A Trip to the Allergist

Yesterday, Reid joined the cast of millions who are diagnosed with a food allergy. He had his first visit with the pediatric allergist, and I actually learned quite a bit during our exam. Here’s what I took away.

Warning: I am having trouble drawing the line between geeky/academic interest and high-level mom concerns with this recent foray into allergy-land. I’ll try and keep the details light, but I promise nothing.

  • Reid’s reaction to peanut butter last Sunday – while visually jarring – was mild. The mode of contact was mostly topical last time. If he eats it, we could expect that he’d get an itchy mouth and throat as well. He might also puke, just to keep things interesting.
  • Since Reid’s first reaction was hives, we have a really good chance that this is all he’ll ever have. (Whew!) Management of accidental exposure (i.e. if Reid has a reaction) will be through Benadryl, but the doctor still wanted us to have an EpiPen with Reid at all times. (Read: Doctors don’t mess around with peanuts, and there are no absolute guarantees.) For now, we keep the EpiPen.
    • Sidenote: We have a long term action plan for checking in annually (more on this in a minute) to make sure it is still needed. Thank goodness for that because those pens come in a pack of two and were over $200 [AFTER a $100 coupon was applied, HOLY mother of histamines], and they expire in a year. O_0
  • We are now armed with a sheet that lists “Benadryl” symptoms and “EpiPen” symptoms so that we know when to give which medication. Basically, be prepared that if we ever leave Reid with you, you will be getting a training on how to use the EpiPen. Consider it a resume builder.
  • Most food allergies are grown out of… except peanut and tree nut allergies.
  • Only 1 in 4 (or 5, depending on the literature you read) kids will grow out of a peanut allergy, which gives Reid a slim 20-25% chance of shaking this.
  • BUT, since Reid has a mild reaction to peanuts, he is upped to a 50/50 chance of outgrowing it. Yippee!

As for the rest of the visit…

We got ourselves all checked in at the front desk.

Check-in

Making sure I packed an ample supply of snacks

Reid gave the woman across from us in the allergist’s waiting room the full Prince Charming treatment. Like, seriously dude. This has to be sort of tiring, right?

Waiting room

I’m surprised she didn’t melt at the sheer wattage of his smile here.

Eventually we got called back. Reid, being one of the youngest patients they see (perhaps he would *not* have been, had his parents waited until the pediatrician’s recommendation of not giving him peanut products until Age 2. Ahem), our room was a revolving door of nurses saying, “I hear that you are just adorable!!!”

As I write this, I realize this sounds somewhat mom-obnoxious. But I do believe a lot of this has to do with how just… small… Reid is.

We met with our allergist, who was great with Reid. Seriously this was the most calm he’s ever been during a physical exam. This is where we learned most of the things I outlined above. Then he decided to test Reid for not only peanut allergy but egg allergy as well. I guess there is a somewhat significant correlation of kids being allergic to both, and Reid has a distaste for eggs, so he won’t really touch an egg itself. He does A-OK with cookies, cakes, muffins, etc believe you me which all contain egg, but the doctor said that sometimes kids can tolerate them in small amounts like baked goods but not the whole food itself.

Personally? With Reid’s age, I was just thrilled that we weren’t doing the whooooooole comprehensive allergy testing. I mean, part of me wanted the most information possible, but it sure would have been a lot for my little guy.

The nurse dug out a toy for Reid to play with.

In-flight entertainment

It held his interest for a bit. By the time she came back to administer the test, he was pretty well done with it.

The test… device, I guess you’d call it?… itself reminds me of those injection-molded plastic sheets you’d get as a kid, where you had to pop out the toy and twist off any remaining nubs.

avatars-of-war-dwarf-berserkers-regiment-sprue-1

It looked similar to this…

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… except I think the little arms came pre-loaded with the common allergens, so she was able to snap off the allergens she didn’t want to test for (bye-bye milk, wheat, soy, fish & shellfish!) and leave the egg and peanut before applying them on Reid’s back.

He did great. No fussing or complaining at all during the application, which took like 5 seconds total. I put his shirt back on, and we proceeded down the hall to let him pick a toy from the treasure chest.

Treasure

“NOW we’re talking!”

Best treasure chest ever!! There were big toys in there! Reid chose a Nerf football, and we commenced our 15-minute waiting period with many rounds of catch.

photo 1

Reid was also enamored with the pull-out footstool on the examining table.

photo 2

Every so often, a nurse would come in to check on us and leave the door open when she left. Reid took it upon himself to shut the door after them. I mean, we are always concerned with shutting doors and gates at our house (albeit for his safety), so Reid has now taken to compulsively shutting doors as well.

About halfway into the 15-minute period, after Reid shut yet another door, he turned around, backed up against the door, then proceeded to rub his back, back and forth, against the closed door – scratching like a bear would against a tree. I sort of knew what the test was showing us at that point.

Allergy skin test - 1 year old

Voila! The results. The skin test includes two controls as a reference point. A positive control, where they scratch actual histamine into the skin, and a negative control of plain saline solution, so if the skin reacts with a welt to the pressure of the test itself, we know what that looks like. For the test to be considered positive, the welt must be as big as the histamine control. So here you see Reid is negative for egg allergy and positive for peanut.

So what now? Two key things:

1. We have a follow-up appointment in a year. At that point we’ll have two tests:

  1. A blood test that will quantify just how many reactive agents (IgE) are in Reid’s system. You could read this as “How prepared is Reid’s body for a fight?” The higher the amount of IgE in Reid, the lower his chances are of outgrowing the allergy. They will also monitor his IgE every year to see if his levels are dropping over time (i.e. if he is outgrowing it). That’s when we’ll know whether we need to keep renewing our annual EpiPen insurance policy.
  2. A full tree nut panel skin test. We are supposed to keep Reid away from tree nuts & tree nut products until then. 25% of kids who are allergic to peanuts are allergic to tree nuts as well.

2. After talking with the doctor and amongst ourselves, Andy and I have decided to make our house peanut free. We’ll reassess the need every so often. It’s not like Reid is in mortal danger if he consumes peanut products, but he does have a lovely reaction and isn’t all that comfortable during it. Plus, the doctor told us to assess the kids’ life stages. Reid is 1. He has zero inhibitions. He won’t obviously stay away from peanut butter if it’s within reach. Graham is 4. He knows the rules, but isn’t mature or responsible enough to be held accountable for adhering to them with 100% compliance. Obviously. He’s a kid. He gets messy when he eats. He smears peanut butter on the table and chair he sits in. He doesn’t always proceed directly to the bathroom to wash up. He and Reid wrestle, they kiss, they share toys.

Basically, if we decided to take on trying to contain peanut butter exposure within our home, it would be a lot of fuss every time we tried to bring out peanut butter. Plus it’s a lot of pressure for Graham. (“Go wash your hands!” “Rinse out your mouth.” “Don’t touch that!” “Throw that wrapper away!!!”) He feels so bad when he feels like he’s let us down, and I think he’d feel awful if he were responsible for giving Reid something he shouldn’t have.

Seems like a more obvious choice now, right? It could be totally different in 2-3 years. Until then, we as a family just take another little shuffle of a readjustment and give so much thanks that this is yet another very minor medical blip on the radar in the grand scheme. I’ll take it.

Comments

  1. So interesting about the eggs and peanuts. Well, now you know and have a plan. Poor baby but what a cutie! He’s going to be a lineman use like Jase :)

  2. Anonymous says:

    I carried an EpiPen for the 5 years I took allergy shots and am trained…too bad I don’t live closer!

  3. Michael says:

    I guess sometimes you feel like a nut … sometimes you don’t.

  4. Aunt Sheila says:

    Andrew had several nasty food allergies (dairy and soya) but by age three he was out of danger. By age five he could tolerate the occasional tiny bit and by age eight he was in control. Today he calls them intolerances. Love and best wishes.

    • Aunt Sheila says:

      I’m not anonymous – I’m your Aunt Sheila! LOL

      • I’ve got you covered, Aunt Sheila!! Thanks for chiming in. It gives me hope that maybe he won’t have to deal with this forever. :)

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