First visit with allergist - how to prepare?

[jschwab]

I agree with CM.  I hope you find a great allergist.  And I could be wrong but I think you can get RAST tested without going off meds.  Our doc is not big on RAST and does skin usually but I think that's the case.  Testing is not the be all and end all but it can be helpful.  But it isn't necessary.  If you walked into most allergists and described your past reactions they would give you a script for epis and emergency plan. 

I can't remember your whole story but if you are having some mystery reactions testing via RAST could help you figure out the cause and so could in office challenges. 

I would want the very best allergist I could get if I were you.  Best wishes!

No mystery reactions, thank goodness. It's almonds. Every once in a while I think I get dinged with cross-contamination but that is all. We had almond flour EVERYWHERE in the kitchen, all over everything, so I'd be surprised not to have any issues with that.

I gave myself an oral food challenge by eating a single almond the day after this reaction [DO NOT EVER DO THIS] while I was still pumped full of steroids and planning on having almonds for dessert. At that point I was not sure what happened and thought maybe some sausage had some cross-contamination issues. I had an idea it might have also been the almond milk (worst case scenario, obviously, because a new allergen for me) and my hunch was correct and I reacted strongly. A week after that I had another bad reaction from cross-contamination that resulted in massive hives. After that hives reaction, I started blowing up to anything containing almond oil so it was pretty clear. And I have eaten every other component of that meal since then with no problem. That's enough confirmation for me with no testing.

You might be right about RAST. When I had allergy testing before, I was negative on skin and the allergist told me I was 100% not allergic to shellfish and I could eat it all I wanted. His assistant had a devil of a scare when the RAST came back positive and she could not contact me. So, maybe the skin did not work because I was not compliant enough with the protocol, because I had had skin reactions to shellfish before.

[CMdeux]

Some people just historically don't skin test very reliably, too-- if you're one of them, then it makes much more sense not to bother and just go with RAST and history.

[jschwab]

Some people just historically don't skin test very reliably, too-- if you're one of them, then it makes much more sense not to bother and just go with RAST and history.

I hated the skin testing and how itchy it was so I would be glad to leave it out. Do you know if it's correct that RAST testing can happen without going through the no-antihistamines protocol?

[CMdeux]

Yes-- antihistamines have no impact on circulating levels of IgE.

[jschwab]

Yes-- antihistamines have no impact on circulating levels of IgE.

Really? I have my plan then.

[twinturbo]

We RAST (or if you want to call it IgE test) with the one kid on daily Zyrtec. For SPT he goes off Zyrtec but for oral challenges he actually stays on Zyrtec because it doesn't alter threshold all that much. Doc also reasons since he's on daily Zyrtec it is a more valid test than if he went off anti-histamine for a challenge.

The one thing I would look into given your allergen set is high heat treated milk. That has some validity to it that is somewhat of a treatment that also affects quality of life, and possibly positively influences contamination thresholds for untreated milk. Good, solid data on that one as long as you have an up to date doctor and adherence as an adult. I think there is some validity to dampening down your allergy cup through environmental allergy immunotherapy which is well established.

In essence you can't do much about the shellfish and almond but there are some adjunctive allergy issues that can be attacked with a great statistical likelihood of success that can translate into a better overall outcome.

[jschwab]

We RAST (or if you want to call it IgE test) with the one kid on daily Zyrtec. For SPT he goes off Zyrtec but for oral challenges he actually stays on Zyrtec because it doesn't alter threshold all that much. Doc also reasons since he's on daily Zyrtec it is a more valid test than if he went off anti-histamine for a challenge.

The one thing I would look into given your allergen set is high heat treated milk. That has some validity to it that is somewhat of a treatment that also affects quality of life, and possibly positively influences contamination thresholds for untreated milk. Good, solid data on that one as long as you have an up to date doctor and adherence as an adult. I think there is some validity to dampening down your allergy cup through environmental allergy immunotherapy which is well established.

In essence you can't do much about the shellfish and almond but there are some adjunctive allergy issues that can be attacked with a great statistical likelihood of success that can translate into a better overall outcome.

Thanks, that's helpful. I think I may have outgrown the milk a little recently but I am not sure. I did have a couple bad reactions that could only have been milk cross-contamination early on. About a year ago, I ate at Five Guys and they messed up the no bun part of my order and I could not take going back to switch it out so I just removed the bun and ate my meal. I had been told the buns don't contain milk but that is actually not true. That was a pretty good opportunity for a reaction. While I flushed some and my mouth felt fuzzy, I was OK. And, before that, I was up and down with milk, giving it up after increasingly intense gastro symptoms and then tolerating it again and then going off it and then ana. Before the ana, I thought it was some kind of lactose intolerance. But the fact that I went up and down made me think it was a mutable reaction that can get better or worse with sensitization. I never tested positive for it and it was the one the doctor wanted to do an OFC for. I always said if I did a challenge, I would do it myself sitting in front of the ER instead. Have not done that mostly because no one in my house tolerates dairy much, anyway. Two of my kids decided to give it up because it made them feel not so hot and hubby doesn't eat it, so there is no real incentive. I have always tolerated shared equipment.

My last major reaction was never identified but I assumed it was dairy. It was 18 months ago and pretty intense - it was the first time I reached for the Epi because my throat closed all the way and my airway was completely cut off and I freaked. We could not find the Epi, though, and the reaction passed. We had had a friend house sitting who had butter in the fridge and I got sick after eating peanut butter out of its jar and I assumed she'd double dipped a knife or something. I never asked her what she'd had in the house because I didn't want her to feel bad. I just hired a vegan housesitter for the same vacation so that works out well on the food front LOL

[twinturbo]

Yeah, some of my allergens I have to lump and deal with. The others my general plan is to knock down the well-studied ones with established treatment namely the environmentals. Same for my younger one who is wheat, barley, rye, oats, cow milk, beef, dermatographic, systemic temperature change hives, severely sensitized to dust mites, suspected nuts, shellfish, soy, and overall produces a lot of histamine. The likelihood of him being able to tolerate high histamine foods is very low and skin testing is almost pointless because he reacts to control.

He was the single most significant reason my husband went to the allergy & atopy conference in Asia. The profile of allergic population there is different and treatment has gone a little differently, I think. There's a lot more attention paid to dermatology issues, which coincides with the limited amount of focused study on Asian American patient population here in the states, that our kids are very atopic and prone to eczema. If it's true that transcutaneous sensitization is increased by skin barrier breakdown then it changes our approach slightly to increase attention to treating the underlying environmental allergens earlier through SLIT (as proposed at the conference) and/or SCIT.

For myself I've given it one year. If my pollen-food hasn't resolved I'm pursuing pollen and other environmental immunotherapy. I've decided for my longer term self-care to beat down what I can. I also take Zyrtec daily to deal with the minor issues so I don't have to break my stride any time I have a slightly itchy tongue from a spice.

[jschwab]

Yeah, I am in a slightly different situation. I have had bad environmental allergies pop up (orange cat, I'm looking at you) but, for the most part, these have been controllable for me with daily antihistamine and nasal steroids. I consider myself to have zero quality of life issues around that at this point BUT your point is well-taken and speaks to my experiences, especially around the dust mites > shellfish link.

[jschwab]

The allergist was very good, with good bedside manner and she seemed knowledgeable and personable but not overbearing. She took the time to listen and was able to answer my questions competently. She said at that practice their protocol is to do the blood test first. If nothing shows up, they will skin test. Next step is RAST in January and then follow up.  I was very happy. She was also able to convey the limitations allergists work under in terms of predicting future reactions and offering therapy in a real way, which I appreciated.