Monthly Archives: March 2015

Oral Food Challenge – She Passed Again!

IMG_4474One more food to cross off our list! Bubba passed her oral food challenge to garbanzo beans today. We decided to challenge garbanzo beans because Bubba’s SPT and RAST tests were both low-positive, indicating that she had a strong likelihood of passing. We were still nervous for this one though because 30% of peanut allergic folks are also allergic to garbanzo beans.

We learned our lesson from last week and brought LOTS more fun stuff to do to help ease the boredom. This food challenge was a little tougher for Bubba because she did not like the taste of the garbanzo beans. For her first dose she only had to eat one bean, but the three doses after that were all 1/8 cup. That is actually a LOT of garbanzo beans. She was half gagging trying to chew through them.

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IMG_4480You hear me say often that Bubba is a trooper, well this is what I am talking about. What three-year-old can be convinced to eat something they don’t like, let alone an entire plateful of it? She was doing a lot of fussing by the last dose and wanted me to hand-feed her. She was also promised a trip to the movies this weekend in addition to her post-appointment treats, but all well worth it.

So what do garbanzo beans get us? Especially if she doesn’t like them? Well, first there is the mental ease of removing one more allergen from her list. Yay! Also, I promise I can make some tasty hummus and roasted cinnamon sugar beans that she WILL like. Finally, there are actually a ton of allergy-friendly products that contain chick pea flour that have previously been off-limits for us. Bubba had only ever eaten garbanzo beans (hummus) once and she had a severe reaction, but the hummus contained tahini and she is severely allergic to sesame seeds so we were never able to differentiate what caused the reaction.

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Oral Food Challenge – She Passed!

An oral food challenge is considered the ‘gold standard‘ of allergy testing. Skin-prick testing (SPT) and blood tests have their utility but can result in both over and under diagnosis. Bubba has a number of foods on her allergen list that only have a mild SPT reaction and/or a low blood IgE score. Over time, we would like to challenge these foods to know whether they can safely be incorporated into her diet. I’m in no rush for oysters, but other foods can have a big impact on her diet. So today we challenged pineapple.

Oral food challenges are LONG appointments. Ours was 2 1/2 hours.

Oral food challenges are LONG appointments. Ours was 2 1/2 hours.

We prepared Bubba for her appointment by explaining what would happen and also why this test was so exciting. We told her all the new foods she would be able to eat. We discussed what her allergic reactions have been like in the past, how her mouth felt, and how she would need to tell us if something felt funny or spicy in her mouth. We also told her there would be treats after the test. Oral food challenges are LONG appointments and (God willing) boring. Bubba believed that she “didn’t like pineapple” so we told her she would need to try it anyway and would be rewarded for that. We also emphasized our past success – Bubba outgrew her soy allergy and we confirmed this with an oral food challenge. She now eats (and loves!) edamame and chocolate soy milk.

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Pre-challenge check

The appointment went great. Before the challenge began Bubba’s temp, blood pressure, and blood-oxygen levels were taken. Her full body was examined and all her eczema spots were circled so they wouldn’t be confused with a reaction. We started with a bite of canned pineapple (thought less likely to elicit and allergic reaction). Her whole body contorted and her face screwed up like she’d eaten a lemon. She did NOT like it. But she ate it anyway. Because she’s a trooper. We waited 15 minutes – no reaction. Another bite.

Mysterious red cheek

Mysterious red cheek

This time one of her cheeks turned red so we waited a full 45 minutes before up-dosing. Nothing else happened so the cheek was just a fluke. We switched to fresh pineapple. Bubba did not seem overly impressed with the taste but agreed it tasted ‘better’ and ‘sweet’. Fifteen minutes later, last bite.  After the last dose we had to wait another 45 minutes to be sure of no delayed reaction. She passed!

Post-challenge treat!

Post-challenge treat!

So why is pineapple so exciting? Well, I’m sure you can imagine with a food allergy list of nearly 30 foods, there are not a lot of places Bubba can eat or convenience foods we can buy. She has never been able to eat fruit salad because it almost always has pineapple. Also, pineapple concentrate is added to many of the otherwise safe sorbets at frozen yogurt shops. Many kids’ juice boxes have pineapple juice as do several chicken apple sausage brands. My favorite BBQ sauce is now an option for Bubba too. Lastly, it adds one more frozen waffle brand to our options. Exciting stuff in our little world. If you and your allergist think an oral food challenge is appropriate, I recommend reading a great publication put together by Kids with Food Allergies to help you and your child prepare for the appointment.

Should you feed your baby peanuts?

You may have read about the recent peanut allergy study suggesting that early exposure to peanuts is beneficial for reducing the incidence of an allergy. I saw the same headlines and shared the links on social media. This is exciting stuff and the more people that have access to this information, the better. At least you’d think so. More on that below.

So the study. The idea of feeding your children peanuts earlier in life rather than purposely delaying exposure to prevent a peanut allergy is not so much ‘groundbreaking’ as it is a direct counter to the years of advice parents were given. As my mother will tell you, the old approach was to delay introducing major allergens to kids who might be predisposed to food allergies due family history. Maybe the body would be better able to digest the proteins or maybe any ‘allergy’ would simply be outgrown by the time first exposure came. So was the thinking.

Well, it turns out that was wrong. That said, there should be two major take-aways from the study. (A) not every baby should be fed peanuts and (B) there is not a direct link between my daughter’s peanut allergy and her lack of exposure. At least not one that this study found.

Let’s start with the study. “Investigators tested the hypothesis that regularly eating foods containing peanut – if started during within the first year of life – could elicit a protective immune response rather than an allergic reaction.” The infants were chosen for the study because they were considered high risk for developing a peanut allergy because they had severe eczema* and/or an egg allergy. Participants were excluded if they showed a significant sensitization to peanut as measured by skin prick test (SPT). So Bubba would have been excluded. She showed signs of a severe peanut allergy upon her very first SPT at six months old. These researchers didn’t study early peanut exposure to kids with an allergy, aka don’t tell me my kid wouldn’t have a peanut allergy if I had just fed her peanuts.

But here is what they did find: “Early (peanut) consumption is effective not only in high-risk infants who show no sensitivity to peanuts early on, but it is also effective in infants who already demonstrate peanut sensitivity.” That is AWESOME. Anything that reduces the number of kids with a food allergy is just plain rad.

So what’s the harm in mainstream media carrying this story? People like this guy. Too many people who know nothing about allergies now feel like they know what has caused the outbreak in peanut allergies – overprotective parents. And that’s not only wrong, it’s dangerous. Not every baby should be fed peanuts. If you have a family history of food allergies, a baby with eczema, or a child who has had an allergic reaction to any food, please discuss the best course of action with your pediatrician and/or an allergist.

So, parent to parent…what would I say if you told me you’re scared to feed your kid peanuts for the first time because of kids like Bubba? I would tell you I understand the fear. I would tell you there is no harm in talking to your doctor. I would ask about eczema and family history. If it all sounds clear? I would tell you that current research says you should feed your baby peanuts sooner rather than later.

Want to read the study for yourself? You can read more here and the trial details are available on TrialShare. I also recommend reading both Robyn O’Brien’s piece about the limitations of the study and FARE’s response.

*Note – please consider taking your infant to an allergist if they have eczema that is not resolving. 37% of infants with moderate to severe eczema have food allergies. Here is another article discussing the link between eczema and allergies. Bubba had moderate to severe eczema and we took it seriously. The rest is history.

Blood testing – round two

3196625932_5802361214_qBubba is normally a TROOPER. Blood tests, skin tests, epi-pens, hospital trips, you name it. She handles it better than most adults would. So she was about due to just be DONE with being pricked. Not too long after our last round of skin prick testing, Bubba was due for updated blood testing. Our first attempt was an utter fail. Apparently, someone can become so upset during a blood draw that the blood will literally not even come out. How’s that for some kind of ninja body control? Poor Bubba. Boy did she scream. I held her for a good 5 minutes with a needle in her arm and we got about a teaspoon of blood. Not nearly enough to fill the four vials we needed. So we left, only to have to go back again another day.

Our next attempt was much more pleasant. I pumped her full of fluids the whole morning and sent her into the lab with Daddy and a bag full of candy. Success!

We added a few new foods to our allergy list and increased the class of our milk allergy. We can add to Bubba’s obscure allergen list oysters, mussels, and rye. But she tested negative to fennel, celery, and green pepper so those are wins. She also tested very low-positive to pineapple, poppy, and tomato. We have an appointment to food challenge pineapple. Believe it or not pineapple would actually be a huge victory for us. It randomly appears as an ingredient in several otherwise safe foods – sorbet, frozen waffles, juice boxes, and sausages. So keep your fingers crossed for us!