Wednesday, January 27, 2010

Does Your Child Really Have Food Allergies? News from The Wall Street Journal

Yesterday I received many notifications about the Wall Street Journal food allergy article from friends and blog readers. Thanks everybody, 'cause this story is one we don't want to miss.

Please read the story for full details, but here is my take on it. First of all, I'm picturing allergist's phones ringing off the hook today from parents of food-allergic kids asking for new tests or more clarification. And that's who we should be calling: a board-certified, qualified and experienced allergist. I caution everyone not to put too much stock in all of these studies, articles and whatnot until we have much more scientific evidence. The bottom line is that life-threatening food allergies are a phenomenon that is still not understood very well, even by the experts. It doesn't serve our children, or ourselves well, to second-guess our child's condition each time a new article comes out. It's tempting to do so and for people who've never witnessed an actual reaction, I say, get more info from your doctor.

The article in WSJ quoted some of the top allergy docs in the country--people that I respect. These guys are not alarmists, nor are they dismissive. They see numerous cases every day and every year, so I appreciate their input on this story.

The gist of the article is that there is some evidence that food allergies may be over diagnosed in some cases. That makes sense to me and it doesn't point to the fact that food allergies don't exist. Two different things could be going on here at the same time.

For one thing, more kids are going to the hospital and being diagnosed with food allergies following a severe reaction. That can't be discounted. More people--adults and kids--are having severe allergic reactions to food. Who knows why, but a reaction doesn't need a blood test to prove anything. Identifying the food that caused it is enough. Dr. Sampson is quoted as saying as much in the WSJ article. Witnessing a severe reaction is what brought my family to the allergist with our first child.

However, here's the second thing. Once a child has experienced the reaction, subsequent children in the family are tested--even before they have a reaction. For example, in my family we were told to avoid giving our youngest any peanut butter products before 3 years of age--simply as a precaution. This was because my oldest had experienced a life-threatening allergic reaction.

Then at 3, my youngest was tested for all known food allergies. She came up with all negative results. Obviously, I was elated. But here's the thing--many siblings of allergic kids test positive to allergy tests. Parents are then told to avoid certain foods for the sibs--and rightly so. While a food challenge is considered the ultimate in diagnosing a food allergy, blood tests still can indicate severe food allergies. The problem is, they can also indicate seasonal allergies, eczema, etc.

Also, with more tests, come more positives--both true and false. I would think that's true for most medical tests--not just ones for food allergies.

Plus, every allergic response is different--sometimes even in the same person. Can there be false positives? Of course. They exist for every medical test out there. But does that mean that all positive blood or skins test are false? Sadly, no. It's not that simple.

More research is needed, obviously. Better, more conclusive tests have to be devised so that people don't have to restrict their child's diets and frankly, entire lifestyles without cause. What concerns me is that for whatever reason, many in the general public want to dismiss severe food allergies are a conspiracy between allergists and neurotic parents. (For the record, all of the allergists my family has worked with have been sensible and caring.) Despite being well-written and often illuminating, the WSJ article gives parents that much more to worry about and adds fuel to the detractor's fire. ("See, food allergies aren't really that big of a problem.") It's hard enough to get people to listen and take food allergies seriously.

That's the downside. However, if some people are truly not allergic, I hope they are "liberated" and get a correct diagnosis. That would be great. I'd also like to see a cure happen, because, like many of you out there in my shoes, I don't have to question if my child's allergy is "real" or not. I know that it is--reactions speak louder than words.

I hope everyone doesn't let all of these news stories rattle them--you know we haven't heard the last of this. Talk to your allergists and keep being cautious until you know you can do otherwise.


Unknown said...

Jenny, you said it perfectly! I could not agree with you more. Thank you--great post!

Lisita said...

Here, here. Exactly my thoughts!!

ZM said...

thank you for so sensible a summary - well said! Both of my boys had questionable allergies to some foods (and clear, nasty ones to others), thanks to complicated evidence and positive bloodwork. To oh, anything we cared to test for, thanks to undiagnosed environmental allergies...

Now, my boys are by no means typical (they go to Dr. Sampson's clinic because they're a nice challenge to the allergist brain), but they do help illustrate how tricky allergies can be to diagnose properly, and how enormous their impact can be on quality of life. Which makes me wonder why so many pediatricians still feel qualified to diagnose and manage them.


Jenny, thanks for so clearly and calmly reviewing such a tangled issue. What a great post!