Questions-Sent in from families

It has been suggested that I offer a page for questions. Each page and posting on the home page has an opportunity for comments and I have had many great questions. Lets see how this special page works.

Fred Leickly

Does a child with walnut allergy (tree nut allergy) need to be careful around walnut trees?

This was a question that came through one of our area pediatricians. The school has walnut trees and the family was concerned if the trees pose a threat to the tree nut sensitive child.

The child has a reaction to the ‘fruit’ of the tree. The wood, bark, and pollen of that tree would not pose a problem. The pollen of the walnut tree has a very limited season. Depending upon the area walnut tree pollen would be in the air for only a few weeks. The pollen is the male part of the plant and has unique proteins that elicit allergic responses. These responses are usually respiratory with allergic rhinitis and asthma as the main presentations.

I would suggest that the child stay away from the fallen fruit of the tree.В  He/she should not play with the material.

FEL

My 7 year old daughter has asthma and severe dry skin she has temps that stay at 100.0-104.6 for several days can this be caused by an allergy?

This is a very frequent question. Type 1, the typical IgE-mediated allergic reaction, does not cause fever. These are immediate responses by the body to a protein for which an antibody (IgE) has been made. There are other immune reactions that can cause fever.
In the world of allergy there are misnomers- Rose Fever and Hay Fever. These refer to nasal symptoms in the month of June (due to grass) when the roses are in full bloom. During the haying season, August until 2nd frost, it is ragweed causing the problem. In both cases the problem is not due to roses or hay and the reaction does not cause a fever.
During a severe asthma attack there may be fever associated with what is called atelectasis or collapse of some of the smaller airways.
Recurrent fever has a different set of diagnostic possibilities- recurrent infection, rheumatologic issues.
We will see dry skin in the context of a child who has atopic dermatitis. The dry skin is part of the symptom complex.
I would doubt that dry skin in isolation of other skin issues would be due to an IgE-mediated type-1 typical allergy.

FEL

7 Responses

  1. Jennifer - April 14, 2010

    I have recently read that a soy allergy can present itself gradually over time and culminate in an unsuspecting anaphylactic reaction. Due to my son’s milk allergy he drinks/eats a considerable amount of soy. We now wonder, could soy be causing his exhaustion, frequent itchy face during meals and dark under-eye circles? We have been searching for the cause of these symptoms for almost a year. Sorry, I had trouble summarizing this question!

  2. fleickly - April 14, 2010

    Thank you for the question. I have not heard this about soy. It would seem that he has tolerance to soy- having been a major and regular part of his diet.
    The symptoms may not be consistent with a type I (IgE) mediated reaction. The itch could be- especially if it was due to hives (urticaria), however the other symptoms would not be due to allergy. Exhaustion and dark circles have many different causes. The dark circles are seen in patients who have ocular/upper respiratory tract allergy. Anything that causes nasal congestion and subsequent blockage of the blood vessal can lead to the dark circles.
    Can you lead me to what you read about this aspect of soy allergy. Could it be that they were refering to some other mechanism of an adverse reaction to food?
    Let me know.
    FEL

  3. Meg - July 20, 2010

    Dr. Leickly,

    We are preparing for our daughter’s first year in public school (first grade). Upon meeting with the assistant principal earlier in the year I found out that the school keeps epipens locked in the nurse’s cabinet. I spoke with you regarding this at my daugther’s annual appointment for allergy testing and you said that is unacceptable – that children with severe allergies need their epipens with them at all times.

    I have not yet spoken with the school regarding your comment however I will be advocating for my daughter – that she be able to have her epipen with her at all times. The catch is that the school handbook, paperwork and the Indiana Code 20-33-9-13 imply that if a child is permitted to carry his or her epipen he or she would also have to self administer. My daughter, at age 6, is unable to recognize her reaction symptoms and would not be able to be trusted to know when to self administer an epipen.

    Have you run into this problem before? Do you know what the schools of your other patients do?

    Thank you!

  4. fleickly - July 20, 2010

    Great question and a real dilemna. My perspective is that the epi pen is like a life preserver- you would want it close by when you need it.
    Certainly a child should have one very close by, perferably on their person. Carrying an epin pen is also a function of the maturation level of the child. You have presented one concern about carrying an epi pen and that is the ability of the child to self administer the medications. The other is the child who thinks this is a toy. In these instances it would not be a good idea for them to carry the epi pen.
    If the young lady can’t recognize what is going on and may not be able to respond appropriately or effectively then we need to consider alternatives.
    When these situations arise we try to compromise. We are all here for the safety and well-being of the child and that must not be forgotten. As the parent, you need to feel comfortable about her new environment. Also, you do not want to have an antagonistic relationship with the school-you need/want a supportive one. Let’s find a set-up that works.
    If there is any chance of peanut products being in the classroom, then the epi pen should be close by for immediate use. A special place, designated for that injector could be arranged so only an adult (repsonsible person) can reach it and get to it fast without fumbling with keys/combinations or other locks.
    It is all about the safety of the food allergic child and the ability to respond swiftly- within seconds, when an exposure and reaction occurs.
    FEL

  5. Katie - October 19, 2010

    hello! I just scheduled an appointment for my son ( will be 2 years old by then) to see you on December 29. I am very excited to finally be able to hopefully put an answer to all of my questions! My son struggled with sinus symptoms and pneumonia from Febuary to June. After that he started getting better but I have noticed everytime we visit my parents house, He gets sticky eyes, runny nose, and a nasty wet cough. (they have 3 yorkies) I am thinking he has allergies to dogs. It seems everytime he gets sick it goes straight to his lungs. The runny nose goes away but the cough seems to stay forever. I also worry because Asthma runs pretty think in my family, so needless to say I am very excited for December 29th to roll around :). We look forward to meeting you!

  6. fleickly - October 20, 2010

    I look forward to meeting you as well. It certainly sounds as if you have allergy at work here. We will go through the history and see if we can find anything.
    Thanks for looking at the site.
    FEL

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