Process to start allergy testing

Makalani3

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Dec 7, 2022
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My Son has received a principal nomination from his Senator and is in the process of finishing his application to the USNA. I am assuming that means he is a good candidate and if there are medical issues that arise, he might be able to apply for a waiver? I am wondering what is the preferred process for us to undergo further testing to definitively answer the questions he will be asked regarding allergies once he schedules his physical. He had blood tests in the past for IgE levels of peanuts, tree nuts, sesame, etc. (standard testing) but nothing like a full workup for a true diagnosis or to be ruled out for a true allergy. He has never had any sort of severe reaction to food but it could be an issue. Should I pursue this now with a local allergist or wait until he goes for his physical? I'd like to get ahead but is this the correct way to proceed and do I need to take him to a specialist who is familiar with the service academies and the DOD MERB criteria? Thank you very much.
 
Sorry, your post wasn't very clear. Does he have an allergy diagnosis in his medical records?
Your son does not apply for a waiver, if the DoDMERB disqualifies him due to a medical condition, the service academy will automatically review it to consider a waiver. At that point, they would tell you what if any additional testing is required. The most important step right now is for your son to get his physical done as soon as possible. All if it takes time, and cases needing further review or waiver considerations take even additional time. If your son hasn't filled out the medical history forms, and scheduled appointments, he should do that ASAP. Just be as honest as possible on the medical history and the experts at DoDMERB will ask for whatever additional information is needed and advise him on how to move forward.
 
Thank you for your response. I'm sorry I wasn't sure how detailed I should be. It's in his records because we brought it up to our current Dr. (we've moved a lot). When he was a toddler he had some mild reactions so we have avoided peanuts. He can eat other nuts just fine and his blood test shows the same level for other nuts as peanuts but he's totally fine with those like walnuts, pecans, mac nuts, cashews, etc. She ordered a blood test a couple of years ago because he gets a very mild reaction, a few bumps on his face (that generally subsides or he may take claritin or benadryl). We never pursued any of the options I see listed on some threads like the OIT (I think it's too late for that as he is a Senior now) or a skin prick test or the oral test. He does not carry an epi pen or anything like that. It's never been a problem. I am unsure at this time as to what to do. Do I just follow the DoDMERB process and get that scheduled and just hope they refer him for additional testing for a waiver or should I see an allergist now? He would be crushed if he could not go to the academy, so I just want to make sure I know the best way to go forward. I have an appointment with his pediatrician to discuss it.
 
Hopefully someone with more expertise will chime in (I'm not expert and really only know what I have researched and read) but if it were my child I would have him get the DoDMERB process started. The physical that is done is pretty much 80-90% reviewing the medical history. That will be your son's opportunity to tell the provider what you just said here. "He has a mild reaction that is self-resolving." It is likely that DoDMERB will ask for more details. So have the blood test results and doctor notes handy to submit when asked for them. But I would get the process started ASAP. You can't really prepare for what you don't know, and you won't know what they will ask for, until they ask. I would prepare your son for the long road it is going to be. I do think that allergies of any kind are one of the harder waiver roads to travel, given the gravity of a possible reaction in a situation where his or others' lives could be at risk. But as the very smart people on here always say...keep going until someone tells you no. I totally understand trying to mitigate it before it reaches DoDMERB, but I'm just not sure that there is any way to do that. I think the best way forward is to get the ball rolling as soon as possible.
 
Thank you for your response. I'm sorry I wasn't sure how detailed I should be. It's in his records because we brought it up to our current Dr. (we've moved a lot). When he was a toddler he had some mild reactions so we have avoided peanuts. He can eat other nuts just fine and his blood test shows the same level for other nuts as peanuts but he's totally fine with those like walnuts, pecans, mac nuts, cashews, etc. She ordered a blood test a couple of years ago because he gets a very mild reaction, a few bumps on his face (that generally subsides or he may take claritin or benadryl). We never pursued any of the options I see listed on some threads like the OIT (I think it's too late for that as he is a Senior now) or a skin prick test or the oral test. He does not carry an epi pen or anything like that. It's never been a problem. I am unsure at this time as to what to do. Do I just follow the DoDMERB process and get that scheduled and just hope they refer him for additional testing for a waiver or should I see an allergist now? He would be crushed if he could not go to the academy, so I just want to make sure I know the best way to go forward. I have an appointment with his pediatrician to discuss it.
You may have already addressed this but my son was in similar predicament. Had a blood test when young that showed high IgE levels so avoided nuts since then. I wanted to be proactive so i took him to allergist in August and explained that he was applying to military academy. The Dr was great and did a thorough blood test which shows all the components of peanuts. His results showed that he was high in one component that is known to be less serious and the others were pretty low so Dr felt comfortable doing a food challenge. He gave a very small amount of a peanut and then progress from there. He did have tingling in throat after first dose but then subsided. So he proceeded to eat quite a few peanuts with no other reactions and Dr gave me a letter to give to academy (should they ask) that states he is safe to eat peanuts without incident and not allergic therefore does not need to carry epipen. My son already completed his Dodmerb exam and listed past hx of nut allergy bc its in his record so i am assuming they will ask for AMI and i will have the Dr note to send them. But to answer your question i would get started with the allergist if you know it is something that will need clarifying.
 
You may have already addressed this but my son was in similar predicament. Had a blood test when young that showed high IgE levels so avoided nuts since then. I wanted to be proactive so i took him to allergist in August and explained that he was applying to military academy. The Dr was great and did a thorough blood test which shows all the components of peanuts. His results showed that he was high in one component that is known to be less serious and the others were pretty low so Dr felt comfortable doing a food challenge. He gave a very small amount of a peanut and then progress from there. He did have tingling in throat after first dose but then subsided. So he proceeded to eat quite a few peanuts with no other reactions and Dr gave me a letter to give to academy (should they ask) that states he is safe to eat peanuts without incident and not allergic therefore does not need to carry epipen. My son already completed his Dodmerb exam and listed past hx of nut allergy bc its in his record so i am assuming they will ask for AMI and i will have the Dr note to send them. But to answer your question i would get started with the allergist if you know it is something that will need clarifying.
Not sure if this will be pertinent to you, but usually when DoDMERB asks for AMI, they don't want a letter, but rather a copy of the test results and doctor's actual visit notes. Maybe you will get lucky and only need a letter, it normally depends on whether they request your son fill out a questionnaire, or provide AMI from the doctor's office. Good Luck, sounds like you are being proactive:)
 
Thank you both so much, this is very helpful information! This is precisely my situation as we were told to "avoid" peanuts early in life because of one little hive on the face but not really sure it's a true allergy. Did some more bloodwork and will get the component test back soon. We consulted with an allergist and said if the IgE is below 14 (for peanuts) it's not as concerning for a true allergy but would need to do an oral challenge just as you stated, because everyone is different. Our primary Dr. never referred us for further testing his whole life which is so frustrating, just took a blood test and sent us on our way. She will not sign off based just on the blood test. Thank you for the advice on the doctor's notes and test results, that helps me to understand what they may be requesting. Fingers crossed.
 
We had our DS tested with an oral challenge last month and he is NOT allergic to peanuts! Yay. Now he is beginning to enjoy a food he's been denied his whole life. Unfortunately, he was DQ recently because of this self reporting on his physical that he was misdiagnosed. We'll be joining the others in navigating the process and rollercoaster of DQ's with providing supporting documentation the issue has been cleared, along with another injury which has also been cleared. What an emotional ride it's been through this application process. I feel like a mama bear sitting on the sidelines cheering on my kid as he jumps over each hurdle, knocking over some and getting up again to finish strong. It's been very humbling and I am very proud of him either way. Fingers crossed.
 
We had our DS tested with an oral challenge last month and he is NOT allergic to peanuts! Yay. Now he is beginning to enjoy a food he's been denied his whole life. Unfortunately, he was DQ recently because of this self reporting on his physical that he was misdiagnosed. We'll be joining the others in navigating the process and rollercoaster of DQ's with providing supporting documentation the issue has been cleared, along with another injury which has also been cleared. What an emotional ride it's been through this application process. I feel like a mama bear sitting on the sidelines cheering on my kid as he jumps over each hurdle, knocking over some and getting up again to finish strong. It's been very humbling and I am very proud of him either way. Fingers crossed.
Peanut butter cookies all around! These kinds of posts shine a light on the allergy path and are very helpful.
 
Yes! My favorite ones to bake are the one with the Hershey's kisses on top, now I can share with him. He immediately asked for Reeses' Puffs cereal of all things :p
 
Yes! My favorite ones to bake are the one with the Hershey's kisses on top, now I can share with him. He immediately asked for Reeses' Puffs cereal of all things :p
Peanut butter cookie dough rolled into balls and put into a non-stick mini-muffin tin.
Partially cook until cookie has spread out and started to turn into a cookie on the edges but center is soft.
Pull out of oven and press small Reese’s Cup into center for max PB goodness.
Complete cooking. Rest 5 minutes in the pan and carefully remove with slim spatula or knife.
This was off top of head, but you probably have a recipe to adapt that gives cook times and temps.

This also works well with a dark chocolate cookie dough. With Reese’s Cup or Hershey’s Mint or Caramel Kiss pressed in.

Cheater tip: roll of PB cookie dough from chill case. Cut 1” slices from roll. Cut slice in half. Roll the half slice in palm gently to get a sphere. Drop in mini-muffin tin.

Encourage son to take on PB baking duties and trap the results.
 
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DD was also DQ'd last week for History of Food Allergy. She was tested about a month ago and tests showed no sensitivity to any foods. She happily ate her "allergy" foods that night. Allergist refused to do a Food Challenge as it was not a medically warranted test but will if requested by the SAs. Currently DD is under "waiver review" at DoDMERB but has not been emailed by any SA yet that they are requesting waiver. She is at the bottom of the food chain for acceptable standardized test scores but the ALO/BGO didn't seem to be overly concerned with them. Hoping she hears something soon about a waiver and AMI needed to gain the waiver. Otherwise... her Plan C/D/E etc are not bad options! Nothing could be worse than studying calculus in Malibu!
 
Currently DD is under "waiver review" at DoDMERB but has not been emailed by any SA yet that they are requesting waiver
We are exactly in the same boat as you. Under waiver review and hoping for an email from SA for waiver. The process is moving quickly though, we just found out (the DoDMerb exam was done jut 10 days ago). So that is a good thing, they are moving things through, let's keep positive thoughts. He is also applying for ROTC so this would DQ him from that as well, I am assuming. One thing I've learned from researching food allergies is how many kids are put into the allergic pile by pediatricians with no definitive testing. After reading many studies, I've learned there is a good % of kids that fall into a gray area of whether they will pass an oral challenge or not, based on their IgE levels.
 
We are exactly in the same boat as you. Under waiver review and hoping for an email from SA for waiver. The process is moving quickly though, we just found out (the DoDMerb exam was done jut 10 days ago). So that is a good thing, they are moving things through, let's keep positive thoughts. He is also applying for ROTC so this would DQ him from that as well, I am assuming. One thing I've learned from researching food allergies is how many kids are put into the allergic pile by pediatricians with no definitive testing. After reading many studies, I've learned there is a good % of kids that fall into a gray area of whether they will pass an oral challenge or not, based on their IgE levels.
Well...our DD was allergic at 18 months. So definitely has a "history of systemic reaction" and she avoided the food until this month. We never bothered to clear her of the allergy as she grew up as it was an easy food to avoid and she never once seemed interested in the military...until she turned 18 a few months ago. So...here we are!

The entire process is very frustrating as a parent but is very much realistic of the bureaucracy of military medicine. Best to get used to it...unfortunately.
 
Exactly.
We never bothered to clear her of the allergy as she grew up as it was an easy food to avoid and she never once seemed interested in the military...until she turned 18 a few months ago. So...here we are!

Ditto. I'm trying hard not to feel guilty as a parent, but I listened to our pediatrician to avoid peanuts when he had a couple of hives at a very young age. Also pretty caught off guard while navigating the process once he let us know how serious he was. It has been stressful because it's not his fault, having peanuts withheld from him thinking he was allergic for 17 years. At least now we know for sure and can at least not worry about him reacting. It's going to be a rainy weekend so I think I'll bake up some of those Reese's PB cookies and try to enjoy some time with my son as we sit and wait for the process to play out.
 
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