Accuracy of allergy skin test in 6 month old & eczema question

[ett]

So we took DS2, who is 6 months old, to the allergist today because he's been having eczema that won't go away. They did a skin test and tested for milk, soy, eggs, wheat, peanuts, and dust mites. It all came back negative. They also drew blood for a blood test, but we won't know the results until next week.

My question is, is the skin test pretty reliable if you test negatively? And if indeed DS is not allergic to any of these foods, then what's causing his eczema?

I'm BF'ing so since 2 weeks ago I've eliminated milk, soy, eggs, wheat, peanuts/tree nuts, and fish/shellfish out of my diet to see if I can figure out what he's allergic to. His eczema did improve slightly last week but got worse this week, so I'm not sure what's going on. Since the skin test came out negative, is it safe to try to add one of the foods I've eliminated back into my diet?

Thanks for any insight anyone may have.

[val01]

My pediatrician says that it's not 100% accurate in children under 2, and that some children never test positive to the IGE on the RAST testing. My husband was one of them.

Of course, the allergist will tell you otherwise. All I know is that my DD responds to allergy meds, and has tested negative to the usual suspects.

Valerie

[almostamom]

My DS has had a skin test and multiple RAST tests. None of the results of any of these tests were consistent. The first RAST showed that he was allergic to everything. The next one showed level 2 for corn, wheat, soy, dairy, and eggs and level 5 for peanuts. The skin test was negative for everything including peanuts. The food challenge showed he is anaphylactic to peanuts. The only test I believe now is the food challenge.

I wish I could be more helpful. Sorry.

Linda

[almostamom]

My DS has had a skin test and multiple RAST tests. None of the results of any of these tests were consistent. The first RAST showed that he was allergic to everything. The next one showed level 2 for corn, wheat, soy, dairy, and eggs and level 5 for peanuts. The skin test was negative for everything including peanuts. The food challenge showed he is anaphylactic to peanuts. The only test I believe now is the food challenge.

I wish I could be more helpful. Sorry.

Linda

[mudder17]

I agree with PP, it's not the most accurate test in the world. While the skin test and the blood test can give you some indication, as Linda implied, the food challenge is the one test that can tell you yes or no. However, even that's tricky if you haven't eliminated everything from your system that could possibly cause the problem. In my case, food was definitely one of the problems. She tested negative in her skin for all but eggs, she tested positive in her blood test for eggs and sesame, she tested negative for dairy in both. However, experiences with elimination showed me that she did have some reaction to dairy (although that seems to be getting better so that if I eat hidden dairy it doesn't seem to affect her anymore). But there's something else--environmental factors such as detergents, pollen, pet dander, etc. So it's not only food that can cause eczema but other things as well. In Mika's case, it's food and something in our house. Washing her sheets daily and changing her clothes at least once a day has made a tremendous difference in her eczema. We are still not there yet, because we do have 5 cats (don't ask how that happened). Fortunately, she does not seem to be allergic to the cats, but still, I need to try keeping things as clean as possible because I don't know what it is exactly that is affecting her eczema.

There is one other thing you can do--is the eczema worse when the skin is dry/irritated? Do you give a lot of baths or not many? Depending on the cause, more or fewer baths can help. With Mika, we don't want to give her too many because her skin is prone to drying out and that makes things worse. However, there is some suggestion that if we gave her a bath daily and put lotion on her while she was still wet, it would help. I've also done things like add a few drops of a massage oil (or olive oil when we were in a pinch) to her bath water and that does help. Rose otto oil also seems to be healing when she has a bad patch.

Ultimately, eliminating the foods and washing her sheets daily made the biggest difference. She still gets breakouts, but not nearly as bad. Oh, and I should also mention that the heat seems to exacerbate everything. Lovely, since we're in the middle of summer.

Good luck!

Eileen

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[mudder17]

I agree with PP, it's not the most accurate test in the world. While the skin test and the blood test can give you some indication, as Linda implied, the food challenge is the one test that can tell you yes or no. However, even that's tricky if you haven't eliminated everything from your system that could possibly cause the problem. In my case, food was definitely one of the problems. She tested negative in her skin for all but eggs, she tested positive in her blood test for eggs and sesame, she tested negative for dairy in both. However, experiences with elimination showed me that she did have some reaction to dairy (although that seems to be getting better so that if I eat hidden dairy it doesn't seem to affect her anymore). But there's something else--environmental factors such as detergents, pollen, pet dander, etc. So it's not only food that can cause eczema but other things as well. In Mika's case, it's food and something in our house. Washing her sheets daily and changing her clothes at least once a day has made a tremendous difference in her eczema. We are still not there yet, because we do have 5 cats (don't ask how that happened). Fortunately, she does not seem to be allergic to the cats, but still, I need to try keeping things as clean as possible because I don't know what it is exactly that is affecting her eczema.

There is one other thing you can do--is the eczema worse when the skin is dry/irritated? Do you give a lot of baths or not many? Depending on the cause, more or fewer baths can help. With Mika, we don't want to give her too many because her skin is prone to drying out and that makes things worse. However, there is some suggestion that if we gave her a bath daily and put lotion on her while she was still wet, it would help. I've also done things like add a few drops of a massage oil (or olive oil when we were in a pinch) to her bath water and that does help. Rose otto oil also seems to be healing when she has a bad patch.

Ultimately, eliminating the foods and washing her sheets daily made the biggest difference. She still gets breakouts, but not nearly as bad. Oh, and I should also mention that the heat seems to exacerbate everything. Lovely, since we're in the middle of summer.

Good luck!

Eileen

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[bubbaray]

DD#2 had/has horrible, SEVERE eczema, starting when she was just over 2mo. She screamed for 3 months, 24/7. It was horrible. She was covered, head to toe, in red, flareups. Seriously, she looked burned and nasty. I can still hear the screaming, it was like she was being tortured. It really brought our family unit to the brink.

6 drs later (including a pediatric allergist, who swore via scratch tests done at 3m that she was allergic to oatmeal, beef, dairy, eggs, peanuts, almonds, and dust mites, as well as various veggies & fruits), we finally were referred to an amazing dermatology clinic at our Children's Hospital. They told us what 5/6 of the other dr's told us -- scratch tests are NOT reliable under 2 years of age and even then, the scratch test +ve only gives you a 20% chance of a "true" positive with a food challenge. I was NOT happy to hear that, as I lived through three months of pure hell with my own diet (I'm EBFg). They told me that I could change my diet and it wouldn't make any difference. I had me the BEST Starbucks frapuccino before I even left the hospital!

They told me that eczema is multifactorial. For some patients, it is food related, but more often it is not. Sometimes its environmental (soaps, laundry detergent, things in the air such as pollen). Most often, it just "is". It often runs in families (I'm blaming DH, he has it). It is associated with allergies and asthma, but not necessarily causally.

Eczema, according to this clinic, cannot be cured. It can be treated and managed and (with any luck) outgrown, but not cured.

DD#2 had a 2w course of Keflex (because by that time, she had a number of infected areas). We use beta methasone ointment on her when she flares on her non-facial areas and 2.5% hydrocortisone ointment on her facial areas. We bathe her daily (they said we could do it multiple times a day, as long as we moisturize immediately afterward), using Cetaphil. We moisturize with either Vaseline or Aquaphor ointment. I wash our clothes in dye/perfume free detergent and double rinse her stuff (I did a vinegar rinse for a month, but don't do that now) and don't use any softener of any kind (I use dryer balls). We have Honeywell HEPA filters running in all our bedrooms now (to reduce dust mites). I don't think they make much of a difference, but they are great (but expensive) white noise machines!

For the most part, DD#2 is much more comfortable now. The main problem area is inside her ears -- she has eczema inside her ears and they must be VERY itchy b/c she's always trying to scratch them (and, no, she d/n have an ear infection, 2 drs have seen eczema inside her ears).

The clinic we go to told us that even though its "just" eczema, apparently studies have found that eczema can be an extremely debilitating condition for families of young babies. She said that in severe cases like ours, the family really suffers as much as the baby because of the screaming and sleep deprivation.

FWIW, we tried every single natural remedy. I even went to a naturopath. Nothing worked except what we're doing now. And, I'm still ticked at the allergist who insisted that she was allergic to all those foods and informed me that I either had to live on air or give her formula. All the other drs that I saw were in agreement that the benefits of BFg far outweighed any risk that my diet was contributing to her eczema. I eat my normal diet now.

Hopefully you find a treatment that works for your DS


Melissa

DD#1: 04/2004

DD#2: 01/2007

[bubbaray]

DD#2 had/has horrible, SEVERE eczema, starting when she was just over 2mo. She screamed for 3 months, 24/7. It was horrible. She was covered, head to toe, in red, flareups. Seriously, she looked burned and nasty. I can still hear the screaming, it was like she was being tortured. It really brought our family unit to the brink.

6 drs later (including a pediatric allergist, who swore via scratch tests done at 3m that she was allergic to oatmeal, beef, dairy, eggs, peanuts, almonds, and dust mites, as well as various veggies & fruits), we finally were referred to an amazing dermatology clinic at our Children's Hospital. They told us what 5/6 of the other dr's told us -- scratch tests are NOT reliable under 2 years of age and even then, the scratch test +ve only gives you a 20% chance of a "true" positive with a food challenge. I was NOT happy to hear that, as I lived through three months of pure hell with my own diet (I'm EBFg). They told me that I could change my diet and it wouldn't make any difference. I had me the BEST Starbucks frapuccino before I even left the hospital!

They told me that eczema is multifactorial. For some patients, it is food related, but more often it is not. Sometimes its environmental (soaps, laundry detergent, things in the air such as pollen). Most often, it just "is". It often runs in families (I'm blaming DH, he has it). It is associated with allergies and asthma, but not necessarily causally.

Eczema, according to this clinic, cannot be cured. It can be treated and managed and (with any luck) outgrown, but not cured.

DD#2 had a 2w course of Keflex (because by that time, she had a number of infected areas). We use beta methasone ointment on her when she flares on her non-facial areas and 2.5% hydrocortisone ointment on her facial areas. We bathe her daily (they said we could do it multiple times a day, as long as we moisturize immediately afterward), using Cetaphil. We moisturize with either Vaseline or Aquaphor ointment. I wash our clothes in dye/perfume free detergent and double rinse her stuff (I did a vinegar rinse for a month, but don't do that now) and don't use any softener of any kind (I use dryer balls). We have Honeywell HEPA filters running in all our bedrooms now (to reduce dust mites). I don't think they make much of a difference, but they are great (but expensive) white noise machines!

For the most part, DD#2 is much more comfortable now. The main problem area is inside her ears -- she has eczema inside her ears and they must be VERY itchy b/c she's always trying to scratch them (and, no, she d/n have an ear infection, 2 drs have seen eczema inside her ears).

The clinic we go to told us that even though its "just" eczema, apparently studies have found that eczema can be an extremely debilitating condition for families of young babies. She said that in severe cases like ours, the family really suffers as much as the baby because of the screaming and sleep deprivation.

FWIW, we tried every single natural remedy. I even went to a naturopath. Nothing worked except what we're doing now. And, I'm still ticked at the allergist who insisted that she was allergic to all those foods and informed me that I either had to live on air or give her formula. All the other drs that I saw were in agreement that the benefits of BFg far outweighed any risk that my diet was contributing to her eczema. I eat my normal diet now.

Hopefully you find a treatment that works for your DS


Melissa

DD#1: 04/2004

DD#2: 01/2007

[ett]

Thank you for the suggestions and experiences that you have all shared. At this point I'm going to start adding the foods I've eliminated back into my diet since the allergist said it wasn't healthy for me or the baby to stay on this elimination diet. Hopefully, I'll be able to figure out whether one of the foods is making his eczema worse. And I totally agree about the heat. It definitely exacerbates DS's eczema.

We are able to control the eczema with 1% and 2.5% hydrocortisone, but I just hate having to put that stuff on DS. We're also doing aquaphor and Aveeno oatmeal baths daily, but that alone is not enough. I will have to try the other suggestions PPs have described.

[ged]

Just wanted to add that Cerave Cream has been really helpful for us. A dermatologist friend recommended it to us.

[ilovetivo]

New article abt the different blood test accuracies:

http://www.medicalnewstoday.com/articles/77096.php

Data Show Accuracy Of ImmunoCAP(R) Is Superior To Other Specific IgE Blood Tests In The Diagnosis Of Allergies
"When quantitative evaluation was performed, the 3gAllergy Universal Module overestimated (nearly four-fold) and the Turbo-RAST assay underestimated (approximately ten-fold) the specific IgE antibody levels for peanut and soy, whereas ImmunoCAP very closely agreed with the known results. Similar results were seen with the mouse-human chimeric IgE antibody samples.

[ilovetivo]

Yes, skin tests under a year can be iffy. Environmental i don't thank can be accurate until they've been in that season for a whole year for indoor. Outdoor longer b/c they have to be playing in the environment for a whole season. Then test the next year. So like age 2 -3 for outdoor.

ETA: Same with food. You have to have had it to be tested for it. My allergist didn't count what I ate during BF as enough to test for things she wouldn't be eating now anyway. Like peanut, she won't be tested until she's 5 because she won't get it until then ...testing first...b/c test result numbers change year to year. We're just protectively avoiding peanut etc as if it's an allergy.

50% of eczema is food allergy related. For a diagnoses of allergy to a specific food, you have to take into account the skin test, the blood test and history. One of them positive or negative isn't the whole story. However, if the only positive test is if ds reacts with ingestion.

If he's super sensitive, his eczema won't clear until all traces of the food have been eliminated. Look up my other posts on allergies and you'll find other names for the foods. Once he's at "baseline" (not reacting) you can add 1 type of food back at a time.

It could take weeks for his eczema to clear. Upon re-adding it, it could take a while for it to show up again. When dd ate her allergen, eczema came back quickly (same day or so). Don't remember for breastfeeding though.

You and ds can be healthy while BF with an elimination diet. There's a whole support group on it at www.kidswithfoodallergies.com They'll help you get all the vitamins and proteins etc you need. There's mom's on there only eating like 4 foods. It's very difficult but can be done.
I eliminated dairy, peanut, tree nut, fish, shellfish, egg for a month. DD was 13 months after the month and self weaning anyway so I stopped. Very challenging to do, but doable. I was glad it was over though :) Now however, we don't have Dairy, pn, tn, f or sf in the house.

With topicals - make sure there's no allergen in it either. Cetaphil lotions, for ex, has nuts or something in it. We use Vanicream.

good luck!