Day 16: Allergy Testing

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This is Day 16 in the series: 31 days on Living with ADHD, Autism and Sensory Processing Disorder: What We Have Tried, What Has Worked, What Hasn’t Worked, and Never Giving Up. 

A few months ago Mr Rockstar’s psychiatrist suggested we try an elimination diet to see if it might help with his behavior.  I found there was good research (read my summary here) to support the psychiatrist’s suggestion.  As we started our elimination diet, it all seemed so complicated.  The longer we did the diet the more I wondered if we should’t have first had Mr Rockstar allergy tested.  Our elimination diet excluded Casein, Chocolate, Citrus, Corn, Dairy, Egg, Gluten, High Salicylate Food, Legumes, Peanuts, Soy, Sugar, Yeast, Artificial Food Color, and Artificial Preservatives.

I know there is a difference between food sensitivities and food allergies.  But still I kept wondering, what if Mr Rockstar has a mild allergy to some food we aren’t eliminating?  He has had a few very minor indications he might have some allergies.

Near the end of the elimination diet a reader sent me this article which was posted in her doctor’s office:

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Here is a zoomed in picture of the Common Cross-Reactions listed in this article:

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I had never heard of oral allergy syndrome so I did some more research.  According to an article on Webmd “in oral allergy syndrome, your immune system treats proteins similar to those in pollen that are sometimes found in fruits or vegetables the same way. It’s as if it says, “Close enough!” and attacks it. That’s called cross-reactivity.

“Ragweed Allergy: “Ragweed, in theory, cross-reacts with bananas and melons, so people with ragweed allergies may react to honeydew, cantaloupe, and watermelons, or tomatoes,” says Warren V. Filley, MD, from the Oklahoma Allergy & Asthma Clinic in Oklahoma City.

Zucchini, sunflower seeds, dandelions, chamomile tea, and echinacea also go on that list.

Birch Pollen Allergy: People with birch pollen allergies may react to kiwi, apples, pears, peaches, plums, coriander, fennel, parsley, celery, cherries, carrots, hazelnuts, and almonds.

Grass Allergy: People with grass allergy may react to peaches, celery, tomatoes, melons, and oranges, according to the AAAAI.

Latex Rubber Allergy: Like pollen allergy, people allergic to latex rubber may react to bananas, avocados, kiwi, chestnut, and papaya.”

This confirmed what I had suspected all along.  What if Mr Rockstar was allergic to tree or grass pollen (which we strongly suspected since he breaks out in a rash on his feet every spring after playing outside)?  Then should we have avoided celery in our diet!?! Of course no one says you need to avoid celery on an elimination diet so we were eating it from day 1 of the diet.  Or maybe he is allergic to birch pollen and here we are eating a ton of apples, carrots, celery, hazelnuts, pears, etc.

On a side note…cooking, peeling, and canning all alter the proteins in foods so some foods that are oral allergy issues for Mr Rockstar might be ok after being cooked, peeled, or canned.

Allergic Reactions

When I first took Mr Rockstar to an allergist 4 weeks ago I felt like the doctor might laugh at me and call me crazy.  As far as allergic reactions/symptoms go, Mr Rockstar has almost none….at least nothing severe enough to warrant extensive allergy testing.  Thankfully the doctor was a referral from a friend and he was great!  He understood when I explained Mr Rockstar’s behavioral issues, ADHD, SPD, etc that I just needed to rule out mild allergies.  The doctor said he HAD seen a number of kids over the years who DID in fact have food allergies causing some of their behavioral/ADHD issues.  Also, given our family history of environmental allergies, Mr Rockstar has a 90% chance of developing allergies.  Mr Rockstar’s allergy symptoms are:

  1. He had a pretty severe allergic reaction when he was 2.5 yo (see picture at top of this post).  We never did figure out what caused it and it never happened again.  His lips and ears swelled up and it lasted a few hours.
  2. When he was a baby he would break out around his face if he ate peaches.  I waited 6 months and gave him peaches again and he seemed fine.
  3. In the spring Mr Rockstar breaks out in a fine rash on his feet and hands.
  4. Mr Rockstar gets eczema in the fall/winter
  5. Mr Rockstar has a pretty constant runny nose for months on end.  I had actually talked to my allergist about this when Mr Rockstar was 2.  My doctor at the time said the standard practice for kids with mild allergies was to just treat with an antihistamine like Zyrtec and if the runny nose went away then you know it is allergies and just keep giving him the Zyrtec.  I did try this and it did help with the runny nose but after finishing off a bottle of Zyrtec I stopped to see if the runny nose came back.  It did after a while but at the time since it didn’t seem to bother Mr Rockstar much, I would rather not be medicating him daily.

Allergy Testing

There are two types of tests you can have done these days.  You can have a blood test, where they take a blood sample and then measure the level of allergy specific anti-bodies in your blood.  This is usually the route they go with children because it is one poke vs the skin testing which is a ton of pricks.  The blood test is less sensitive than the skin test at determining very minor allergies.  Because we were looking for very subtle allergies the allergist recommended Mr Rockstar have the skin test.

When we saw the allergist, his recommendation was a full panel of foods and environmental allergens as well as a breathing test.  To test 30 environmental allergens and 60 foods we had to go three separate times.  Mr Rockstar only has so much space on his back for them to poke!  Thankfully they can load 10 allergens into a cartridge to all prick at once.  So each time we went he got 3 pricks, each with 10 smaller pricks in the cartridge.

With each pinprick there is also a drop of liquid that contains whatever allergen is being tested.
With each pinprick there is also a drop of liquid that contains whatever allergen is being tested.

The first week Mr Rockstar was tested, he didn’t know what was coming so he didn’t make much fuss.  So I wasn’t prepared for week two when he got quite upset and it took us a while to calm him down enough to do the test.  Thankfully the nurses were able to do it super fast (they can do all 30 in about the same time it takes to get a flu shot).  By the third week he was an old pro; I took his sisters with us and he wanted to show them how “brave” he was.

After getting his back pricked he had to sit for 15 minutes without touching his back.  We took the iPad so he could watch a movie while he waited.  The pain from the pricks goes away almost immediately.  There is always one test that is a histamine…and everyone should react to the histamine since it is the control for the test.  So even if he wasn’t allergic to anything they are testing him for (the first week he wasn’t), he still had one annoying itchy spot for those 15 minutes before they came in and wiped his back clean.

Histamine reaction
Histamine reaction

Results

The breathing test indicated Mr Rockstar probably has allergies but not asthma.  For the skin tests he only got very small indications for a handful of things.  But because of the breathing test results the doctors were pretty confident he really is allergic to a number of the items that showed up in testing

The doctor said Mr Rockstar was definitely mildly allergic to Spinach and Cats.  Seriously spinach!?!  After I just let the kids watch a few episodes of Popeye to hype of the nutritional value of spinach.  Sigh.  Also, he had a very small reaction to Peaches, Timothy Grass, Birchwood, and Pigweed.

The doctor suggested we try a month of no spinach or peaches to see if that helps Mr Rockstar’s runny nose clear up.  Guess what I found has spinach in it?  The only vitamins I have found that have no artificial food colors yet still have a high does of iron.  Sigh.  I guess we will go back to Flintstone.  Anyone know of a good vitamin out there with iron, no spinach, and no artificial food colors?

Based on the info in the article above, Mr Rockstar should try to avoid:

  • Birch wood allergy: apples, almonds, carrots, celery, cherries, hazelnuts, kiwi, peaches (is it just a coincidence he is middy allergic to peaches and birch wood?), pears, plums, coriander, fennel, and parsley
  • Grass Pollen: celery, melons, oranges, peaches, and tomatoes
  • Pigweed – If the same applies to pigweed as it does to the more common ragweed allergen then: bananas, cucumbers, melons, sunflower seeds, zucchini, honeydew, cantaloupe, watermelon, and tomatoes.

Elimination Diet

While we were on our elimination diet, our consumption of fresh fruits (especially bananas, pears, and apples), vegetables (celery, carrots, spinach), spices (coriander, fennel and parsley were a few of the “ok” spices), and nuts/seeds (excluding peanuts and also almonds early on) went way up.  Mr Rockstar’s behavior also got A LOT worse.  At first I thought he was just having withdrawal symptoms….and maybe that was part of it but now I am thinking maybe we unwittingly increased the consumption of foods he was mildly allergic to?  If he had oral allergy syndrome to go along with his mild allergies then these foods would give him a mildly itchy mouth and throat.  Given his sensory issues I can imagine this would drive him crazy!  Plus I noticed his runny nose got worse while on the diet….but maybe that is just seasonal.

For the next month we will cut out Spinach and Peaches plus attempt to eliminate Cherries, Hazelnuts, Kiwi, Plums, Coriander, Fennel, Parsley, Melons, Cucumbers, Sunflower Seeds, Zucchini, Honeydew, and Chamomile Tea

Apples, almonds, carrots, celery, oranges, tomatoes, bananas, pears, and watermelon were all included in the allergy testing for Mr Rockstar and came up negative.  Based on this I highly doubt he could have a negative skin test and still have an oral allergy to these foods so I am not going to worry about these.  Also the Cherries, Hazelnuts, Kiwi, Plums, Coriander, Fennel, Parsley, Melons, Cucumbers, Sunflower Seeds, Zucchini, Honeydew, and Chamomile Tea are probably ok if they are cooked so the proteins are broken down so I may give him some of these foods in small quantities if cooked.

After a month of tailored elimination diet, we will see if there was any benefit to Mr Rockstar (either behaviorally or with his runny nose) and then try to reintroduce each food.  Once we know what if any of these fruits or vegetables Mr Rockstar might have a reaction to I plan to try the Elimination Diet again armed with more information.  Depending on who you read some people say you need 1-2 weeks before reintroducing foods and other people say 4-6 weeks.  The first go around we made it about 2 weeks before reintroduction started.  Next time I would like to make it 4 weeks.  I am also thinking I might have a separate Salicylate challenge since removing high salicylate foods from our diet was the hardest part of the elimination diet.

Any suggestions?

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