The New Allergist

When the allergist walked into the room on Thursday, I was surprised. Dr. O didn't look or carry himself like a doctor at all.

Although he didn't look at all like my dad, the way he dressed and acted reminded me of Dad--just a regular guy in regular clothes, relaxed and friendly. I felt immediately at home with him.

I tried to summarize Baby E's history for him, and told him the three reasons I was there: To discuss whether further allergy testing might be appropriate, to get advice about managing Baby E's allergies, and to get some help determining whether or not we really needed to be avoiding apples.

He listened carefully. He said that he could certainly help us with those things, and that it seemed that more allergy testing would be appropriate in Baby E's situation.

Then he started explaining allergy testing to me.

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He said, "We can do a skin-prick test or an IgE blood test--the one I use is ImmunoCAP." He explained in layman's terms the pros and cons of each, and what percent accuracy each had in sensitivity and specificity.

Dr. O said that a positive result accurately identifies the presence of IgE antibodies, but that the presence of antibodies doesn't necessarily tell us whether there are clinical symptoms with that food or not. So it has to be interpreted in light of the patient's history.

Then he said, "A negative result is, oh, maybe 95% accurate. Now, you might think 95% is pretty good, and it is. But if you have a negative test result to a food you have a reaction to, that doesn't help you much. Statistics can be useful, but they don't tell you a thing about the individual patient sitting right there in front of you. The only REALLY accurate way to diagnose an allergy is through clinical history and symptoms."

He went on to say that with most allergies the triggering cause is fairly obvious, because a reaction happens pretty quickly and consistently after eating a certain food.

But, he said, then you have the whole group of delayed-reaction allergies, like with many cases of food-induced eczema.

"It's when you eat a food and get symptoms three days later that it's really hard to figure out," he said. "You're thinking, 'What did the kid eat three days ago? The same thing he eats every day. Now what?'"

"And a lot of allergists will do a skin-prick test, and when it comes back negative they'll say that means you're not allergic to that food. But you just can't diagnose eczema that way. If you remove the food from the diet and the eczema goes away, then you know you've got an allergy."

I just sat there and listened, smiling and nodding. Finally, I told him that it was refreshing to have an allergist who was more interested in the individual than in statistics. That the other two allergists we'd seen had taken the attitude that if something was rare than it must not be what was happening.

He said, "Well, that's silly. That doesn't make any sense."

I agreed.

He talked quite a bit about eczema . . . I'll post about that in a separate post for those who are interested.

In the end, we ended up deciding to do blood testing for a bunch of different foods, to try to get more information on what might be causing Baby E's reactions. Particularly we want to test for yeast, coconut, palm kernel oil, and a number of other possibilities we suspect. We're going to test vanilla, for example, just to try to pinpoint whether it is vanilla itself or the corn-derived alcohol in most vanilla extracts that may be a problem.

He also wrote a prescription to have Benadryl compounded, and for a second set of epi-pens. He thought that with Baby E's level of sensitivity it would be wise to have another set around, just in case. He also gave me a lot of information about allergies in general and coping with them to read. We're going to follow up after the test results come back.

Dr. O seemed to like and enjoy interacting with all three of my kids. When AJ coughed, he suggested we have her evaluated for asthma. With allergies on both sides of the family and all three kids having symptoms that could be allergy-related, we'll probably have some allergy testing done for everyone.

Just as we were about to leave, the allergist said, "Baby E is the first person I've seen with such extensive issues like this. I've never seen anything like it before, ever."

But the way he said it wasn't as though he didn't believe it or found it an annoyance. No, he said it more in the tone of a kid who had just been given a toaster to take apart. He said it as if he was fascinated and eager; almost as though he felt it was a privilege to have Baby E as a patient.

And that, my friends, is why I think we have finally found the right allergist.