So, when do you just DEMAND a challenge?

[CMdeux]

Ajas-- I would truly hope that most people eventually have a relationship with an allergist in which they can ask such things quite frankly.

What are your reasons for being reluctant here?  Please explain your thoughts on this subject to me.

This is the kind of dialogue that our allergist readily engages in with well-educated patients who ask.  I love that about him.

[twinturbo]

How is the rate of outgrowth calculated for peanut? Is it dependent on the rate of passed challenges? Which would mean not going through a challenge at adolescent or young adult even w/o recent history of reaction would affect that ultimate number?

[booandbrimom]

With Boo's doc, I think she has reported that 50-50 is about the break point. 

Actually, my son's doctor is quite conservative. We have changed doctors in the practice to the one who participated in the OIT trials and is less conservative, but they really still like to see values essentially become 0 before they will test.

My son is still Class 3 for milk - something like an 8 for total milk. I think she could see the last time we were in how exasperated I was with the slow pace of challenges, particularly since the RAST numbers have not seemed to mean much. However, this is the highest one he's attempted .

If he passes this one, we'll talk about hazelnut (he's ~12 for that).

The Mt. Sinai recommendation is that a child be tested for milk or egg every two years he/she has gone without a reaction.

RAST tests seem to be a measure of how well you avoid the allergen, more than they are a measure of still having an allergy. My son's peanut RAST is way up again after all the food challenges. The question is when the magic tolerance window occurs.

[maeve]

If he passes this one, we'll talk about hazelnut (he's ~12 for that).

The Mt. Sinai recommendation is that a child be tested for milk or egg every two years he/she has gone without a reaction.

RAST tests seem to be a measure of how well you avoid the allergen, more than they are a measure of still having an allergy. My son's peanut RAST is way up again after all the food challenges. The question is when the magic tolerance window occurs.

That doesn't really correllate with my experience with DD.  Her egg RAST went down the year of her last reaction (contact but rubbed allergen in her eye).  Her RAST scores have gone up and down over the years, but her egg was at its lowest this year (5.43) even though she no longer avoids cross-contaminated things and occasionally eats baked egg items (cannot get her to comply with the regimen since her baked egg challenge).

Is the 12 you mention for the hazelnut a RAST measurement?  DD's is 1.96 and there's no talk of challenging her.

[booandbrimom]

Yes, 12 is the RAST. This just came up during the clinical trial, as they were thinking they could use hazelnut as the allergen if peanut didn't work.

It may be a pollen cross-reaction. None of us remembers a reaction to hazelnut - my son swears he's eaten them.

[CMdeux]

Unfortunately nutella isn't available for you guys as a challenge material, either.   

I have whole in-shell hazelnuts if you ever need them.  I've had about three gallon containers of them stashed in my china hutch for a bit.  Just sayin.


[spoiler]But you have to promise that you'll never call me a squirrel.

[/spoiler]

[maeve]

Yes, 12 is the RAST. This just came up during the clinical trial, as they were thinking they could use hazelnut as the allergen if peanut didn't work.

It may be a pollen cross-reaction. None of us remembers a reaction to hazelnut - my son swears he's eaten them.

Does he react to birch pollen, I think hazelnut is cross-reactive with birch. Wow, DD's RAST is so much lower and there's never been a mention of challenging.  She's never had hazelnut either.  If you and the doctor are up for challenge, I'd go for it; it would be so nice to get rid of an allergy.

DD will always be allergic to peanuts and tree nuts, and I'm beginning to think that she'll never outgrow egg.  Even if she did outgrow egg, I just don't see her eating it.

[ajasfolks2]

CM, I may take you up on the hazelnuts for DS as we *may* get to a point this summer where allergist would agree to challenge her on that.

[CMdeux]

Sure-- but unless you have a milk allergy, nutella is a GREAT option. 

[Macabre]

[Macabre]

And look in the Teen Travel thread. I show a picture of portable Nutella. You can get it at Target. It comes in n a box that is just a bit bigger than a Wet Ones box and had packets. That way you can open small amounts and easily and without mess throw the rest away if it doesn't work.

[LinksEtc]

I thought I remembered something about Nutella not being the best for challenges & found this ...

Re: Dd's OIT for PA, an update

it mentions an AAAAI tweet on the topic.

[CMdeux]

Links, I recalled that as well when we challenged, and although I could never FIND the AAAAI source for the info (and still can't)-- we didn't use Nutella for DD's challenge--

Food challenge-- hazelnut.

This seems to indicate that the major concern in that particular question was related to heat-processing which might have reduced the allergenicity of an OAS offender in Nutella in particular.

Honestly, our allergist suggested Nutella for the challenge.  I just wanted a better idea of threshold if she failed, given where we live.  Knowing whether or not her threshold is VERY low or quite high makes a huge difference in quality of life here.  For most people it wouldn't because daily exposure is not very likely as it is with us (we have filbert/hazelnut TREES-- everywhere... shell-based MULCH-- everywhere....).

[ajasfolks2]

Honestly, I'd rather she have the experience of the texture / chew of real nuts.  I think it would be helpful for her  . . .  esp if it is a fail.

[booandbrimom]

Yes, 12 is the RAST. This just came up during the clinical trial, as they were thinking they could use hazelnut as the allergen if peanut didn't work.

It may be a pollen cross-reaction. None of us remembers a reaction to hazelnut - my son swears he's eaten them.

Does he react to birch pollen, I think hazelnut is cross-reactive with birch. Wow, DD's RAST is so much lower and there's never been a mention of challenging.  She's never had hazelnut either.  If you and the doctor are up for challenge, I'd go for it; it would be so nice to get rid of an allergy.

DD will always be allergic to peanuts and tree nuts, and I'm beginning to think that she'll never outgrow egg.  Even if she did outgrow egg, I just don't see her eating it.

Gosh, never saw this Maeve. Yes, my son reacts to birch and just about every environmental allergen.

I think the calculus changes a bit when a child's overall IgE is so high. The doctors at Children's said they would not do a challenge for the hazelnut at that level (other than in the context of the clinical trial), so doctors definitely disagree.