The allergist and his extracts

CC picks dandelions in our courtyard

A few months ago, I read the Alchemist by Paulo Coelho. It is a very profound allegoric novel. Prior to reading this novel, I had never heard of an alchemist. Upon reading the description, I thought immediately of our modern-day allergists with their countless vials of extracts. As a medical student, I had observed a pediatric allergist test his young patients for a number of foods, pollens, and antibiotics. The skin testing used by allergists is considered somewhat controversial as a food allergy can be inferred based on your skin's reactivity to an extract (and not ingestion).  In the more common version of the test, the allergist applies the purified extracts to the skin, then either scratches, or pricks the skin under the extract.  The excess extract is then blotted with a cloth. After a 10-20 minute delay, the allergist measures the skin's response to the extract. Positive and negative controls are also used (histamine and water respectively).

Example of skin testing on forearm

My observational stage with the pediatric allergist took place eight years ago, and I would have never imagined that I would be consulting, within ten years, a pediatric allergist for my child.  Food allergies are very rare in both my husband and my families, so I was very surprised to discover that our daughter reacted with a mild rash to dairy products.  We have been avoiding dairy since I made this discovery. I was hoping that like many children with dairy allergies (up to 80%), she would "grow out of it".  I was not too worried until I discovered that my baby was also allergic to peanuts.  At the recommended age (in the absence of family history of peanut allergies) of 12 months, I introduced peanut butter. She only took one lick, but within a minute she developed a rash all over her body. I pulled her out of her highchair, and administered the appropriate dose of Benadryl. Within 30 minutes, the rash had dissipated, she calmed down, and fell asleep shortly thereafter. I did not sleep very well that night, although my daughter did, probably under the influence of the Benadryl. I was instantly worried because I realized that peanut allergies are often associated with life-threatening anaphylactic reactions. Shortly after this discovery, our pediatrican prescribed an Epi-pen for the baby, and referred us to a pediatric allergist.  I was perplexed by my daughter's peanut allergy. Not only was there not a family history on either side, but I had also avoided peanuts while pregnant and subsequently while breast-feeding. Breastfeeding has also been demonstrated in many studies  to reduce the risk of food allergy, and I had breastfed the baby up until a few weeks ago!

With much trepidation, we met with a pediatric allergist yesterday. Would I discover that my daughter was also allergic to other tree nuts, and a number of other substances that we had not yet tried? Would I be living in fear of an anaphylactic reaction for years? As it happened, the allergist tested only for dairy and peanuts. As she explained it, the risk of false positives and false negatives was high enough, that to test substances that our baby had not yet been in contact with might create false hope, or false fear. Even though the baby was overdue for her afternoon nap, she behaved relatively well for the skin testing. After the extracts, along with negative and positive controls were applied, the baby discovered a large toy truck in allergist's office. This occupied her time, and the 10 minute delay flew by. The allergist got out her special ruler, and declared the skin test positive for peanuts, but negative for dairy. I was somewhat relieved, as I had discovered just how ubiquitous milk products were. Whether in the guise of caseine, whey, or skim milk products, dairy was present in a large number of prepared foods, including lactose-free products. I got the OK from the allergist to re-introduce dairy products such as yogurt and cheese. As for peanuts, the allergist would be re-testing at 31/2  to 4 years of age. And as for other tree nuts, she suggested that we introduce minute amounts of crushed nuts, gradually increases the quantity to a full nut after a few days.

While I have been in no rush to test other nuts, I have already successfully introduced yogurt and cheese sticks. But mostly I am happy I can kiss my daughter after having ingested dairy, and not have to worry about transmitting allergens into her system.  As for Peanuts, thankfully we live in an environment that is relatively conscientious of nut-allergies. Many food products geared towards children mention the words "may contain traces of peanuts", or alternatively "peanut-free". I was surprised to learn from the allergist the other terms for peanuts that may be used in ingredient lists: earthnuts, ground nuts, goober peas, monkey nuts, pygmy nuts and pig nuts. The good news, said the allergist, was that our baby's response to peanuts, although positive, was relatively small. This meant that her chances of falling into the 20% group of children that "grow out of" peanuts allergies was good.

Until then, I have a feeling that I will be attending all birthday parties, restaurant outings and after-school activities with my daughter. Or prevent her from attending. I am turning into my mother (see last post), but at least I have a valid excuse!