Unfortunately, we are not in a position where we can offer individualized or specific medical advice regarding your situation with the school.

Dr. Stukus -

Thank you for sharing this information.  I agree with much of what you had to say and wanted to know if you would ever recommend the "Gold Standard" for accommodations in school?  I have two children with close to 40 ER visits between them for allergic reactions.  One has had RAST scores over 100 to Peanuts since infancy - he is 12.  The other has RAST over 100 to Dairy and Eggs since infancy - she is 8.  They both had systemic reactions to skin testing done last summer.  They were denied accommodations in school under their 504 plan so, we went through Due Process litigation to get those accommodations.  The Dr who testified for the school district is a very well known pediatrician / advocate in the food allergy community.  She has never met my children, never performed skin testing or treated patients for food allergies.  She testified that she was not so sure that our children even had food allergies since our Allergist (with 40+ years of experience - including work at National Jewish) had failed to perform the oral food challenges on our kids.  Our Allergist testified that our children are contact, airborne and ingest to their allergens based on their history, skin and RAST tests.  Because of the pediatrician's testimony and her experience in the food allergy community, the judge ruled with her recommendation of oral and inhalation food challenges for both of our children.  The judge stated that because we failed to provide the burden of proof by submitting our children to both oral and inhalation challenges that the school district would not have to accommodate our children.  Would you ever advise a patient to undergo an oral food challenge under such a circumstance?  What are your thoughts?  Thanks!  

Missy24, sorry to hear that your son had a severe reaction to cashew. Unfortunately you can develop allergies at any time, so in his case he was not allergic before but then became allergic.  The article is referring to testing positive to a food but being able to eat it without reaction.  Some docs will run a panel to whole list of foods, even if the patient has only reacted to one.  This can lead to avoiding more foods than is necessary as there is a high chance of false positives with allergy testing.

Lots of great comments here and hope there is room for a question. Can you discuss puddle testing?

Regarding the MRT and it's usefulness for the treatment of food sensitivities, not food allergies... The absence of a particular type of reference on PubMed does not denote the absence of clinical utility in the treatment of the targeted disease states, especially for newer emerging complementary treatments.The establishment of clinical utility of new complementary treatments usually precedes the appearance of references on Pubmed, often by many years.

Dr. Stukus, I will be happy to send you information on MRT as well as contact info for physicians who use MRT in their practices.

I find it difficult advocate a blind elimination diet for type 3 & 4 food hypersensitivity (non-IgE-mediated reactions),when a test to detect type 3 & 4 food hypersensitivity,w/proven 93% accuracy,is available. Not only does the blind elimination often prove unsuccessful in detecting triggers of symptoms, but poses the risk of malnutrition,particularly in children.

Yes, we've been seeing allergists since she was 6 or 9 months old.  We have moved a couple of times and had to switch allergists and it can be confusing, some say lip swelling alone is anaphylaxis, what she had with banana and mustard, and some say it's not.  It's hard when allergist's don't agree. 

Maggie - I would say discussion about egg free flu shots is outside the scope of this particular blog post - but I can tell you we will be doing a blog post in the near future about egg allergy and flu vaccine, so that should provide some more insight on this issue. Stay tuned!

Deidre - negative test results are usually accurate, but in a small percentage of cases, children can react with negative test results.  That is why it's important to get evaluated by an allergist, since they are most qualified to sort these types of situations out (and not rely on test results alone). Glad to see you are working with an allergist!

Gale - Thanks for the suggestion.

My daughter (now 16 years old) was diagnosed at age 2 and had two subsequent positive skin tests to peanuts and tree nuts, but has never had a reaction at all other than her first (to walnut) at about 1 yr old. So I was hoping that the peanut positive was a false positive all along. We had component testing done recently, using the Uknow peanut test through Phadia (Thermo Fisher Scientific) which we were told was more comprehensive and accurate and the results show a severe peanut allergy. I'd like to learn more about component testing (in layman's terms).

The predictive values for likelihood of an allergy being present differ with every food, but in general, the higher the level, the more likely that an IgE mediated allergy is present.

My daughter actually tested negative several times to some things as a baby despite reacting to them and then went on to test positive with low numbers.

With egg for example her IgE was about 1.2, but she failed the in office food challenge with the initial dose of egg powder before the real food.

She also tests positve with 1.92 and 1.98 to mustard and banana but just a tiny pin prick amount of her first taste of mustard her lip swelled up like a duck, and with 1/4 of a banana the same.

Her dairy allergy is over 100 and is her worst, but with these others at 1.9 she still has big reactions.

Also as a baby she tested negative to egg and banana but had reactions to them, it wasn't until a couple years later that the test even came up positive, after we retrialed to be sure and she indeed reacted to them again.

So the:

"negative" results are more likely correct.

Didn't fully work with us either.

Recent research shows that the flu shot is tolerated by almost everyone with an egg allergy: http://www.kidswithfoodallergies.org/resourcespre.php?id=163&title=Is_the_flu_vaccine_safe_for_egg_allergy?

My son gets his flu shot in divided doses in the allergist's office.  He is anaphylactic to even trace amounts of egg and has never had a reaction to the flu shot. Our allergist says that in recent years, the amount of egg protein in the flu shot is almost nothing.  Before my son developed asthma, I was not too concerned about the flu shot, but now that he has been shown to be high-risk for developing complications from the flu, I am want him to have the shot in the safest manner possible.

Perhaps you can ask your allergist if he will give the flu shot in an office setting?

I had my son tested IgE with an allergist because of his eczema condition.  We knew his allergy to milk at age of one, hives right after 1 oz of whole milk.  He was bs mostly the first 6 months, then alimentum after.  He had regular Similic couple times before 6 months but no reactions.  His IgE for milk is 6.29, so I think it confirmed his milk allergy. He is still on alimentum and he is 16 1/2 months.

His IgE for egg white is above 50, I had not introduced egg to him yet, but with the MMR (had egg in it) at 15 months he had no reaction that I noticed.  He had flu shot last year at 6 months which his pediatrcian said no egg in it.   Now the allgist wants him to stay away from egg completely including flu shots, and have Epipen with him at all time.  I can NOT find anything with egg-free flu shot online. Will have to check with his pediatrcian again next appt.  Do anyone knows about egg-free flu shots?  

He had hives after flaxseed and IgE is 18. Fish (Cod) and Nut (Almond) are 13,  sesame is 4.7, peanut and soy are above 3.

His allegist wants him to stay away from milk, egg, fish, nuts, seeds, soy and peanuts, and he had reaction to egg and flaxseed only.  Any thoughts? 

His dust mite IgE is also 50+, had ordered dust covers online already, see if it helps. 

I would say that EE and testing is another complicated topic best addressed with its own blog post in the future and the issue of behavioral reactions to foods is another one outside the scope of what this blog post was intended to cover. Both would best be addressed in a future blog post as well. Thanks for your suggestions!

Any thoughts or direction on behavioral issues due to food? My now 6 year old daughter never had any stomach issues, eczema, or anything else, but she became absolutely uncontrollable (threatening to kill me, punching, kicking)after a strep infection back in February. I figured something had to have happened and had the doctor do all the gluten related bloodwork since it was just not her and her oldest brother is GFCF. Sure enough, it came back positive. The allergist put her on an elimination diet and we found she reacts just as strongly to corn - again only with behavior. Didn't show up with his tests so he thinks I'm a lunatic but about 36 hours after eating something with corn, her behavior starts going downhill and it takes over a week to get it all back out of her system. How do I find a doctor who will take me seriously and not just blow me off because he doesn't see a physical reaction?

Thank you for the article. Could you provide additional information regarding EE and testing please?

Lindsay - right.  Good doctor-patient partnerships are key, especially for complicated cases such as eczema. As Dr. Stukus indicates, the evaluation and care for complicated eczema cases needs to be individualized for the child.

Thank you for posting your comments!

Jennifer - I absolutely agree with you.  Sitting in a lab room for one day while they have them ingest a suspected food is not going to lead to a diagnosis because many reactions, as you note, occur after gradual built up ingestion has occurred.  My son was exactly the same way!.  Elimination diets are the best as your story clearly shows!  But they require observation over time...not in one visit.  Parents need their doctors to explore the elimination diet idea and trusting what a parent reports in a food diary.  Parents need their doctors to be on the same team - without it we feel frustrated, alone, and embattled. 

My son had a myriad of issues including stomach, bronchial, and behavior - only after I eliminated foods myself did I find the sources causing the issues - none of which the allergy testing helped find.

Lindsay

http://www.mypickyglutenfreekid.blog.com/

This is a well well written article and explains the issues involved in diagnosis of food allergies very well!

For those of you posting about eczema - you are invited to join us in our Asthma, Eczema and GERD forum as well!  Just log in as you did to comment on this blog, and scroll down the list of forums to find it. Or you can go there directly by clicking here. We'd love to have you join us!

Jennifer: AGREED!!! DS was tested low score on WHEAT & SOY both skin test and blood test, we never took it seriously only avoided wheat by itself (wheat bread) and soy by itself (tofu, soybean..etc) but since birth he had eczema and stuffy nose throughout the year. We thought it's more related to seasonal/weather, but his skin problem and congestion issue lasted through summer-winter, hot OR cold seasons; we also thought it's environmental (dust mite) so we changed to special pillows/ beddings, but all of these effort only helped a bit- until our allergist told us we should totally eleminate ALL WHEAT/ SOY PRODUCT from DS diet. She even garenteed us after we try for a couple of months we will defenietly see improvements. It has been difficult, but after less than a week we saw MAJOR improvements!! My son no longer wakes up rubbing his nose, no longer need x2-x3 pillows during sleep, most of all, his skin cleared up like a BABY!!! I have never ever seen his skin so clear & smooth since birth, and he is 6 years old now!! He still have no problem if acidentally consumed wheat or soy product (before the diet change he ate them on a daily basis) he will not break out right away in rashes, but if he continually eats food contains wheat/soy for couple of days he will start having eczema/ itching and there would be some rash here and there which he scratches and is really bothersome for DS. For some reason it also dramatically effects his mood if he consumed too much wheat/soy. DS becomes hyper with short temper and a bit out of control (attention deficit), doesn't sleep well at night and gets tired easily during the day. Our allergist said although he might not breakout right away, but these are "trigger foods" for him that will built up in his system. DS lgE score is close to 1000.

What advice to you give to parents of children with eczema/asthma who may have false positives from IgE testing?  My daughter's IgE numbers are off the charts, and we've been avoiding likely allergens.  The only food she's (accidently) ingested that we've avoided based on likely food allergy is cow's milk (to which she had an immediate negative reaction).

We've consulted 2 allergists, and both have reommended avoiding the foods she's likely allergic to until she is 5 or 6 at which time they recommened re-testing as she may have outgrown her allergies.

We're going to invite Dr. Stukus to reply to some of the questions here. He won't be able to give you medical advice, of course, but he may be able to give out general information about the issues you have brought up.

Eczema is a tough one to explain. I will defer that one to Dr. Stukus.

Regarding the MRT post, I want to take issue with your last point. One is that if RAST or skin tests are negative a child could still have an immune-mediated non-IgE mediated food allergy as is explained in the blog post above. Non-IgE mediated conditions include food protein-induced enterocolitis syndrome (FPIES), eosinophilic gastrointestinal disease (including eosinophilic esophagitis) (EGID, EoE), Heiner Syndrome and infantile proctocolitis and a couple of others.   A board certified allergist are the professionals who evaluate patients and make the diagnosis of non-IgE-mediated food allergy and should be where the patients go first for a food allergy evaluation.