Bubba first tested positive for a peanut allergy at ten months old. She had never been exposed to or ingested peanuts and in fact still hasn’t. Our house went peanut-free when she was still an infant and we have been diligent about her exposures to the ‘outside world’. Our gym childcare is food-free, our preschool went nut-free for Bubba (and others), and we were always proactive about asking friends at parties to please keep nuts out of reach from Bubba’s toddler hands. Keeping Bubba safe from peanuts was (relatively) easy when she was so small, but she starts Kindergarten in less than two months and a whole big world is about to open up for her: a classroom and cafeteria that will have nut products, potential playdates and Daisy meetings with unsupervised snacking, field trips and class parties. Of course I will still be involved in keeping her safe by educating others, checking ingredient labels, and providing her own food. The reality is she won’t be as protected as she has been however. The reality is that I will have to rely on many other adults and Bubba herself in ways that I never have had to before.
I’m proud of the allergy education I have given Bubba. I’ve shown her foods in the grocery that aren’t safe, pointed out different dishes at parties, compared candy bags so she can see how tricky it can be to know if something is safe just by its appearance. We’ve drilled into her “if we can’t read it, we don’t eat it” so that she knows ingredients have to be read, by an adult, every time. We’ve encouraged her to tell others about her allergies and to say “no thank you” when offered food. We have a plethora of children’s books talking about food allergies so she can understand what happens to her body when she has an allergic reaction. Bubba knows to speak up quickly when her body feels funny or itchy. But Bubba is still LITTLE. Really, really little. Kids are curious and test boundaries and get confused and are so trusting of adults, who may or may not know what is best. As much as I’d like to think otherwise, Bubba is no smarter and no more mature than any other Kindergartener. For her safety, we’ll have to make decisions about her ability to ride a bus (where kids sometimes secretly snack), whether she needs to sit at a peanut-free table in the cafeteria, whether she can participate in class parties and field trips without me present. Of course peanuts are just one of her many food allergies, but the prevalence of peanuts in children’s food products and the prolific nature of peanut ‘facility’ warnings make peanuts a bigger concern for us.
So what if she weren’t allergic?
A food allergy is defined by an allergic reaction upon ingesting a food – not by a positive skin prick or blood test. It’s possible to test positive to an allergen, and yet safely eat the food. A food challenge, where the food is eaten under medical supervision in a controlled environment is the ‘gold standard’ of allergy testing. The decision to truly test an allergy in this way, is one made with great care and with the advice of allergists. Our decision to move forward with a peanut challenge was based on factors very specific to Bubba: (1) She has successfully passed many food challenges (six!) and we feel she is mature enough to be able to handle a potential failure, (2) Her IgE numbers have gone down over the years. Her most recent level was 1.85 which puts her at a Class II allergy, (3) I am comfortable and experienced in treating anaphylaxis after having given Bubba epinephrine numerous times, (4) our allergist’s office is a five minute drive from the hospital, (5) we believe the potential benefits (increased freedom, reduced anxiety, additional safe foods) outweigh the risk.
So what are her chances? Well, unfortunately not 100%. One study of preschool children with positive peanut allergy tests but no previous peanut exposure found that 50% of those children could safely eat peanuts. The children most likely to pass had an IgE of less than 2 kU/L (like Bubba) and a wheal size of <7mm on a skin prick test. Only 5% of children who met both criteria failed the peanut challenge. Bubba’s last wheal size was 13mm so I can’t give her those kind of odds. But there’s a chance and for us that offers us hope. Wish us luck…