Wednesday, April 9, 2008

Why the Challenge?

(I have been avoiding my blog the past week. I've been having really angry feelings and misdirecting this anger at my husband (mostly my husband) and kids. And when I'm unbalanced emotionally everyone here seems to be off. So trying to recognize where I am and move on.)

3 for me asked why we challenged egg with Owen instead of testing. My husband actually asked the same question when I called to tell him what had happened. It's a good question.

I'll start that with a brief history of Owen's egg allergy. Having an older child with food allergies, I watched for ANY signs that Owen might have an allergy. He was a very colicky infant. So when he was only weeks old I did an elimination diet on myself (I was breastfeeding exclusively). I slowly added things back in by eight weeks he was a happy baby and the only thing I hadn't added back in my diet was eggs (interestingly enough toward the end of my pregnancy I couldn't tolerate eggs and threw up everytime I ate them.) We were on a trip the time Owen was eight weeks old and I had an Egg McMuffin one morning for breakfast. By evening Owen was a miserable baby. The connection seemed clear to me. So I steered clear of eggs until he was around 17 months old. By then he was only breastfeeding once (okay most of the time twice) a day and my diet no longer seemed to be affecting him. Some eczema but otherwise fine. He had by now exhibited allergy symptoms to dairy.

We did have Owen tested. Skin test at 9 months was negative for milk, small positives for egg and rice. At 17 months he was skin tested again, small positives for milk and egg. When I say small his wheals were 4 or 5 mm compared to Max's tests at this age which were 10 and 12 mm. Rice was negative we added it back in his diet.

After his reaction to sunflower seed we did a RAST. Milk was 2.6 (moderate level) Egg yolk was negative and egg white was only .55 (very low). On the same RAST sesame was .44. The doctor asked if he was eating sesame. I said yes. She said to continue to give it to him if he was tolerating it. He loves hummus and sesame crackers and eats them all the time.

Based on all these low test results the doctor suggested we challenge egg. I actually waited 8 months before I followed through with her suggestion.

So, what does all this mean? I think it means that the numbers don't always matter. Someone with a low RAST score can still have a severe reaction to a food. The number indicates that someone MIGHT react. It can't predict severity. And these tests are not perfect. They are performed by human being in a lab and errors do occur.

More than one allergist has said to "History trumps test results."


allergicmom said...

Different allergists are also giving different advice. Here's the NoPeanutsPlease story, if you haven't read it:

I freaked out at the prospect, frankly -- if my kid was hiving, I'd be to scared to keep feeding him that food.

I think you did the right thing in doing the challenge, given his RAST numbers, and I'm sorry that it didn't work for you -- this year. Maybe in a couple more years?

ChupieandJ'smama said...

We get that question all the time about our challenge. My son never had egg (that I know of) so there was no history of reaction. Twice he was tested via RAST and came back a 2.10. The doctor said it could be a false positive and we could challenge it and see. So we did. It wasn't false. We used the EPI and ended up in the ER. My thought process for the challenge was: Since we are avoiding so many things already, I'd hate to be avoiding things he can have. Egg would have given him so much more to eat. But it wasn't to be and now we know for sure. Our challenge was done by baking safe cookies with egg in them. He took one bite and reacted. You just never know. Numbers don't always give you the full story.
I'm glad your son is doing well now. We are still hopeful that my son will outgrow the egg allergy and I'm keeping my fingers crossed for your son too.

FoodAllergyMom said...

Thank you for this post. I struggle with test results vs. my own observation all the time. We had the blood test done on my youngest and I wonder sometimes...she tested negative for several nuts that her father is anaphylactic to, but she has never been anywhere near these nuts so could the negative result be due to lack of antibodies? She tested positive for pistacios and cashews both of which she had tried before. Anyway, I'm not going to feed them to her (especially since we can't even have them in the house) so I guess I'll never know.

3 for Me!! said...

Thanks for answering the question... we have similar backgrounds with exclusively breastfeeding, finding food patterns (except mine projectile vomited and spit-up a LOT... ewww)!

It's always a challenge with doctors and allergists/tests versus what I've seen at home and doing our own elimination diets to find the problem foods.

It think we've been lucky in that my children's reactions when eating the food themselves have been immediate hives and so we can quickly ID the problem food. And since they reaction with hives on their skin ... the skin tests have been pretty accurate. Except with foods that I hadn't exposed them too a false negative to eggs on the baby who hadn't had eggs yet.

Thanks again for answering my question! This journey is easier with information from other moms that are journeying with their kids and allergies!