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Does a late-phase reaction of hives indicate allergy?
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Author:  mariuerla [ Thu Feb 07, 2008 10:22 pm ]
Post subject:  Does a late-phase reaction of hives indicate allergy?

My daughter (now 5) reacted with hives all over her body 24 hours after she ate peanut butter at 18 months old. She also had the same reaction at about 2.5 years, and I didn't know what she was reacting to at the time, but I traced it to walnuts in a carrot cake. At the walnut time, she was tested with a scratch test, but all that showed positive was milk (she can now drink milk). I was told that she wasn't allergic to peanuts or tree nuts, because the scratch test was negative and because a reaction to these foods presents immediately. She had no symptpoms other than hives. It's been suggested by my doctor the last time I asked, that she try a peanut. I haven't tried this, but keep asking her if she wants to and would only do so in a hospital. I've been told by a friend with multiple allergies and with grown kids with multiple allergies -- never give her peanuts or tree nuts again, because the next exposure could be anaphylaxis. My daughter happily eats No Nuts pea butter and her eating habits and attitude are that she's comfortable doing what she's doing. She seems scared to try. Any reassurance that a late-phase reaction is valid?

Author:  _Susan_ [ Fri Feb 08, 2008 7:43 am ]
Post subject: 

You can get an all over hive from a viral infection and often Dr's will tell you that they can't pinpoint the cause. If you have had 2 similar reactions then you might have an allergy but I haven't heard of the initial reaction being delayed like that (not saying it can't happen, just that I haven't heard of it).

Skin Prick Tests are not 100% conclusive, neither are RAST. The gold standard is an oral challenge. It is only recommended to be done in the presence of a Dr. If you suspect the reaction can be delayed up to 24 hours, that can pose challenging.

Has she had a blood test? Would the Dr confirm by oral challenge? Does she currently have an auto-injector?

I understand her anxiety and how she is happy to eat No Nuts butter and all but if the tests were conclusive re: no allergy, that would reduce her anxiety and improve her quality of life.

It's all about life enhancement as far as I'm concerned.

Author:  Helen [ Fri Feb 08, 2008 9:40 pm ]
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All over body hives can be serious, and yes, a reaction can be worse (or not as severe) the next time. That being said, as Susan points out, hives aren't always from allergies, and allergies are a lot easier to pinpoint if the reaction is not delayed. I for sure wouldn't want to give your daughter nuts outside of a hospital setting. I know someone who does have a severe delayed reaction to shellfish.

Does your daughter have environmental allergies (animals, dust, mould, trees, ragweed, etc.?) If so, then I'd say that food allergy is a more likely culprit.

When my allergist does a food challenge, he never gives the person the food right away--first he does a pinprick test with the actual food. Then he asks the patient to put the food on her tongue for a period of time (but not to swallow--although this is hard not to do!) If everything is still okay, he has the patient swallow the food. Wait. try a bit more. Wait. try a bit more (you get the picture.)

If you do want your child to try nuts in a hospital setting but she isn't ready, you might consider shelving the idea for awhile to see if she feels differently as time goes on. (And before moving to that stage, I'd definitely ask for a RAST test, as Susan suggested.)

Author:  KarenOASG [ Sun Feb 10, 2008 11:54 am ]
Post subject: 

My son was given the go-ahead to do a peanut challenge when he was about 8, but he was not comfortable with the idea until about 1.5 years later. At that point, we did a successful challenge. (But first we re-did the skin prick test and blood test to confirm that his levels were really low.)

I think it's a very good idea to wait until your daughter is mentally ready to do the oral challenge.

K.

Author:  gwentheeditor [ Sun Feb 10, 2008 3:22 pm ]
Post subject: 

Some really good advice being given here.

While delayed reactions aren't common, there are certainly some instances of them I've read about (more in the range of 8 or 10 hours).

I'd definitely consider an oral challenge when the child feels ready. If there was no other obvious possible reason for the body hives, you'd want to err on the side of caution.

Author:  mariuerla [ Wed Feb 27, 2008 2:38 pm ]
Post subject: 

Thanks for all of your replies. She has not had a blood test done and has no other allergies. I'll talk to her pediatrician and try to get a blood test and then an oral test at the Dr.'s office. She hasn't been carrying an Epi Pen and it would be nice to rule out an allergy, As you say, quality of life. Thank you, my mind is at ease, knowing what to do now.

Author:  KarenOASG [ Wed Feb 27, 2008 9:44 pm ]
Post subject: 

I would see an allergist rather than a family physician for the blood test interpretation and oral challenge, if that is an option.

K.

Author:  gem [ Sat Apr 12, 2008 6:24 am ]
Post subject: 

My daughter's reactions have all been delayed by 2-4 hours and then her reactions are rapid and severe ( anaphylaxis). Last summer she had some peanut butter ( was not diagnosed with peanut allergy at that time) and 10 hours later threw up. Peanut allergy was just confirmed yesterday. ( That's why I'm catching up on this topic!)

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