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Anaphylaxis reaction, but tested negative
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queencat0730 posted:
I am hoping someone here can help me out. About two weeks ago we took our family to a japanese hibatchi restaurant. We ordered the kids chicken, with rice and noodles. The meal came with a shrimp appitizer. My daughter's plate was closest to the cooking top so we had the guy put everything on her plate and then we split it with the kids. During the meal, my daughter, who had been eating a lot of food, stopped eating and told me she was done. She started looking tired and went to curl up in my mother's lap. We finished dinner and went home. As we were getting her ready for bed, my husband noticed that our daughter couldn't close her mouth and she was drooling. Then I noticed that she couldn't close her mouth because her tongue was swollen. We went to the er and the doctors there confirmed she was having an anaphylaxis reaction. They treated her and she was released from the hospital. During the week, she went to her primary doctor and he prescribed us an epi-pen and gave us a script for a blood test for food and environment because allergies run in my family. The test results came back yesterday and she tested through the roof for dog hair, but not for any food allergies. Could the blood test not show an allergy to shellfish? We have a dog that we have had for several months. My daughter kisses and pets the dog all the time. I am mildly allergic to the dog so I know what happens when I just pet the dog too much and my daughter has never had a reaction to the dog. Could the test results be wrong? Should I ask my daughter's doctor to send us to an allergist anyway?
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DUKE MEDICINE
Michael H Land, MD responded:
Dear Queencat,

I think it's time to talk to an allergist. Even if you have undetected IgE levels, if you have a strong history of a reaction, it is possible that your level of specific IgE might just be below the level detected by the test (for example, some labs report <0.35, but what if your level was 0.34). I wouldn't say that they are "wrong" but it may be that the test results aren't as supportive of her history.

In patients who have a STRONG clinical history of a reaction, pursuing other testing (i.e. confirmatory skin testing) may be helpful in your case. It is important (I don't believe you mentioned) if this was the first time she might have eaten any of these foods like shrimp (or sesame seeds, often used in this type of food). It is possible that it was not an allergic reaction but more of an effect of a food additive like MSG (commonly known as asian restaurant syndrome) or something else.

Nevertheless, unfortunately, it is impossible to make this diagnosis over the web--you'll have to talk to an allergist to really get to the bottom of this. I would highly suggest going to a Board Certified specialist who has trained in Allergy and Immunology.

Good luck, and let us know what happens.
Michael
 
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mrswhitecastle responded:
I just wanted to say that your experience was really, really similar to what happened to my daughter in regards to tree nuts.

After eating some cashews, she had an anaphylactic reaction, we took her to the ER, and we got the Epi Pen. We took her to the pedi, did the blood test, and she tested negative for tree nuts. She IS severely allergic to tree nuts.

Please do as the doctor posted -- TAKE HER TO AN ALLERGIST. A pedi tries to help, but they just don't know it all.

If we had listened to our pedi, we would have thrown away the Epi Pen and wouldn't have avoided nuts. I shudder to think what could have happened.

I asked my allergist why her blood test would have been negative. The allergist said that it some cases, after a severe reaction like that, it is not uncommon to then get a negative blood test. For an accurate blood test, our allergist would wait for several months after a reaction to perform a blood test that she would consider reliable.

An allergist will help you to correctly identify what it is that caused the reaction and what you can do to avoid one in the future.
 
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jellybeanasmommy responded:
Another possibility, which I have encountered with my daughter, is cross-contamination. My daughter is not allergic to shrimp, but she is allergic to shellfish - clams, oysters, crab, lobster, etc. A lot of the time these items are stored together or cooked on the same surface and can cause a reaction. Allergy tests measure an immune/histamine response. Our allergist told us that allergy tests are not 100% and to go off of our daughters responses to allergens regardless of what the test results say. If she has a reaction to a food, then don't give it to her - even if it's not on the list.

I third the recommendation to seek out an allergist, they are specially trained to diagnose and treat these conditions and should give you some insight into how it all works.
 
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An_253529 replied to mrswhitecastle's response:
Thank you very much for this information! I just got done with this exact experience!! My daughter, one week ago, ate a small handful of cashews and immediately started complaining that it was "too spicy", she's 4 so doesn't yet completely understand spicy foods. She immediately swelled up, got red, itchy and broke out in hives but didn't have swelling in the throat, so I'm not even sure if it would qualify as an anaphalactic reaction. After the trip to the ER and a new Epi Pen I took her in to see her pedi for the recheck and allergy test. I got the test results back today and the blood test they did came back completely negative, for everything including cashews. Reading your story has calmed my nerves somewhat and convinced me that I do need to go with my gut instinct and take her to the allergist. Luckily, our pedi did tell us to continue treating it exactly how we would if it had been positive, but the questions aren't answered. Thank you!


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