Kids Food Allergies Blog

One of my seeming obsessions is to provide my daughter with “treat foods” that make her feel like any other kid.  Cupcakes - check.  Salty snacks - check.  Sugary concoctions (cotton candy and slurpies) - check, check.

The two treats that have evaded me for a long time were chocolate bars and good looking pizza.  But apparently the good folks at Whole Foods are going to fix that for me.

I just saw a press release from Enjoy Life Foods that they are introducing dairy-, nut-, and soy-free chocolate bars.  Sounds too good to be true, doesn’t it?  I’ve tasted their chocolate chips before.  And they’re pretty good.  So I’ll be watching the shelves at Whole Foods for this product.  It’s going to make Halloween a whole lot easier/sweeter at my house.

My other new find is a generic Whole Foods brand pizza crust (365 Organic Pizza Crusts) that does not appear to have dairy, eggs, nuts, or garlic.  My daughter loves that it looks like pizza that other kids eat.   I loved that she didn’t have an allergic reaction to it.  And the whole family liked the taste (always a bonus).  We topped ours with safe spaghetti sauce and tofutti cheese.

Bon apetit!

Purple Mommy has done it again. Made me laugh out loud. Not a ha-ha laugh, mind you. Rather an “isn’t the world a sad, strange place” laugh.

Her post about peanut oil appearing in eczema remedies made me think. So many babies and toddlers suffer from eczema. Mine did terribly. And I slathered on her whatever prescription cream(s) her doctor(s) prescribed, hoping it would bring her a little relief. I wonder whether those remedies also contained peanut oil. It never occurred to me to check.

Eczema is an allergic disorder. Food allergies are an allergic disorder. One would think drug manufacturers would take every caution to make eczema medicines hypo-allergenic. Or at least to wave huge red flags for potential patients about the risks of introducing one allergen to combat another.

A London study is examining the correlation of peanut allergies and eczema remedies.

New theories have linked (peanut allergies) to the use of eczema creams containing arachis oil, a medical name for peanut oil. Scientists have found that 90% of children with peanut allergy had previously suffered from eczema, raising concerns that exposing broken skin to peanut oil could trigger the allergy.

The research is part of a 10 year study in the Bristol area called Children of the 90s, following 12,000 children and their parents. Dr Gideon Lack, a paediatric allergy specialist based at St Mary’s Hospital, London, carried out the study into eczema. His initial findings suggest that the breakdown of the top layer of skin in eczema can expose the immune system cells to peanut allergens present in emollients. This could make the cells abnormally sensitive to these allergens.

It is already known that there is a genetic link between eczema, asthma and other allergic conditions, but Dr Lack’s research indicates that emollients could be a key factor in triggering peanut allergy. Children with the condition were eight times more likely to have had their eczema treated with creams containing arachis.

So thanks to Purple Mommy for the reminder to check ingredients in medicines before taking them or administering them to your children. And, as someone who has suffered several bouts of eczema in recent months — my heart goes out to Purple Mommy. And I hope her ear gets better soon.

I thought I was the only one interested in the creation of “peanut-controlled” sections of Mariners stadium on Aug. 5 and September 9.  While I am delighted that kids who would not ordinarily get to see a game may now have the chance, I am also concerned that the nosebleed seats may diminish the kids’ game experience.

Apparently, lots of other folks are worked up about the creation of peanut-free sections, but their complaints are a lot different than mine.  If you need a reminder about how far we still need to go to educate mainstream society about food allergies, check out the post on Allergymoms blog.

Today, we celebrated my daughter’s 5th birthday with a big pool party. Her actual birthday’s in early September, but lets not quibble over details.

For all you observant allergy parents - the rings under her eyes are goggle marks, not allergic shiners.

This also marks my 5th anniversary of baking dairy/egg/nut free birthday cakes. My first one was just terrible: a half-cooked blob that looked horrible and tasted worse. The second year was a bit better. The third year, I used the wrong kind of vinegar and my daughter refused to eat the cake (complained it tasted bitter). Last year, I got the ingredients right, but the proportions wrong. I baked a cake so high and heavy that it was tough to transport neatly. This year –I am proud to report– my cake was absolutely perfect. It’s a variation of the Moosewood Six-Minute Chocolate Cake. I hope your guests enjoy it as much as ours.

KidsFoodAllergiesBlog.com Chocolate Birthday Cake
(Makes 1/4 sheet)

Cake:

• 2 1/4 cups unbleached white flour
• 1/2 Hershey’s Special Dark unsweetened cocoa powder
• 1 1/2 teaspoon baking soda
• 3/4 teaspoon salt
• 1 1/2 cup sugar
• 3/4 cup vegetable oil
• 1 1/2 cup cold water
• 3 teaspoons vanilla extract
• 3 tablespoons rice vinegar

Directions:

1. Preheat the oven to 375°F.
2. Combine the flour, cocoa, baking soda, salt and sugar into a large mixing bowl.
3. Measure and mix the water, oil, and vanilla. Add to dry ingredients.
4. Mix the batter with a fork or small whisk.
5. When the batter is smooth, add the vinegar and stir quickly. Pale swirls will occur where the vinegar and baking soda react. Stir just until the vinegar is even distributed throughout the batter.
6. Pour batter into two 1/4 sheet baking pans.
7. Bake for 20 minutes. Set aside the cake to cool. Frost cake with your favorite frosting recipe.

Frosting:

• 1 C. Earth Balance vegan butter sticks — room temperature
• 1 C. unsweetened cocoa powder (do not use special dark)
• 5 1/3 C. unsifted confectioners sugar
• 1/2 C. water
• 2 t. vanilla

Directions:

1. Combine vegan butter and cocoa in electric mixer (use batters at low speed)
2. Add powdered sugar slowly, with a splash of water after each addition, until well mixed and desired consistency achieved. (use batters at medium-high speed)
3. Add vanilla

Three cheers for the Seattle Mariners. The Mariners have designated two “peanut controlled” seating sections for the Aug. 5 game against the Twins and the Sept. 9 game against the Rangers. According to an article posted yesterday on MLB.com:

Sections 311 and 312 in the right-field upper seating area will be cleaned thoroughly before each of the games. Signs will also be posted nearby to alert fans of a ban on all peanut products in those two sections. No peanuts or foods containing peanut products will be sold at nearby concession stands to ensure the safety of those in the section. People who buy tickets in those sections must agree to obey the peanut ban.

If other baseball clubs would try this out, I bet parents of food allergic kids would feel safer taking their kids to games. The only practical downside from my perspective is the seats. My daughter is an avid Nationals fan. And, she has a serious crush on Ryan Zimmerman. She loves sitting on the 3rd baseline to cheer him on. (This season he’s been out with an injury for most of the season, so it hasn’t much mattered.) Something tells me she wouldn’t be happy that — because of her allergies — she was restricted to an upper seating area.

Do you take your peanut allergic kid to baseball games? How do handle it?

There’s a 3/4 chance that milk-allergic children can tolerate cow’s milk if it’s heated extensively.

Huh?

I am not a doctor.  I am supremely unqualified to offer medical advice.  However, my non-medical opinion is that none of us should try this at home.

But, according to a Reuter’s article based on a recent study written up in the July 15 2008 Journal of Allergy and Clinical Immunology, it’s true.  Here’s why:

Children with persistent milk allergy produce antibodies that react against specific milk proteins that their immune system recognizes as foreign, according to Dr. Anna Nowak-Wegrzyn, from Mount Sinai School of Medicine in New York, and her colleagues. Children who have outgrown their milk allergies still have milk-specific antibodies, but the specific milk proteins that trigger this reaction can almost entirely be destroyed through exposure to high temperatures. The researchers therefore reasoned that children with milk allergy might tolerate milk if it were extensively heated.

According to the article, there is one caveat.  The higher your child’s skin prick test to milk — the less likely they are to be able to tolerate heated milk, and the more severe symptoms they will exhibit when exposed to heated milk.   That confirms my suspicion that my daughter would be in the 25% for whom heating milk would make no difference.

For those of you still planning to fly with food allergic children this summer — I urge you to check out an interview on traveling with children with severe food allergies on the DeliciousBaby.com blog.

Some of the tips are straightforward common sense to those of us who have been doing this for some time.  But other recommendations made me think.  Of particular interest to me was the documentation recommended we have on hand about our children at all times.  It’s precisely the information schools are asking for that I cannot provide.  (What will happen to the child if allergen X is inhaled, touched, or ingested.)  The more vigilant we are as parents in removing these allergens from our children’s lives to create safe environments for them — the more difficult it is to predict how that child will react under conditions to which they have not been exposed.

He also offers some smart suggestions on things I never thought about: choose flights in the morning to avoid allergen exposure, and research contact information of a pediatric allergy specialist in your destination city before you leave.

Things to think about.  Happy travels.

I have not been able to bring myself to blog for the past two weeks.

Between the egg challenge debacle and the bungled camp/school forms, I’ve been at my wits ends with food allergies.  It’s been so all encompassing and upsetting that the last thing I’ve wanted to do is to blog about it.  Since I am unable to get a vacation from the constant vigilance required to manage a child’s food allergies on a daily basis, I took what I could — a vacation from blogging about food allergies.

But, at least for the time being, things seem more in control.  I’m back.

So, here’s how things resolved at school.

I need to enact a plan that balances the health needs of my daughter with ease of administration and minimal liability for the county.  Not an easy task.  The county policy is that if an epi-pen is authorized for an allergen and a child is sent to the health clinic for exposure to that allergen — an epi-pen will be given without waiting to see what symptoms manifest.  After much hand-wringing about the wisdom of this policy (and worrying how it would be enforced) — I talked to a county nurse who would allow my doctor to authorize benedryl and an epi-pen based on allergen and exposure type (ingestion vs. skin contact or inhalation).  While this solultion made me more comfortable, in the abstract, at least — a long talk with the nurse who oversees the clinic illustrated how confusing my plan might be to implement and the myriad of opportunities for confusion it could present in a very busy clinic.

So, I’m back to square one, really.  The only thing my daughter’s allergist and I have firmly decided is that we’re not authorizing an epi-pen for allergens that are unlikely to provoke a systemic allergic reaction.  Rather: authorize benedryl, callling me and 911 if there are signs of breathing distress or anaphylaxis.

The decision on peanuts and tree nuts is equally clear — better to err on the side of caution by authorizing an epi-pen than not.  The only remaining allergen that gives me pause is milk.  She had such immediate contact reactions when she was little — and benedryl or zyrtec has always resolved the problem within minutes.  It seems clear that benedryl is the right medicine to authorize.   But I would feel so much more comfortable if I could also authorize an epi-pen for milk as well, for severe reactions only.  I am afraid of her being given an epi-pen as a first response to the allergen to which she is most likely to be exposed to at school.  (She is in 1/2 day a.m. kindergarten next year, with no lunch, in a nut-free classroom.)

Part of me is mad at myself for getting all wrapped around the axel about this.  My daughter is extremely well-trained not to eat anything that has not been pre-approved by me.  She will not eat other’s snacks or partake in their birthday celebration treats.   She asks friends to wash their hands if she thinks they may have eaten something to which she’s allergic before she will play with them.  I know that the risk of allergen ingestion for her in next year’s environment is small.  But I know that accidents happen.  And, it’s my job, as a mother, to worry about all the what if’s.  And to slowly start to brace myself for the horror of her entering the school cafeteria in first grade.   It won’t get any easier next year, right?

Today was my daughter’s first day of camp.  I am not sure whose jitters were worse — hers or mine.

Okay.  Mine were worse.  Far worse.  I did not feel completely comfortable that they understood the variety of reactions that could occur and how to handle them.  But then we showed up.  The teacher and camp director reassured me they took food allergies seriously, showed me the letter they were sending home to ask parents not to send peanuts to school, and promised to wash kids hands after snack.  And I felt better.  At least for a few hours.

Then, I got a call from the county public health nurse who supervises my daughter’s camp and school.   She told me that my daughter’s forms were filled out all wrong.  They also rejected my FAAN food allergy action plan because it’s based on symptoms (if you see X reaction, administer medication Y) rather than hard and fast rules.  But that’s exactly the problem with food allergies.  Some things are cut and dry, but there’s a whole lot of murky in between.   Especially with her milder allergies, some of which she can even ingest in small quantities and not get sick.  When you are managing multiple allergies with a wide variety of potential reactions, it is hard to have one iron-clad rule of what to do in the case of an allergic reaction.

If you are too cautious in your plan, your child will get epipens unnecessarily.  If you are not cautious enough, the school will not administer an epipen even in the throws of anaphylaxis.

What’s a parent to do?

Sincere and heartfelt thanks to all of you who expressed support over the egg challenge. Over the past week, we had an additional mild reaction to a cookie containing egg. Though in fairness, the culprit could have been white chocolate chips — which I’ve used only once before — that may have had traces of nuts or milk.

Still, the allergist recommends that if it happens again that we discontinue the experiment. It doesn’t much matter. In practical terms, the experiment is over anyway. My daughter can tell if there is egg in a food. If there is, she will eat very little of it (if any at all). And instead of beating myself up, I’m coming to terms with the benefits of a few more years of living mostly egg free.

1. Right now, the smell of eggs cooking (plain or in food) makes me kind of sick to my stomach. Probably a pregnancy thing.
2. I’m supposed to be avoiding eggs in my last trimester of pregnancy and while nursing. And I don’t plan to introduce eggs to the baby for a good 2 years. A mostly egg free household can be a helpful.
3. I actually prefer vegan chocolate chip cookies to those with eggs.

What did I get to eat over the past week that I really missed? I had forgotten how good French toast can be. And after a few days of pancakes with eggs, I realized that my egg-free pancakes were a poor substitute for the real thing.

The only products with eggs I’m keeping on the approved list are those with small quantities of egg, and those to which she has had no adverse reaction:

1. Pancakes
2. Tofutti cheese blintzes (which are amazing, by the way with a touch of apricot jam)
3. challah (I’m eager to see how she likes a recipe authored by a famous DC Jewish chef, Fred Loeb. My husband and I loved it years ago. If she likes it, I’ll post it.)