Monday, May 4, 2009

Green pea food challenge - (and some info about food allergy testing)

I apologize if I mess up the medical terms here.

Battle Green Pea: Georgia 1, Peas 0
Rematch: Georgia 0, Peas 1
Declared winner: Georgia!

Food allergy testing is comprised of several components: blood testing, skin testing, the patient’s history of reactions to a particular food, and, when appropriate, supervised food challenges in a doctor’s office. Basically, a lot of research remains to be done in the field of food allergies; therefore, the blood and skin tests are unreliable at best, and the only failsafe way to determine food allergy is to look at past reactions or have the patient ingest the food and see what happens. However, it can obviously be very dangerous to perform “experimental” ingestion in allergic patients, so doctors use their best judgment to determine when a patient should be considered eligible to do a supervised food challenge.

“Food challenge”? Our first was in November, for green peas. (Does this not sound like an episode of Iron Chef?) The appointment was around 8 a.m., and we were instructed not to feed Georgia anything after dinner the night before. DO YOU HAVE ANY IDEA HOW HARD THAT PART WAS? That was the real food challenge in my opinion, not the actual testing at the doctor’s office. This is a kid who wakes up saying, “Eat! Eat!” and has no comprehension of the word “later.” Anyway, we go, they continually monitor her vitals and start feeding her portions of pureed baby food peas in half hour, and then 15 minute intervals, in ever increasing quantities. (Again, please sympathize with the difficulty of giving a 15 month-old who thinks she’s starving only one bite of food and then telling her to wait.) Total time spent completing this food challenge: 4 hours. Georgia charmed the nurses and staff, behaved really well (considering her hunger, and the fact that we had to keep her entertained in a tiny examining room for 4 hours), and passed with flying colors. Yea! We were cleared to add peas back to her diet starting 24 hours later.

Fast forward to dinner the next night. I put peas and carrots on the menu, and what do you know? She breaks out all over her face! What? This can’t be carrots, can it? She’s never had a problem with them before. But how can it be the peas? Did we not just spend half a day getting cleared to eat peas?!

Conclusion: We spoke further with the allergist about this, and peas are back in Georgia's diet. It was the peas and not the carrots, but it was not an “allergic” reaction. Georgia's extremely sensitive skin is just irritated by contact with peas, so she can eat them so long as she doesn’t get them on her. In her case, they are an irritant, not an allergen. Or, in medical-speak, she was not having an “immune mediated” response.
Fantastic – we’ll take it!

And, for anyone who thinks I’m making this stuff up, here are a couple of pictures. (Sorry the quality is poor, but you’ll get the idea.)

Just before getting peas on her face:

Same meal, after having peas on her face for about 2 minutes:

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