Wednesday, May 30, 2012

The three-year allergy test: a comedy of error and opinion

It’s a schizophrenic experience to write a blog covering research on a medical condition while at the same time being a patient and a parent of a child with that disease. Some days I’m writing about what’s possible at the cutting edge. Other days I’m dealing with the imperfections of medicine when it’s applied by real people.

Yesterday it was the latter. My daughter Voov had her 3-year allergy checkup at Kaiser Permanente. First time around, we saw an allergist who barely spoke English. She administered a skin prick test that showed Voov reacting to virtually every food allergen. She advised us to feed her nothing but three things (rice, broccoli, and bananas) for two years.

Can you believe that? Where did this allergist learn about nutrition? Fortunately we, as Voov’s parents, had heard of fat and protein and the idea of a balanced diet. We negotiated a list of ten or so items—including meat—and the possibility of trying a few others.

Voov eats boring food, but she doesn’t care. Her absolute favorite is potato chips. She can go through a party bowl of chips like a school of piranhas through a pig.

Two years later, Voov has her second allergy test—again, a battery of skin-prick tests—with a different allergist, because we weren’t going to put up with the first one again. Voov squirms as the pricks are made and writhes as the itch sets in. She appears to register positive only to dairy. Hooray!

But wait. After consultation it appears that Voov is not allergic to dust mites, which virtually every eczema patient reacts to. Is she really not allergic to dust mites? Let’s look at her back again. Oops—there’s a big red wheal about where the dust mite allergen was applied. Or is it?

It turns out that the tech who read the results didn’t do so in a rigorous manner. She just noted the few spots that showed positive reactions, rather than going through every spot to verify the negative locations. And immediately after reading in this shortcut fashion, she erased all the pen markings on Voov’s back with alcohol.

The allergist is left advising us that Voov is probably allergic to dust mites and dairy. But, she adds, the results of skin prick tests don’t bear much relation to what foods people really react to. Just feed the kid stuff and see if she reacts, the allergist says—and no need to wait the usual two weeks; three days is enough.

I like this idea—let’s just get on with trying foods and seeing if there’s a problem. But it’s unnerving to run into medical professionals who have different opinions—not to mention the odd opinion that is clearly wrong. I’d like to think there was something close to truth out there regarding food allergies and eczema. Unfortunately, while scientists can agree that barrier problems with eczema somehow predispose kids to develop food triggers, the best practice in the clinic seems to be to leave it up to the parents to figure out what’s causing the problem.

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