Hellobee

The second appointment is also referred to as “the two day appointment”.  After your first in-office appointment, they will schedule you for a second “two day appointment” about 6 weeks later. It needs to be at least 6 weeks out in order to give the lab enough time to get the blood results back to Dr. Randhawa, and for him to create an action plan based on all the various testing.

The first day of the two-day appointment is only 10-15 minutes long, so a super short office visit. They have you come in so that they can put a patch test on your child. They stick a patch that looks like a grid on your child’s back, with each box clearly labeled with an allergen. Lil’ Miss Louboutin’ was required to wear this patch for 24 hours. She couldn’t be too active while wearing the patch, so we kept it mellow the rest of that day. She also couldn’t take a bath that night.

This is what the patch test looks like

The second day of the two-day appointment was a lot longer, lasting about 3-4 hours.  This was the appointment I anticipated most, as we finally had the opportunity to sit down with the doctor and review our results in full detail. I was anxious to finally see our results, and understand how this would all work. They provided me with 8 pages of detailed results, and also this really interesting visual:

The columns are separated by anaphylactic, sensitized, and tolerant (non-allergic). Those highest on the Y-axis are the most severe, so peanut being on the very top left corner means she is most allergic to peanuts. You can also see that there are some groupings.  Peanut, soy, hazel, almond, legumes, sesame, and are grouped in one circle. Cashew, pistachio, and macadamia nuts are grouped in another circle, and so on. This means that these foods are in the same family, and have similar protein profiles. For example, sesame is in the same circle as peanut, but Lil’ Miss Louboutin’ is only slightly sensitive to sesame. By introducing her to sesame first, her body will already be building on a tolerance to peanut because they have some similarities between them. So by the time we introduce her to peanut, her body will have already developed some immunity to peanut because it will recognize the protein that exists both in sesame and peanut. Pretty interesting, huh? They are not just tackling the actual food allergen by itself. They are tackling the common denominator between foods.

On that 2nd day, as Dr. Randhawa was going through all this with us, he simultaneously had Lil’ Miss Louboutin start on an in-office food challenge. He started her off with pine nuts, which straddles the tolerant and sensitized columns.  he had trouble eating the pine nuts on their own, and wouldn’t even put one in her mouth, so he had his staff grind it up and turn it into a piece of chocolate for her.  Dr. Randhawa said it’s common for children with food allergies to be very slow eaters, and be hesitant with trying new foods because of the fear factor. Now it made so much more sense to me why Lil’ Miss Louboutin’ would always lick every new food with the tip of her tongue before she tried it!

Biting into her pine nut infused chocolate

After she finished her pine nuts, the staff took her to an exercise room (they had treadmills, bikes, and a mini trampoline for the younger ones) to get her heart rate up for 5 minutes. Higher heart rates increase the risk of an allergic reaction, so if she passes this step without a reaction that means she is in the clear for that particular food. This same routine will happen in all future office visits (an in office food challenge followed by 5 minutes of exercise).

We left that visit with a detailed plan of care, which I will cover in my next post.  Any questions?