Yeah... I've got a lot to say on this one. The premise of the article is absolutely 100% true. I've known (and said) all along that the only true test for food allergies is oral challenge. The blood tests are worthless, the skin tests are only a little better. It is my opinion after a lot of research (and, luckily it's an opinion shared by Caroline's doctor) that it's best to wait until a child is 3 to do an actually full-on oral challenge. There are a couple major reasons for this: (1)the older a child is, the more they are able to withstand and recover from a serious allergic reaction, so why would you try to induce one when they're so young? (2)there is still a lot of debate in the medical community over whether repeated or early introduction to an allergen can increase the likelihood of an allergic response or the severity of an allergic response - that's why the recommendations are out there to not give nuts until a child is 3, or not to give egg until they're 1... the recommendations vary WIDELY within the medical community and has changed a great deal even in the past three years that I've been following it.

As for Caroline specifically - we know that she has had actual allergic responses (mainly hives, along with other skin reactions and some coughing which could indicate a respiratory response) to egg. We did a minor oral challenge over a year ago where Dr. Ruff had me make a batch of cookies using a single egg (result: she ate one half of one cookie and broke out around her mouth). We are due for our next oral challenge within the next month. Since her skin test was negative for peanut, we did actually give her peanut butter (result: no reaction on first exposure, then a possible skin reaction to a secondary exposure - enough to have us decide jointly with the doctor to avoid peanut until she was old enough to have an oral challenge in the doctor's office - again, we are due for that within the month). After the peanut response we decided to heed the tree nut positive skin test until, again, the oral challenge.

 The trick here is in managing information. All that is very detailed, and yet really ambiguous. So, do we try to explain the intricacies of the process and our reasoning to everyone? No. You saw at Christmas how hard it was for people not familiar with food allergies to grasp the simple statements of allergy (i.e.: Caroline is allergic to egg, tree nuts and peanuts). We make a conscious decision to not cloud the understanding with the prevarications inherent in explaining that she may or may not have a true allergy, but we have to act like she does for now. All of a sudden it sounds a lot less serious and people would treat it as such - not a risk we are willing or able to take.

 The main concern I have with this study (it has shown up in a bunch of media outlets today, not just the WSJ) is that 90%+ of the population are going to only see the headline. Many of them will then nod their heads and think to themselves, "I've known it all along - these food allergy parents are full of it. Their kids don't really have these allergies and I'm the one who's having to pay for it. Why can't my kid have his PB&J at school?" Of the ones that bother to read the whole article, few will understand the real implications behind the study. It's just not a topic on which most people are well informed. Why would they be if they don't have a compelling reason, like having a child who has been diagnosed?

 Another issue that this article doesn't address (and I think they missed a really interesting angle) is that there is NO test available that will tell you the severity of an allergy. There is a huge misconception that a RAST test (a type of skin test) can predict how severe an allergy is. You see it a lot among food allergy parents (or adult food allergic individuals) - people comparing their RAST numbers. "Well, I'm a 5 on the RAST for peanut, so I could die just from touching one!" or similar. It's simply not true. It's a misunderstanding of what that test tells you. The test only predicts the likelihood of experiencing a reaction to a particular substance. It cannot tell you what the reaction will be. If you've only ever had hives and itchiness when eating eggs in the past, there is nothing that says that that will remain the level of reaction you have in the future. Each exposure, each reaction is unique. So many people have this false sense of security that they aren't "that allergic" to something, so they don't always have their Epi-Pens with them. It only takes one reaction. There are many stories of this type of complacency costing people their lives. There's a lot of research in this area right now, but so far there continues to be no test that can predict severity of a reaction and it's foolish to think otherwise.

 So, I assume if you're a follower of this blog that you likely have a child with food allergies - either that or you really like to follow my witty commentary on the pitfalls of raising a food allergic kiddo.  What are your thoughts on the tests that are available and the interpretation of them?