How old is she? Has she had some symptoms and/or reactions that may 
have been triggered by contaminated foods? How much of the food? How 
bad were the reactions?

Our son, who just turned 20, is asking for oral challenges (again), 
and we're thinking seriously about doing so. But with some 
trepidation, and most certainly under medical supervision, at his 
doctor's office (at Childrens Hospital), possibly as an in-patient 
and/or with an IV inserted (at the allergist's discretion).

Here's our story, which I've told before: Our son was as you describe 
your daughter, but perhaps a bit worse. He's allergic to milk, eggs, 
and all nuts. He has been sensitive to topical exposure. He's also 
had hives and respiratory symptoms upon accidental ingestion of small 
amounts. He's had a few scary trips to the ER, and has had several 
epinephrine injections at the ER or doctor's office, but not yet 
using an EpiPen (for at least one reaction we should have given the 
EpiPen, but were either very close to the ER or the EpiPen was not on 
hand :-().

When he was approx 5 we decided to try an oral challenge for milk, 
based on negative skin and blood tests to milk. Our allergist at the 
time assured us that our son was not allergic to milk (in spite of 
our son's highly atopic nature), so on a Sunday morning(!), at 
home(!), we gave him 4 oz. of whole milk (too much, but what did we 
know?). As we watched him balloon up and not be able to breathe, we 
rushed him to the nearest ER, where he got epi and lots of IV 
steroids. We dumped that allergist quick and went to Childrens for 
more competent care.

It took until our son was 10 before he tested allergic to milk. We're 
still not sure why the allergy did not show up in the tests. Perhaps 
he hadn't had enough exposure to have the tests show reactivity,  But 
the true test is the patient. Some doctors insist on double-blind 
challenges, to trust the veracity of both the patient's reaction and 
the physician's observation. We went through that, but it seemed like 
a bit of folly at the time. Of course, we didn't do that for his 
known anaphylactic triggers.

Our son just reported that he had an accidental exposure to a small 
amount of cheese recently at his dorm, and only had minor GI 
symptoms. He wants oral challenges for eggs and possibly milk. We'll 
be thinking about that and possibly scheduling a challenge soon.

There are a few things that concern me, and that we'll have to watch. 
He may have what I've heard referred to as "subclinical" symptoms - 
too minor to be detected but still a reaction. If this were the case, 
I'd expect such things as worse hay fever symptoms, more sinus and 
ear infections, etc., due to more inflamed  upper respiratory 
tissues. There's also the possibility, if he tests negative and 
starts to consume either milk or eggs, that he'll become sensitized 
and have a reaction. As a young adult, it's hard to get him to carry 
his EpiPen, but for at least a while he'll be at increased risk. 
Making him promise, as part of the bargain, to carry it after the 
tests might work. At least for a few weeks :-S

But it would be good to know the outcome of a challenge, and would 
even make his life easier if he was not so worried about accidental 
exposure. If he does ok with the challenge, he doesn't have to go out 
and pig out on pizza, milkshakes, and omelettes. But he might have a 
bite of something and not have to wonder quite so much about whether 
it will put him into medical crisis.

None of us (he, his allergist, I, or my wife) will be inclined to 
oral challenge nuts. His allergist did point out that nut allergies 
are more likely to be serious and life-long, and that "some reactions 
you just can't bring them back from."

But for the other things, if you have confidence in your allergist, 
if accidental small ingestions of milk or eggs have not elicited 
strong symptoms, and you have a good, safe plan in the event of 
symptoms, and if the challenge is successful, your child will have a 
somewhat simpler life. The biggest challenge is for us as parents to 
have the courage to consciously go through something that potentially 
puts our children at risk.

Not sure if that helps.

Good luck,

Mark

At 02:01 PM 1/23/2007, Alex Oren wrote:
>My daughter is allergic to dairy, raw eggs and tree nuts.
>
>...
>The allergist currently suggests a set of two challenges, one week =
>apart, involving ingestion of 30ml (1 US fluid ounce) of milk and a =
>similar set for raw egg (yuck).  If no reaction is observed he would =
>pronounce her allergy free for the tested substances.