Warning - This is going to be a very long post!  Yesterday was our trip to Children's Hospital Boston to see the gastroenterologist and the allergist for Tyler.  I am trying to capture everything we found out yesterday in this post, to make sure I remember it all while it's fresh.

The day went very well, and Tyler was quite the trooper, holding up well despite the very long day, missed naps, repeated undressing and dressing, and getting pricked on the back for a skin test.  We got there a little after 10 am, and didn't leave until 4 pm.  It wasn't until we were on the way home (and stuck in traffic) that it finally caught up with him and he started to have a meltdown until he eventually fell asleep.

So here's a summary of what we learned:

The gastroenterologist seemed to think that most of the problems he is having is allergy related.  Although she did think that, according to everything we described to her, he does still have reflux.  She said that the dosage of reflux medicine (omeprazole) he was on was very low (1.5 ml, 2x/day), and that he could easily go to 3-4 ml 2x/day.  she wrote him a prescription for 3 ml 2x/day.  She also wants us to meet with a nutritionist that specializes in food allergies when we come back in 6-8 weeks.

The appointment with the allergist took much longer, and was a pretty exhaustive look at his symptoms, his family history, etc.  The doctors were wonderful, taking the time to answer all of our questions (I had printed up a list of questions before hand, and she went through them one by one).  The first thing she told us was that based on the results of the blood test, he has an allergy to peanut and egg.  She gave us a prescription for an epi-pen for home and for daycare, just to be safe.

They also decided to do a skin test to check his reaction to milk, casein (a different milk protein), rice, soy, oat and dog.  She said that a negative result means he is almost certainly <em>not</em> allergic to that item, but sometimes a positive result can be false.  After they did the skin test, he reacted to milk and dog.  So based on his symptoms and the reaction to the skin test, he definitely has a milk allergy.  He is also <em>not</em> allergic to rice, soy and oat, which means we can start him on cereal when we feel he's ready.  She also said there's no reason not to go back to Nutramigen if we felt he was doing better on that.  It should not cause a reaction in him.  In terms of starting solids, once we get to that point, start with veggies and fruits first, and only introduce one at a time and wait several days before starting each new one so we can see if he has a reaction to it.

During the family history interview, we told them that we had had a dog that passed away when Tyler was about three months old.  I asked her what his reaction to dog meant in terms of us ever getting another one, which we had planned to do when Tyler got a little older. she said it would be good to wait a while, until we have a good handle on his food allergies, a few months at least.  But she didn't seem to be too worried about us eventually getting a dog.  I am not terribly worried either, because when I got skin tested for allergies a few years ago, I tested positive for dog but never had any symptoms.

I commented that he's on the Elecare formula and that's the only thing he eats.  It is supposed to be completely hypo-allergenic, but he still seems to be allergic to something.  She said, actually, no he isn't.  The rashes can be a sign of an allergy reaction, but allergy is not the only thing that can cause the rash to get worse.  The eczema can be aggravated by all sorts of things.  She said he actually doesn't look too bad.  (we thought he looked a little worse yesterday than he has the last few days).

His sensitive skin will require a lot of care.  We should moisturize within 3 minutes of getting him out of a bath, and moisturize as many times during the days as we can.  They recommend Hydrolatum for general moisturizing, and gave us a prescription for Desonide to use during flare-ups (use for seven days when he has a flare-up, then discontinue until the next flare-up).  She also said it's ok to use the Desonide anywhere on his body, because it gets absorbed pretty fast.  I asked her about using the "natural" non-petroleum based laundry detergents, because they all seem to contain coconut oil, and I didn't know if that might be a problem.  She said to avoid them, not so much because of the coconut oil, but because many of them use apricot oil as well, and that tends to be more of a problem with "atopic" children (atopic means prone to allergies).  She said just use a dye and fragrance free detergent, and double rinse.

So that's pretty much all the stuff we found out yesterday.  Phew!  We are supposed to come back in 3 months for a follow up, and he will be re-tested for allergies when he's a year old.