Which Test?

[EmilyAnn]

My son had a reaction in late December. He was 4 1/2 at the time. We are not 100% sure what he reacted to. He was eating a Christmas dinner with lots of different foods, all of which he had eaten multiple times before. We are pretty sure it was the pecans he reacted to. While eating his lips got very swollen. He did not have trouble breathing or any tongue swelling at that time.

In early March I took him to a pediatric allergy specialist. She did the skin prick test and he tested positive to peanuts and tree nuts. I have talked to his pediatrician and he said we could do a blood test if I feel it is needed. Because I have no idea how severe his allergy is and I was told the skin test has a pretty high false positive rate. From what I have read it has an even higher chance of false positive because he is still so young, 4 years 8 months at the time of testing. So I have been looking into the blood tests. What test do I ask for? RAST? CAP-RAST? What are the differences? Are there others I should look into?

[twinturbo]

I would not do this through a primary pediatrician because you want a qualified food allergy and anaphylaxis experienced pediatric allergist to order the test, deal with a preferred lab and help you interpret results. They kind of triangulate the information to chart a course forward.

You can increase your odds of getting current best practices by going on a doctor recommended by people here based on your location especially if you're near a good research institute like Duke. Else you can go to AAAAI.org to use their immunologist search.

I send my oldest to NYC because it's within short flying distance but for my youngest I used AAAAI.org to find a board certified pediatric allergist whose allergy rotation was from one of the top research hospitals for food allergy and anaphylaxis. I interviewed the heck out of him too because I need someone who will work with me.

On labs, I don't know how all work but ours if you get the draw from the testing lab they draw a lesser amount than another place that needs overage to cover transport issues. A large lab attached to a hospital will have phlebotimists experienced with kids.

[EmilyAnn]

I think we are about 2 hours from Duke. I am not sure, because I have never been there.

The allergy specialist we have gone to before said a blood test wasn't needed and if I tried to make an appointment with her now there would be about a 6 month wait. Does anyone know if there are any allergy specialists with Brenners? I looked on their website, but could not find what I was looking for.

[twinturbo]

Two hours by car? I wonder if you could see Burks like some of the others on FAS do. The plus on the facilities like Duke and Jaffe (NYC) is the support staff, testing practices, access to clinical trials or investigational studies. As long as insurance isn't an issue I'd drive two hours to Duke.

My two cents.

[CMdeux]

I would, too, if I were just a couple hours from them by car.


The staff at Duke might be able to 'recommend' someone closer to you to use as a "regular" family allergist, too.

[twinturbo]

Yeah, I sort of do that our allergists call it having a mutual patient. The way it works between Jaffe Mt. Sinai and our local National Jewish allergist is Sinai establishes the protocol and our local guy tunes in to that protocol.

All parties worked together on this before hand, Sicherer knows our local guy by name and has other mutual patients with him. Our local guy gets to network with a larger facility and it takes the bulk of the work off of his support staff which helps streamline things for him in the long run. It's not all that uncommon, I think.

[EmilyAnn]

Are you talking about Duke in Durham, NC? If so, then yes, it is a little less than 2 hours by car.

[Macabre]

I mentioned in the other thread that we were with Burks at Duke when we lived in Virginia. He has moved his practice to UNC Chapel Hill. I would go there. He is the leader in the desenitization studies. He was great with DS. For part of the appointment you'll see a medical intern (I assume it's a teaching hospital like Duke) but he comes in and I never felt rushed.

And he, like every allergist, does the tests he does. He did ImmunoCAP with us. My DS, until this year had only had that and we've been at this 13+ years.

[hopechap]

I concur. Go for the experts. Save yourself from the pediatricians and local yokels.