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Crohn's Disease Forum » Treatment » Humira/Adalimumab » Humira dosing in 8yr old/freaking out


 
02-28-2017, 05:06 PM   #31
nelsonshan
 
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When he was first diagnosed with Crohns 2 years ago, we saw another dr who did the Genova IgG, IgE Food antibody assessment and inhalants profile. He basically reacted to everything. They said his case was one of the worst they've ever seen. Several IgE allergies - peanut, tree nut, dairy, eggs, every grain - wheat, soy, corn, rice, buckwheat. I asked why he doesn't anaphylax/rash then, and they said everyone reacts differently. His reaction could be the stomach pain/vomiting he was doing everyday (at that time had gastroduodenal crohns). I asked what he could eat then, and they were at a loss. I was beside myself. Our ped GI said that the blood tests are not as accurate as the skin tests for allergies, so sent us to a ped allergist. We had all the skin testing done, and besides every environmental allergy, he reacted to peanuts, tree nuts, soy, egg, carrots, raspberries. The rice/wheat/corn were all negative and she said that may have shown up in the blood test because they are all grasses and he's very allergic to grass. She told us to completely avoid the peanuts/tree nuts since it may be causing inflammation that was aggravating his crohns. But we've never needed an epi-pen. And she didn't want to label him "peanut allergy" so that he'd need special treatment at school, etc.. So we just avoid all those things and have no problems.
02-28-2017, 05:45 PM   #32
my little penguin
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I see now
First random testing is never recommended for food allergies
Please really review those links
Igg is not a valid test at all for food allergies
Kids with high environmental and eczema etc will have extra IgE floating in there blood and look allergic to everything
False positive rate for blood and skin tests are 50%

Ds tests positive to BUT IS NOT ALLERGIC to

Corn
Wheat
Rye
Oats
Barley
Rice
Sesame
Peanuts
And soy

He is only really allergic to tree nuts and fish
The rest are false positives due to grass /tree allergies

The gold standard of food allergies is an in office food challenge done at a hospital
Your allergist should have done one in the office or at home for anything he was suppose to avoid that was below the positive predictor value (ppv) and had a good chance of passing
Blood values above 15 are ppv for peanut

Do NOT try to feed your child anything at home without an allergist advice

Most allergist will not do blanket food testing anymore since you will get lots of false positives

Has he eaten all the food before without any issues ?

Please get a second opinion allergist asap

Just because you don't "label " a child with true food allergies doesn't mean their body knows the difference and won't have anaphylaxis

Low blood test results do NOT mean the reaction will be less severe
It's sorta like a stick pregnancy test
It doesn't tell you how pregnant your are or when your due
Just that you are

So please for your child see a second opinion allergist and read the links
Most kids with FA will have anaphylaxis within 5 years of dx


If your child is truly allergic to peanuts and tree nuts or any other food then you need an epi pen regardless of past reactions .
They also need to tell the school
Your child doesn't need to be "special "
But you do need to let the schoo know
Ds eats at the regular table etc
But he brings his own lunch and doesn't eat Anything that I couldn't read the label on when he was younger and now that he is older he reads the label


That's it - not sure where the"labeling special " came from

Kids have gone years without a reaction only to eat a high risk food
At a buffet or bakery and Go into anaphylaxis from traces of a nut they couldn't see or didn't know was there even places they ate before


I am not trying to scare you but too many years on kids with food allergies foundation
I have heard some bad reactions because no one thought to educate the parent

So if your child is actually allergic to tree nuts /peanuts
They need to read all labels
Call all companies since May contains or made in the same facilities as statements are voluntary
Avoid high risk foods
Bring their own food for parties unless they can read the label

So please get a second opinion pediatric allergist who specializes in food allergies
And get an epi pen /Auvi q

Your kiddo and you have enough to deal with
Having a severe allergic reaction shouldn't be one of them


Big hugs
A lot info is in the links I posted

So sorry you have had such a tough time
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02-28-2017, 05:55 PM   #33
my little penguin
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Skin Testing

The positive predictive value (PPV) for skin testing is ≤ 50%, whereas the negative predictive value (NPV) is ≥ 95%.[10] Because of a high rate of false positives, a positive skin test should be correlated with clinical history, whereas a negative skin test can be used to rule out an IgE-mediated allergy. The larger the diameter of a wheal in a positive skin test, the greater the probability of clinical reactivity; however, the size cannot predict the type or severity of a potential reaction.[48-50] In one study, a median wheal size of ≥ 8 mm for milk, egg, or peanut in children younger than 2 years was found to be 95% predictive of food allergy.[51]

Food-Specific IgE Testing

Food-specific IgE testing has similar specificity (~ 50%) but slightly lower sensitivity (> 90%) than skin testing.[10] In vitro testing is useful when skin testing is not possible; for instance, if the patient is taking antihistamines, the patient has dermatographism, a large number of allergens need to be tested, the patient is acutely ill, or the patient has active atopic dermatitis and no skin is free of inflammation. Monitoring food-specific IgE levels over time is also useful, because falling levels could indicate that the patient is outgrowing the allergy. Like the size of skin tests, the concentration of food-specific IgE does not predict the type or severity of reaction, only the probability of clinical reactivity.[48-50]

Using the ImmunoCAP system to measure food-specific IgE levels, studies have established PPV and NPV for common food allergens. These are frequently used to confirm an allergy diagnosis and to assess the risks and benefits of doing an oral food challenge. For example, an IgE level of 14 kU/L for peanut is > 95% predictive of clinical reactivity, and on the basis of this level, it would be unlikely that a patient would pass an oral food challenge.[48] An undetectable IgE level (< 0.35 kU/L) for peanut is still associated with a 20% chance of reactivity.[48]

The diagnostic levels of food-specific IgE for common allergens and associated PPVs for clinical reactivity are[15,52-54]:

Egg: In children > 2 years of age, IgE level 7 kU/L (98% PPV); in infants ≤ 2 years, IgE level 2 kU/L (95% PPV)

Milk: IgE level 15 kU/L (95% PPV)

Peanut:IgE level 14 kU/L (95% PPV)

Fish: IgE level 20 kU/L (95% PPV)

Tree nuts: IgE level 15 kU/L (95% PPV)

Soy: IgE level 30 kU/L (73% PPV)

Wheat: IgE level 26 kU/L (74% PPV)

The probability of clinical reactivity on the basis of IgE levels depends on the particular food, and these levels are not comparable between foods. Therefore, the "classes" assigned to food-specific IgE levels by many laboratories are often confusing and may not be useful in predicting reactivity.

Overdiagnosis of Food Allergy

The high rate of false positives combined with the wide commercial availability of food-specific IgE testing (particularly the food allergy panels) has led to overdiagnosis and unnecessarily restrictive diets.[10] Not only could this have a significant effect on quality of life, but it may be detrimental in children if dietary restriction affects nutrition and results in poor growth or development.

Food allergies can develop at any time; however, people uncommonly develop allergies to foods that are being regularly ingested. Cases of individuals who developed systemic reactions to food allergens that they previously tolerated after a period of strict avoidance because of atopic dermatitis have been reported.[55-57] On the basis of these observations, it is not recommended that a food be taken out of a patient's diet as a result of a positive or even high IgE level, if the patient is tolerating the food on a regular basis. Evaluation by an allergist is recommended for patients who have atopic dermatitis but the causative food is not evident. Trial elimination diets can also be useful in certain situations but should not be continued if improvement is not seen.

Tests Not Recommended for Food Allergy Diagnosis

The following tests have not been supported by scientific data from controlled studies and are therefore not recommended by the American Academy of Allergy, Asthma, and Immunology to diagnose food allergies[58]:

Applied kinesiology testing and Nambudripad's allergy elimination test;

Body chemical analysis;

Cytotoxic testing;

ELISA/ACT;

Electrodermal diagnosis;

IgG testing;

Provocation and neutralization; and

Pulse testing.

Some of these tests require ingestion or injection of the suspect allergen, which puts the patient at risk for a reaction. The European Academy of Allergy and Clinical Immunology (EAACI) published a strong statement against IgG and IgG4 testing for diagnosing food allergies.[59] Several studies have presented evidence that food-specific IgG4 simply indicates repeated exposure to specific foods, and that IgG4 in conjunction with regulatory T cells seems to be an indicator of tolerance rather than hypersensitivity.[59,60] Continue Reading


From
http://www.medscape.com/viewarticle/732184_4
03-03-2017, 05:17 PM   #34
nelsonshan
 
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I would send him peanut butter packets in his lunch every day, because it was a good source of protein, since we can't get him to eat meat. He would come home from school and snack on mixed nuts!! When we did those blood tests and got all of those allergies, we went to the ped allergist. They did the skin testing and didn't react to as many things as the blood test said, but nothing was done as a food challenge. He used to constantly rub his eyes (and we thought due to environmental allergies), but that stopped when we stopped the peanut butter/peanuts/tree nuts. So you are saying to have him food challenged? How would they see that he was reacting?? He doesn't get the rash/hives/anaphylaxis.
03-03-2017, 06:31 PM   #35
my little penguin
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In office food challenge
Is done at a hospital clinic
Typically your taken off all antihistamines prior to that for 4-10 days depends on the clinic
Then they give the kiddo increasing amounts of the suspected food allergy( very slowly -tiny amounts at first )
Over a period of 4 hours to see if the react at all to the food
Not just hives or rashes
If they get to a full serving and no reaction
They watch for another hour or so
If then no reaction
Kiddo passed and does not have true food allergies to the food

Ds tests positive to peanuts
But can eat them daily without incident
Therefore is not allergic to the food per his allergist

Please get a second opinion allergist
Most will not do blanket testing
Or pull Foods a child can eat a full serving of without an allergic reaction

You really need to know if he is allergic or not
Giving up nuts when which is an easy source of protein
When you don't have to .....

Plus if he tests positive and you avoid
Sometimes the kids blood sensitivity becomes a true allergy just by avoidance


Please DO NOT try to feed your child nuts at home .
Always follow the advice of your child's doctor
03-09-2017, 10:40 PM   #36
Pilgrim
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I'm sorry I missed this thread initially. My daughter started a pediatric dose of Humira at age 4 and the 40mg adult dose at age 5 and about 60 lbs.
She has done well with Humira. It has helped give her a more normal life. We have seen no reaction to the adult dose.
Often the reason for an allergic reaction to Remicade is the mouse protein. Humira has no mouse protein.
Our child, however, does not have any known food allergies. Not sure how that would complicate treatment. Good luck.
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