I took Elizabeth to an allergy/asthma doctor for an evaluation (the results of her blood test for a pecan/walnut allergy made the pediatrician say she should see a specialist). I always hate the first time doing something new: I’m so anxious when I don’t know what to expect. And it seemed like things got off on the wrong foot from the very first phone call: the receptionist asked me “Is she having a skin test?” and I didn’t know: the pediatrician just told us to see the specialist. So then I was thrown by the question, and felt foolish for feeling thrown, and got into the kind of scrambled-up talking where I have to say to myself that it doesn’t matter if I sound stupid, it only matters that I GET THE WORDS OUT and not sit in silence on my end of the phone. And that it’s okay to say, “Oh! I don’t know! The pediatrician just told us to see the allergist! It’s because she had a blood test that showed a nut allergy.” I was pleased that we could get an appointment so soon: sometimes with specialists it can be AGES.
They sent us some paperwork to fill out before her visit. It asked a lot of questions about things like hives, wheezing, seasonal allergies, etc., and I kept feeling silly because I couldn’t answer. How long has she had this reaction to nuts? Hm. I don’t know, because she hardly ever HAD pecans or walnuts. How long has she had reactive airways? Hm. I don’t know; she was DIAGNOSED last winter, but she’s had those symptoms on and off for…years? I don’t know, I wasn’t even sure if I was supposed to mention it or if she was only here for the allergies. What are her primary symptoms, and how serious are they on a scale of 1 to 10? I don’t know what symptoms would be considered “primary,” and I don’t know how serious they are on a scale of 1 to 10. Etc. So I just filled them out the best I could, with too many little explanatory notes in the margins. When we got to the appointment, they asked all the questions on the form ANYWAY, and no one criticized my patchy form-filling-out, and they DID want to know about the reactive airways because with allergies and breathing issues it’s all a rich tapestry.
She wasn’t supposed to have any antihistamines for 72 hours before the appointment. I was nervous I’d forget, but I didn’t: I put it on the calendar, and also the doctor’s office called 72 hours before the appointment and said “No antihistamines from now until the appointment,” which was nice.
They told us to expect the appointment to take an hour and a half, but it was more like an hour. We were the only ones in the waiting room, so I wondered if they build in time to deal with other patients but didn’t need that time while we were there. First the nurse called us back and got Elizabeth’s weight and height, pulse and blood pressure. She then asked me pretty much every single question that had been on the form, and entered the answers into a laptop.
Next, the nurse did the asthma testing. She set up the laptop to show some animated birthday candles. She had Elizabeth take a huge deep breath in, then breathe out as hard as she could into a plastic tube; the harder she breathed out, the more candles blew out. Then, without taking her mouth off the tube, she had to breathe in again as hard as she could. The nurse had her repeat this three times with short breaks (15-30 seconds) in between. Then she gave her two puffs from an inhaler, waited a few minutes, and had her do it all again. The doctor never said, “Yes, she has asthma”; he just came into the room referring repeatedly to “her asthma.” She’ll have an as-needed inhaler. Right now she only has trouble when she gets sick, so he said we could come back in the winter for another evaluation if the inhaler wasn’t enough.
The doctor came in to talk to us about the allergy testing before beginning. He said there were two ways to do it: the less-torturous, less-accurate way, or the more-torturous, more-accurate way. I was leaning toward the latter, but was having trouble understanding the difference and asked what he’d recommend. He said he recommended the former for children and for first-time screenings, so I went with that. When the nurse came back in, I thought to ask if there was a price difference between the two methods (we have a high deductible, so we’d be paying for the whole visit), and she said she didn’t think there could be because they bill both methods using the same code.
It turns out that the more-torturous way involves marking the child’s back with a grid, then doing a separate needle-stick into each of forty grid squares (in Elizabeth’s case—I don’t know if it’s always forty, or if they do a different number depending on what they’re testing for) and putting a drip of chemical onto each needle-stick. The less-torturous way involves using pre-made blocks of ten needles each, pre-filled with the chemicals. The nurse presses down each block, so it’s ten needle-sticks at a time but only four of them, and it’s over quickly. Pain-wise, Elizabeth said, “Ow. OW” with each press-down—but in sort of an annoyed, “Hello, this HURTS” way rather than in any kind of distressing way. The “less accurate” part is because it’s harder to be consistent with the depth of the needle-sticks, and because the testing sites are closer together: a reaction from one can easily spread into the area reserved for another.
Elizabeth had to lie on her stomach for this, with her shirt off. I think she hated having her shirt off more than she hated the rest of it. She was glad the nurse did the actual testing, because the nurse was female. She had a paper johnny to wear, and that helped a little, but she still felt nervous and exposed.
First the nurse wiped Elizabeth’s back with rubbing alcohol, and then she used a marker to label four areas with A, B, C, and D, so they’d know which area was which testing block, and then she did the needle-stick blocks. After the four blocks of needles had been pressed down, the nurse checked to make sure all of them had worked, and then she gently blotted off the extra chemical. She then used a marker to put a dot by each of the forty test sites.
Then Elizabeth could sit up, and we waited 15 minutes for the test to finish; the nurse set a timer outside the door “so you won’t have to suffer any longer than necessary!” The doctor came and checked twice mid-test, and the nurse also kept checking. Elizabeth said it was very itchy, and that it itched more and more. But she didn’t freak out or cry or anything, just a few irritable complaints. I kept looking at her back—it looked pretty cool and dramatic, because even the places where she had no reaction were pink from irritation, and then of course there were all the dots and letters. Very quickly some of them started looking like mosquito bites; the nurse had left the testing sheet behind, so I could see for myself which ones were which.
When the timer rang, the doctor came in and filled in a chart of the reactions: little dashes if there’d been no reaction, or little size-of-reaction codes (3, 3+, 3-, etc.) if there was. She had reactions to pecans, walnuts, and most of the other tree nuts. He said her skin-test results were nowhere near as bad as her blood-test results had been: if her skin test had matched her blood test, he said the reaction area would have been as big as a plum; instead it was about the size of a mosquito bite. He recommends not having pecans or walnuts in the house, but he didn’t sound too impressed with her reaction. She had no reaction to peanuts or almonds, which is convenient. He prescribed her an Epipen, but said we should use Benadryl instead unless she (1) was struggling to breathe, or (2) turned pink all over her face and down her torso, or (3) threw up the Benadryl.
So! Then we went back to the receptionist, and she made us copies of all the testing forms and also printed out a sheet that included the doctor’s instructions. Meanwhile Elizabeth was rubbing her back against the wall, and I realized I’d forgotten my plan to give her a Benadryl as soon as the testing was over, AND I’d left the water bottle in the car. The receptionist offered her a Zyrtec, but I gave her the water/Benadryl in the car instead. (I was remembering when she had a single dose of children’s Tylenol in the hospital and we were billed $14 for it.)
The whole thing was about what I’d expected, except less stress for Elizabeth: I’d thought she might be weepy and upset during the allergy testing, but she was just annoyed. I was relieved that at this point her allergies and asthma are unimpressive, though I was also a bit stirred up by references to “if she can’t breathe” and so forth. We had lunch out to celebrate having the appointment done with.
[Edited to add: Because our insurance denied the claim, saying there was no referral (sigh, we have a COPY OF THE REFERRAL in our anxious little hands, AND the allergist’s receptionist told us they’d received it), I can also tell you how much this appointment costs without insurance: $1,045. That’s $570 for the nurse to run the allergy tests, $125 for the nurse to run the asthma test, and $350 for the pleasure of the doctor’s company.]
I’m glad they’re unimpressive–my best friend coded from an allergy test! Had to restart her heart and everything!
Oh DEAR! And I do most sincerely thank you for waiting to tell that story until AFTER Elizabeth’s testing!
When I had an allergy test it was very similar to this, but in addition they taped a bottle cap-like container to my back full of avocado for 5 days, because that’s what I thought I was allergic to but the in-office test didn’t show much reaction.
I’m glad to hear Elizabeth has a mild allergy.
I always like it when you write posts like these, in case I ever need to take a child for allergy testing.
This brought back memories from when we had to have Nina tested. I’m glad to hear that it all sounds familiar, since we are debating taking our youngest in for testing. I’m very happy for you that it is “unimpressive” but also glad that you are on top of it.
My son had to have this done twice. Different dr, in what I assume is a different state, and the process went exactly the same except there was a t.v. in the room so the kids could watch a video while they waited the 15 minutes for the test to be done. My son has reactive airways and was allergic to milk. Even though his allergy wasn’t all that bad (3 if I remember correctly), once we eliminated milk from his diet the airway problem improved dramatically. I don’t know if that will work for Elizabeth since tree nuts aren’t in as many things as milk is, but you might see an improvement in her asthma/reactive airways when you eliminate the nuts.
I found this really interesting to read. I’m glad that no MAJOR reactions came up and you can worry less. The doctor’s office sounds nice too.
I remember taking my son for his allergy tests. They used the other method on him though. I remember the dr saying that his symptoms didn’t sound too bad, but within 2 min of doing the test, he began having severe reactions. Turns out he is allergic to all grasses, trees, etc. Small reaction to peanuts. This is terrible for a boy who loves to be outside, in the woods, hunting, exploring, etc. He had to get four shots twice a week for about a year, before they reduced it. He got allergy shots for several years until he decided he would rather suffer with it than take all that time to go in for the shots. (He was a teenager by this time.) He’s 19 now, and just talkes over the counter meds, and they seem to control/help him.
I’ve been tested twice (once before treatment and once after about 2 years of allergy shots). I was tested for (I think) 80 different things, which is a whole lot of needle poking. The good news is the shots worked and I only had 20 or so reactions with the second round of tests (vs. 70ish with the first round). Oh, and my allergist doesn’t charge for any on the spot allergy meds they give…
So the skin test is more accurate than the blood test? We opted to just go with blood test results since most of our son’s blood test results came back OFF THE CHARTS ALLERGIC FOR ALL TREE NUTS AND OMG DONT EVER LET HIM EAT PEANUT BUTTER AGAIN EVEN THOUGH HE’S NOT ALLERGIC TO PEANUTS! And keep an epipen on his person at all times.
He was diagnosed as asthmatic as toddler, which he’s outgrowing in the sense that he’s now labeled “exercise induced asthmatic.” The tree nut allergy diagnosis came into play around age 9. He was the type to not really eat nuts anyway, not liking the texture. He’d run to the trash can to spit out a nutty chocolate (the kind from a box where you sometimes don’t realize there are nuts in there). He ate creamy PB w/out incident. He’d even had Nutella a few times. But then he had a reaction to Nutella (Hazelnuts), and the ball got rolling on the tree nut allergy.
Nutella scares the crap out of me because it does not have a nut texture at all, and people bake with it, and it just looks like chocolate. He basically avoids all school bake sales. Our Pediatrician would like him to avoid all baked goods, peanut butter, peanuts, and products which may contain any/all nuts (because of cross-contamination).
Anyway, welcome to the epipen world :-( Sucks, because even with insurance, they’re expensive, and they expire. So while we always get a twin pack, even though we’ve never had to use one, we still need to get new ones each year. And we’ve found having multiple makes for much peace of mind. We have a few at home, one that stays in my purse always, one in the school office, one in his backpack (because after-school activities don’t have access to the school office), and one at my parents’ house because he’s there often enough.
And explaining all this to school/camp staff. Fun. Not. Yep, if he’s having a reaction, you jam the epipen into this thigh, yep through his pants/jeans (yes, it will go through, please don’t ask him to remove his pants, every second matters!), and then you call 911. Yes, 911 first. Then me. No, them first, then me. Sometimes one dose of epinephrin isn’t enough – 911 first!
I don’t know—I would have THOUGHT a blood test would be more accurate, but the allergist gave precedence to the skin test. Elizabeth’s blood tests showed she was hugely allergic to pecans and walnuts, but the skin test said mild. She’s not allergic to peanuts, and the allergist said she could continue eating them. To me the main benefit of the skin test is that it’s given and evaluated by a doctor who specializes only in allergies and asthma—so then we got advice and instructions from someone who specializes only in allergies and asthma.
It is true that skin tests are more accurate than blood tests. Blood tests measure antibodies. Antibodies react to the shape of structural proteins and lots of foods could share the same basic structural shape. In addition, having antibodies in your blood does not necessarily mean you will have an allergic reaction of hives/trouble breathing/etc.
On the other hand, skin tests measure a reaction to each food individually which is how it could tell you that Elizabeth has specific nut allergies but still can eat peanuts.
We wee able to decipher a tree nut allergy from a peanut allergy through the blood test. Our son is allergic to tree nuts but not peanuts. Our ped recommends avoiding peanuts/PB though due to cross-contamination.
Anyway, very good to know a skin test could clarify a lot of things for us. Being that our son doesn’t like nuts anyway, we do just avoid.
Your fear of Nutella sounds like my fear of coconut. My husband is allergic to coconut to the point of needing an epipen. We have discovered the hard way how many things are made with coconut oil over the years, but only recently discovered the incredible danger of gluten free products. A lot of gluten free foods are made with coconut flour. It is a good thing neither of us are gluten intolerant.
When I was a little girl, about 6 or 7 they tested me for allergies and I remember it being miserable. I was so allergic to so many things that they could not distinguish pretty much any of the reactions from one another. All of my boxes ran into one another. So I had to let them do the tests again on my arms over a two day period because they could space them out better. I was pretty well decently allergic to everything but not severely allergic enough to anything to leave me with an epipen. I instead got to get 8 allergy shots a week for the next 4 years of my life. On the bright side though I now have absolutely no issue with needles, but I am completely immune to Benadryl.
I am so glad that Elizabeth’s tests were not too distressful. And that she is not allergic to peanuts or almonds, in case she likes “nut” butters or crunch in her brownies, etc. :)
And I am also glad that you found out in a relatively non-threatening way. I found out that my son was allergic to shrimp in a very dramatic way. He had eaten shrimp always with no reaction until his going-away-to-college special meal. I won’t go into details but it was very dramatic and I was afraid we would lose him before we could get medical help.
The worst part: I lived in Oregon, he was going to college in Massachusetts and the idiot boy calls me a couple of weeks later to tell me that he had eaten shrimp again to make sure he was truly allergic. He was allergic to all shellfish!
He had just turned 17 then. Fast forward 23 yrs. This month he ate lobster. To make sure he was still allergic!!! What is wrong with this “child”? (He is an MIT graduate, by the way. Oy!)
Both my son’s pulmonologist and allergist said the skin test is more accurate than the blood test. Your description of the allergy test is very similar to what my son’s allergy test was like. His asthma testing was different though.
I am surprised they didn’t wipe her back with a topical benadryl when they were done. They always have done that for me (and I’ve had skin tests 5 times over the years)
Allergies have always terrified me, but they are even more of a PTSD trigger for me now after Violet.
D is already starting to show signs of dietary intolerances and/or allergies at just under 8 months, but I am so hoping they are the outgrow-able kind.
I also remember being part of a summer camp day out program where we carried an epipen for a boy all summer thinking it was for his bee sting allergy, but it was actually for his peanut allergy. Oh, no. I shouldn’t have mentioned that, huh? Will Elizabeth be banned from GS camps now? Sorry!
This was very informative. I felt both calm, intrigued, and stressed with you at the appropriate times, I think. Thank you for sharing!
I can empathize with your experience, since my older daughter was about Elizabeth’s age when we tested. They didn’t ask me about the less accurate vs more accurate method though, poor kiddo had to sit through 40 pricks. She however, impressed the doctors when her back ended up covered in large spots on all the tree nut tests. She ended up getting an EpiPen. I felt really guilty afterwards, because I had always encouraged her to try nuts, thinking she hated them just because of her general pickiness. The only reason we tested her is because she had a huge projectile vomiting session at the Kroger, after eating one of the sample cookies with pecans. Glad everything turned out more or less okay for you and Elizabeth.
Someone else said this, but thanks for writing such a useful post for anyone searching for information on what to expect when you take your child to an allergist. As you noted, it can be a stressful experience not only for the child but also for the parent. It’s nice to see what others have experienced. You’ve got great insight, Swistle.
My brothers did the whole allergy testing thing, and then weekly allergy shots. (They’re 10 yrs older than me, and Ma decided she didn’t want to go thru it. Or didn’t want me to go thru it, something like that :)
Anywho, all 3 of us grew up with asthma- they only had the shots and inhaler as needed. I had daily asthma meds (3 types, I think), and a few hospitalizations – which were years apart (Kindergarten and.. 5th grade?). Interestingly enough, all three of us more or less outgrew the asthma, to the point where as adults we only need the inhalers as needed- and that’s rare (like, in conjunction with getting a cold, or when our allergies flare up, because none of us outgrew that).
I’m saying this mostly to let you know that asthma was serious in our family, but we were all pretty matter of fact about what to do about it, and we learned fairly quickly when things were manageable, and when we needed more help. So for instance, a wheeze would freak out my friends (and their moms) but I knew to take the inhaler and just sit for a while, but when my fingertips turned blue it was time to go to the ER.
So the doc/nurse attitude might be because they’re pretty familiar with stuff, and as you and Elizabeth get more familiar, you’ll be more confident and matter of fact about it too. And the ‘getting more familiar” might have some serious or scary parts, but I think if you and her mostly pay attention / listen to her body, you’ll get thru it okay…