Sometimes You Feel Like a Nut

I have to write this down, so that I can remember this allergy journey we’ve been on with Reid. Last year about this time, Reid – at 1.5 years old – was diagnosed with a peanut allergy. First with a food reaction, then with a positive skin scratch test.

The Year Follow-Up

This May, we had our year follow-up with the allergist. We got to tell him about the time Reid bit through a Snickers wrapper and sunk his teeth into peanutty-nuggety goodness at Halloween. We chatted about Reid’s wheezes when he runs after his big brother down the sidewalk.

At that appointment, Reid had a blood draw. They submitted it for allergy testing of all tree nuts (which we were explicitly told to avoid last year) and environmental allergens. I’d been giving Reid Zyrtec for what I thought were seasonal allergies (turned out to just be a cold), and dingbat me gave him Zyrtec the night before our appointment, which pre-empted our being able to administer a skin scratch test for all these things.

That whole blood test/skin scratch test nuance becomes important later. Stay with me.

We left the appointment with a new asthma maintenance regimen to follow and made an appointment to follow-up with the allergist in a month to check on his breathing.

The Results are In

A week later, we got the blood test results back: negative for all allergies except for cats. The nurse relayed the message that we could now try tree nuts “safely at home” and that our allergist recommended we stick to individual tree nuts before moving on to mixes. Done and done.

It’s funny the mindset you get into when you’ve been avoiding something for a year as if it were basically poison. It seems almost unbelievable that tree nuts wouldn’t cause some sort of harm.

I know, I’m living the irony – the TORTURE that Facebook is to read sometimes because some folks are so fearstruck by absolutely nothing consequential when there is hard data available that reinforces that whatever it is is completely harmless. I’m now doing that very thing.

In fact, Andy and I did our little happy dance and immediately started to list all the breakfast cereals available to us given these test results. And yet weeks passed while I consciously opted out of opportunities to let Reid try nuts. We’re about to go on a long car ride… Camping really isn’t the time for this… yadda yadda.

Trial and Error

Honey Nut Cheerios was the first thing we tried. Success! He LOVED it. Devoured an entire bowl, in fact. And he didn’t explode! I mentally high-fived his immune system that day and crossed that off my long list of anxieties.

Last Monday, Andy came up to the bathroom where I was getting ready. He held Reid, facing out, in his arms and said, “Mommy… look at this,” then proceeded to lift his shirt which revealed a red rash covering his entire trunk. I blinked a couple of times, but my mind didn’t connect the dots until Andy said, “He just had a bowl of Honey Bunches of Oats with Almonds.”

The hives came shortly after. We gave Reid the Benadryl, per his allergy action plan, then watched him for signs of any sort of distress. None came, so we called the allergist’s office when it opened and followed their instructions.  Reid now fully medicated, he watched Despicable Me, and I googled error rates of food allergy blood tests (15-20% chance you’ll react to the actual food when you get a blood test negative, by the way).

We already had a follow-up with the allergist for Reid’s asthma regimen, so we tacked on “tree nut re-testing” onto the agenda for that visit. Good times.

Back to the Allergist

Reid had his allergist’s appointment today, and I’m more confused than ever. Reid doesn’t have an almond allergy. 

We tested him six ways from Sunday:

  • Skin scratch test for all tree nut allergens: negative
  • Crushed up almond, scratched on the skin: negative
  • Gave him an almond to eat: negative
  • Gave him five almonds to eat: managed to choke one down before refusing to eat any more because almonds are gross and ENOUGH WITH THE ALMONDS ALREADY YOU CRAZY PEOPLE!!!!
  • Crushed up remaining uneaten almonds into vanilla ice cream: negative (and DELICIOUS)

A half hour after the contaminated ice cream treat, Reid’s doctor told me with certainty that Reid isn’t allergic to almonds – or other tree nuts for that matter. We scoured the cereal’s ingredient panel for other possible reactive items, but cinnamon was all we could come up with. Reid eats cinnamon toast and other cinnamon-y things, so… nope.

My prevailing guess is that peanut in some form or another was accidentally introduced to the cereal. It can happen. I’ve seen how it can happen. We in the food industry try so SO very hard to make absolutely no mistakes where food safety is concerned , but it takes one guy not reading a label. Or a label not being where it should. R&D running a test for a new peanut cereal on that line and it not getting sanitized properly. I thank God that Reid’s allergy isn’t life-threatening. I can’t imagine what life would be like for us if it was.

A Trip to the Allergist

Yesterday, Reid joined the cast of millions who are diagnosed with a food allergy. He had his first visit with the pediatric allergist, and I actually learned quite a bit during our exam. Here’s what I took away.

Warning: I am having trouble drawing the line between geeky/academic interest and high-level mom concerns with this recent foray into allergy-land. I’ll try and keep the details light, but I promise nothing.

  • Reid’s reaction to peanut butter last Sunday – while visually jarring – was mild. The mode of contact was mostly topical last time. If he eats it, we could expect that he’d get an itchy mouth and throat as well. He might also puke, just to keep things interesting.
  • Since Reid’s first reaction was hives, we have a really good chance that this is all he’ll ever have. (Whew!) Management of accidental exposure (i.e. if Reid has a reaction) will be through Benadryl, but the doctor still wanted us to have an EpiPen with Reid at all times. (Read: Doctors don’t mess around with peanuts, and there are no absolute guarantees.) For now, we keep the EpiPen.
    • Sidenote: We have a long term action plan for checking in annually (more on this in a minute) to make sure it is still needed. Thank goodness for that because those pens come in a pack of two and were over $200 [AFTER a $100 coupon was applied, HOLY mother of histamines], and they expire in a year. O_0
  • We are now armed with a sheet that lists “Benadryl” symptoms and “EpiPen” symptoms so that we know when to give which medication. Basically, be prepared that if we ever leave Reid with you, you will be getting a training on how to use the EpiPen. Consider it a resume builder.
  • Most food allergies are grown out of… except peanut and tree nut allergies.
  • Only 1 in 4 (or 5, depending on the literature you read) kids will grow out of a peanut allergy, which gives Reid a slim 20-25% chance of shaking this.
  • BUT, since Reid has a mild reaction to peanuts, he is upped to a 50/50 chance of outgrowing it. Yippee!

As for the rest of the visit…

We got ourselves all checked in at the front desk.

Check-in

Making sure I packed an ample supply of snacks

Reid gave the woman across from us in the allergist’s waiting room the full Prince Charming treatment. Like, seriously dude. This has to be sort of tiring, right?

Waiting room

I’m surprised she didn’t melt at the sheer wattage of his smile here.

Eventually we got called back. Reid, being one of the youngest patients they see (perhaps he would *not* have been, had his parents waited until the pediatrician’s recommendation of not giving him peanut products until Age 2. Ahem), our room was a revolving door of nurses saying, “I hear that you are just adorable!!!”

As I write this, I realize this sounds somewhat mom-obnoxious. But I do believe a lot of this has to do with how just… small… Reid is.

We met with our allergist, who was great with Reid. Seriously this was the most calm he’s ever been during a physical exam. This is where we learned most of the things I outlined above. Then he decided to test Reid for not only peanut allergy but egg allergy as well. I guess there is a somewhat significant correlation of kids being allergic to both, and Reid has a distaste for eggs, so he won’t really touch an egg itself. He does A-OK with cookies, cakes, muffins, etc believe you me which all contain egg, but the doctor said that sometimes kids can tolerate them in small amounts like baked goods but not the whole food itself.

Personally? With Reid’s age, I was just thrilled that we weren’t doing the whooooooole comprehensive allergy testing. I mean, part of me wanted the most information possible, but it sure would have been a lot for my little guy.

The nurse dug out a toy for Reid to play with.

In-flight entertainment

It held his interest for a bit. By the time she came back to administer the test, he was pretty well done with it.

The test… device, I guess you’d call it?… itself reminds me of those injection-molded plastic sheets you’d get as a kid, where you had to pop out the toy and twist off any remaining nubs.

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It looked similar to this…

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… except I think the little arms came pre-loaded with the common allergens, so she was able to snap off the allergens she didn’t want to test for (bye-bye milk, wheat, soy, fish & shellfish!) and leave the egg and peanut before applying them on Reid’s back.

He did great. No fussing or complaining at all during the application, which took like 5 seconds total. I put his shirt back on, and we proceeded down the hall to let him pick a toy from the treasure chest.

Treasure

“NOW we’re talking!”

Best treasure chest ever!! There were big toys in there! Reid chose a Nerf football, and we commenced our 15-minute waiting period with many rounds of catch.

photo 1

Reid was also enamored with the pull-out footstool on the examining table.

photo 2

Every so often, a nurse would come in to check on us and leave the door open when she left. Reid took it upon himself to shut the door after them. I mean, we are always concerned with shutting doors and gates at our house (albeit for his safety), so Reid has now taken to compulsively shutting doors as well.

About halfway into the 15-minute period, after Reid shut yet another door, he turned around, backed up against the door, then proceeded to rub his back, back and forth, against the closed door – scratching like a bear would against a tree. I sort of knew what the test was showing us at that point.

Allergy skin test - 1 year old

Voila! The results. The skin test includes two controls as a reference point. A positive control, where they scratch actual histamine into the skin, and a negative control of plain saline solution, so if the skin reacts with a welt to the pressure of the test itself, we know what that looks like. For the test to be considered positive, the welt must be as big as the histamine control. So here you see Reid is negative for egg allergy and positive for peanut.

So what now? Two key things:

1. We have a follow-up appointment in a year. At that point we’ll have two tests:

  1. A blood test that will quantify just how many reactive agents (IgE) are in Reid’s system. You could read this as “How prepared is Reid’s body for a fight?” The higher the amount of IgE in Reid, the lower his chances are of outgrowing the allergy. They will also monitor his IgE every year to see if his levels are dropping over time (i.e. if he is outgrowing it). That’s when we’ll know whether we need to keep renewing our annual EpiPen insurance policy.
  2. A full tree nut panel skin test. We are supposed to keep Reid away from tree nuts & tree nut products until then. 25% of kids who are allergic to peanuts are allergic to tree nuts as well.

2. After talking with the doctor and amongst ourselves, Andy and I have decided to make our house peanut free. We’ll reassess the need every so often. It’s not like Reid is in mortal danger if he consumes peanut products, but he does have a lovely reaction and isn’t all that comfortable during it. Plus, the doctor told us to assess the kids’ life stages. Reid is 1. He has zero inhibitions. He won’t obviously stay away from peanut butter if it’s within reach. Graham is 4. He knows the rules, but isn’t mature or responsible enough to be held accountable for adhering to them with 100% compliance. Obviously. He’s a kid. He gets messy when he eats. He smears peanut butter on the table and chair he sits in. He doesn’t always proceed directly to the bathroom to wash up. He and Reid wrestle, they kiss, they share toys.

Basically, if we decided to take on trying to contain peanut butter exposure within our home, it would be a lot of fuss every time we tried to bring out peanut butter. Plus it’s a lot of pressure for Graham. (“Go wash your hands!” “Rinse out your mouth.” “Don’t touch that!” “Throw that wrapper away!!!”) He feels so bad when he feels like he’s let us down, and I think he’d feel awful if he were responsible for giving Reid something he shouldn’t have.

Seems like a more obvious choice now, right? It could be totally different in 2-3 years. Until then, we as a family just take another little shuffle of a readjustment and give so much thanks that this is yet another very minor medical blip on the radar in the grand scheme. I’ll take it.

Post-Peanut Pediatrician’s Visit

Just a quick update before I start my day of work.

I picked Graham & Reid up from daycare mid-afternoon yesterday, and we headed to the boys’ pediatrician. Our appointment was at the tail end of the day, and both boys were tired. The office was also running just a bit behind schedule, which left me entertaining two wound up boys in a 6×10 room with nothing but a pile of books for just a li-ttle too long.

Oh, just tottering around in Mom's heels and my Elmo Canadian mounties shirt. What of it?

Oh, just tottering around in Mom’s heels and my Elmo Canadian mounties shirt. What of it?

We had fun for the first 15 minutes, but the last 15 minutes found us in an escalated state: Graham shouting and bouncing off the walls and Reid wavering between gleeful joy and ugly crying tears. (Also? I had no pacifier.)

This was the state our pediatrician found us in when she walked through the operatory door. It was the first time I’d met her since Andy had handled any and all doctor visits while he was job hunting. Reid lit up when he saw her and started softly laughing in anticipation of what she was going to say to him. Graham was on her like a bug on a windshield.

“DOCTOR!DOCTOR!DOCTOR!DOCTOR! I can spell my name! G-R-A-H-A-M. DOCTORDOCTOR! Do you have band-aids? Reid has an allergy. Yesterday I had two germs but then I brushed my teeth and they were GONE. DOCTOR! My brother can’t eat peanut butter!!…. “

And on it went. Our pedi was amazing with him. She talked with me while every so often returning her attention to Graham and engaging him in conversation. Usually seeing what letter sounds he could identify and seeing if he could spell.

Reid cried intermittently – both when we paid too little attention to him and when we paid too much attention to him.

Oh yeah, did I mention I have laryngitis? So in the midst of Graham’s shouted proclamations of anything-that-occurs-to-him-at-the-moment and Reid’s cries, I squeak-barked out a recap of Reid’s reaction and our doctor probably mostly lip-read what I was saying.

All that preamble aside, here was the meat of the conversation:

We established that we do have a family history of peanut allergies (my brother, Tony). We went over the nature of Reid’s reaction. She asked a few clarifying questions and then started in on next steps.

“Well, there are two tests we can run now. A blood test and a skin/scratch test. I’d like for you to get the skin test, because it’s a little more accurate and gives us the most information, but you can do the blood test in addition if you really want to. I’ll also get you a prescription for an Epi-pen.”

This is where I told her that we’d had a few friends & family telling us that we were lucky that he’d had a mild reaction. She nodded. “So… is that right? Do you consider this a mild reaction?”

Her response: “Well, yes and no. ‘Yes’ that he didn’t have swelling in his tongue, around his mouth or any coughing.. nothing respiratory. And ‘no’ because food allergy can get worse with repeated exposure. Just because that didn’t happen this time doesn’t guarantee that it won’t happen next time. We just don’t know. So we’re just going to make sure we’re ready if it does.”

I asked her if we’re at the point of talking about whether we needed to be a peanut free household or if that’s a premature step (because it sure feels like it.) She said that those [the “where do we go from here”] questions are ones we’ll tackle with the allergist once we get Reid’s test results.

Now we have an appointment with a pediatric allergist next Tuesday morning. There we get to figure out if Reid is even old enough to undergo the skin test, if he’ll have bloodwork done and then there was another test, a food challenge study, thrown out as a possibility as well.

All of this sort of doesn’t feel real. It feels like we’ve triggered some sort of overreaction on the behalf of the pediatric medical community. Some grand “crying wolf,” of sorts. Like once we get in the office and get testing underway, he’ll test negative across the board and “overprotective mother” will be written in his chart somewhere in the password-protected section where they make special notes about such things.

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I never snapped a picture of Reid while he was broken out in hives, so all I have to go off of is my memory of what he looked like in that moment. Knowing from my line of work how unreliable our perceptions are, I’m starting to get embarrassed at all of this.

Oddly enough, this is what it felt like to first start telling people we were pregnant with Graham. I didn’t really feel any different. I had only one little at-home test to go off of (for awhile, anyway) but telling people (doctors, friends, family…) instituted instant excitement. A slew of doctor’s appointments. Dramatic lifestyle changes. All from one little sign that something very big was happening – even though day-to-day life felt no different. All while a little voice in my head worried “What if I’m wrong? What if I’m blowing this out of proportion? What if I go to the doctor and they don’t find anything? What if I have to go back and tell everyone I overreacted?” 

Back then, I sort of felt like I was living a lie for awhile. And, if we’re being honest, I feel like that now. It makes me thankful that Andy was there for Reid’s peanut butter aftermath. Maybe together – until next Tuesday’s appointment – we can convince ourselves that we’re not totally insane.

Aw, Nuts.

peanut-allergiesIt really had been such a lovely Mother’s Day. I was the first out of bed and was greeted by a cheery kitchen table display of cards and gifts. Next out of bed was Graham, who – as he was padding down the stairs – announced that I should open my special Mother’s Day chocolates that Daddy had bought me.

Really, spending money on gift wrap is a pretty ridiculous expense when you’ve got a 4-year-old around the house. Yet, we persist for some unknown reason.

The day meandered from this activity to the next. All at home, per my request, since home is where I’ve wished to be for the last two weeks.

After naps, the boys were hungry. I spied an unopened package of English muffins and announced that was what would be served, with peanut butter, for snack. I really should know better, because when I get that specific, it’s like demanding that some line item of the contract be renegotiated. And so it was.

“I DON’T WANT PEANUT BUTTER; I WANT JELLY!!!”
[parental gobbledegook spoken in gently reprimanding tones]
“…PLEAASSE!!!!”

The English muffins were prepared, the jelly muffin was quickly snubbed for “tasting weird” and the peanut butter muffin wasn’t met with much more enthusiasm. Reid, at his tender 17 months of age, wasn’t exactly sure what we wanted him to do with the puck-shaped snack with jaggedy sharp points sticking off the top. It was covered with sticky warm gloop though, so that clearly must’ve been the selling point.

He splayed out his chubby hand and laid it smack in the middle of the peanut butter, picked it up, looked at it, made a few fists in rapid succession, then reloaded his weapon and began making like William Wallace.

braveheart

“Guess it’s bath night… aww man, he’s getting it in his eye,” said Andy. He headed for the paper towel, ran some water on it and took to cleaning up our Kabuki artist. “Can you help me? He keeps rubbing his eye with his peanut-buttery hand.”

Eventually Andy grabbed Reid and headed upstairs for an actual washcloth and running water. I resumed my discussion with Graham, insisting that, no, jelly does not “go bad” or “turn rotten” but he probably just didn’t like the taste, which is fine… when a voice from upstairs came:

“Uhhh. We’re having an allergic reaction to peanut butter up here!”

I jogged up the stairs, figuring Reid’s eye was just irritated from the foreign material, when I was met by a smiling baby with wide, bright-red strips criss-crossing all over his face and small bumps raising among the red marks. His eye, yes, was red too and watering.

One thing I will say about myself, is that I have an uncanny ability to shut out emotion and lock into tactical mode in a crisis. Not that this was life-threatening, but OK, he was having a reaction to peanuts, so I guess maybe the word ‘crisis’ applies.

(That’s the thing about parenting. When something acute like a fever crops up, your mind just sort of downshifts into if-then scenarios. When you experience something for the first time, the possible paths of ALL THE WAYS THIS COULD PLAY OUT are darn near infinite – which makes being a new parent sort of exhausting.)

But in crises, I can deal. I don’t panic. I like this about me. “Put him on the counter, I’ll get the Benadryl.” We got a teaspoon of Benadryl in Reid, and then I told Andy we should get him in the bath to get any remaining peanut butter off of him.

While Reid was in the bath, I asked Dr. Google what symptoms I should watch for. The question in my head is always about escalation: 1) At what point do we call the nurse/doctor 2) At what point do we go to the ER.

Being a Sunday, our only real choice was the ER, and I wanted to avoid that as much as humanly possible. I gathered a list of respiratory reaction symptoms (runny nose, sneezing, coughing, wheezing) to look for, stopped in the kitchen to calm the wail of requests for a “PEAR!! MOMMY I DECIDED, I WANT A PEAR!!! MOMMY???” and headed upstairs to check on Reid and download the list of things to watch for to Andy.

Reid wasn’t in distress. He was happily kicking in the bath, loving all the attention. We noticed some mild swelling around his eye, but he wasn’t getting any worse otherwise.

An hour later, the hives were gone, and Reid just had the look of a kid who’d been crying his eyes out. Just a teeny bit rosy, with pink watery eyes and a bit of that under-eye puffiness.

*~*~*~*~*~*~*~*~*~*~*~

This morning I called his doctor’s office for a follow-up. His primary care pediatrician isn’t in the office today, and I insisted on seeing her – as this will be a fairly critical on-going issue we want her to be aware and mindful of. We go see her tomorrow for additional testing. Usually this is just a blood test that gives us an understanding of his immune sensitivity to the biggest known allergens. This is the first [and maybe only] step.

Reid has had persistent eczema all his life, so his pediatrician has brought up the idea of doing allergy testing before. Eczema, apparently, can be a reaction to an environmental or food allergy. I pray for God’s sheer grace that Reid doesn’t have a milk allergy because I’m not sure how our Moose would handle that news. Milk products are his life.

So, we’ll keep this posted as we learn more. Second kids, man. They think up a whole new bag of tricks just to keep you on your toes!!