DD may have food allergies :o(

[Zizzle]

When I picked up my daughter from daycare yesterday, she was covered in pink bumps from chin to waist and complained of itching since nap time and trouble swallowing. Somehow her teachers didn't notice. I thought it might be a reaction to an unlaundered hand-me down shirt, but the rash turned into hives as the evening went on (with a different shirt on). She had Allegra before bed and woke up with pink dots and large hives all over her back...so we went to the allergist. The hives nearly resolved by the time we got there, but I had pictures on my phone for proof.

She had pretzels, raisins and celery for snack, and lentils, beef, rice and cantaloupe for lunch before the itching and rash began. I suspected the cantaloupe, since she's never really liked it until recently, and it's related to bananas (which she hates) and ragweed. The allergist said cantaloupe usually only causes oral allergy syndrome, not systemic hives. She suspected the lentils or the beef. We discussed her severe tree pollen allergies that have improved recently, and her daily loose stool.

We left with lab orders for a celiac panel and RAST testing for lentils, beef, oranges and bananas (no melon test, I guess?).
Then we went to a store and Chick-Fil-A for lunch. She had chicken nuggets, fries and a fruit cup of apples, mandarins and grapes....and she broke out in hives and rash again!! So I took her back to the allergist to update them. We left with additional lab orders for RAST tests of grape, wheat, tomato, and peanut.

Sooo, I'm new to this IgE stuff. My MIL and BIL have familial chronic idiopathic urticaria (hereditary hives for no known reason!, although I know Hashimoto's is a factor for my MIL) I hope that's not in her future.

I have one question. I discontinued nightly Zyrtec and switched to milder Allegra at night 2 days earlier. She had missed her morning dose of Allegra when this reaction happened (but it was a rainy low-pollen day). It is possible her body just freaked at the drop in antihistamine levels that she's been on since early March?

Another question. She had her last dose of Allegra last night (it's dosed every 12 hours). Will her RAST tests and celiac tests be accurate if I get her blood drawn tomorrow morning (technically 24 hours overdue for a dose)?

[Zizzle]

I got my answer on test accuracy and antihistamines. It seems the skin prick tests are affected by antihistamines. Many docs order RAST blood tests so their patients don't have to take a break from their antihistamine regimen. Phew.

[Leah]

So sorry to hear that your daughter is suffering :( When I was young, I had hives and swollen face and throat reaction to certain foods. Now, I barely make IgE and have no allergies. Weird.

[jmayk8]

ohh no! Im sorry to hear that...
It's a terrible thing what all of us PP are going thru but, it really just hurts my heart to hear about children and food allergies-it's just not fair!
Jenny

[Zizzle]

We got blood tests today for celiac and several food allergies (RAST). She was so good through it all, it killed me to drop her off at daycare afterwards. I cried the whole way into work.

I think I understand what's happening now...

Her allergist says most kids are growing out of allergies at her age, not adding them, so I think this may be a result of gluten-induced leaky gut. She's had loose stool every day for months now. Last year she had a bout of shiga-toxin producing e-coli from Guatemala. Add my celiac genes and my MC altered flora passed on at birth, and you have a toxic cocktail!! It's a small wonder her brain is not affected.

Tex said:

This is how celiac disease begins, by continued exposure to gluten, (in the presence of certain other environmental influences). Intestinal permeability becomes progressively more severe, with repeated exposure, until it finally becomes sufficient to allow peptides to cross the barrier. After the gut becomes leaky, the disease develops more rapidly, and the familiar clinical symptoms show up. By this point, a lot of damage has been done.

My thinking is, with a leaky gut, food proteins can cross the intestinal barrier and cause IgE allergic responses too, especially in an allergy-oriented kid. Ugh.

[Zizzle]

http://www.peoplespharmacy.com/2010/05/ ... ithdrawal/

http://www.consumeraffairs.com/rx/zyrtec.html

Omg, I knew I had read this somewhere. DD is suffering from Zyrtec withdrawal!!  The itching and hives are all related and her allergist didn't make the connection!  I stopped her bedtime Zyrtec dose and switched to Allegra 2 days before this started.  On the day of her big reaction I missed the morning Allegra too, so it wasn't helping suppress the Post-Zyrtec symptoms. Makes perfect sense!  She still has little bumps on her back, as some people mention. 

I'm still glad we got the celiac and allergy testing, but I strongly suspect this was a rebound effect immune freak out which is being helped by her daily Allegra now.

Beware of Zyrtec!! I hate all medications!!!!

Now to wean her off Allegra now that her pollen allergies are winding down....

[jmayk8]

OMG!
That's such good news AND great detective work on your part!

[Martha]

Oh my goodness, Zizzle! Here you were trying to figure out what your daughter had eaten that caused her symptoms, and all the time it was what she hadn't eaten! You'll have to go slow to wean her off the meds, it looks like.

Love,
Martha

[tex]

Wow! Great detective work, Zizzle!

Thanks for the headsup.

Tex

[Zizzle]

Blood tests came back…

She tested mildly allergic to strawberries, peanut and lentils. She needs skin allergy testing for them now, but she must be off antihistamines for 8 days to do it, so we’ll wait until late May. They say it is possible to have a mild peanut allergy (non-anaphylactic). I still believe going off Zyrtec made her more reactive. "Her IgG levels were elevated, indicating allergy." Could this be tree pollen related? Does this mean she has delayed food allergies as opposed to immediate IgE allergies? Could the IgG allergies be causing her loose stool and undigested food?

She was negative for beef, orange, banana, tomato, wheat and grape. And her celiac panel was negative. Phew!! (for now)

Incidentally, her school serves lentils and rice at least once a week, and they always come out the other end whole!! I'm always telling her to chew her food instead of swallowing it whole! Oops!

[Zizzle]

Whoa! I had no idea lentils were so allergenic!! And they seem to cross-react with peas (which my daughter hates and excretes whole), and peanuts! It seems we have a legume problem!

http://www.allallergy.net/fapaidfind.cfm?cdeoc=863

Ranked 4th as a cause of hypersensitivity reactions in Spanish children, and 5th in India. Antigens are heat-stable. Lentils seem to be the most common legume implicated in pediatric allergic patients in the Mediterranean area. In this study, lentil allergic children had urticaria and OAS as the most frequent symptoms. (Sanchez-Monge 2000 ref.3996 6) In a Spanish study, 10.1% of 355 pediatric patients with food allergy had a convincing history of allergy to lentils. (Crespo 1995 ref.1304 2)

In a Spanish study, in 20 of 22 subjects who experienced allergy symptoms following exposure to lentils, the most frequent symptoms were oropharyngeal symptoms (40%) and acute urticaria (30%); 3 patients also reported symptoms when they were exposed to steam from cooked lentils. Onset of sensitisation occurred less than 4 years of age and 9 patients had allergic reactions to other legumes: chick peas (6 patients), peas (2 patients), and green beans (1 patient). (Pascual 1999 ref.7341 3)

Urticaria, angioedema, abdominal symptoms and rhinoconjunctivitis and/or asthma following ingestion or inhalation of vapours from cooked legumes (lentil, bean or chick-pea). Lentil was found to induce the most severe reactions. (Carrillo 1986 ref.2349 6)

[tex]

Could this be tree pollen related? Does this mean she has delayed food allergies as opposed to immediate IgE allergies? Could the IgG allergies be causing her loose stool and undigested food?

Tree pollen allergy is typically associated with an increase in IgE and in eosinophils and/or neutrophils, (both of which can release histamines). Was her eosinophil and/or neutrophil count elevated? That would suggest a pollen allergy.

The presence of IgG antibodies is associated with a chronic reaction. Yes, they can be associated with digestive issues. For example, the serum screening test for celiac disease is based on a combination of IgA and IgG antibodies.

I agree that you're probably correct about the legumes.

Tex

[Zizzle]

I don't have the results yet, so I don't know what else they measured. We already know she has massive tree pollen allergy, so I was wondering if that raised the IgG, rather than the foods.

More than 50 percent of people who are allergic to lentils also have an allergy to peas and chickpeas. Cross-reactivity with peanuts is not as common; however, in the United States, allergy to peanuts is more common than allergy to lentils.

Read more: http://www.livestrong.com/article/48409 ... z1tGcdr3Mj

I guess I'll stop buying hummus now.

I hope she doesn't react to black and kidney beans! We'll all starve!

[tex]

We already know she has massive tree pollen allergy, so I was wondering if that raised the IgG, rather than the foods.

I believe both can cause an elevated IgG level, though it probably takes longer, for food-sensitivities. If pollen allergies are active, yes, I believe that it's possible that they may dominate the IgG production, but I'm only guessing about that possibility/probability.

Tex

[Zizzle]

I read up on lentil allergy. Sadly it seems only one team of researchers in Spain has studied it, but DD has Spanish and Italian genes, so it certainly applies here. DD continues to have mild allergic symptoms with some meals -- an itchy or sore upper lip, "not feeling well," increasing pickyness about what she'll eat, and increasing bowel urgency and loose stool. Although she did have a firmer stool yesterday. I strongly suspect a legume problem now, including lentils, chickpeas, peas, peanuts, and *perhaps* soy. It seems once you have one, the othes follow, particularly if you are exposed often. Hence, more peanut and soy allergies in the USA compared to Spain. Learning more about their structure, it doesn't surprise me that many with MC don't tolerate them well (including me). I note that green beans, white, red and black beans are not as closely related as the others, and rarely cause cross-reactive allergies (phew). I tolerate those other beans quite well, and DD has a new found love for Bush's Baked Beans (which are all gluten free!)

I also learned that this particular legume allergy is more common among people with tree pollen allergy!!

Allergol Immunopathol (Madr). 2003 May-Jun;31(3):151-61.
[Legume cross-reactivity].
[Article in Spanish]
Ibáñez MD, Martínez M, Sánchez JJ, Fernández-Caldas E.
SourceServicio de Alergia del Hospital Niño Jesús, Madrid. Spain.

Abstract
Legumes are dicotyledonous plants belonging to the Fabales order. The main distinctive characteristic of which is their fruit (legumen, seeds contained in pods). This botanical order is formed by three families: Mimosaceae, Caesalpiniaceae and Papilionaceae or Fabacea. The Papilionaceae family includes the most important allergenic species: Lens culinaris (lentil), Cicer arietinum (chick-pea), Pisum sátivum (pea), Arachis hipogea (peanut), Phaseolus vulgaris (bean) y Glycine max (soy). Legumes are an important ingredient in the Mediterranean diet. Among Spanish children, sensitivity to legumes is the fifth most prevalent food allergy. Lentil and chick-pea are the most frequent cause of allergic reactions to legumes in Spanish children. Legumes could be involved in severe allergic symptoms. The different legumes have structurally homologous proteins, but they are not all equally allergenic, thus making it difficult to distinguish in vitro and in vivo cross-reactivity. We have demonstrated by skin tests and CAP that most of the patients are sensitised to more than one species. We have demonstrated a great degree of cross-reactivity among lentil, chick-pea, pea and peanut by ELISA inhibition (> 50 % max. inhibition). Unlike the Anglo-Saxons population, this phenomenon implies clinical sensitisation for many Spanish children. The majority of our patients have had symptoms with more than one legume (median 3 legumes). Thirty-nine patients were challenged (open or simple blind) with two or more legumes and 32 (82 %) reacted to two or more legumes: 43,5 % to 3, 25,6 % to 2, 13 % to 4 legumes. Seventy three per cent of the patients challenged with lentil and pea had positive challenge to both, 69,4 % to lentil and chick-pea, 60 % to chick-pea and 64,3 % to lentil, chick-pea and pea simultaneously. Peanut allergy peanut can be associated to allergy to lentil, chick-pea and pea but less frequently. Contrarily, white bean and overall green bean and soy are well tolerated by children allergic to other legumes. In our study, 82 % of the children allergic to legumes had a sensitisation to pollen. Pea and bean are the legumes with more in vitro cross-reactivity with Lolium perenne, Olea europea and Betula alba. This cross-reactivity could be because of common antigenic determinants or due to the coexistence of pollen and legume allergy. Panallergens implication seems to be less probable. It is important to emphasize that in spite of an evident clinical and immunological cross-reactivity, the diagnosis of legume allergy should not be based only on specific IgE tests. The decision to eliminate one legume from the diet should be based on a positive oral food challenge.