Clear as Mud (Trip to the Allergist)

Yesterday afternoon was Michael's allergist appointment. We were there to discover if allergies are playing a part in his nasal congestion and habitual mouth breathing. When we made our appointment we were told to make sure he wasn't on any antihistamines for 5 days prior to the appointment so that skin testing would be valid if the doctor decided to test.

Monday night, and again the morning of the appointment I told Michael that we were going to a special doctor to help figure out why he has trouble breathing through his nose. I told him the doctor might decide to do a special detective test to figure out if his body is allergic to certain things. I explained that some people have bodies that get confused and think regular things like tree pollen and cat or dog hair are germs. Then those people might get stuffy noses when they are around those things.

I told him that the nurse would write on his back and use a special device to poke his back several times. I showed him some of the less scary google image search results of pictures of skin testing on children's backs. I think I struck a good balance, because he was intrigued at the idea of the "detective test", but not scared.

After collecting a little bit of family medical history and listening to my concerns, the doctor decided to do a skin test. I held a shirtless Michael in my lap with his chest to my chest. His arms were around my neck. The nurse drew some lines and numbers on his back first and then cleaned his back with alcohol soaked cotton. This made him giggle. She had all seven pricking devices ready to go. She was two down before he realized that he didn't much like what was going on. She got two more done before he managed to voice his first complaint. She was done by the time I finished telling Michael he could choose a small bag of candy when we were done.

When he realized she was finished he decided it wasn't worth getting upset and asked for his candy instead. After that he hopped back up on the exam table and watched Wall-E on the iPad for the 15-20 minutes it takes to complete the test. I only had to remind him he couldn't touch his back once or twice. The kid loves Wall-E.

The doctor came back in to read the test results. As far as I could tell that was based upon the size of the wheal (mosquito bite like bump) in each spot. Her rating could be from 0 (no reaction) to 4++ (large reaction). They tested 54 things. Michael had no reaction to 32 of those. He had a 1+ reaction to 13 substances. He had a 2+ reaction to 2 more. He had a 3+ reaction to horse, cat hair, pigweed, and kochia. He had a 4+ reaction to dog. He had a 4++ reaction to oak. Well, that seemed like a lot of reactions to me.

Then she explained that the magnitude of the reaction does not correlate to the magnitude of actual allergy symptoms experienced by the patient. ?!?! So, some people might have a huge allergic reaction to something their allergy skin test showed as 1+ and no reaction at all to something their skin test showed as 4+. The only thing she could say for sure was that the substances he didn't react to at all would be unlikely to cause allergy symptoms. So, of the things he does react to (21 things!) any of them could be causing the most trouble? Or all of them? Or none of them? Well, how on earth is that useful at all?

I left with the instructions to continue Flonase at night and try switching from Claritin (which didn't seem to help) to Zyrtec in the morning. Call her in 8 weeks if that doesn't seem to be helping. In addition to the medical treatment we should try to reduce allergens in our home starting with keeping the cats out of his bedroom and washing all his bedding in hot water once a week.

Somehow I expected more. I thought we would get a definitive answer about whether or not allergies are contributing to the mouth breathing problem. I thought that if allergies are a contributing factor we'd know which ones, specifically, are the problem and could react accordingly. Instead, she isn't actually convinced allergies are the issue. Any allergic symptoms could be caused by one of 21 things. And taking medicine and cleaning the house may or may not help.

Great. Clear as mud.

I'm hoping the ENT visit on Friday will be much more helpful. Aren't I the optimist?


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One year ago I wrote a post on how to use gestural prompts during therapy with children with apraxia (or any other severe speech delay). One year later we still use gestural prompts in every single therapy session. They are a powerful therapy tool. The video I linked to in that post is very helpful if you've never actually seen someone using gestural prompts before.