Blood IGE ,skin prick and physical reaction do not match

[the5woolfs]

My daughter had a reaction to egg when she was 18 months old so she was given a blood test with IGE of 18 to egg. She was then put on an egg free diet. Ok was happy with that but as she also had high IGE results for nuts (22 for hazelnuts, 17 for almond and 9 for peanut) she was also put on a ban for those but had never even eaten them so we had seen no physical reaction to them, and to avoid risk sesame and shellfish also but wasn't even tested for those. She was issued an epipen and all the usual action plan and have been so scared what to feed her for 5 years. She is now 6 and was reasently sent to another hospital for skin prick testing. The results still yielded a high reaction to egg but she has since been introduced to baked egg and tolerating it. As only small Wealds appeared for hazelnut, peanut and almond we have been advised to try on them and see if she reacts. We have gradually introduced one of the nuts at a time everyday for about two weeks and have now tested her on them all and so far no reaction she has had them all about 10times. We are now so confused as how can she have a high IGE and a skin prick reaction but not react when eating them? Also when do we deem her not allergic to them fully? We really don't know where to go from here , shall we carry on and test all the tree nuts as she was banned from them all. This allergy stuff is so confusing and I really don't want my daughter banned anymore from foods unless she really has to be. Hope you can offer some advise please

[Dr Chris Rutkowski]

if you have high total IgE it might be difficult to interpret specific IgEs to food for example egg

Skin tests can be positive even if your child has been tolerating baked egg

If you have hayfever you can have falsely positive skin and blood tests to nuts (with no reaction when you eat them)

I suggest you continue with baked egg and nuts if tolerated; then contact your allergist again to discuss next steps of egg introduction (scrambled and boiled egg might not be as tolerated as baked). A hospital lightly cooked egg challenge might be needed