YOUR FIRST ALLERGY APPOINTMENT: WHAT TO EXPECT
After arriving for an allergy appointment in hospital, one of the first things that happens is that your child will get weighed and measured, it’s a similar process as getting them weighed at your health centre or health visitor appointments. If they are under 2 years old this will involve removing all their clothes and nappy (so bring a couple of spares!). If they are over 2 they’ll just need to remove their coat and shoes and sit in a special weighing chair.
Once your child has been weighed and measured you are likely to be seen by a doctor. The doctor will ask you lots of questions including details of any allergic reactions or displays of sensitivities you have noticed. It’s a good idea to bring a record of any symptoms and your food diary if you’ve been keeping one (it’s a great idea to do this!). They may also take a full history of your child: including details of their birth, if they are breastfed or formula fed, how their weight has been and if they have any signs of eczema. They are likely to ask to examine your child.
The doctor may suggest your child has further tests such skin-prick tests or blood tests. These will only help with the diagnosis of an immediate (IgE-mediated) allergy and won’t assist the diagnosis of a delayed allergy.
Skin-prick tests are carried out to see how the skin reacts to an allergen. They are always carried out by a nurse or other healthcare professional. They will ask you to roll up one of your child’s sleeves or possibly both. Sometimes tests are done on your child’s back, depending on how young your child is and how many tests they are having. The healthcare professional will then draw numbers on your child’s arm. Next to each number they will drop a tiny amount of a diluted allergen. They will then prick the skin through the droplet which may feel like a tiny scratch. Once the full set has been completed you will wait for 15 minutes before they check to see if any small bumps or ‘weals’ have appeared. They will do this by looking and feeling for any raised bump. If they detect one they will get out a ruler and measure it.
What do the results mean?
The healthcare professional will explain the results to you and what they mean for your child as each case is different. Generally, the size of the weal relates to the likelihood that your child is allergic to that food – it is not a test of severity. A large weal means it is likely your child has an allergy to the food, not that they will have a severe reaction. If there is a small weal then there is a risk your child may be allergic to the food but this needs to be interpreted based on any history of previous exposure. If there is no weal the chances of your child having an allergic reaction to that allergen is small but as with any test, it has to be interpreted in the context of their clinical history. After the skin-prick testing is complete, in conjunction with your child’s medical history, the doctor may diagnose your child with an IgE-mediated food allergy.
A skin-prick test is a good guide but it’s not perfect. Some children don’t get a bump at all but react to the food when eating it, others can tolerate a food, even though a weal developed, so it’s important to talk through the results carefully with your healthcare professional so you fully understand them. It’s worth remembering, the size of the weal is not indicative of the seriousness of the allergy, or the likelihood of a serious reaction.
Blood tests also known as RAST (Radio Allergo Sorbent Test) may be carried out, especially if your child has a lot of eczema on their skin or your child has recently had antihistamine (antihistamines interfere with a skin-prick test). Blood tests measure the amount of IgE antibodies in your child’s blood but the tests only have meaning when interpreted alongside your child’s clinical history. You’ll have to wait a few days to hear the outcome, as unlike a skin prick test, the results aren’t immediate.
After your child has had their tests you might see the doctor again to have the skin-prick results explained. If you have been diagnosed with a food allergy you may also see a dietitian.
A dietitian’s role is to help your child eat a balanced diet, make sure they are getting all the nutrients they need and help guide you through planning and preparing the best foods for your child and your family. They will discuss how you feed your child. If your baby isn’t on solid foods yet (pre-weaning) they will talk about how many milk feeds they are having and discuss introducing solid food, taking their allergies into account. If your baby has a cow’s milk protein allergy and you are breastfeeding they may talk to you about your diet and whether you need to exclude dairy products. They will talk to you about how you make sure you’re getting all the right nutrients. They may also discuss milk-free formulas. A dietitian can also help you work out how to feed the family if your baby has older siblings.
You might be prescribed medicine for your child at this appointment. It could include anti-histamine, an adrenalin auto-injector (AAI), creams for eczema, inhalers for asthma or specialist baby formula. AAIs are prescribed if your doctor thinks your child is at increased risk of a severe reaction. This may be because of a history of severe reactions or because of co-existing asthma (which increases the chance of a bad reaction). Not all children with food allergy are prescribed AAIs, for example if they are very young or if they don’t have any other risk factors. A healthcare professional will explain carefully how you should use the medicine and will fill out a care plan with you.
Following your appointment, you may still be waiting for blood tests results. The doctor will write to you or arrange a follow-up consultation. If some of the results are inconclusive (for example it’s not very clear if there is an allergy or not, or possibly because there is a chance the allergy has been outgrown) the doctor may suggest you try an oral food challenge. This is where small amounts of an allergen are fed to your child in hospital to see if they can tolerate it.
How to prepare for an allergy appointment
In the video below Dee Brown who is a Clinical Specialist Nurse (Allergy and Asthma) reveals her tips for preparing for your allergy appointment.
THINGS TO TAKE TO YOUR allergy appointment
- Bring a record of any reactions you think your child might have had. This can include a rash, a period of discomfort or being unsettled, diarrhoea, vomiting, hives, swelling, itching. It can be useful to compile this into one file and include photographs of any rashes or hives as well as a written diary.
- If your child has an explosive poo or diarrhoea shortly before your appointment then a stool sample can also be helpful.
- Bring a food diary which details what they ate, both immediately before the reaction and in the 48 hours beforehand. A delayed reaction can take a while to show symptoms.
- Bring a spare set of clothes and nappies. It’s also worth bringing snacks or a meal (although be sensitive to the fact you are in an environment where there are other food allergic children) and some small books or toys. You may be there for a while!
- If you have a young child with a red book, it is useful to bring that.
- Bring any medication you have previously been prescribed. It can also help to bring your care plans. A nurse is likely to go through these with you and may do new care plans with you if anything has changed.
- It is worth asking for a refresher lesson on using an auto-adrenalin pen if you have one.
- Write a list of questions in advance. There can be a lot of information to take in, and you might forget something you really wanted to ask.
- Bring a friend or a relative. They will help you remember more of the details from the appointment.
Written by The Allergy Team, 15th March 2021
Dr Neeta Patel, Consultant Paediatrician and Allergy Lead
Professor Adam Fox, Professor of Paediatric Allergy
Dr David Mass, GP with a special interest in allergy
Disclaimer: All information provided by The Allergy Team Ltd is general information only. Please contact your GP or other qualified healthcare professionals for specific advice.