Thursday, September 1, 2011

Annual Allergy Visit

Alexa had her annual allergy visit this week.  If you have never been through the experience here is what it looks like for us.  The process is a little different in NYC than it was in Boston.  In Boston our Dr. would order blood work a week before the appointment so when we arrived we could review the results and determine which items to skin test.  In NYC we arrive without prior blood work, discuss the previous year's events, evaluate what foods we want to test and the blood work comes later. Also, in Boston, they used these plastic plates with little "prongs" on them.  They would load up the panel and then apply it to her back.  She could lay on her tummy and watch TV while waiting for results.  It made it more comfortable for her and harder for her to scratch if it was itchy. In NYC they use the "fork" method on her arms.  OUCH.   Honestly, I prefer the Boston method but not much I can do about that since we are in NYC ;-) Anyhoo, here is a run down of the appointment.   The nurse weighed and measured Alexa and put is in a room to wait for the Dr.  When she arrived I spoke with her about Alexa's year and some challenges we experienced.  I gave her a summary of Alexa's last reaction which required an ER visit and epinephrine.  She actually was upset and shocked that the ER doctor did not administer Epinephrine right away.  She was additionally shocked to hear I had to request Epinephrine but was very please to hear that I did.  She reassured me that I absolutely did the right thing and that in the future I should go with my gut and give her the Epinephrine myself.  I assured her I would never hesitate again and that I learned a valuable lesson.  We also reviewed the new foods she's been eating (kidney beans, white beans, some baked egg) and discussed foods we'd like to add (soy, chickpea, peas).  She surprised me by asking if I wanted to skin test tree nuts.  I was told if you are allergic to one tree nut avoid them all.  The Dr. explained that there is a peanut safe Almond butter on the market and that pistachios are also a good option for some peanut allergic people.  I like the idea of adding new foods to her diet so I agreed.  After discussing the food items we also talked about her asthma and reevaluated our treatment plan.  Basically we agreed on a nebulizer and an increase in some of her medications.  One major thing I learned is that I should not be waiting to have her cough evaluated.  She explained that even with a "virus" type cough if she is not better in 3 days she should get steroids and be seen.  In the past I would wait closer to 5 days because I had been told "kids coughs can last a long time".  Also, her pediatrician prescribed us a cough medicine with codeine instead of steroids because she wasn't wheezing.  Dr. Kim stated that this is not the right approach.  That even though her lungs sound clear there is inflammation which needs to be addressed and the codeine is just masking it not helping it! wow.  The Dr. explained that a child with asthma needs to be treated more aggressively than a non asthmatic.  Lesson learned!!  We moved on to the skin tests.  She skin tested: egg, soy, green pea, almond, dust mite, grass, ragweed, birch, aspergillus, chickpea, lentil, black bean, pine nut, and pistachio.  There were some great surprises with these results, she is no longer allergic to dust mites and tested negative to black beans, grass and aspergillus.  Egg, lentil, birch and soy were the largest positive "welts".   Green pea, almond, ragweed, chickpea, pine nut and pistachio were all small reactions so we will wait for blood tests before proceeding with food challenges on those items.  Alexa really wants to add soy to her diet but based on her skin tests I'm not sure she's ready.  It is a wait and see game now ;-) I am excited to bring black beans into our rotation.  My husband immediately texted me Black Bean Soup! in response to her negative test but I'm excited about the black bean brownies my girlfriend told me about! Thanks Cari!! I've posted a photo of her arm after the skin tests for those who haven't what these kids endure with their allergies.  

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