Rast went from 12 to 2.6 in two years. Is that a level that can be challenged

[dlibby1angel]

On the day of the blood test our ds's allergist said he would consider a baked egg challenge if the result went from the 12 in 2010 result to a single digit, say a "6". Well it came back at 2.6! Upon calling us with that result, his nurse said the Dr. does not like to do a challenge until the number is less than 2.

We did ask for clarification and are waiting to hear back. What do think?  Challenge-ready or not? I don't mind waiting but dh is wanting it to happen.

For what it's worth, all other rast numbers are up-some significantly enough to move from a class of "high" to "extreme." 

[maeve]

Are you talking a challenge for baked egg (which is really a dose setting challenge) or a challenge for egg itself?

My DD had a baked egg challenge at Hopkins a couple of years ago when her rast was between 12 and 9. Her dose during the challenge was set at 1/16 of an egg.

[rebekahc]

They have determined positive and negative predictive values for egg.  Of those who have a RAST value of 6 kU/L or higher, 95% will fail an egg challenge (actual egg - not low dose baked).  Of those who have a RAST value of 0.6 or lower, 90% will pass an egg challenge.  Your son falls somewhere between those, so it seems he would at least be a candidate for a baked egg challenge.

Did they skin test him, too?  50% of kids with skin test of 3mm passed oral challenges.

Here's a PDF with the info www.newenglandsocietyofallergy.org/Meeting%20PDFs/Young.pdf‎

Edited to fix child's gender  Sorry!

[CMdeux]

BUT-- low-dose baked (that is, a dose-setting challenge, which is what we did when my DD's RAST was still pretty high, around 8-9, I think) those numbers aren't really accurate, remember...

apparently the RAST has little correlation with who can pass those.  Our allergist's anecdotal statement about that is that "around half"of people even with VERY high RAST values can tolerate baked egg.

[maeve]

And yet at our last appointment at Hopkins we were told that they're finding in their practice that the egg allergic tolerate baked egg less well than the milk allergic tolerate baked milk.

[CMdeux]

Right-- so that tolerated dose may be lower, and it may be harder to "hold" it well off of dosing.

One of the things that often indicates a good opportunity to challenge for baked dosing is a large decrease in RAST scores, btw.  That's anecdotal from our doc (who talks to Maeve's doc-- a researcher-- at meetings).

[dlibby1angel]

Thank you, you have provided some great information.  It was a baked egg challenge that he had mentioned, and based on what you said above, that makes sense. I guess we will just wait and see what he says and go from there. Our son has some anxiety about the whole idea, so I don't mind the wait.

I believe he said that if ds can tolerate a baked egg challenge that he may outgrow the egg allergy sooner. He did outgrow milk and wheat. Does that mean he might be even more likely to outgrow egg as well? We have pretty much resigned ourselves to the fact that he won't likely outgrow the pn and tn's.

Thanks again.

[dlibby1angel]

Oh, yes he has been skin tested three times in his life. Egg was always included and quite reactive.

[joanna5]

My son's is around six and the considered a baked egg challenge.  First, Dr.  Young had us do a component test to see if D was allergic to the more heat stable protein.  That came back fine, but they also require a skin test of less than 35 mm and he failed that... twice. 

[dlibby1angel]

Hmmm...our allergist didn't test for the heat tolerant protein and I don't know the size of his last reaction when skin tested.

In spite of that our baked egg challenge is scheduled for next Wednesday. I am both excited and hesitant. It is going to be done at the allergist office, not the hospital. Is that bad? The children's hospital is just a short drive away...but I'm not 100% comfortable with that.

I think I'm getting cold feet. I keep putting off making the muffins...I just can't seem to put eggs in something I know he is going to eat. Last night I laid awake wondering if the children's hospital has a heart/lung bypass machine....just in case.   

It seems as though the nurses at our allergists office are in charge of saying he is ready for this and setting it up etc. I'm guessing the Dr. Had the final say, but we didn't hear directly from him.  I don't know what kind of precautions they take there during the challenge. If he reacts mildly and they just give him Benadryl, I know I'm going to worry that he should actually have the epi.

The last time he knowingly had egg, he was two --now hw is eight. When he had it, he projectile vomited after just two bites. Dh really REALLY wants to do this...


Apparently I can use any cake-type recipe for the muffin/cupcake, as long as it takes 2 eggs and we make sure each muffin has equal amounts of batter. We have to bake it for 30 minutes at 375 degrees....are they rock-hard muffins that are difficult to eat?  

Is there a trick to make sure each muffin has the same amount of batter--other than just using a measuring cup? Does it matter that truly one cannot get all the batter out of the cup every time?

Thanks for listening to me fret!

[CMdeux]

I did it by weight.

That is, I used a kitchen scale to weigh out the full batch and then each individual bit.

Honestly, if you're super nervous, you CAN cut the dose in half-- that is, use only one egg, not two-- and just tell the allergist when you show up.

But truthfully, your child sounds like a GREAT candidate for a baked egg pass. 

I'll be thinking of you!!   

[maeve]

I'd follow the allergist's directions for making the cupcakes/muffins. I did cupcakes and we were allowed to have frosting on the which made the drier cupcakes tolerable. Our baked egg challenge was in the clinic, which was directly across the street from Johns Hopkins. Our doctor's nurse practicioner told us that, if needed, they would administer epinepherine by syringe (vs. Epi) so as not to be limited to the dose in the Epi. DD did have some mild symptoms (complained her stomach hurt) and was given 4 teaspoons of Benadryl. She was then monitored for an hour before we could go home. That wasn't a fail of the challenge; it just meant her dose would be set lower. Now, she really doesn't want to follow the baked egg protocol and I'm not pushing it; Hopkins is also fine with her following her heart on this.

[CMdeux]

Passing with a low dose (and DD's initial challenge "pass" was on 1/90th of an egg, consumed well-cooked in the equivalent of about 3 mini-muffins over 3 hours) has really changed my DD's life for the better. 



You can go through with it, I know!!  (I was terrified going into this, honestly... I had a plan for 'what if they have to intubate' and everything.  Seriously.)

[dlibby1angel]

I made the muffins this evening, using a digital scale to weigh the batter between 6 muffin cups. I did grease the top of the tin because I knew they would be big if I was to fit all the batter in them. They still stuck and edges were left behind. I tried to match them up to the proper muffin so they would be equal. My dh said this is fine and it doesn't have to be perfect. But now they are likely not equal...dh says not to make another batch. I hope they accept these. I don't want to waste their time or ours because my muffins don't measure up.....

Do I need to make more?

[CMdeux]

I don't think so-- it's either a pass or fail, after all, and in all reality, you probably will NOT be pushing things this much if you wind up dosing at home, right?

(So if you were actually feeding 'baked egg' cooked into things, it'd be about 1/2 as much at once, correct?)