Eggs, and Preschools, and Birthday Parties, Oh My!

There's quite possibly nothing more boring to read than blogging about blogging, but please bear with me for a moment. The problem with this blog is that I don't get around to posting my occasional post-worthy allergy thoughts, so they accumulate. After time passes, none seem important enough to post, or maybe they do, but then it's too daunting to write them all up, or I worry that it will all come across like I'm allergy obsessed because suddenly I have 6 allergy posts in 6 days? I don't know - clearly I'm over thinking all of this and just making excuses for what boils down to procrastination, so with no further ado, here is a dumping of some of these accumulated thoughts, boiled down as best as I can get them:

FAQ: How is the introduction of baked egg going?
Short answer is that it's going great - Georgia's been tolerating homemade baked goods without any reactions. Longer answer is that, as exciting as it was to be able to get started on introducing eggs to her diet, we've fallen off course in terms of following the doctor's protocol for introducing more and more egg. We haven't yet jumped on to the pancake step, because how am I supposed to think of recipes for getting her up to 1/4 of an egg per serving in her tummy three times a day? No, really -- that was a serious question -- does anyone have any suggestions? A serving of cornbread really only has about 1/8th of an egg at most, so I'd have to double the portion size and serve it at breakfast lunch and dinner to get us there. With cupcakes, I'd have to give her even MORE, because each cupcake would have less egg. I'm about ready to say screw it, things have been going fine, let's move on and try the pancakes.

FAQ: What is the rationale behind the introduction of baked egg? Is the idea that she is building up a tolerance to eggs?
Good question, but no, it's not about building up a tolerance to eggs. My lay person's way of explaining this is that baking the eggs at a high temperature ever so slightly changes the shape of the protein that she's allergic to, just enough that when she eats it her body no longer recognizes it as an allergen (i.e., her immune system stops treating the food in question as a dangerous invader that it needs to fight). I'll post a link to the relevant study sometime.

Ugh. Preschool.
Georgia will be old enough to attend in the fall. Aside from anxiety I have about taking that next step of having to trust Georgia and a bunch of other people (teachers, kids, etc.) to keep her safe, I've also been dreading just having the allergy conversation with the folks at the preschools we've been touring. Well, she got accepted to one, and the way it works is you accept and say you're going to attend while you wait to hear back from the others -- apparently this is pretty standard around here. So, we had our first allergy conversation with the preschool that she is, as of today, supposedly attending. (Can you tell I still have my fingers crossed about coming off the wait list at another one? For geographic proximity reasons, that's all.) I'll be positive here and say that the conversation went about as well as one could hope for. The woman giving the tour assured us that it would be no problem, that other children at the school did have food allergies so they were accustomed to dealing with it, and that we could leave EpiPens in the school office or with the classroom teacher, etc.. On the other hand, I have to be honest and say that even when given a pretty good answer, I felt like there was no possible way this woman could understand the fear that an allergy parent has. Because even when EVERYONE (parents, teachers, etc.) all have the best intentions, people sometimes make mistakes. I couldn't help but see the bowls of snack mix in the kindergarten classroom that we walked by and just start to worry. Georgia will be barely 3 years old when she starts preschool. Can I really hope to drill it into her head that she cannot share snacks with other kids? I think they have "snack parents" at this school that trade off bringing food in for snacks. I am hoping that we can get Georgia on a regime of just eating her own personal food rather than the provided snacks, even though the snack parents will be told not to bring things with nuts. Partially because in my opinion I can't really ask them to look out for any ingredients including nuts, fish, and sesame. (Although, how many preschooler snacks have a fish ingredient, right? I wonder about all of the DHA (fish oil) that's getting added to more and more things these days, though. Not sure if Georgia would have a problem with that or not.) But if we have Georgia just eat her own food, then will all of the other parents question why they're even being made to have to deal with my kid's food allergy and therefore just stop reading ingredients? (If she were in 4th grade, that might make sense, but I think at the preschool level it's still important to keep all those sticky pb hands and nut-crumbs, etc. as far away as possible - there's too much risk of contamination and sharing.) Is it time for me to just start trusting a little more, even though that might mean exposing my child to greater risk? I want to protect her (as any parent would). I have to balance that against the idea that I can't protect her from everything forever. Ugh. You can see I'm already going around in circles about this mentally. Broken record here, but can I just say for the one millionth time that it sure would be nice if a test for the severity of my child's allergies existed, so that I might only have to worry that she'll get a mild case of hives at school rather than worrying about something potentially fatal.

Other allergy parents
I feel comfortable discussing food allergies in this forum, but generally speaking I'm uncomfortable with it as a conversation topic. I guess I'm insecure, because I always assume the other person I'm talking to is judging me in some way - either judging me for having a child with food allergies (i.e., they must be assuming it's my fault!) or judging me for how I'm dealing with it (i.e., they probably think I'm being overprotective!). At a recent birthday party, though, it occurred to me that I'm perhaps even more uncomfortable and insecure about discussing food allergies with other food allergy parents. Isn't that awful? Aren't these the very people that should understand where I'm coming from the most? Yes, that is true. And I'm always happy to find them, except that there's no handbook for how to deal with children's food allergies, so I'm always a little bit dumbfounded as to how to address the fact that we don't all deal with allergies the same way. Perhaps the issue is that no one's way is the one and only "right" way, and yet I just so want to be doing the "right" thing, whatever that is. So anyway, at this particular birthday party, the allergy mom was allowing her peanut and tree nut allergic child to dive right into a bakery-bought cupcake with crumbled chocolate cookie as a topping while I was making Georgia have some more fruit and promising her that we'd get her a special treat later in the day instead. (I know, I'm horrible - I really should start bringing my own stuff to these parties, but I keep forgetting and then it's time to head to the party and we're usually running late already. Fortunately she's just young enough to still not really care about missing the treats, so I've been getting away with this.) I just sat there watching this other kid with her cupcake wondering, "Am I doing this all wrong? Am I being too uptight?" The mom in question happens to be a work friend of mine, so I was able to ask her whether her child still had food allergies. Answer - "Yes, but her allergies aren't severe - it would just be like hives or something. " Hmmm...already a different response than what our allergist would ever say. So I said, "But doesn't it make you nervous that one reaction isn't really predictive of the next? You know, that it could be hives last time, but um, something far worse the next?" (Don't want to say anything too terrible around the kids!) Answer - "I didn't know that. Our allergist never told us that." Hmmmm....for various reasons, I already had the impression that their allergist isn't the best. (My friend had even told me as much before.) But this is all very frustrating to me! Why aren't the allergists telling everyone the same set of information? Let me just tell you the two conflicting thoughts going through my head at the time: (1) Ugh! Other allergy parents that are not as vigilant as us are not helping our cause (see preschool discussion above). If she's walking around acting like possible nut ingestion is no big deal (she actually wants to try to "build up a tolerance" for her daughter by exposing her to more and more nuts (at home), despite her allergist having told her that that's not a good idea right now and her husband disagreeing with her as well), then how am I supposed to get other parents and school officials that come into contact with folks like her to understand that when my kid shows up, I expect them to take the whole allergy thing much more seriously?, and (2) Maybe she is the smarter one here. Because maybe if we look at our lifetime happiness levels, and the lifetime happiness levels of our children, her approach of being WAY more relaxed about food allergies and less protective will result in so much less anxiety and mental stress for her and her family that any medical consequences of the increased number of allergic reactions potentially resulting from her approach will be outweighed by the fact that they just didn't worry so much! I mean, I can guarantee you that she's not off thinking about this birthday party right now, writing a blog entry about it! : ) Maybe this is a case where ignorance really is bliss.
Anyway, it's like I want to go with conclusion #2 and just relax, but I can't get my mind to stop slipping back to the, "Yeah, that's all fine and well, but what if she DIES?" thoughts. You know what I mean? Ugh. Again, have I mentioned lately my annoyance with the fact that they cannot yet test for the severity of one's allergies?

Another reaction
Last week I picked up a loaf of bread at our neighborhood food co-op. The ingredients passed inspection, but Georgia ended up having a minor (skin) reaction to it. We think it was sesame, because other available loaves did include sesame as an ingredient. I feel like I should've known better, like my gut was telling me at the time not to buy the loaf because of those other loaves. But what does this mean? That we can only buy from national producers that can give me a better allergen statement, and we can never buy the farmer's market type stuff? Maybe. I don't know. I'll be doing a separate post later on my frustration with labeling.

Okay, that's enough dumping for today.

Operation Pancake

For anyone who's interested, here's the protocol for phasing baked eggs into Georgia's diet that they sent us home with, verbatim. (I'm not sure why I'm posting this in so much detail, maybe so I'll remember it years from now? The lawyer in me also now feels compelled to add that I'm not posting this as a suggestion that anyone else try it. Talk to your doctor - duh.)

Home Introduction of Baked Egg

It has been determined that it should be safe to introduce egg in a baked form into your child's diet. If your child experiences any possible reaction or concerning symptoms, stop the food and contact us for further instructions. Once your child has clearly tolerated baked goods with 1/8 to 1/4 of egg per serving, you can add similar products up to three servings a day, as well as commercially prepared baked goods that are otherwise safe. The following is a genreal plan for the introduction of baked egg - you can do this as often as once a day to start, although you can also progress as slowly as you like and do this over weeks or months rather than days:

• Begin with any baked egg recipe - cookies, cakes, muffins, cupcakes, brownies - and use one egg for a recipe that makes 12-16 servings. Your child can have one full serving to start, therefore will get 1/12 to 1/16 of an egg to start. You can also use a recipe with 2 eggs and give one-half serving.

• If there is no reaction to these products, you can increase so that your child can get up to 1/4 egg per servings.

• If these products are tolerated with no signs of a reaction, you child may have them up to 3 servings a day.

• After two to three months, you may introduce pancakes or waffles.

• You can then contact us to discuss the possibility of introducing straight egg if you desire. Up until this point, you also need to continue to avoid mayonnaise, custards, ice creams, meringues, and other foods with concentrated, less cooked eggs.

More weirdness...

Just writing to say that in the past couple of weeks we've had a few more mild skin reactions around here that are apparently from kisses.
Like, Joe went to a business lunch and had crab cakes, later came home and gave Georgia a kiss hello, and voila, big red marks.
None of these incidents has been any big deal, but still it's disconcerting. I don't know if she's somehow getting more sensitive, if we've gotten too lax, or if we've just been unlucky.
The moral of the story is: we're now doing a better job of brushing our teeth after eating any of Georgia's allergens.

Hmmm...that was weird

Georgia had a mild reaction to something tonight. We're pretty sure it was from Joe kissing her (a lot) when he got home from work. This is not the first time that she's had problems from kisses. She did not seem at all phased (or even notice that she was having a reaction), but we gradually noticed the appearance of red blotches and tiny hives on her face knee caps.

Isn't that crazy? Someone eats something -- hours earlier -- then kisses her face, and she ends up with hives on her knee caps of all places.

So the great mystery is what food it was. Joe didn't think he had eaten any allergens, but he did have a pizza for lunch that included pine nuts. I'm off to google whether pine nuts are a tree nut. I thought they were considered a seed and are okay for Georgia to eat?

If anyone is reading this and knows the answer, please leave a comment or email me. Gracias.

UPDATE: Okay, I'm feeling like a lousy allergy mom, because apparently pine nuts are a tree nut, so I should have known that. I definitely would have looked into that before feeding her anything with pine nuts (like pesto), but I did not think that Joe eating a pizza 5 hours before kissing his daughter would cause any problems. Ugh.

Georgia's egg challenge (a.k.a., "worst playdate ever")

So, here's the rest of the story about yesterday's failed egg challenge at the allergist's office.

First of all, in a stroke of amazing coincidence, one of my best friends, Maggie, and her family were there at the same time that we were. I mean, what are the chances that she, who lives in the suburbs, would get an appointment to bring her son to the doctor in the city, at the same time and on the same day and in the same pediatric allergy practice as us? Do you have any idea how long it usually takes to even get an appointment there? Given the expected long length of these appointments (thus requiring backup help for child entertainment), and the importance of the information to be conveyed and the opportunity to ask questions, both of our husbands were also in attendance at these appointments, as was Maggie's daughter, Anna, a favorite playmate of Georgia's. Beforehand we joked about how hard it can be in our busy lives to find the time to get together and how maybe we should just meet up like this more often. Of course, that was before Georgia failed her egg challenge and Maggie's son Abe got sent home with a diagnosis of a peanut allergy! I'm joking about it being the worst playdate ever, though, because it was still nice to see familiar faces and for Georgia to have someone to play with for a while during the FIVE hours that we were there, most of it cooped up in a little exam room.

I don't want this to be the wordiest blog post ever, so I'm going to cut to the conclusion and then back up and give you the recap in bullet point form. Conclusion: Georgia had an allergic reaction during her egg challenge, so she's still considered allergic to eggs, but since the reaction was (a) relatively slow to develop, (b) not extremely severe, and (c) occurred after eating a pretty large amount of egg (about a full egg and a half), they think that she is "well on her way" to outgrowing egg allergy and that she may be able to tolerate eggs in baked goods. We were sent home with specific instructions about how to safely attempt to phase baked egg into her diet. (More on that in a later post.)

Now, the play by play:

• Arrive. They take Georgia's vitals. We hand over the 1 egg scrambled and 1 piece of french toast prepared with 1 egg that we had been instructed to bring along.
  
• Challenge consists of feeding Georgia ever-increasing quantities of this food at 15 minute timed intervals. After each interval, her skin, breathing and blood pressure are checked before more food is given.
  
• First "dose" = 10% = about 2 bites of a piece of french toast.
  
• Next "dose" = 20% = about 4 bites.
  
• She seemed to be doing great, showing no signs of a reaction to the egg. We thought she'd pass with flying colors and that we'd get out early.
  
• More "doses" of food. Eventually they added about a teaspoon of scrambled egg to the mix.
  
• Last "dose" = she was told to eat the remainder, so a few more bites of french toast and a couple of bites of scrambled egg. We were then put on a half hour wait period, so we went out to the waiting room with Georgia's friend Anna to give the girls some more space to run around and toys to play with. That's when things started to get weird.
  
• Anna was getting into the toys. Georgia was playing well at first, but then we noticed that she was coughing every few minutes - not like a coughing fit, more like a clear your throat a few times type of thing. Hmmm, we thought....probably nothing...just coincidental timing...maybe she was coming down with a cold? Her cheeks, which were a bit pink before the food challenge even started (due to the cold winter winds and uber-dry heat of our home), seemed to be growing redder, but we wondered if we were imagining that or if she was just getting flushed from playing around. She started rubbing her ears, which also grew red, but it took us a while to notice that. The truly odd part was that she kept saying, "Can I go to sleep on those chairs?" and then went over and laid herself across a few of the waiting room chairs and began sucking on her fingers, her normal self-soothing routine for going to sleep. It wasn't even close to her nap time.
  
• To show you just how convinced we were going into the egg challenge that she'd pass it, we somehow deluded ourselves into the belief that all of these symptoms meant an oncoming cold, not an allergic reaction. We took her back to the exam room to be checked out.
  
• They agreed that it was theoretically possible that this was a cold starting. They decided to wait a bit more before giving her any Benadryl to stop the reaction, to see if it would progress (like an allergic reaction) or not (like a cold, which would obviously take much longer to develop and worsen).
  
• By about 15 minutes later, she had broken out in an eczema flare over most of her body - her chest, back, stomach, legs, hands, wrists, etc. She had hives on her hips, knee caps, wrists, and maybe some tiny ones a few other places. She was occasionally sneezing. She was scratching herself but not complaining of being itchy. Actually, she seemed fairly oblivious to all of this and did not complain of being bothered by the reaction, even though she was acting kind of weird
• Benadryl was given to stop the reaction. A 1 hour wait period began, so that they could make sure that the reaction had subsided before letting us go. It took a while for the symptoms to subside, but they eventually did.
  
• We went home. Georgia ate lunch and went down for her nap. She slept so long we eventually had to wake her up to keep her on some semblance of a normal schedule. By the time she woke up from her nap, her skin looked much better. By her bedtime, her cheeks weren't even pink. You never would guess that any of this had happened. We gave her 1 tsp of Benadryl at bedtime as instructed by the allergist.
  

So, there you have it. In retrospect, it is kind of funny that we would even kid ourselves into thinking that she had spontaneously caught a cold in the middle of her allergist appointment, seeing as how we were there for a food challenge with the known possibility of an allergic reaction. Duh! Call it hopeful optimism or denial, whichever you prefer.

The egg challenge was a big bummer in a number of respects. We really had been hoping to cross at least one of Georgia's food allergies off of the list, just to make it more manageable. Also, it is never fun to witness your own child going through something uncomfortable (and potentially dangerous) like an allergic reaction, not just because of the presently occurring reaction, but also because of what it means for her future. Although I'm sure she'll learn to live with her allergies, we just so wish that she didn't have to grow up dealing with any of this stuff.

So, that was the bad part. However, as mentioned above, based on Georgia's reaction yesterday they think she may be able to tolerate baked eggs. From a lifestyle perspective, this is hugely positive news. As my sister pointed out, two year olds are a lot more likely to be running across cupcakes and cookies than scrambled eggs.

More on the "Baked Egg Study" and the doctor's protocol for introducing baked eggs into Georgia's diet in a later post. Bye for now!

Don't Count Your Chickens Before They Hatch

Or your eggs before you've eaten them, as the case may be.

So much for my motherly intuition! Georgia failed her egg challenge. (Um, did you read my last post? Well, don't I look like the fool!)

Silver lining here is that she may be able to eat eggs in baked goods, so at least some good news came out of yesterday's appointment.

Full story later when I have time to report.

IS EVERYONE AS EXCITED AS I AM?! No? Okay, anyway...

Scrambled eggs and french toast? Bring it.

Tomorrow is the egg challenge, and I'm so excited!

We've tried to prep Georgia with just enough facts to prepare her for what's in store. For a two year old, that means keeping it really simple. I know she's soaking it all in, though, since she started telling the grocery store clerk about her allergist appointment as we were checking out with our carton of eggs.

Also, I don't want to scare her about it. But if anything, my concern has been more the opposite -- not trying to hype it up too much. I've had to control the urge to express extreme excitement, as in, "We'll go out for cupcakes afterwards to celebrate!" I'm so confident that tomorrow is going to go well that I kind of have to remind myself that there is at least the possibility that she'll have an allergic reaction.

Here's to hoping that my motherly intuition is spot on in this case.

Fluarix Vaccine

As mentioned in my prior post, for egg allergy reasons, Georgia can't get the H1N1 vaccine right now. Nor is she eligible for the regular seasonal flu vaccine.

But! (--and this is the good part--) We were able to get her an alternative type of seasonal flu vaccine, administered at the allergist's office. It's called Fluarix, and I'm no doctor, but it is my understanding that in the U.S. it has been FDA approved for adults, but in the case of young children it requires a doctor's prescription. Also, I think it has been approved for both adults and children in Europe for some time now. The allergist's office sent us a thorough letter explaining this drug, and I'm kicking myself because I can't find it now. I believe the drug still contains egg proteins (like most flu vaccines), but perhaps it contains less egg, which is why our allergist is okay with giving it to patients like Georgia? (Again, kicking myself for not being better able to explain this right now, but I swear it all made perfect sense in the letter. If I ever find it I will update this post with more information.)

Anyway, if your child has tested positive for an egg allergy but has never had an anaphylactic reaction to eggs, it might be something to ask your allergist about.

Now, as for the actual shots? I was under prepared. I knew they wanted to give Georgia a partial dose and then have us wait to make sure she had no reaction before giving her the remainder of the dose. I thought we were talking about a 5 minute wait or something. Turns out there was a wait at the allergist's office before our appointment even started, then there was the first shot in her right thigh, followed by a half hour wait, then the second shot in her left thigh, followed by another half hour wait, and then we were dismissed. Whew! Had I known, I would've packed a couple more books to entertain my two year old. Oops.

It all went as well as can be expected, although I did feel bad for Georgia heading back in for the second shot. I mean, the first one was like the kid didn't know exactly what was coming, but c'mon -- she's no idiot. By the time we were walking back in for the second shot, she knew what to expect and wasn't happy about it. There weren't too many tears, though.

Another thing I didn't know about until after we got there: We had to return 4 weeks later for yet another dosage -- the booster that's apparently required for any children getting their first seasonal flu vaccination. She was more scared walking in for the booster, because she knew a "pinch" was coming (that's what she calls shots these days). But it was nothing that an Ernie and a Cookie Monster sticker couldn't fix.

Thoughts on H1N1 and French Toast

Unless you're living in a cave, you know that flu scare is in full swing this year. There's the seasonal flu, and then the dreaded H1N1, a.k.a. swine flu, and if you were pregnant this year (like I was), or have a baby under six months old at home (like we do now), then you're officially high risk and should probably get yourself and your whole fam-damily vaccinated a.s.a.p.

How do I sum up my conundrum succinctly?

-Georgia's allergic to eggs, so she can't get the regular seasonal or swine flu vaccines;
-But she's testing so low on the RAST scale that she's scheduled for a food challenge for eggs in January;

-In the meantime, we've got an infant at home that we should be going the extra mile to protect from swine flu.
-Basically, this leaves me wondering, what is the greater risk? Georgia having an allergic reaction to eggs, or June getting the swine flu?

You see what I'm saying? I mean, we're following doctors' orders and all, so we are NOT feeding Georgia eggs on our own - we are waiting for the medically supervised food challenge - and we are not getting her swine flu vaccinated until she passes the food challenge. However, I'm just saying that we sometimes wonder whether this protocol makes 100% sense, given the possible dire consequence of June getting the swine flu, and given the fact that the allergists must believe that Georgia's probably not allergic to eggs at this point, otherwise they wouldn't have recommended that she do the food challenge.

In semi-related news, they called from the allergist's office to say that we are supposed to bring our own food to the food challenge, and specifically that we are supposed to make FRENCH TOAST to bring. Something about that just cracked me up. "Hi, I'm just calling to remind you of your daughter's appointment and to make sure that you know how to cook french toast. Will that be a problem?"

Then, a few days later, we show up at my sister's house for Christmas Eve brunch, and what is she serving but french toast! Suddenly it just seemed so odd to be heading off to a doctor's appointment in January to feed Georgia french toast, when I could've just given her some right then and there on the spot.

Again, we did not do that. We are following the doctor's instructions. I do not recommend that anyone else out there perform food challenges at home with respect to allergens that they've been told to avoid. All I'm saying is.......well, you can appreciate the weirdness of this stuff, right? The oddity of going through such formalities (like a 4 hour doctor's appointment) to eat french toast, when it's right there available on your table.

Christmas Morning Reaction

Just a brief note to record the fact that Georgia had some kind of contact irritation or allergic reaction on Christmas morning. Not sure what it was from, but she broke out in a red rash with hives all over her face, mostly on one side, and had to have some Benadryl.

She had eaten Dum Dums and Tootsie Rolls from her stocking, both of which I think were safe.
Not sure if she got kisses from someone who had been eating something unsafe or what exactly happened? This one will remain a mystery.

Since I'm on the topic of holidays, I just want to add that in my opinion there are too many allergen-laden foods in our house right now. I know that some "allergy moms" are super strict with their families when it comes to holidays and food. We, however, are not a "strict prohibition" or "zero tolerance" household, which is to say that we generally allow in foods that Georgia is allergic to and just police them. That said, we try to remain nut free and sesame free as much as possible. We do not buy these things and bring them into our home. This helps to avoid pantry mix ups, problem crumbs, cross contamination, and that kind of thing. (We are not as strict with eggs - we still keep eggs in the house and some processed foods made with eggs.) With family in town, and neighbors and friends having dropped off a few food gifts, I suddenly feel like we've got about 10-12 off limits foods floating around. Not a huge big deal, but I will be more comfortable when we're back to our usual ways. I tend to view these ingredients as threats to my child's health and safety; I think that others just view them as "things she can't have." Anyway, Joe may have to take a few of these items to the office with him tomorrow.