Pediatric Allergist?

[elizabethkott]

JJ's doctor has referred us to a pediatric allergist (finally!). We're going on May 2nd. When I made the appointment, the nurse said she would be sending me a packet of stuff as well as a list of antihistamines to avoid for 5 days prior to the appointment. All I can think is that the poor kiddo is going to be m.i.s.e.r.a.b.l.e. leading up to this appointment. :(
What can I expect from this appointment? I'd like to try and prepare him if there will be an excessive number of needles involved...

[BabyMine]

We had a great allergist for M. The first appointment he brought toys in and played with (examined) him. After that he gave us a list of skin tests he wanted M to have. We scheduled that a week later and another department in his office did those. M was 3 at the time and did pretty well. It's the skin tests he had a 4 that he had a harder time with.

[Wondermom]

You should call and find out what, if any, tests will be performed to confirm whether your kid really needs to be off of all the antihistimines. Both my sons have been to pedi allergist--as infants. Both have had to have skin tests (little needle pokes in the back to see if they were allergic to x, y, z substances. You do need to be OFF any antihistime meds for the skin tests, but if it's just a first-time consultation-type visit with no tests involved, maybe they'll say it's fine to keep taking the antihistimines.

Good luck to you and your DC! My older one had several visit after he had what we thought was a severe allergic reaction. Over time, he was tested for all the common allergens. He never tested positive for anything, and he's fine now. Yay. The younger one has a definite peanut allergy, and mild allergy to other nuts, so we'll be seeing the pedi allergist at least once a year.

[bubbaray]

Where to start?! Just got back from spending the morning at the ped. allergist. We've also been to a ped. allergist in private practice, but MUCH prefer the hospital-based one. Both my girls go to this ped. allergist, and he has a double-specialty, so he also treats DD#1's asthma.

Needles. Yes, there will be some. Both of the ped. allergists that we've been to do skin testing. The first one we went to did a large panel, regardless of history. Interestingly, he did not include all of the top 9 allergens (and he totally missed DD#2's fish anaphylaxis, which is part of the reason we didn't continue with him).

Our current allergist does a selective panel based upon history. I MUCH prefer this method. He also does not repeat the panel at every visit. For example, DD#1 has been going to him for 2 yrs and he just did another panel on her today -- and it was a very small panel, just trees. DD#1 is fine with the panels now -- has them done on her arm, doesn't play with them.

DD#2, OTOH, is brutal with panels and I cringe when he wants to do them. OMG. It is an ordeal. She still gets hers on the back.

Our current ped. allergist is big on RAST testing too. So, they get regular blood draws and specific RAST panels at the first visit (based upon the history and skin tests) and 1m prior to any subsequent food challenge.

DD#1's visits are LOOOOONG because there is always asthma testing, which involves treadmill testing, etc. That is about 2hrs. They do the allergy stuff in between.

Our instructions are detailed with what to avoid. In allergy season, I ignore the restriction re antihistamines. They did the allergy testing today anyway, they just were extra careful with the control (ie., they did the control first, and if it showed a rxn, then they could proceed with the other testing). However, this wasn't a first visit and the panel was very small. DD#1's current symptoms are pretty bad and there is NO WAY she could be antihistamine free at this time of year and not end up in the ER with her asthma.

I'm happy to answer any questions if I can.

[MSWR0319]

At our first appointment (DS was 23 months) they told us to go off antihistamine as well. When we got there, he ended up not getting any testing done. Our allergist was ok with waiting a year and saw no point in putting him through the skin test/more RAST when he just had the blood draw a few weeks earlier. We have a long lists of foods to avoid, and he gave us a lot of helpful information. At our next appointment, he will have to have all of the testing done. So you may want to call and double check to see what will be done.

FWIW, I don't know if it's like this with all allergists, but our skin testing/back prick is done with plastic applicators, not actual needles. So the only needle he encounters is the one for the blood draw.

[elizabethkott]

Where to start?! Just got back from spending the morning at the ped. allergist. We've also been to a ped. allergist in private practice, but MUCH prefer the hospital-based one. Both my girls go to this ped. allergist, and he has a double-specialty, so he also treats DD#1's asthma.

Needles. Yes, there will be some. Both of the ped. allergists that we've been to do skin testing. The first one we went to did a large panel, regardless of history. Interestingly, he did not include all of the top 9 allergens (and he totally missed DD#2's fish anaphylaxis, which is part of the reason we didn't continue with him).

Our current allergist does a selective panel based upon history. I MUCH prefer this method. He also does not repeat the panel at every visit. For example, DD#1 has been going to him for 2 yrs and he just did another panel on her today -- and it was a very small panel, just trees. DD#1 is fine with the panels now -- has them done on her arm, doesn't play with them.

DD#2, OTOH, is brutal with panels and I cringe when he wants to do them. OMG. It is an ordeal. She still gets hers on the back.

Our current ped. allergist is big on RAST testing too. So, they get regular blood draws and specific RAST panels at the first visit (based upon the history and skin tests) and 1m prior to any subsequent food challenge.

DD#1's visits are LOOOOONG because there is always asthma testing, which involves treadmill testing, etc. That is about 2hrs. They do the allergy stuff in between.

Our instructions are detailed with what to avoid. In allergy season, I ignore the restriction re antihistamines. They did the allergy testing today anyway, they just were extra careful with the control (ie., they did the control first, and if it showed a rxn, then they could proceed with the other testing). However, this wasn't a first visit and the panel was very small. DD#1's current symptoms are pretty bad and there is NO WAY she could be antihistamine free at this time of year and not end up in the ER with her asthma.

I'm happy to answer any questions if I can.

See, your last part is what concerns me - his asthma. He's currently on albuterol and pulmacort to deal with the most recent flair up, PLUS children's zyrtec PLUS singulair. I have a bad, bad feeling that if I take him off the zyrtec and the singulair, I'm going to wind up in the ER like I did about a week and a half ago with a kid who literally can't breathe. In talking to the woman on the phone, she seemed VERY ADAMANT that he be off the antihistamine for that many days.
What do the panels entail? And why do they have to be on the back? Sorry I'm so clueless!

[lablover]

Are you sure he has to be off singulair? When my DD was on singulair I never had to stop that prior to allergy testing. It isn't an antihistamine. From your list, I would think the only thing you need to stop is the zyrtec. DD has had skin testing on both her back and her arms, depending on the dr. Most prefer the back so that the child can't mess with it/scratch it (the control and any positives can get itchy). If he is on all the meds due to the spring pollen could you postpone the appt a little bit?

[bubbaray]

See, your last part is what concerns me - his asthma. He's currently on albuterol and pulmacort to deal with the most recent flair up, PLUS children's zyrtec PLUS singulair. I have a bad, bad feeling that if I take him off the zyrtec and the singulair, I'm going to wind up in the ER like I did about a week and a half ago with a kid who literally can't breathe. In talking to the woman on the phone, she seemed VERY ADAMANT that he be off the antihistamine for that many days.
What do the panels entail? And why do they have to be on the back? Sorry I'm so clueless!


Reading from our instructions, DD#1 was to continue (as applicable): pulmicort, flovent, beclovent, singulair and accolate. Do not take on the day of appt (unless absolutely necessary): ventolin, bricanyl. Discontinue (only typing in what you use b/c its a loooong list): Reactine (what you call zyrtec) 4 days prior to appt.

I would try taking him off the Zyrtec but keep him on the Singulair and Pulmicort as he is currently prescribed. If he needs the ventolin (albuterol), then use it, but try to avoid it on the day of the appt if possible.

Don't forget running shoes and shorts for a treadmill test.

The skin panels don't have to be on the back, but that is what they do on smaller/younger kids for 2 reasons -- they can't reach to scratch AND its a larger area to do the tests (if they do a full panel, its a LOT of tests). On adults, if they do a full panel, they often use both arms. FWIW, neither of my girls has every had a full panel, always partial. But, even with the partials they take up a fair bit of room.

ETA: skin prick testing can vary. Some docs eye dropper the fluid onto the skin, then scratch with a needle. Our doc uses a one-use plastic scraper to both place and scratch at the same time.