?  If not, then I would not change her diet based on test results.  If she's eaten things regularly with no reaction, then she's not allergic no matter what the test says.

As far as vomiting 4 hours after chicken...

Has it always been the same preparation or different?  If the same, what are the other factors - brand? other ingredients? fried? grilled? location?  Does she ever eat anything with chicken broth or some other "hidden" chicken - soups? ramen? gravy?

If there's no other factor in common with the vomiting, then my guess would be some type of non-IgE mediated reaction, an intolerance, to the chicken.  In that case, I would avoid what makes her sick, but not anything that doesn't even if chicken is an ingredient, KWIM?  Occasionally (10%), there are false negatives on skin testing, but it seems to be a long shot that the ONE thing she seems to react to would come up falsely negative - especially considering how easily her skin seems to show some type of reaction.

One other thought - you could have her skin tested with actual chicken (boil some and bring it with you).  Maybe she reacts to a component not in the serum or the serum was a bad batch or outdated or something.

[Frosted Crunch]

I'm questioning the 0.0 myself, see they didn't PRICK her there. there were several empty spots.  I didn't question them at the time, because it was my first round of allergy testing.

After the testing was over, and it showed a 0.0, i still didn't know to question it.

Maybe when we go back next week, i'll ask about re-testing. (for the chicken & eggs & Wheat)

She doesn't eat PB anyway (she's SUPER picky eater) and she'll refuse it 100% of the time. Nothing has ever happen to her while eating it (when she was littler.)

As for the chicken. It doesn't matter WHAT form of chicken. Chicken nugget from costco, chicken potstickers, bbq chicken, chicken broth, anything, it all makes her sick. all ways make her vomit. She hasn't had chicken in forever since it's so easy to avoid, and she's had no symptoms since not giving it to her.

The pediatrician thought that the chicken thing was a little weird, then decided that since she's such a picky eater, that she ALWAYS complains of her belly hurting. no matter what she eats. Her belly is distended, and bloated (hollow sounding) 99% of the time.

She's ALWAYS hungry too.

before 8 this morning, she had 2 bowls of cereal, cheese its, and asked for: fruit snack, rice crispy treat, more cheese its, string cheese.


ETA: When she was a early toddler (10-12 is months) she would eat foods, and they would go straight through her, and end up in her diaper the same as they went in her mouth. this happened several times. She ended up seeing a GI doc for that (we're currently scheduled to see one in april again) and they said she didn't have any Villi in her intestine. (they did a probe of her intestine and duodenum. they didn't know if was because she was severely allergic to reoccurring foods, or if she hadn't grown them in yet. (?)

She's lactose intolerant.

[Carefulmom]

Just curious, what are her height and weight?  If she always complains about her belly hurting, the most common cause of this is kids who are being forced to eat (either overtly or in a subtle way).  Any chance someone else is doing this?  Is she in preschool?  As far as vomiting the chicken, is it possible she just doesn`t like it?  I would again wonder about forcing.  She doesn`t sound like a picky eater at all if she was already eating or asking for 2 bowls of cereal, cheese its, fruit snack, rice crispy treat, and string cheese all before 8 A.M.  I can`t wrap my head around how anyone could see that as picky. 

[Arkadia]

Just curious, what are her height and weight?  If she always complains about her belly hurting, the most common cause of this is kids who are being forced to eat (either overtly or in a subtle way).  Any chance someone else is doing this?  Is she in preschool?  As far as vomiting the chicken, is it possible she just doesn`t like it?  I would again wonder about forcing.  She doesn`t sound like a picky eater at all if she was already eating or asking for 2 bowls of cereal, cheese its, fruit snack, rice crispy treat, and string cheese all before 8 A.M.  I can`t wrap my head around how anyone could see that as picky.

explain that to my mother...

[Frosted Crunch]

Just curious, what are her height and weight?  If she always complains about her belly hurting, the most common cause of this is kids who are being forced to eat (either overtly or in a subtle way).  Any chance someone else is doing this?  Is she in preschool?  As far as vomiting the chicken, is it possible she just doesn`t like it?  I would again wonder about forcing.  She doesn`t sound like a picky eater at all if she was already eating or asking for 2 bowls of cereal, cheese its, fruit snack, rice crispy treat, and string cheese all before 8 A.M.  I can`t wrap my head around how anyone could see that as picky.

She's with me 24/7.

Her favorite phrase is 'i'm getting hungry'

She's pick about what she eats.

[CMdeux]

Chicken broth is actually much harder to avoid than most people realize.  Just noting that.  Unless you've been really careful about NEVER feeding processed foods (and from the list above, I'm seeing this is a "probably not") then she's certainly been getting some chicken derivatives on a regular basis.    Possible that it's just below some threshold that she tolerates, though.

I'm with Rebekah there-- avoid what she doesn't seem to tolerate and I wouldn't worry about that one otherwise. 

Some of the things you list, though...like bloating/distension... intestinal abnormalities... lactose intolerance (umm... not to pick on you here, but why all the dairy if she's lactose intolerant?)

has she ever been evaluated for celiac?   That can cause odd GI symptoms that aren't necessarily overtly related to gluten.  Might be worth asking the GI specialist about if it hasn't been explored previously.  Whatever you do, though-- do NOT remove gluten from her diet before exploring that one, or testing won't be accurate.

[CMdeux]

What does she eat if you don't offer her processed foods like those on your list when she tells you she's hungry?


So... if you offered her, say a cut up apple or a banana instead of cheez-its, fruit snacks, or a rice krispie treat, what would she do? 

[Frosted Crunch]

What does she eat if you don't offer her processed foods like those on your list when she tells you she's hungry?


So... if you offered her, say a cut up apple or a banana instead of cheez-its, fruit snacks, or a rice krispie treat, what would she do?

She'll eat it. we have tons of fresh fruits, veggies, and such on the table at all times (i've got a prader-willi like kid) and it needs to be available at all times.

I discovered she likes pears the other day too!

[hezzier]

The fact that she's refusing PB is a red flag in my book.  I realize there are many that don't care for it, but I've meet more than one PA kid that refused PB due to smell when young and then found the allergy later.  My own DS was that way with tree nuts...he always turned down tree nuts or anything with tree nuts (around age 3) because he said he didn't like them, but he had never eaten them because they were a choking hazard.  I didn't push it, but I used to ask him how do you know if you've never tried them.  He just knew.

[rebekahc]

Yes, I agree, refusing PB is a big red flag.  With that information and the fact she NEVER eats it, I would definitely be suspicious of an allergy there.

Your DD sounds like she has a lot of the same symptoms my DS had when he was little.  He was dx'ed failure to thrive at age 3 because he couldn't maintain a healthy weight despite eating a ton.  As a preschooler he ate way more than I did!  His belly was distented, etc. - kind of like the pictures you see of little famine kids  .  He was tested for celiac, cystic fibrosis, etc.  Blood tests for celiac were inconclusive.  At that time they tested antigliadin antibodies IgA and IgG, but I think the blood tests are much better now.  They scoped him and found abnormalities, but said it wasn't celiac.  Cystic fibrosis, he was positive on the sweat test, but negative on the genetic markers.  He was referred to the pediatric hematologist/oncologist because his bloodwork was off (extremely elevated platelet count).  He ordered an abdominal ultrasound and found an enlarged spleen.  He never figured anything out either.  We finally found a good allergist who helped us get him healthy.  It turns out that DS's food allergies (specifically his corn allergy) was causing him to have malabsorption and intestinal damage.  Once we removed the corn, his gut healed, he quit having the yucky poops, etc.  We always knew if he accidentally got corn (it's in almost everything so very hard to avoid) because exactly 3 hours after eating he would have an extreme behavior/mood change and say it felt like there were bugs crawling in his brain.  At one point, after the cerebral reactions seemed to stop, we tried to reintroduce corn into his diet, but after about a week, the gut damage symptoms kicked back in.

I'm glad to hear you're heading back to the GI.  The GI was the one who finally said he thought our DS had severe food allergies and connected us with our wonderful allergist.

We knew DS was allergic to eggs and were avoiding those and we were avoiding peanuts due to my allergy, but other than the extreme sickliness and eczema, DS didn't show typical food allergy symptoms.  The allergist did skin testing and blood testing with a majority of things tested showing very high positives.  She worked with us for months trying to narrow down the true allergies.  Once we narrowed down what DS was actually allergic to and got him healthy, he did begin to show more typical food allergy reactions (hives, wheezing, swelling, etc.) to his allergens.

ETA:  You'll probably notice in my siggy that DS's allergy list is pretty small at this point.  We were lucky enough to be able to put him on an anti-IgE asthma medicine for several years that allowed him to tolerate most of the things he was allergic to.  Unfortunately, we lost our insurance a couple of years ago and had to stop the med.  For the first 12-18 months after stopping, his allergies remained at bay, but over the last few months they've begun creeping back.    The most disappointing for us is that when he was little, although he tested highly positive for milk (both blood and skin tests), he never had any symptoms of milk allergy.  Now, he's begun reacting to milk and his tolerance keeps going down. 

[AllergyMum]

Yes only vomiting or diarrhea can be a sign of an allergic reaction.  My son used to be allergic to oats.  His only outward signs were massive vomiting & diarrhea about an hour or so after he ate.  His skin tested & blood tested positive to oats.  He has since outgrown that allergy and can eat them without any issues.  We were given an epi for his allergy.

[Carefulmom]

What are her height and weight, and is she at the old end of 4 (almost 5), just turned 4, or in the middle (around 4 1/2)?

[Frosted Crunch]

What are her height and weight, and is she at the old end of 4 (almost 5), just turned 4, or in the middle (around 4 1/2)?

She's 35lbs and IIRC 42 inches?

She just turned 4 at the end of january.