My name is Dr. Chet Tharpe and I’m a board-certified allergy specialist located in South Carolina. I am making this video blog in response to a post on the Facebook group “Parents of Children with Multiple Food Allergies“.
To summarize the post that I read, a mother reported that her 12-year-old has now been diagnosed with Apple allergy per positive Apple IgE blood results after having a swollen lip in the context of eating a cookie that contained an apple and cinnamon. The mother questioned this new diagnosis and was seeking input on Facebook. Since this was all the info given, I just wanted to give my interpretation of this scenario as an allergy specialist and how I’d approach it if this presented in my clinic. I hoping this can help you if you or a loved one have encountered a similar situation or just want some more information of the diagnosis and treatment of Food Allergy. Please remember, this is not medical advice and just some information to help and hopefully guide you a little bit. Or maybe stimulate some discussion with the doctor.
So, my first thoughts and question would be, what is the time relationship between eating the cookie and developing that lip swelling? Did she eat the cookie, and within minutes to hours develop the lip swelling or was it a cookie that she ate several hours prior or something like that? The reason I ask is the classic IgE mediated allergic reaction to a food, the one that we test for, is where you develop symptoms that occur within minutes, to maybe an hour or couple of hours max after consuming the food. Obviously there’s no perfect time scenario but the symptoms should be pretty immediate. Yes, delayed IgE reactions can occur but they typically do not occur without having some sort of immediate reaction. And those symptoms could include lip swelling, along with a whole host of other symptoms including localized mouth itching or irriation, diffuse body Itching, rash, swelling in other parts of the body, possibly shortness of breath, nausea, vomiting, dizziness or diarrhea. Typically patients will develop a few of these symptoms and in severe cases develop all. So, again, I would first want to know what is the time relationship between eating the cookie and developing the lip swelling. Once I had that knowledge, I would discuss with the parents to help decide if we should or should not test? This patient had IgE testing and I don’t disagree with testing but we have to know the limitations of the test. We know that allergy testing is full of false positives and that’s the bad part about them. They’re really good if they’re negative, they’re not so good if they’re positive. The concern is, without a good history where we highly suspect that the apple cinnamon cookie caused immediate symptoms, we could get a false positive test and mistakenly diagnose her with food allergy. And the development of an Apple Allergy at the age of 12, especially for someone who potentially eats this on a regular basis, is highly, highly unlikely. It is possible, anything is possible in the medical world. But, developing an Apple Allergy out of the blue, especially if your child consumes these regularly, would just be highly unlikely.
Remember, a positive allergy test does not diagnose a food allergy or tell you that you are allergic to something. A positive test alone can increase the likelihood of being allergic to something. But alone and without a history of the food causing symptoms, the test does not diagnose food allergy. Again, the positive test could be a false positive, and the only way to truly evaluate whether your child is truly allergic or not allergic is performing a food challenge where the food can be given under observation so that a reaction can be treated if necessary.
So, at this point, with the positive test to apple you have to avoid apple and all apple containing food products for the time being. You definitely need to carry an epinephrine device with you at all times in the event of accidental exposure and severe allergy symptoms. If apple is not a major food in your diet and you feel that avoiding apple containing foods is not an issue at the moment there is nothing more that needs to be done. However, if apple is a food your child enjoys and/or if avoidance will be difficult I would highly recommend a food challenge. As many of you probably know, avoidance is extremely difficult and can cause a lot of anxiety for the entire family. We’d hate for a false positive result to be the cause of this anxiety. IN this case, the next step would be a food challenge where you would come to a physician’s office, and your child would get a graded challenge to apple under observation in a controlled setting where a reaction can be properly treated if necessary. This will be the true way to determine if apple is really an issue.
I suspect, like many of you may also suspect, that there’s probably some cross-reactivity to your child’s environmental allergies, specifically tree pollen or something like that, causing the apple blood IgE test to be positive. Thus, I suspect that the apple allergy is a false positive. Again I don’t know for sure at this moment in time and I would avoid, avoid, avoid until you can do some further investigations if necessary with your physician. But again, the development of an Apple Allergy in a 12-year-old would be highly unlikely.
So just some things to consider. I hope this has helped you in your respective situation and also hope it will stimulate a productive discussion with your physician. If you liked this video, please leave me a comment and subscribe to my e-mail list where I can keep you updated on new videos and educational opportunities through ChetTharpeMD.com. Thanks for your support! Great days are ahead!