Blood Work

As of a few months ago, Dr. B was the only provider to have ever ordered blood work for Penny.  At our first visit, he ordered CBC, CMP, CRP, absolute IGE, absolute IGA, and absolute IGG.  All of her values came back within normal limits.  He was surprised, "astonished" actually, that her eosinophil, basophil, and absolute IGE counts were normal.  He said that for his other food-allergic kids, their lab results were extremely elevated.  Dr. B told us that this aligns with his leaky gut theory because of the absence of widespread, systemic eosinophils and basophils in the blood.

The only problem with Dr. B is that he is a chiropractor and a Board Certified Functional Neurologist and so there are limitations to what he is legally allowed to do for his patients.  He is not able to order the specific food IGE labs that are most pertinent to understanding Penny's condition, so he encouraged us to call Dr. M and request them from her.

In retrospect, I feel very silly that I was never aware that IGE blood work was a thing.  Nope.  Never knew. 

That was until a fellow allergy mom at Penny's pre-school mentioned that her sons "peanut numbers on his blood work have gotten so much better."  Peanut numbers?  What ever did she mean?  I suppose I should have asked her what in the world she was talking about.  But, instead, I chose to remain true to my socially-awkward, anxious self and just smiled and replied, "wow, that's so good." 

Sigh.  

Ok - so, now I am googling furiously on my phone "peanut numbers blood work." HELLLOOOOO IGE LABS!  You mean to tell me that 3 years after my child was diagnosed with what Dr. M categorized as severe and life-threatening food allergies, there are blood tests that could help guide us towards a more accurate clinical diagnosis?  That, perhaps, there is a way to study the cells in her body to determine what is actually happening inside of her?! My God.

I called Dr. M's office the next day and spoke to a nurse. 

"I'd like for Penny to have blood work done."

"What kind of blood work?"

"Um.. blood work for peanuts, tree nuts, and eggs? I'm not sure what it's called.  She has never had it done before."

"She's never had blood work done before?"

"No, not by Dr. M."

"But she did the egg challenge... we always do blood work before a challenge."

"No, she did not have blood work done. I would like it done now."

"Let me ask Dr. M why it has never been ordered and I will call you back."

We went for blood work, ordered by Dr. M, the following day.  

- peanut, cashew, pecan, walnut, pistachio, macadamia, pine nut, almond, hazelnut, egg white

- peanut specific proteins: ara h 1, 2, 3, 6, 8, 9

It took a week to get the results.  I e-mailed LabCorp about 50 times.  Nina, in customer service, and I became friendly. She assured me that the lab results would be available in about 7-9 business days.  On the 7th day, I received them.

Penny's IGE peanut was 27. It was a gut punch.  I though maybe 5 or 10? But, 27? We have to get that number down. It is close to a 100% probability of anaphylaxis for peanut IGE >5. 

The relevance of the peanut specific proteins: ara h 2 is enemy #1.  Ara h 2 peanut protein is the single protein in a peanut that has been positively correlated to anaphylaxis.  Ara h 6 is very similar to ara h 2.  Penny's ara h 2 and ara h 6 proteins were elevated at 16 and 15, respectively.

The good news: the upper limit on results is >100.  So, literally, infinity.  In that context, 27, 16, and 15 are really not that bad. I have full confidence that we can bring those numbers down through diet, supplements, and acupuncture.  

Almond, hazelnut, pine nut, macadamia are essentially negative. Egg whites are only slightly elevated. Well, she did pass the almond and baked-in egg challenge after all. 

Pecan, walnut, cashew, and pistachio have room for improvement.  Walnut is the most severe of all, even worse than peanut.

But we have numbers.  We have data.  We have a baseline. 

At the behest of Dr. B, a provider that most Board Certified Allergists consider to be a "quack" and openly disparage, we have data. 

So, the plan is to repeat skin prick testing 1 month from now.  I will ask for blood work by Dr. M to be repeated before the end of the year.  

We are looking forward to a hazelnut challenge as well.  

Nutella, here we come.