A Little Chef's Card Victory

First, a confession:  We don't go out to eat with the kids very often for a variety of reasons, one of which happens to be avoiding food allergy hassles.  And by "hassles" I mean both cross-contamination risk and the hassle of having to talk to restaurant staff about allergies.  There, I said it.  I am not very practiced at it, and so I still feel...shy?  Embarrassed?  Like I am bothering them?  

I know it's important for us to go out, and to model proper food allergy behavior for Georgia so that she can grow up to one day handle all of this on her own without a second thought about it.  I get that.  I'm just admitting here that I do not love it, and it is something I am having to force myself to practice. 

So anyway, that's a little bit of background, but tonight I have a success story to report.  Georgia and Joe went out for their first ever daddy/daughter dinner date, something we've been trying to incorporate in order to give each of our kids a little more one on one time with us, their awesome parents. 

Joe called ahead to the restaurant, Dunlay's on the Square, to ask what kind of oil they use for their french fries and to confirm that the same oil was not used for frying fish, since Georgia has both nut and fish allergies.  Whoever he spoke to on the phone assured him no fish were fried in the french fry oil.  

Fast forward to the restaurant.  Joe brought our little laminated chef's card along and handed it to the server while mentioning Georgia's allergies and placing her order.  The server returned momentarily to the table, apologetically explaining that it turns out fish had been fried in the french fry oil earlier.  What a great catch!  Ah, the power of communication. 

So, I guess the lesson here is: yea for chef's cards!  And also: suck up any feelings of embarrassment over being a high-maintenance customer, and always communicate!  (To his credit, Joe is really better about this stuff than I am.) 

Sesame Reaction

Please ignore the fact that I titled a post "2012 Allergist Appointment" (or something like that) and then never got around to describing that appointment.  I'll get back to that eventually (maybe).

In the meantime, I thought I'd mention that several weeks back, Georgia had an allergic reaction to sesame.  Thankfully, it was minor and subsided after a dose of Benadryl, but it was a little disheartening nonetheless.  You see, as important as it is to be vigilant about avoiding Georgia's allergens, when we do it successfully I think it sometimes lulls me into a false sense of security.  I start thinking no reactions = no allergy, as opposed to no reactions = no exposure.  I had begun to think that maybe, just maybe, Georgia had outgrown her sesame allergy, and at our 2012 allergist appointment I was asking the allergist about doing a sesame food challenge.  (We were told, "maybe next year, depending on her test numbers.")  So, having convinced myself that maybe she wasn't even really allergic to sesame anymore, it was a bit of a bummer to find out that nope, she still is.  (Funny, this happened with egg a few years back, too.  Although I guess that experience should give me hope since she has since outgrown her egg allergy.)

The story of what happened just illustrates once again the importance of always reading labels.  We were at home, and Georgia asked for a sandwich so I made her one using some store bought bread we had on hand.  It was a brand we typically buy but turned out to be a different variety than what we normally buy.  I didn't even notice that the packaging was slightly different until Georgia took one bite of her sandwich and started complaining that her throat and face itched.  At that point I grabbed the bag, realized it was something new, and scoured the ingredients to find, sure enough, sesame.  Oops.

Now, I don't want to play the blame game, because there is no point to that.  We're all doing our best to keep our house allergen free to keep Georgia safe, no question.  But I couldn't help but be curious to understand how this happened.  It turns out that while at the grocery store, my husband Joe asked Georgia to grab the loaf of bread off of the shelf and put it in the cart.  She was happy to oblige, and he did not stop to read the ingredients (seeing that she had picked up the right type - or so he thought), and no one noticed that it was a different type of bread than our usual stuff.  So, lessons learned: (1) probably can't trust the 5 year old quite yet on food selection without double checking her work, and (2) we all need to pay more attention to slight differences in packaging.  [All experts and smart people agree that even if the packaging looks the same and it is something you've eaten 1,000 times before, you should still re-read the ingredients every time before purchasing, because you never know when the recipe of a processed food, or its manufacturing practices, have changed.  And that is 100% good advice, but I'm just being honest here and admitting that we do not always follow it.  I have not, for example, been re-reading the mac 'n cheese ingredients every time I buy a box of our "regular" brand.]

Another lesson:  maybe I should get back to making homemade sandwich bread more often.  I did that regularly for a year, to the point that we rarely bought bread.  The recipe contains only 6 ingredients (including water), and the whole family likes the taste even better than the store bought stuff.  It's not that time consuming to bake, but let's face it - does take more time than pulling a loaf off the shelf at the grocery store!  So I just need a figure out a way to work it into the schedule more frequently.  

Allergist Appointment 2012

I can't believe that I never really got around to discussing Georgia's October 2011 allergist appointment, and now here we are having completed her 2012 allergist appointment.  Mostly that just means I've been busy (raising children, taking care of a baby, etc.), but I think it's also a positive sign that allergies don't mentally plague me on a daily basis as much as they used to.  At the beginning, when you get a food allergy diagnosis, your mind is swirling and there is a steep learning curve with many unanswered (and in some cases, unanswerable) questions to confront.  But as time passes, allergies just become a part of life like anything else.  So, I guess that is a good thing. 

Before we get into how this year's allergist appointment went, let me share a few bullets about other stuff.

• My father passed away in May.  Obviously, that's a whole other story (and one of the reasons I've had a busy year), but the reason I'm mentioning it here is that I believe it to be noteworthy that we survived a week of non-stop grieving food generosity without incident.  We traveled for the funeral and were staying at my parents' house. My parents' friends were unbelievably kind to put on a veritable buffet of homemade comfort food for days on end after my dad died.  It truly was amazing - and delicious.  Obviously, my first feeling about this was thankfulness.  However, I was quite nervous about the prospect of Georgia eating so many things prepared in others' homes.  Many people were nice enough to even ask about her allergies, but good intentions and loving care do not always translate to safety.  For example, when sesame seed buns were offered, someone thought that Georgia simply eating bottom buns only would work.  But with vigilance, and passing on pretty much all of the baked goods, everything was just fine.  I will admit that my safety standards were not as high as normal, but high enough I guess?  Or did we just get lucky?
  
  
• We made it through an entire school year without Georgia suffering any allergic reactions at school.  Woo-hoo!  Props to her teachers for so carefully reading all snack labels.  I'm thrilled that she'll be in the same classroom again this year with the same teachers.  (It's Montessori, so even though she's moving on to kindergarten, it is a mixed-ages environment.)  It's such a comfort to know that her teachers already know the drill.  Nevertheless, we still met with them a few weeks ago, because it never hurts to review emergency procedures and that kind of thing. 

• Minor gripe:  if the school in practice is storing her Epipens and Benadryl in a conveniently located cabinet in the classroom, why must they continue to have me sign an "official policy" that states all medication will be kept in a locked cabinet in the main office, accessible only by the principal and her designees?  I'm satisfied because I've seen with my own two eyes where Georgia's meds are stored.  But I know our allergist would not be happy with the thought of medication being locked up and not in immediate reach.  I've been led to believe that in some cases of anaphylaxis, an extra 15 seconds or 1 minute can be the difference between life and death.  Anyway, I'm biting my tongue on this one since at base I've already gotten what I want, but it always bothers me when policies don't match reality.  
  
  
• Earlier this month we went to the American Girl store in Chicago for the first time.  Overall, I was quite impressed with their allergy awareness.  (Of course you should use your own judgment, but I felt comfortable letting Georgia eat their food.)  When we booked the reservation online, there were boxes to check to indicate certain common food allergies.  I later called to speak to one of their customer service reps about Georgia's allergies and their allergen practices generally.  The only part I'd give them low marks on was communicating all of this to the server, because when I made sure to mention Georgia's allergies to the server, she handled it very politely, but clearly it was the first she'd heard of it.  I suppose from a practical standpoint that may have made absolutely no difference, but somehow it didn't instill a feeling of confidence in me about everything else they'd already told me on the phone.  I guess I assumed if you checked an allergy box on your reservation form that when you showed up there would be an allergy indicator next to your name or something.  Also, American Girl serves soy nut butter rather than peanut butter finger sandwiches, which is great.  However, I think they (or at least our server, perhaps I should say) are in the habit of nevertheless describing these in person as peanut butter sandwiches when setting them on the table.  I imagine this is to help the parents of picky eaters avoid any difficulties; call it peanut butter, and nobody asks questions (at least I assume that's the idea).  It caused our table to do a double-take, though, at which point the server corrected herself and we all chuckled mildly in relief.  Interestingly, Georgia still declined to eat any of them.  She really is unbelievably cautious at this age, at least when it comes to food, which is fine by me.  One more American Girl anecdote:  did you know that amongst their doll accessories, they sell an allergy-free lunch, including a faux allergy shot and medical bracelet?  We didn't buy one, but how cool is that?
   

I think it's a sign of the times that enough children have food allergies that a doll store would even have something like this available.  My first thought was, "Who needs this expensive set? We could fashion our own from stuff we already have at home."  I could see myself eventually deciding to treat Georgia to this, though, because in my view it's no different than the dolls with glasses, braces, or the ones in wheelchairs; every child just wants to feel normal and accepted for who they are. 

Wow.  Those were some seriously long bullet points!  Sorry for rambling on, but now I think I've got to go.  The allergist appointment summary will have to wait for a different post.  (And because I am too lazy to change it, this post will now have the most poorly selected title ever!)

Until next time...take care!  

Oh, hello there!

Hi there, poor, neglected little allergy blog o' mine. I'm not sure where the time has gone, except, wait, actually, yes I am. I had a baby boy in August, and as such critters are wont to do, he's been keeping me quite busy. Three kids under 5 is officially a handful in my book. With a scarcity of spare minutes for blogging, I've been devoting those minutes to capturing Waylon's babyhood and our girls' antics elsewhere rather than Georgia's allergies on this blog.

All of that said, I have made connections on this blog with other families dealing with food allergies (sidenote: my apologies to those of you to whom I owe emails; it's nothing personal but I've been terrible about correspondence lately), plus I like having some record of Georgia's progress, so I'm not yet interested in totally foregoing this blog or shutting it down.

They say when you get behind in school, sometimes it's best to just let go of what you haven't done and instead start reading for the next class. With that sentiment in mind, I'm jumping back into this blog without rehashing every detail of the past 6+ months.

But there were a few events worth mentioning...

In September, our family participated in a FAAN Walk for Food Allergy. I am not sure whether Georgia really got a kick out of being in a community of supportive people and others with food allergies, or if I was just projecting that sentiment on to her because I sort of felt that way? Anyway, it was a gorgeous fall day. We tried to explain to Georgia beforehand that the purpose of the walk was to raise money for scientists and doctors to learn more about food allergies, and she really latched on to that apparently. My favorite part of the walk was that she kept asking where the scientists and doctors were. "Is he one of the scientists, mommy?"




It was a 2 stroller kind of day for our crew.


Waylon, always the supportive little brother at 5 weeks old, wore his green ribbon in honor of his big sister. (Blue ribbons were for those with food allergies, green for friends and family.)


Good thing this wasn't a race; I think we would've come in dead last. Actually, we didn't really complete the whole walk, but I think it's the thought that counts, don't you? At this point in our life as a freshly minted family of five, I was impressed with us just for showing up.


June enjoying some fancy top 8 allergen-free jelly beans. (They had all sorts of free goodies there.)






I think I look pretty terrible here, but with good reason, right? And now you can see part of the reason our troupe was moving so slowly.


Georgia proudly showing off her free t-shirt.


Normally, people with food allergies just want to fit in with the crowd and be "normal." But when you're 4, you think it's pretty darn cool to get your very own special blue ribbon just for having allergies.


June kept running way ahead of us on this path along Lakeshore Drive. I love her wobbly toddler jogging. : )

Oh, shoot. Look at the time! Well, I had intended to write about Georgia's October allergist appointment, too, but if I wait to complete that, this will probably never get posted. So I'm just going to hit "Publish Post", run to get in the preschool pickup line now, and save the rest for a different day. Ta ta!

Peas? Really?

This should be short because I'm not sure what to make of it yet. Georgia has started occasionally complaining that eating peas makes her mouth itch.

What? Please, no. Peas, like peanuts, are a legume, so it's not totally unheard of for people with a peanut allergy to also be allergic to other legumes like peas and beans. But Georgia did a food challenge for green peas at her allergist's office nearly 3 years ago and passed. She's been happily eating peas with no problem ever since. (Yes, I know from experience that food allergies can crop up at any time, but still, it's harder for me to accept that that is what's happening here.)

Oddly, she likes to eat her frozen veggies straight out of the freezer sometimes (hey, it's easier for me as the chef, so I'm not gonna deny her that request), and she has told me that her mouth doesn't itch when she eats the peas frozen.

For now, I haven't cut them out of her diet, because I'm still trying to figure out if this is all real or not. Of course we take potential allergies seriously around here, but at age 3, she's not always the most reliable reporter and has been known to put on academy award worthy performances sometimes. So, we're keeping an eye on her pea intake and will ask the allergist about it at her next appointment.

Allergy Dad Confession: Cookie

Okay, that post title is a misnomer, because it's not really a confession when someone else is doing it for you. I think it's more like tattling. Whatever.

Georgia's preschool teacher sent her home with a homemade star-shaped cookie to celebrate the 4th of July. (Aside: people often do not get it why allergic folks are so wary of others' home baked goods. I know they mean well. I'm sure the teacher, who of course knows of Georgia's allergies, gave it to her thinking that it was safe. I'm guessing she'd be surprised and not totally get it if she heard that we still wouldn't let Georgia eat that thing. I'm just glad and amazed that in this instance Georgia didn't immediately gobble it up.)

Anyway, the point of the story is that not knowing more about the ingredients or the cross contamination risk from this woman's kitchen, we did not allow Georgia to eat the cookie and instead threw it out, or so I thought, but then I later found my husband standing at his dresser munching on it. You little devil, you! I guess he just can't let a good cookie go to waste!

Are Food Allergies Funny?

I know that post title makes it sound like I'm about to go off on a diatribe about how food allergies are not funny, but I honestly mean the question sincerely and would be very curious to hear your thoughts, especially if you (or your child) do not have food allergies. I am always interested to hear the viewpoint of people not so immersed in the allergy world as I am.

I've noticed that it's apparently okay in popular culture to poke a little fun at food allergies. This recent post over at Dooce, (which largely has nothing to do with food allergies), just reminded me of the topic. Clearly, she wasn't trying to offend people with food allergies, she was just trying to make her point in a humorous way by poking a little fun at herself.

I can also think off the top of my head of episodes of The Office, 30 Rock, and Modern Family that have all incorporated food allergies as part of the plot within the last two years. Being sitcoms, the situations shown are meant to be funny of course, but I find myself clenching up and having trouble appreciating the humor. I literally sit there having an internal dialogue with myself going, "Kate. Do not be so uptight. It is just a joke, for crying out loud." And in the category of "any press is good press," one could argue that even poorly portrayed images of food allergies raise food allergy awareness amongst the general public. (I'm not so sure I agree with that theory in this case, but I'm just throwing it out there. In my opinion, a truly inaccurate portrayal of food allergies can do a real disservice to people dealing with them. For example, a portrayal of a buffoon with a fake food allergy might fuel doubts about whether other people's properly diagnosed food allergies are real.)

Anyway, I'm mostly not offended by sitcom portrayals of food allergies, or people using food allergies in jokes, I guess, because I have to admit, it does just go to show that with food allergies on the rise, they are much more a part of the viewing public's consciousness than they would have been 5, 10 or 15 years ago. And that apparently makes food allergies acceptable fodder for comedy.

The more uptight part of me has to wonder, though: would it be okay to poke fun at someone with cancer, diabetes, autism, or some other affliction in the same way? Would the viewing audience find it as funny? Why are food allergies so funny? Sadly, I think it's because a lot of people secretly find it sort of annoying to have to be bothered by the food allergies of those around them, so jokes are a way to let off steam about that.

I don't know. Those are just some ideas I've been pondering. What do you think?

I do believe that in life it's critically important (regardless of the situation) to retain some ability to laugh at ourselves. So I'm really striving to foster the part of me that is not offended by attempts to humorously portray food allergies, and to tone down the part of me that is admittedly still a little uptight about it. It's all about finding the right balance, I guess.

I have no idea what just happened there

Well, that's not completely true. In retrospect, we're pretty sure that this was "merely" a contact reaction.

Wait, let me back up and start over from the beginning. We went to Florida on vacation. We stayed in a condo and ate most of our meals in. We didn't want to be total party poopers, so we tried venturing to a restaurant with the kids. And as luck would have it, Georgia somehow broke out into a pretty bad case of hives at the table....BEFORE OUR FOOD WAS EVEN SERVED.

Grrrr. What the hell? I mean, seriously, is this a joke? Can we now not even safely set foot in a restaurant?

I guess we will never know for sure what happened, but our best guess is that she brushed up against something on the table and then touched her face, or that some kind of food residue was left on one of the communal crayons in the crayon bucket that Georgia had started using while we were waiting to be served. For a while there, Joe and I had some fears that this incident might indicate that Georgia is now so allergic to fish that the mere presence of fish "fumes" in the restaurant was enough to set off this reaction. However, we've thankfully since proven that theory invalid, by getting back on the horse so to speak and venturing to a restaurant as a family again four days later -- a heavily seafood oriented one at that. (They're a bit hard to avoid when you're staying on an island.) So, it's probably more likely that it was peanut butter or nut residue of some sort on the table, chair or crayons, I'm guessing.

Anyway, a few more details on what happened:

-Georgia went from totally fine, to "Gee, honey, does her face look a bit splotchy to you?", to "Um, she's clawing at her face now..." in a matter of about 2 minutes.

-We gave her some Benadryl but then realized it was boiling hot from having accidentally been left in the car all day. Not being certain whether the active ingredient would still be effective, we didn't want to take any chances. We bolted from the restaurant, (my parents stayed behind to pay and take the food to go), and then our little family sped around the island stopping at four different convenience/grocery/pharmacy stores before finding a fresh bottle of liquid Benadryl for sale. (Just picture 6 months pregnant me, sprinting in and out of each establishment in pursuit of relief for Georgia.)

-I don't know if these were "bad" hives comparatively speaking, but they were certainly the worst case Georgia has ever had. Her face was the worst and continued to blow up a bit as we drove around, and the hives spread to her neck, shoulders and arms - but not nearly as bad as on her face. Her eyes were extremely puffy, especially underneath. I'm not sure the photos I took show any of it very well.

-Joe maintains a "fake calm" front for Georgia when this stuff happens, but man oh man, does he get tense!

-I was anxious and worried watching the hives spread, but not too panicked because I could see that she was breathing fine, and had no swelling of her lips or tongue. Also, we had the Epipens at the ready if things had taken a turn for the worse. (Thank God that did not happen!)

In the end, the Benadryl kicked in, the hives subsided, and all was well. Georgia took a shower back at the condo just to be safe, ate a makeshift dinner, and went to bed. (We later woke her for 1 more dose of Benadryl, just in case. Oddly, we found her out of bed, sleeping face down on the plush carpeted floor! I wonder if that was total coincidence, or if the Benadryl made her a bit loopy?)

So, that's it, but I think this little incident illustrates two things very well:

1) When dealing with a three year old, food allergies are often harder on the parents than the kid. Sorry if that sounds rude or self-centered, but in our experience, Georgia (at this age) doesn't get too upset about foods she can't have. Also, almost all responsibility for what she eats or doesn't eat falls on our shoulders and not hers. She's not even as mentally affected by her reactions as we are while she is having them. She's complaining of the itch, while we're worried that something life threatening is going on. (In the midst of this reaction, she looked down at her arms and said, "Well, the good news is that at least I don't have hives on my face!" I just laughed and said, "Oh, sweetie. If only you could see a mirror.")

2) Sometimes the eventual outcome doesn't paint a full picture (to friends/relatives/third parties) of what it feels like to witness your child having a reaction, or how it can continue to affect you afterwards as a parent. I'm sure that could be said for any type of accident, disease or medical situation involving one's own children, but what I'm getting at is the idea that this reaction can be boiled down to: she touched something, she had some Benadryl, she was fine! And I realize that the "she was fine" part is the most important. But while it's happening? Your blood pressure skyrockets. Your brain wonders "what if?" You blame yourself for having not wiped the table, or for having left the Benadryl in the car, or for whatever else you might come up with. And then afterwards, you're relieved that she's fine but find yourself wondering, "Is it even worth it to go to restaurants?" followed by, "But geez, she can't live her life in a bubble." Then you find yourself on the plane trip home 5 days later thinking, "Oh holy crap, what would I do, and how would I feel, if she had that same kind of "minor" contact reaction right here, in this confined space flying through the air?" (I really tried to put that thought out of my mind, but it did creep in there from time to time as I reprimanded Georgia for senseless (but totally normal for a three year old) behaviors, like putting part of the seatbelt in her mouth.

So, I guess that's it. None of Georgia's reactions (or our responses to the reactions) ever seem to go down "by the book", and we always learn something new. This time it was don't leave the Benadryl in the 90+ degree heat all day, and maybe wipe down your surroundings and don't use communal crayons. On that note, I think we've officially become "one of those" wiping families. Great. Which makes me feel a bit ridiculous, because it's not like you're going to wipe down every bathroom doorknob, or salt shaker, etc., wherever you go -- it's impossible to clean the whole world around you, so wiping any of it seems slightly pointless. On the other hand, once you've witnessed stuff like this happening to your child, suddenly it seems like a really good idea to not use those crayons, to wipe off her chair, and to clean her tray table and arm rests on the plane. (Side note about airplanes: you might recall our interesting encounter with Peanuts on a Plane from last year. This time I made sure to dress Georgia in long sleeves, pants, socks and tennis shoes just to minimize the chances of contact.)

Here are some pictures that I don't feel too bad about posting, though they break my heart a little. (One day I'll ask her permission, but she's still young enough right now that I think she'll look back on these and laugh, and not get mad at her mom for posting unflattering pictures. Besides, she's still cute as a button to me, even with hives.)

Before:
(Clear picture of her face from earlier in the day.)


Gratuitous "before" shots from the restaurant, while we waited outside for a table:

(That's her Pop Pop's pink lemonade, the only thing she consumed. An unlikely culprit. And we did confirm that Pop Pop hadn't been eating anything that day that would have caused a cross-contamination problem on the shared straw.)


(Doesn't everyone look so relaxed?)

Okay, and now for the "during" shots. These were not taken at the height of the episode, but after things started to subside a bit. The lighting conditions were bad, (or my photography skills were), so I'm not sure these photos do justice to the puffiness under her eyes.








And finally, a couple of photographs taken about 24 hours later. You can see lingering after effects of the hives. (Is that typical? Her forehead had tiny bumps that looked almost like itty bitty acne for the next several days.)



(It's hard to tell, but can you see the swath of redness running underneath her eye?)

One more gratuitous photo for good measure, my sweet girl sucking fingers as she always does to relax or go to sleep. As you can see, she's no worse for wear:

Love her.

Clear as mud

As much as I tried to put the most positive spin on our E.R. trip in the last post, Joe and I realized after having a few days to let it soak in that the experience left us with a lot of unanswered questions. I've since had another conversation with the allergist to clear up some of our confusion, so I thought I'd share the additional insight. (And here's where I again have to remind you that you shouldn't take any of this as more than a fun anecdote. You really can't apply our doctor's medical advice to your own situation, because it might not be apples to apples.) Okay, lawyerly disclaimer over.

And now for a side story. Part of our confusion came from the fact that, completely unrelated to food allergies or this weekend's incident, about 48 hours after our E.R. trip, Georgia ended up seeing a pediatrician regarding an ear infection that she had last month. When the E.R. trip came up in conversation, this pediatrician seemed shocked that the hospital had not followed "protocol" for response to an allergic reaction, and had not directed us to continue giving Benadryl after we went home. During the course of this conversation she exclaimed, "That was a life threatening situation!" Though I was not present at the appointment, Joe assures me he gave the doc a strong stink-eye implying, "Hey, lady, could we please not discuss all things 'life threatening' in front of my impressionable young daughter!" Still, though, it got us to re-evaluating Georgia's reaction.

So, what really happened Sunday night? Was it anaphylaxis? Should we have given the Epipen? Should the hospital have done anything differently? Should we have continued giving Benadryl? When are we out of the woods with respect to any reaction? These are the types of questions we had swirling in our heads.

Here are some (paraphrased) answers:

1) The allergist made us feel better by assuring us that we were understandably confused in the heat of the moment (and afterwards), because this was not a "typical" reaction.

2) She was not surprised by how the hospital treated us and thinks we likely would've gotten the same treatment at most area hospitals. As she put it, in her experience, if you do not have hives, they simply have a hard time believing that you are having an allergic reaction. (Never mind the fact that all literature on the subject indicates that hives need not be present; I think it's just a case of lack of familiarity and E.R. docs having to rely on knowledge of the most typical cases, not to mention juggling all manner of various maladies on any given night.)

3) After Georgia initially recovered from the reaction, we should have continued giving her Benadryl every 4-6 hours for the next 24 hours to make sure that everything stayed under control and that a biphasic reaction did not occur. So, we blew that one! (As did the hospital.) Joe did, however, end up sleeping in the same bed with Georgia that night, just to put our minds at ease, so I don't feel too bad about our flub.

4) Had we spoken to the allergist about 20 minutes earlier, while Georgia was still vomiting in rapid succession, the allergist likely would've advised that we inject the Epipen. She said that is what she usually recommends when internal symptoms (like vomiting, or swelling of the tongue) are occurring. She prefers to err on the side of caution and says it would never be "wrong" to use the Epipen, because it will not hurt Georgia. In this particular case, she said it would have stopped the vomiting and made her feel better. However, by the time we spoke to the allergist in the midst of dealing with this reaction, Georgia had at least temporarily stopped vomiting and had fallen asleep in the car, plus we were not far from a hospital, which is why the allergist did not advise us to inject the Epipen.

It's all so weird, isn't it? I mean, once you have the benefit of hindsight and knowing that everything turned out JUST FINE, it sounds ridiculous to have considered injecting the Epipen, because that's just a much more dramatic thing to do. For starters, it would mean immediately calling 9-1-1, arriving in an ambulance, and likely staying overnight in the hospital. Not to mention the fact that it would probably totally freak Georgia out (which I'm all for if it means saving her life, but generally against if it's not necessary).

But the problem is, you don't know until afterwards that, yeah, things will turn out just fine without the Epipen, and if you need it and wait, it can be too late! Which is why the allergist says when in doubt, use it.

I just feel funny knowing that there have now been two reactions where maybe we should've used the Epipen but didn't. (And then at the same time, with the benefit of hindsight and knowing that she recovered fully without the Epipen, there's a part of me that's glad we didn't inject the Epipen. Is that bad?) I am certainly not trying to take chances with her health in these situations, I'm just saying we've gotten very lucky in the past, but this is all a good reminder that one cannot count on "luck" during future allergic reactions. In short, better safe than sorry.

5) Does it even matter if it was anaphylaxis? What is the point of labeling the type of reaction? I don't know. To us it was just a point of curiosity, wanting to understand Georgia's allergies better, wanting to know if we should've used the Epipen, and wanting to know how "serious" her reaction was. (Also, we were confused by the list of "types of reactions" on FAAN's website, trying to fit Georgia's experience into one of their categories.) The response from the allergist was that, again, this was a confusing, atypical reaction, and we may have hit on a gray area where even she can't fully describe the reaction. It was not "just hives" because it included internal symptoms and no hives. She said certainly it had "anaphylactic potential" if it was not actual anaphylaxis. If her blood pressure had dropped, then it would be deemed anaphylaxis without question. But Georgia's blood pressure measured just fine by the time we were at the hospital. Could a BP drop be what caused her to so easily fall asleep on the couch or to pass out asleep in the car on the way to the hospital? I hope not but guess we'll never know. So if I understand it right, hives alone would not be anaphylactic, hives + vomiting would be anaphylactic, vomiting + blood pressure drop (or just about any symptom + blood pressure drop) would be anaphylacitc, but vomiting without the blood pressure drop = not anaphylactcic probabaly, but "anaphylactic potential." (Whew! What a mess! And maybe it doesn't even matter from a practical standpoint, but I thought I'd share, for what it's worth.)

So, there you go. We've learned a lot, but I'm also amazed at how unclear all this allergy stuff is to me. I mean, I don't consider myself to be on the uneducated end of the spectrum. I write a blog about food allergies (albeit mostly about personal experiences, not research) and read about them frequently. And yet navigating food choices everyday, and handling a reaction when it happens still feels much more like an art than a science to me. It's all just a collection of individual choices guided by medical advice, but not clearly black and white.

A Little Scare

Well, I guess it was bound to happen someday. We had our first allergy-related trip to the E.R. But don't worry - everyone's fine!

Georgia had a very delayed reaction (think: 4-5 hours after ingestion), consisting primarily of vomiting, after eating about a slice and a half of sandwich bread containing tree nuts. She took Benadryl and was later given an anti-nausea pill at the hospital, but at no point did we have to inject the Epipen. Our allergist recommended over the phone that we go straight to the closest E.R., so we did.

This particular E.R. probably deals with more trauma injuries than pediatric allergy cases, so I'm not sure anyone there ever 100% believed that Georgia's symptoms were due to food allergy and not the flu, since she was not presenting the "classic" profile of allergic reaction symptoms including hives and airway restriction. (But I saw my little girl playing hard all afternoon, and I saw her waking up as happy as a clam again this morning, so I don't think she just spontaneously came down with the flu yesterday at 5 p.m. and then fully recovered by 11 p.m.)

Regardless, she is fine now, which we are all thankful for. That is what matters most. The silver lining here is that it was a great learning experience. So I thought I'd just focus on the positives and discuss some of the lessons we gleaned:

• Now we know to give Benadryl once an allergen has been accidentally consumed, even if there are no symptoms yet, because it might help prevent a reaction from starting. (I feel like an idiot for not realizing that we should've done that until well after the fact.)


• Now we'll have the allergist's phone number stored on our cell phones. We had no trouble looking it up online from where we were, but it dawned on us that that won't always be the case.


• Now I will feel less weird about going to the hospital if we ever have to do this again. I'll be less hesitant to seek medical help.


• This is a "data point" for Georgia. I know from talking to adult friends with food allergies that they have developed over the years an ability to know what's going on with their bodies. They probably wouldn't mistake a food allergy reaction for the flu, because they know the sensations of having an allergic reaction. So, for Georgia, this is just another data point to help her better understand her own body.


• We weren't on vacation, but the next time we are, I'll look up where the closest hospital is and how to get there. (I've heard that tip 1,000 times but never thought much about it. I guess I figured we either wouldn't need a hospital or would be calling 9-1-1, but last night I realized that there is a middle ground type of reaction, during which it's helpful to know how to get to the hospital.)


• The pendulum that swings from lax to vigilant in our house just swung back to vigilant. As much as we are all trying to avoid reactions, and accidents are kind of inevitable, there's nothing like a reaction to remind you that allergies are real.


• Having been through the E.R. experience now, I think next time we'll just head to the closest hospital and let the chips fall where they may, instead of thinking ahead to the rest of the evening, or what hospital we'd like to get to (banking on the fact that Georgia is probably fine), or that kind of thing.


• Joe would add that one lesson he learned was to pack a hospital "entertainment bag" for your one year old who will be up way past her bedtime. Yeah, that sounds nice, sweetie, but seriously, what are the chances we'll ever have such a thing at the ready when we really need it?


• Seems that cell phones don't work in most medical buildings. Next time I'll know to tell concerned family members not to worry if they don't hear an update for a couple hours. Also, I have rid myself of the delusional belief that an E.R. visit can be accomplished in thirty minutes or less. : )


• Last valuable lesson: if you walk into triage and promptly throw-up into their trash can, you will be admitted faster. (True, but I'm just kidding about that being a "lesson".)

So, given the probability that an E.R. trip was going to be on our agenda someday anyway (sorry, just being a realist), how great is it that we were able to figure out all of these things in the midst of this reaction instead of a more severe one?

Other positives/funny stories:

• June of course sprung a diaper leak while we were there, so Joe was covered in multiple bodily fluids. We did have a back-up diaper on hand, but no extra clothes, so June spent the rest of the evening charming the hospital staff mostly naked.


• During a fussy toddler moment, some guy followed by two cops walked by, and Joe urgently said to me, "Video! Something that takes video! A camera phone, I don't know - something, anything!" I immediately started scrambling through our bags looking for a recording device, not understanding what he so urgently needed to record, thinking that it related to the guy or the cops. Turns out he was just hoping we had some sort of on-screen entertainment available for June. Ohhhhhhhhhhhhh.....now I get it.


• I let the girls play with surgical gloves, but Georgia quickly and furtively shoved them back at me the moment the physician opened the curtain, because she thought she'd be in trouble for using them. (Maybe you had to be there, but it was really hysterical.)


• We let June eat half of the Pedialyte popsicle that Georgia was given. (Georgia had to keep it down before they'd let us leave.) What can I say? By that point, we were convinced Georgia was fine, desperate to leave faster, and out of ways to keep June pacified.


• We love our allergist! She responded quickly to the after-hours call, gave us clear advice, called ahead to the hospital to let them know that we were on our way in (not that that made any difference, but still, a nice touch!), and then called me this morning to see how Georgia was doing. Love her.

Yeah, I took some pictures. Why not? What else you gonna do when stuck in cramped quarters with your family doing a whole lot of hurry up and wait?

Just a little follow up

Since my last post was kind of a rant, I felt like I should update this blog to reflect that I think we've got everything worked out with Georgia's preschool now. I had a phone conversation with the teacher in which she probably concluded that I'm a little paranoid (her quote: "Um, we ate tomatoes?"), but also managed to convince me that she "gets" it as far as the need to check all foods, the concern for cross contamination, and so on and so forth. We left it that Georgia will continue to bring her own lunch, but will be allowed to eat some of the school's food so long as on any given day the teachers tell her it's safe.

Surprises:
1) I'm surprised that this is where we've ended up, that is, that I even feel comfortable letting Georgia eat ANY of the school's food, given that my generally held belief is that the risk isn't worth the reward, and that classrooms should be a food-free safe haven.
2) I'm surprised that the school/teachers even want the onus to be on them as far as telling Georgia "yes, you can eat it" or "no, you can't." It seems most schools are so afraid of potential liability that they wouldn't touch this issue with a ten foot pole and would prefer to have the parent make the call in every case.

What's playing into this:
1) It's a Montessori preschool, so the serving of food is not just about nourishment, but also about having the children work on a practical skill and share a communal experience. (Or something like that.)
2) I'd be more willing to say "screw the skill/communal experience" except for the fact that Georgia's been so hesitant to get involved in ANY group activities with other children, but her teacher reports that Georgia really likes the meal-prep part of the day, so I am loathe to take that little shred of participation away from her. For the sake of her social development, as parents we're kind of trying to latch on to something she likes and go with it here.
3) The foods in question are very basic, like last week they peeled oranges or bananas, and the week before that I think they made a salad of lettuce and tomatoes. I'd feel more comfortable if someone could give me an actual menu ahead of time, but I guess the teacher has persuaded me to relax and trust her that the foods she's talking about incorporating aren't going to be a problem. The fact that so far they have not been processed foods makes it less worrisome to me from an allergy perspective; I hope it stays that way.

This is fixable. But GRRRRRR I am so mad!

If I had written this post six hours ago, it would've been filled with profanities, so let's all be happy that I didn't have time until now.

Here's the short, cut to the chase version of the story:
Georgia started a new (one day a week) drop-off preschool program today where lunch is served. (God forbid the children go more than an hour and a half without eating, but I digress.) We spoke to the teacher about her allergies beforehand and sent her off to school with her own brown bag lunch. She comes home reporting that "she ate some of the school's food" because they told her it was okay because "nothing they serve has peanuts in it."

Ugh. This is beyond aggravating. There was obviously some kind of miscommunication between us and the teacher. We'll fix it. And no one was hurt, and nothing went wrong, so yeah, I've calmed down (a little) now.

But I was majorly annoyed because:

1) Food allergies suck. Our daughter has had trouble transitioning to a school setting (or any group activity away from mommy and daddy for that matter), so I would really rather have everyone's focus at the school be on her social/emotional development, and how she's doing, and what we can all do to help her feel more comfortable and less anxious, but instead, nearly all of our conversations with the school thus far have been about freakin' FOOD. And I feel I have no choice in that matter, because her health and safety is paramount. But I hate it that it's Day 1 and we're probably already becoming "those food allergy parents" in the teacher's mind, plus I could hardly even focus on the positives of how Georgia's first day went, because it was all overshadowed by dealing with this food mess.

2) I'm p.o.'d that the teacher undercut our instructions to our own daughter, although I'm sure it was unintentional on their part, and thankfully, Georgia was pretty much unphased by the whole thing. Still, how confusing must it be for her when mommy and daddy send her off with a packed lunch and tell her not to eat the school's food, and then her teacher tells her the complete opposite? She's only 3, can't read, and has to rely on adults to protect her, so it's not helpful to send her mixed messages.

3) Grrr...peanuts, peanuts, peanuts. Yeah, yeah, it's so great that there's a lot of peanut allergy awareness out there now. But I've got two beefs about it. One, it gives people a false sense of security and confidence, so they say things like, "this food is peanut free!" and forget to read labels, or think about cross contamination or how the food was processed or cooked. Two, I think peanut allergy awareness is causing people to space out about OTHER allergies. Georgia's allergic to four kinds of food, so please don't give her the wrong idea by handing her something and saying, "You can eat it, because it doesn't have peanuts." In this particular instance, I'd be more forgiving of it as an innocent mistake if my husband hadn't already explicitly discussed Georgia's multiple food allergies with the teacher beforehand, and if we hadn't been required by the school to submit medication authorization forms and a food allergy action plan signed by her doctor.

So there you go. Just had to vent. I feel better now. We'll get it all worked out super tactfully and amicably with the school by next week I'm sure.

Friendly reminder/PSA

This PSA is for:
1) myself;
2) our relatives;
3) the friends and strangers who ask us if Georgia's allergies are "severe";
4) the parents I know who seem to take their children's allergies a little too casually in my opinion, assuming that [no bad reactions thus far] = [no bad reactions in the future].

I'm not trying to scare anybody, and God knows I hope my child's allergies are not severe. This is just a little reminder that unfortunately no one has any way of knowing.

(The following is an excerpt from a recent blog post I read on Food Allergy Mama):

Finally, I wanted to pass along an email a good friend of mine sent to her family members after a child in her daughter’s class suffered a severe reaction during a school field trip, and didn’t have their medication. I think it serves as a good reminder that you can never be vigilant enough….

I was in Springfield yesterday on a 5th grade field trip with Laney when one of her classmates had a allergic reaction to peanut butter. He is 11yrs. old and has never had a bad reaction before. His mom did not have her epipen with her. He was sitting next to a boy that had peanut butter and they think he somehow touched his hand or the table and was exposed. He started out with hives and then started coughing and his throat was closing up. We called 911 and they were there within minutes. I went in the ambulance to the hospital with the mom and child and they were able to get him the epipen, oxygen, etc… in time.

As you can imagine it was a very scary experience for everyone involved. I send this to you as a reminder that we need to carry Maddie’s epipen with us at all times, no exceptions. Yes, the chances of it happening to her are extremely rare but I would never want to be in that situation without it.

I asked him, after he was feeling better, what it felt like and he actually said he thought he was going to die or suffocate.. It was really sad and the fear in his eyes is not something easily forgotten.

Finally, everyone was hesitant to call 911, thinking that the benedryl he was given would kick in. Never wait, every second counts in these situation.

A Happy Moment

After church, walking back from the bathroom, our route took us through a post-baptism celebration spread of delicious foods.

Donuts, pastries, cookies, and cake galor. Amidst it all, a plate of bananas and orange slices.

I did not say a word and figured we'd just walk right through (I'm not the most outgoing of creatures when it comes to the church setting), but Georgia immediately asked, "Can I have one of those bananas? Because we don't know if the cookies are safe."

Me: beaming with pride!
Georgia: happily eating a banana.

I know there may come a day as she gets older when it will bother her that others can eat things that she can't, but for now, I just think it's awesome that she really is starting to understand her food allergies, and that it doesn't phase her one bit. So I'm going to live in the present and try to enjoy happy moments like this one. Now, if only I could always do as good a job as she did of picking the healthy option for myself!

Explaining my Absence

It's been a while since I updated this blog, so much so that I feel the need to explain my absence. Here's the answer: Don't take this the wrong way, but sometimes I just get bored of food allergies. (To the other food allergy sufferers or food allergy parents out there: do you?)

As a parent of a food allergic child, there's a certain amount of continuing education that must go on, or else you'll be totally out of touch with medical advances, legislative changes (that affect things like your child's school experience, or food labeling), etc. This is especially true because even the best allergists in my opinion do not equip patients and parents with all the information we need to get by; there is a lot of patient "self education" that we're left to take care of on our own. But on the other hand, my real goal is just to go about living my normal life, allowing my food-allergic child to go about living hers, not thinking about food allergies any more than we have to. So, while advocacy and education in the food allergy community is invaluable, it's also something I just have to step away from now and then. If I read (or write) too much about food allergies, it can have the effect of overwhelming me, or sometimes getting me down or just plain scared, rather than empowering me, which is supposed to be the intent.

Anyway, I also take my boredom with the subject of food allergies to be a good sign that our family has been very, very lucky in recent months. (knock on wood.) Only when you're not dealing with actual allergic reactions can you indulge in not focusing so much on food allergies. It seems almost paradoxical, but I think our vigilance has allowed us to be more relaxed. It's always a balancing act, though...I don't want the pendulum to swing from relaxed all the way over to lazy or careless. But I fully admit that a lack of reactions can have that effect; our family gets too comfortable and starts taking more chances, making more assumptions about food ingredients that we shouldn't.

(Oh, also, I'm pregnant, and that's such a good excuse for so many random things that I might as well put it forth here as another reason that updating this blog has not been top priority.) : )

So, had I had the urge to update this blog in the last few months, here are a few things I would've posted on: (skip this if you want....it's about to get really long as I brain-dump)

• Ugh. The comments. When will I ever learn to NOT READ THE COMMENTS to allergy articles in main stream media? They are filled with hatred. I made the mistake of reading the comments to the December news of a Chicago Public School student's allergy related death. The allergy community stepped up with heartfelt responses and offers of support. But many others were screaming that the family was to blame, because they should've just homeschooled their child. I hear this sentiment a lot, but there's no winning. If you go out of your way to protect your food allergic child, then you are considered a zealous freak who needs to just relax and not make such a big deal of your child's allergies, who just needs to realize that allergic children can't grow up living in a bubble or they won't be prepared for living in the real world when they grow up, yada yada yada. But if you put them in public school, well then you're subject to potential shouts of "don't make your problem my problem" from other parents, or "you should've homeschooled" if something goes wrong. That's frustrating. With all due respect to families that for whatever reason have decided that homeschooling is the best option for their child, I do think that access to a public education and a safe classroom for my child is not too much to ask. The types of things I would even consider asking my child's elementary school to do in light of her food allergies are all (in my opinion) very "reasonable accommodations" under the ADA. If you can build a wheelchair ramp, offer a special ed class, and bring in a speech therapist, surely you can also keep my child's Epipen accessible, train teachers to use it, and consider keeping food in the cafeteria rather than the classroom?


• There was this whole brouhaha about a district in Florida where parents protested food allergy accommodations that one family had requested. Honestly, I don't know enough about it to have a strong opinion, because I've been tuning out the news so I don't know what the family asked for exactly. But it was so bad that FAAN had to get involved to help educate the parent population and the school board, and suffice it to say that the sentiment coming from the protesters was not very compassionate (e.g., "My child is special too!"). Read all about it here if you want.


• Back in December, the Wall Street Journal (amongst other publications) ran an article about the National Institute for Allergy and Infectious Diseases having issued the first clinical guidelines for diagnosing and treating food allergies. (Hello? It's about time.) It explained why relying on blood and skin tests alone is not sufficient. This was not news to me, and should not be news to anyone dealing directly with food allergies, but unfortunately I think it is. Too many doctors (generally speaking, pediatricians, as opposed to allergists) have not been properly educated about how to correctly identify food allergies, and this results in misdiagnosis and over-diagnosis, with families avoiding foods for no good reason. As someone who once had to put my daughter on an extrememly restrictive diet based on a simple blood test while we waited for two months to get an appointment with the allergist, I can certainly relate. Even after Georgia was seen by the allergist, she was left avoiding foods for quite some time that we were later able to add back into her diet. (Poppy seeds and green beans (all beans, for that matter) were once on our list. And they shouldn't have been. What a pain for us, and what a burden to put on others interacting with or caring for my child. I also felt it distracted from the significance of her real allergies to have all of these other foods coming on and off the list. How is someone supposed to trust me that she's really allergic to sesame, if just last week I told that same person "no beans!", but then turned around and said, "never mind"?) So, the article made some valid points, and I think the accompanying graphic did a good job of visually explaining the difference between proper and improper diagnostic procedures. Certainly there is still room for improvement in allergy testing, and I hope the scientists are working hard on that! The downside of the article (and similar articles covering the same topic) was that there was disproportionate focus on the false positives/over-diagnosis issue. Which only leads to more of the general public thinking, "food allergies aren't real," or, "is your daughter really allergic to nuts?" That sentiment gets annoying. For every person that asks me, "Why are there so many food allergies now, when no one I knew in the 70's had allergies?" I feel like half of them are genuinely curious with no ulterior motive, and the other half are secretly thinking, "I think a lot of these so-called allergies that people are being told they have are just fake. Are Georgia's fake?"


• My in-laws successfully watched the girls at their house for 3 nights while Joe and I went on vacation, and the weekend passed without allergy incident! Woo-hoo! This was a big milestone for us as parents to cross. I hope we didn't annoy Joe's parents beforehand with too much information and instruction, but I warned them that we'll do it again every time. : ) I'm so glad it went well, because it helps us build trust (not just with them, but with ALL other caretakers), which is something that we have to be willing to do in order to give our daughter a normal life. But I'm not gonna lie - I was anxious about it beforehand. (Which, don't misunderstand - had absolutely nothing personally to do with my in-laws. I had complete confidence in them but was nervous nonetheless.)

I think that's enough for now! I hope I didn't bore you too much in the process, because I think I'll be writing here off and on more regularly for a while now that I've come off of this 3 month hiatus.

A Sobering Reminder...

...that kids sometimes die from their food allergies. Ugh.

Full story here: Seventh-grader dies of food allergy at Chicago school

So tragically sad. I'd say I'm speechless, except there are countless thoughts swirling in my head, such as:

--it is stupid that all schools are equipped with defibrilators but not Epipens. At this point shouldn't Epipens be standard issue at all places hosting children, like camps, schools, airplanes, etc.? (I mean, I wouldn't personally want to solely rely on my child's school having an Epipen around rather than sending her own Epipen to school to be stored there, but still -- it seems there should be one there as a backup. What is the great harm we are trying to prevent here by NOT having extra Epipens around? Accidental injection? Overdose? Give me a break. The risk of potential death trumps that.)

--why does food have to be a part of SO, SO many school events in the first place? We wouldn't even have to get into the question of nut bans so much if food were just kept in the cafeteria at lunchtime. Kids deserve to have their classroom be a safe place for learning.

--Georgia has never had Chinese food. I view it as extremely high risk. I'd flip a lid if someone served her Chinese food at school. [EDITED TO ADD: I should clarify that I'm not blaming the teacher involved in this particular incident. I presume permission to eat the Chinese food was given by this girl's parents, but I have no idea. I just meant that as of right now I can't imagine ever feeling comfortable allowing Georgia to eat Chinese food at school, outside of my immediate supervision. But who knows, maybe I will feel differently about that when she's 13.]

--Georgia's preschool kept her Epipens at school, but this story reminds us all of how quickly a reaction can grow out of control. As they say, seconds count. (People TOTALLY forget that and look at you like you are crazy when you act annoyed about your daughter going to gym class in a separate building where her Epipen will be a block and a half away. No, they don't eat in gym. But do you want to be the one sprinting on a mad dash looking for an Epipen in case of some freak emergency? I don't think so.) I wonder if Georgia's teachers would've remembered where the Epi was in a time of crisis? I wonder if they'd have remembered how to use it? For my own sanity, I generally like to assume the answer is yes and put these terrible thoughts out of my head, but stories like this one are a painful reminder that things can go horribly wrong.

--it's not clear to me what all the facts were here. It appears there was no Epipen in the classroom or at the school to give the girl. But we have no idea how long it took the EMTs to arrive. Presumably they had epinepherine on board the ambulance, but I don't know. Also, as much as Epipens are thought of as a life-saving device (which they can be), I think people need to realize that sometimes they are not enough.

I don't mean to make this all about ME, and Georgia, and our family. My heart goes out to this family. I can't even imagine the pain and grief they are dealing with.

Now go hug your little ones, be they babies or all grown up. Squeeze them tight.

I just visited Kourtney Kardashian's blog. Really???

I'm not a follower of the Kardashians or their reality TV show, but I heard via FAAN's Facebook feed that Kourtney Kardashian recently had to rush her 11 month old son to the hospital after he had an allergic reaction (vomiting and hives) to eating his first taste of peanut butter.

Here's a link to the People.com blurb about it:
http://www.people.com/people/article/0,,20444171,00.html

Oh! I feel for her! I have never had to rush Georgia to the hospital and can only imagine how scary this must have been.

The reason I was compelled to visit her blog and comment was to leave an encouraging word. Apparently a lot of people have been criticizing Kourtney and calling her a bad mom for giving her son peanut butter in the first place, and then also for taking him to the hospital, saying things like, "I can't believe you'd go to the hospital for an allergic reaction."

Others in the food allergy community seem instantly ready for her to become a spokesperson, never mind that she's probably still adjusting to the news herself and isn't up to speed on all the facts about food allergies.

It is hard enough to deal with the overwhelming feelings that come with discovering your child has a food allergy. I can't imagine adding to that the stress of being in the public eye and having your every move judged. She may have chosen a life of celebrity and everything that comes with that, but she sure didn't choose for her son to have a food allergy. Good luck to you, Kourtney. I'm glad your son is okay.

RAST results

The results of Georgia's blood work came in and are as follows: (I'll explain the "Class" numbers to the best of my ability at the bottom of this post.)

Peanut went up but remains at a Class III.
Sesame went up and rose from a Class II to a Class III.

For some of the fish, we were able to get more specific results than in the past. They were able to separately test for cod fish, tuna, salmon, halibut and tilapia, and I'm not sure they did that before because I don't have 2008 and 2009 numbers for all those fish. She's testing positive for all of those. Her cod fish and tilapia scores went down, although they both remain in the Class III range.

Similarly, we got a more specific breakdown of the tree nut scores this year. The good news is that for some of the nuts (i.e., almonds, pine nuts and hazel nuts) her scores are so low that they are considered a Class 0 (i.e., negative test result) or Class I. Our allergist explained this to mean that if Georgia's scores remain low, then when Georgia gets a little bigger the allergist will recommend that she do a food challenge for those nuts. Now, even if she were to pass such a food challenge, she might have to continue avoiding those nuts for fear of cross contamination. However, manufacturing practices are improving, as is allergy awareness, so I know there are already certain products out there (e.g., particular brands of almond butter) that you can safely consume even if you're allergic to other nuts. So, no change on our nut avoidance practices for now, but maybe in a year or two? Fingers crossed.

Her highest tree nut scores were for pecans and walnuts.

Now the grand finale: Georgia's not allergic to shellfish! (Or "sellfish" as she likes to pronounce it.) Woo hoo! As the results have been explained to me, Georgia may never have been allergic to shellfish, but we were previously told to avoid all shellfish due to (1) her allergic history/profile; (2) the fact that testing is not 100% reliable; and (3) the fact that she has a fish allergy, thus making the risk of cross contamination high (due to the handling/processing of seafood). Anyway, we are thrilled. I don't know any 3 year olds who eat tons of shrimp and crab, but I don't care - this still opens up a whole new category of protein for us and moves a few foods back out of the "threat" column for our family. Even if Georgia hates the taste of shellfish, or refuses to eat it, at least Joe and I can now eat crab and shrimp at home without worrying - yea!

Practically speaking, we will be reading labels carefully, and probably buying exclusively frozen shellfish to eat at home. The risk of cross contamination from other fish in restaurants or from the fresh seafood counter at the grocery store is too high to risk eating that stuff.

While I had the allergist on the phone I also picked her brain about DHA fortified foods. You may have noticed your milk or other foods being marketed as, "Now with DHA!" They want you to believe it will make you smarter or make you live longer - I don't know. Hey, I'm not knocking it - I take a fish oil pill everyday hoping there's at least some value to it. What I was worried about was that these DHA fortified products may contain a fish oil that Georgia's allergic to. The allergist's answer was that many DHA products are actually made from seaweed and should be okay, but that we should always read labels. If something's made with fish, it is required by law to state that it includes fish. So, I'll be doing some label perusing at the grocery store soon. Last thing I need is for Georgia to be served supposedly safe milk and cookies, only to find out that the food scientists of the world have figured out a way to get fish into them.

Oh - so a word about the "Class" levels referred to above. In my own words: the Class just corresponds to the level of probability that a positive result is in fact accurate. It is not a measure of the "severity" of one's allergy, though you will see many confused parents discussing these things online as if that is the case. (In looking into the meaning of the Classes, I was amazed at the misinformation swirling around on online message boards. People saying things like, "My son scored a 6 on a scale from 1 to 4." What? That doesn't even make sense. Made me think of Spinal Tap, though - turn it to ELEVEN.) : )

Here's a slightly more scientific explanation from a website called Food Allergy Support, though I have to add that I'm not really familiar with the site or that organization and therefore can't vouch for the veracity of the following:

"The severity of a person's allergic response is not related to RAST level. Class 3 individuals can have severe responses and Class 6 can have mild. RAST tests are only useful to determine whether an individual is allergy, not how allergic they are. However, different antigens have different threshold levels above which an allergic response is likely. For example, people with a peanut RAST result of >14kU/l are likely to have an allergic response to peanut. Soybean typically required >30kU/l; egg as little as 7kU/l. Class 1 and Class 2 often fall below the threshold where most individuals would experience a food reaction, so doctors often consider results in this range equivocal. If results fall in this range and the patient has not experienced an actual reaction to a food, the allergy may be confirmed via a food challenge."

So, there you have it! This was supposed to be a quickie post. Oops.

Allergist Visit (and answers to some questions)

Our first visit to Georgia's new allergist was great! We all really liked her, including Georgia.

I can't believe how positive I felt after this appointment, considering that at the end of the day, nothing has really changed for us so far. We'll have to wait 7-10 days to get the RAST score results from Georgia's blood work, and even then I'll be surprised if she's eligible for any food challenges. Still, though, this doctor just spoke so positively about all of the research that's being done in the field of food allergies that it was the first time I've felt like there's real hope for a cure, not in the esoteric "someday" sense, but truly in the "Georgia won't always have to deal with this" sense. (Maybe even by high school!) For any food allergy sufferer, I'm sure that would be happy news. For a mother, the thought is enough to make one burst into tears of joy. (I didn't. I'm just sayin.)

Anyway, we asked some questions (some of which are frequently posed to me by friends or family), so I thought I'd share the answers. (The nerdy lawyer in me is now compelled to remind you that I'm just relaying what I heard, and that no one should follow this advice but should instead talk to a doctor about your individual circumstances.) Also, all of the answers below have been paraphrased and elaborated on to my heart's content.

1) The EpiPen temperature and light control issue. Official guidelines recommend keeping the EpiPen between 76-78 degrees and out of direct sunlight. This is tricky when you live in a place with temps ranging from -10 to 110. I know some people who keep their Epi in a cooler all summer when they go out. Others have been told to keep the Epi in its original cardboard box so as not to expose it to too much light. What are we supposed to do?

Our allergist's answers:
Temperature: She tells people to take it with them, and that if they're comfortable, the Epi is comfortable, and not to worry about it too much. So basically, I took this to mean don't leave it in your car's glove box (duh), but you don't need to stress if it's 90 degrees out and you're heading to lunch. Based on her answer, I won't be worrying with a special case for the Epi unless we'll be somewhere very hot or very cold for an extended period of time. Beach day? Yes. Quick trip to the park on a hot day? No.

Light: No, you do not need to keep it in a cardboard box, or a bag, or otherwise strive for darkness. The idea is to not leave it lying in direct sunlight, but carrying it around in the plastic green carrier it comes with should be fine. In other words, it's not going to go bad in light the way that exposed film would.

2) Labeling. We were looking for greater clarity about whether to avoid all foods made on shared equipment, or "made in the same facility as," and that kind of thing. We asked this question knowing that there's no "right" answer, but I just wanted someone to tell me what to do! Plus I wanted to know that the answer is based on facts and reasoning. (To elaborate: I feel like we have been living a double standard, because we never bring foods labeled this way into our home from the grocery store, and yet when we do occasionally eat out it's not like I'm asking to see the packaging of the bread that Georgia's sandwich is made on. So while I know, for example, that that bread doesn't contain nuts or sesame (because I asked the wait staff), I can't tell you that it wasn't "produced in the same facility" as another food containing her allergens.)

Allergist's answer: We can serve products that do not contain Georgia's allergens (peanuts, tree nuts, sesame, fish and shellfish) in the ingredients list but are labeled as having been produced in the same facility as those allergens. We should not serve products that are labeled as having been produced on the same equipment as those allergens. (Also, we should not serve products labeled as "may contain" or "may contain traces of" with respect to Georgia's allergens, but we were already clear on that.) The doctor did not know of any good statistical studies about the number of allergic reactions stemming from foods that supposedly did not contain the offending ingredient but were labeled this way (as "same facility" or "same equipment"). However, she did say that she has had patients who have had serious reactions to "shared equipment" foods.

3) What about June? June has eaten eggs, but she has not had any nuts, sesame, fish or shellfish, simply because we don't typically have those foods in our home. So far she has displayed no signs of food allergies. We were wondering whether she is supposed to continue avoiding those foods because we now have a family history of allergies? Or when are we supposed to introduce them?

Allergist's answer: The long and short of it is that before sending June to an environment like preschool (2 years from now), we'll need to know for sure if she has any food allergies. However, we shouldn't really introduce June to Georgia's allergens until we're prepared to make those foods a regular part of her diet, because there have been cases of people eating a food so infrequently that they essentially develop an allergy to it. (I don't think researchers are 100% clear on the science behind this causation concept, or where allergies come from generally, so don't ask me to explain it, but apparently insofar as it relates to how we are to treat June, this is the prevailing wisdom for the time being.) The allergist told us about families where 1 parent has to go on a weekly peanut butter date with the non-allergic sibling just to make sure that the non-allergic sibling continues to be able to eat peanuts.

It's a big sacrifice, I know, but I will go out on a limb now and say that when the time comes, I'll go on a weekly date to eat Reese's cups with June. : ) It would be a needless hassle in our daily lives right now to incorporate nuts, fish, shellfish and sesame into June's diet when the rest of us aren't eating those things at home, so we'll be tabling the introduction of those foods for at least another year or so.

4) EpiPen Use. Should we have injected Georgia with the EpiPen during reactions that were (a) handled adequately by Benadryl, but (b) caused her to cough? (We asked this question because of stuff I have been reading on the topic. My confusion was, if it's a seemingly "mild" reaction that appears to be adequately handled by Benadryl, is it really necessary to inject the EpiPen just because there's a little coughing involved?)

Allergist's answer: Yes. If the reaction is affecting skin only (hives, some facial swelling), then Benadryl is okay. If it is affecting breathing in any way or involves the swelling of the tongue, then inject Georgia's thigh with the EpiPen and call 911. Ugh. I could write a whole post about this topic. It's a bit frustrating and disheartening.

5) Peanut oil. Must we avoid it? Prior to this appointment, we hadn't been worrying about avoiding peanut oil in most settings, because studies show that most allergic individuals can safely consume peanut oil if it's not cold pressed, expelled or extruded -- types of peanut oil that are all associated with "gourmet" oils, not the stuff they dump in the fryer at your average restaurant.

Allergist's answer: Yes, you should avoid peanut oil. It may be true that most types are okay, but you'll never know for sure what you're getting, and it's too risky. Again, to this I say: ugh. It's not like avoiding peanut oil is hard when you're buying things at the store - you just read the label. The problem is in settings where things like fries or chips are served, and now we can no longer assume that they're fine. As an aside, I would say to anyone reading this who is uninitiated into the world of food allergies, this is part of the problem: you end up having to avoid a lot of foods that in actuality are probably fine for you to eat, not just the ones that you know are dangerous. It's more limiting, and it also causes people to look at you like you are crazy overprotective when you tell them your daughter can't eat the french fries because she's allergic to peanuts.


So, that was it! All in all, a great appointment and wonderful chance to get some questions answered. Our allergist thinks that immunotherapy treatments now being conducted in clinical trials may be available to the public in 2 to 3 years. Wouldn't that be fantastic?

Allergy Mom Confessions: Pad Thai

Last night after the girls went to bed, Joe and I ordered pad thai take-out. You know, the kind with the little mound of tiny bits of chopped up peanuts on top?

We took it outside and ate it on the back porch just to be safe. And it was delicious.

I felt like I should destroy the evidence and take a shower afterwards. Never in a million years did I think I'd be snarfing down pad thai on my porch like it was contraband. The things we do now... Too funny.