Allergies

As of yesterday, we are the proud owners of an EpiPen Jr.

A few months ago we started to notice that with some foods, Patrick got little red spots on his cheeks and chin. He also had a really odd habit of sticking his fingers in his mouth after eating. When he discovered french toast, I learned that the spots always came with that meal, so I started watching ingredients. Pasta produced the same results. Scrambled eggs turned his lips, cheeks and chin bright red. That’s when I stopped wondering and knew. Patrick is allergic to eggs.

So I called his dietician, who gave me a simple answer.. don’t feed him eggs. It sounded easy enough, but the spots appeared at other times, too. On top of that, I knew he’d need a flu shot and other immunizations and that those shots are often egg based.

3 weeks ago, when we saw the fabulous Dr. Jackson, Patrick’s GI, I requested a blood test for allergies to confirm the egg allergy.

Not only did that test come back definitively positive for egg white, but also for 9 other foods including egg yolk, wheat, oats, corn, peanuts, milk, soy, and even a trace positive for carrots.

I had heard that kids with Short Gut easily develop food allergies. The weak intestinal walls allow proteins to leak into the bloodstream, just like they let bacteria through. The extra exposure to undigested proteins can cause allergies. I just didn’t expect to be hit with so many positives at once.

I called his dietician again for answers, and she explained that not all the positives represent real allergies. They just represent a probability of an allergy. Therefore, I should avoid feeding Patrick foods that I knew he was allergic to, but there was no need to withhold ALL of the foods.

So I started cutting back on glutens to see if those might be contributing to a recent unexplained bout of stomach upset I was seeing in him. Patrick was pleased to be moving up to grown-up cereal instead of baby cereal, but not so happy with the fact that all the cereals I was now offering were rice. I bought rice noodles so that he could have pasta without eggs.

And I still felt lost.

I sent messages to his docs and dieticians here and in Seattle, but the common consensus seemed to be “we can’t really say.” I wasn’t sure which foods he could safely have, and I didn’t have any answer still about how to give him a flu shot. When you’re waiting for transplant, you’re preparing to be immune suppressed. Therefore, you should have every immunization possible.

Finally, I called Patrick’s pediatrician. (Don’t know why I didn’t try this before.) She said she thought it best for Patrick to see an allergist who could at least determine the safety of the flu shot. She gave me the name of one she knew and urged me to push to get an appointment ASAP.

When I called for an appointment, their version of ASAP was “our next opening is in December.” I tried Primary Children’s Allergy Clinic and was told: “We’re not taking any more appointments for this calendar year, and don’t have a calendar yet for next.”

So, I told Patrick’s practically-magic insurance case manager about the problem and she mentioned an allergy clinic that she knew our insurance covered. She said she’d heard good things about them, including short wait times. I called them on a Thursday afternoon and…drum roll please…scheduled an appointment for the next Tuesday.

That was yesterday at 9:15 a.m.

Over the weekend, Patrick had his most severe allergic reaction yet to banana pudding, which I shouldn’t have given him because of the sugar content, but am glad I did cuz it clued us in to allergies I would have otherwise missed. He also had a reaction to playing with a spoon that had been put into my Traci’s Peanut Butter Cup ice cream at Leatherby’s, even though he didn’t eat any food there.

I got up with Brian yesterday. This is, in itself, an accomplishment. But I knew I’d need time. Getting Patrick ready and out the door before 9 requires near superhuman effort, but we managed it, even with time to spare.

Knowing it would be a long appointment, I came with the essentials: a bag of toys, books, and videos; a diaper bag of medical supplies and emergency kits; their 8 page medical history questionairre; an 8 page “condensed” medical history of my own; my purse; and Patrick.

It took a while for the allergist to appear. I was grateful for the wait, as Patrick started to spit up yellow goo right after we arrived in the room. I dug tubes out of my emergency kit, found that his button had been plugged overnight, and coaxed enough drainage from his stomach to avoid him getting sick in the office… finishing just as the doctor arrived.

He apologized for making me wait, but explained that it took a time to catch up on the history I’d brought. Can’t fault him for that.
We talked about why I’d come and the questions I hoped to find answers for. He went through the results of the blood test and explained that for most of the allergens tested, the blood test does only reveal a probability. For most of the low scores, the probability of a reaction was pretty low. He did his best to assure me that these were most likely not a concern. If I hadn’t seen reactions, he was most likely not allergic.

Then we talked about the eggs, the pudding, and the ice cream spoon. He scratch tested for all of the ingredients I thought might be related – 7 allergens in all, including the specific isolated proteins of milk. They also did a scratch from the vial of flu shot that he was intented to have.
Patrick wasn’t happy with the scratches, but otherwise enjoyed sitting shirtless in the office watching Elmo on TV and playing with his backpack full of farm animals. (Thank you to my neighbor who provided Elmo in VHS.) I sat and watched the reaction.

The nurse explained the two “control” scratches at the top that represented no reaction and his worst reaction. (Scratched with saline and histimine respectively.) And I watched the hives that formed at each of the scratches. Only 3 scratches didn’t react. Patrick is not allergic to banana, lactalbumin (a milk protein), or the flu shot. All the rest, he did.

Patrick is allergic to eggs (yolk and white), milk, peanuts, and corn.

His reaction on all of these was a 2 of 5. This means that at present, the reaction is not deadly, but a 2 today can be a 5 with the next exposure, so we are to assume that all of these are.

Next, they gave a partial dose of the flu shot, watched for a reaction for half an hour, and then completed the dose.

While we waited, we got to talk to the doctor about what the results mean, complete some forms, and watch more Elmo. Since we were the longest appointment of the morning, Patrick also was free to take a pantsless walking tour of the halls of the office.

So, now the punchline… what do these results mean?

Patrick can outgrow all of the allergies, except perhaps the peanut allergies IF he avoids contact with the allergens. So for safety, comfort, and future improvement, Patrick should not be exposed to any of the above listed allergens on their own, or as an ingredient.

This means reading a lot of food labels.Some of the ingredients are listed under different names. For help in interpreting labels, check out this site: https://www.foodallergy.org/section/allergens

It’s also possible that he could have a reaction to something that you don’t expect.. either by accidental contact with one of these allergens or by coming in contact with something we don’t know he’s allergic to. (Like I said, Short Gut can lead to food allergies, so it’s possible there are allergies we haven’t discovered.)

Enter the EpiPen. We’ll make sure to train all you caregivers on how to use it. He’ll also carry benadryl for milder reactions.

And so, the adventure of having a child with food allergies begins. Please feel free to ask questions. Either we’ll help you understand, or you’ll help us know what more we need to learn.

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