Newbie

[Jess4879]

Hello all!

I am new here, but not so new to fa's.  My oldest was diagnosed with an egg allergy when she was two and a nut allergy when she was three.  She has outgrown the egg allergy (*cheers*) but her nut allergy levels are "in the hundreds" according to her allergist.  She is now 10.

I am glad to find this group!  We are the only one in our group of family/friends that has a child with fa's and it has been a challenge to say the least. We have a few people that support us fully and realize the dangers of a pn/tn allergy...and we have a lot that just don't get it. 

The big question that has sent me searching lately is:  how/when do you introduce you kids to foods that another member is allergic to?  Our oldest has a severe pn/tn allergy.  Our house is completely nut free, because of this, my other kids have never been introduced to nuts.  We don't restrict their diets when they are out, so they have come in to contact with traces of, etc...but we don't allow them to eat nut products themselves because of the risk of exposure to our oldest.  Our allergist recently made me feel awful for not introducing nuts but he has no advice on how to do it.  When I asked him, he just said "you just have to do it!" NOT helpful.  He wants us to give the other two kids nut products every week.  We homeschool so they are home all the time.  I don't know how to go about doing this.  Do I take the other kids outside, feed them PB, scrub hands, teeth, faces and come back inside?  Is it really worth the risk??  There seems to be so many mixed reviews on what causes allergies.  I definitey don't want to be the cause of triggering a nut allergy in my younger kids, but I don't want to be the cause of triggering a deadly reaction in my oldest.  HELP!

[jschwab]

Is there a clinical reason to do this, or does he just think it's not OK emotionally for them? We are in the extreme, I think, and just shut down on having anything in the house that any one person cannot have - it's just too much trouble. My kids are homeschooled, too, and we never eat out. For us, that means no gluten (hubby), tree nuts (me), milk (me), shellfish (me) in the house, ever. Some things like rice which I react to with a rash we just don't keep in the house, but the kids have elsewhere if they want it. I have recently been thinking about this, though, and whether it had the danger of sensitizing the kids to those things if they don't take in small amounts. They have no food allergies now but maybe I am putting them in danger? They don't like having dairy and don't like nuts so it's not a big deal to them, but maybe it's the wrong path?

[SilverLining]

My son couldn't eat peanuts/nuts at home because I worried about having a severe reaction cleaning him or his mess up.  He couldn't have it at school because they were banned there.

His first taste of peanut butter was given to him by his older brother (first aid and epi-pen trained).  And he vomited.  He tried it again at his friend's house (friend's mother is a nurse).  He didn't like it.

Eventually he was tested for a peanut allergy (negative), and now, as a teen he likes some peanut candy, but still doesn't really like pb.

He's 15 and probably has something with peanut or nut several times a year.  That's it.  I don't see a reason a kid needs to eat it weekly.  The paediatrician my son saw didn't feel it was necessary either.

[LinksEtc]

Welcome Jess.  I hope you find this to be a supportive board.

I don't have a lot of specific advice, but I found a few articles/posts that might be helpful.

-------------------------------------------

"Managing Food Allergies at Home"
http://www.foodallergy.org/managing-food-allergies/at-home

Should You Ban Problem Foods?
Some families decide to allow problem foods in their home, but take precautions to keep the family member who has food allergies safe. Others find it easier to implement a total ban. 

-------------------------------------------

You sound like you are so hard on yourself  - you might enjoy this blog post.
"Mommy Guilt, Or How I Caused My Child's Allergies"
http://foodallergybitch.blogspot.com/2012/07/mommy-guilt-or-how-i-caused-my-childs.html

-------------------------------------------

As far as when to introduce allergenic foods, the advice has changed a lot over the years ... but keep in mind that the docs don't have all the answers on this topic yet.

"Food Allergy Advice for Kids: Don't Delay Peanuts, Eggs"
http://online.wsj.com/news/articles/SB10001424127887324662404578334423524696016

Highly allergenic foods such as peanut butter, fish and eggs can be introduced to babies between 4 and 6 months and may even play a role in preventing food allergies from developing.

The recommendations are a U-turn from 2000

[Jess4879]

Is there a clinical reason to do this, or does he just think it's not OK emotionally for them?  They have no food allergies now but maybe I am putting them in danger? They don't like having dairy and don't like nuts so it's not a big deal to them, but maybe it's the wrong path?

The allergist is telling us that we can trigger an allergy by delaying introduction, but he doesn't know of any safe way to introduce them either.  :/  This is also the exact opposite of what he told us 7 years ago, when the consensus was to wait to avoid allergy.  This is where I struggle, because the docs just don't know what is really causing allergies or if they can be prevented.

I have no idea what is the right path to follow. 

[SilverLining]

I came across this news article and thought about this discussion.

http://www.cbc.ca/news/health/babies-can-try-allergy-provoking-foods-as-early-as-6-months-1.2445748?cmp=fbtl

The American Academy of Pediatrics reversed its recommendations in 2008, but Chan said not enough Canadian family doctors and parents have heard about the change.

Once parents introduce a new food to babies, doctors recommend giving it several times per week with a soft mashed consistency to avoid the risk of choking to maintain a child's tolerance.

So, your doctor is following the current recommendations from the American Academy of Pediatrics.

When Stephanie Schick's four-year-old daughter eats yogurt, she gets fully washed down to help protect her six-year-old sister, who has a dairy allergy.

I don't know how comfortable I would be doing that if it was my child with the food allergy.  Since it's me...it just was not possible. 

[twinturbo]

There's a few ways you could handle this. I'm assuming you have to protect the long term relationship with the allergist?

A home isn't a lab and kids aren't cooperative test subjects. You could point out a couple of items posted by Dr. Wood, a Johns Hopkins allergist who himself has a peanut allergy. On his site is a note about how hard it is in reality for younger kids to manage allergens because they will spread allergens. He himself had his worst reaction from cross-contamination from a colleague's wife's cookies, who assured them they were peanut free. Turned out to be a spatula used to lift pb cookies off a tray were used for the non-pb cookies.

If it were me I'd tell him I can do a lot but I can't control the world, my house is not a lab, my kids are not test subjects and I don't get to punch out on food allergies at 5:00 pm.

Having said that we do live with most of our allergens in the house. I say 'most' because we have so many, particularly my youngest child. There are two we are most careful about: peanut and milk. I don't have either of those in the house because my children's eliciting doses to anaphylaxis are so minute. I also have to go according to a management style that is possible for my kids given their age and developmental stage.

Roasted peanut proteins tend to be the most durable. It takes more wiping, chewing, washing than baked egg or baked milk. It's also a much more narrow category of food item than dairy, egg, wheat, soy (because it's used in so many things). That's something to consider. Now if your child has a wide threshold for peanut then that's different, and no matter how high the numbers they tell you absolutely nothing of threshold. If all you have are high numbers but no history of reaction, especially anaphylactic you may have more room for contamination.

The allergist is going on conventional wisdom based on correlation, I don't believe there's been any publications that provide a direct causation from delayed introduction. In fact, I believe that never became truly set amongst the entire medical community if for no other reason that no one knows how sensitization in allergic disease happens exactly and why some proteins and not others. He's mistaken outright if his idea is that specific allergens run in families rather than allergic disease itself. It would behoove him to keep an open mind about that and not assume because you're not introducing lobster at age 2 then your child will become allergic to lobster. If it were that simple this whole thing would be solved already.



Dr. Sicherer was our previous allergist. I asked him about the idea of highly allergenic foods, introduction and 'keeping them in the diet'. His response (which I am paraphrasing) is he believed that was a slight misinterpretation of OIT data where tolerance was cultivated. He said although sensitization can occur at any time as a reasonable butt-covering possibility, that if you're not allergic to something to begin with there's no value in 'keeping it in the diet'. One simply isn't allergic to it. For reference I was asking about crustaceans and the idea that our son will eat them but not consistently. He did not see that as a concern. This was probably mid 2011.

One good compromise could be if older child is peanut allergic only to start using tolerated tree nuts that all the kids can eat. That should ease the allergist's emotional state a bit, open up new foods for all. The kids w/o allergies could avoid overt peanut until a little older when all the kids can take more responsibility. It's not healthy to create a situation where kids get disciplined due to allergen management.

I would for sure want to find out about peanut for the other kids by school age.

[jschwab]

Is there a clinical reason to do this, or does he just think it's not OK emotionally for them?  They have no food allergies now but maybe I am putting them in danger? They don't like having dairy and don't like nuts so it's not a big deal to them, but maybe it's the wrong path?

The allergist is telling us that we can trigger an allergy by delaying introduction, but he doesn't know of any safe way to introduce them either.  :/  This is also the exact opposite of what he told us 7 years ago, when the consensus was to wait to avoid allergy.  This is where I struggle, because the docs just don't know what is really causing allergies or if they can be prevented.

I have no idea what is the right path to follow. 

I agree with the people who have hinted that this is your path and not your allergist's path and, ultimately, it's your decision. The reality is kid all over the world fail to be exposed to any number of foods due to taste preferences or commonality in cuisine, etc. Before Nutella became popular in the US, how many US kids were eating hazelnuts on a regular basis? Staying safe with food allergies requires a complex set of controls that are social and behavioral in nature and is not easily subjected to alteration, in my experience. There is no way for a clinician to tell you whether changing things up could be done safely or not since it's so complex and based in your family's habits and behaviors.

On the other hand, I worry, too. My thing is that all of my food allergies have developed thus: discomfort eating common food -> giving up food entirely with strict avoidance to avoid discomfort -> ingestion of tiny amount causing full blown anaphylaxis after the period of strict avoidance. Those experiences make me wonder if I'd continued to ingest small amounts, maybe I could have avoided the anaphylaxis? That is the only thing that has really made me wonder about the kids. But none of them are even atopic - no eczema, no environmental allergies except a minor one in one kid (cats). Given that they could develop food allergies to anything at any time and allergy management is such a "soft science" (in the words of my new allergist), I can't bring myself to worry too much.

If he's really insistent, maybe tell him he can set up oral food challenges for nuts in the office for your nonallergic kids. Twice a week .

[YouKnowWho]

Do you have a friend or neighbor that would be willing to give them Reese's Pieces (thinking more contained and less greasy than true PB) or a nut mix.  Maybe possibly go over there the first few times to make sure they are okay and keep your DD safe by staying home.

We opted not to keep an allergen free home but have had to place restrictions on how we do things.  My older son is allergic to wheat, rye, barley and egg - we have those items in the house but I cannot mix them up dry without DS1 reacting.  So I can buy things like refrigerated biscuits in a can, but I cannot mix up a batch of biscuits from dry goods if that makes sense.

[Jess4879]

There's a few ways you could handle this. I'm assuming you have to protect the long term relationship with the allergist?

A home isn't a lab and kids aren't cooperative test subjects. You could point out a couple of items posted by Dr. Wood, a Johns Hopkins allergist who himself has a peanut allergy. On his site is a note about how hard it is in reality for younger kids to manage allergens because they will spread allergens. He himself had his worst reaction from cross-contamination from a colleague's wife's cookies, who assured them they were peanut free. Turned out to be a spatula used to lift pb cookies off a tray were used for the non-pb cookies.

If it were me I'd tell him I can do a lot but I can't control the world, my house is not a lab, my kids are not test subjects and I don't get to punch out on food allergies at 5:00 pm.

Having said that we do live with most of our allergens in the house. I say 'most' because we have so many, particularly my youngest child. There are two we are most careful about: peanut and milk. I don't have either of those in the house because my children's eliciting doses to anaphylaxis are so minute. I also have to go according to a management style that is possible for my kids given their age and developmental stage.

Roasted peanut proteins tend to be the most durable. It takes more wiping, chewing, washing than baked egg or baked milk. It's also a much more narrow category of food item than dairy, egg, wheat, soy (because it's used in so many things). That's something to consider. Now if your child has a wide threshold for peanut then that's different, and no matter how high the numbers they tell you absolutely nothing of threshold. If all you have are high numbers but no history of reaction, especially anaphylactic you may have more room for contamination.

The allergist is going on conventional wisdom based on correlation, I don't believe there's been any publications that provide a direct causation from delayed introduction. In fact, I believe that never became truly set amongst the entire medical community if for no other reason that no one knows how sensitization in allergic disease happens exactly and why some proteins and not others. He's mistaken outright if his idea is that specific allergens run in families rather than allergic disease itself. It would behoove him to keep an open mind about that and not assume because you're not introducing lobster at age 2 then your child will become allergic to lobster. If it were that simple this whole thing would be solved already.



Dr. Sicherer was our previous allergist. I asked him about the idea of highly allergenic foods, introduction and 'keeping them in the diet'. His response (which I am paraphrasing) is he believed that was a slight misinterpretation of OIT data where tolerance was cultivated. He said although sensitization can occur at any time as a reasonable butt-covering possibility, that if you're not allergic to something to begin with there's no value in 'keeping it in the diet'. One simply isn't allergic to it. For reference I was asking about crustaceans and the idea that our son will eat them but not consistently. He did not see that as a concern. This was probably mid 2011.

One good compromise could be if older child is peanut allergic only to start using tolerated tree nuts that all the kids can eat. That should ease the allergist's emotional state a bit, open up new foods for all. The kids w/o allergies could avoid overt peanut until a little older when all the kids can take more responsibility. It's not healthy to create a situation where kids get disciplined due to allergen management.

I would for sure want to find out about peanut for the other kids by school age.

Thank you for responding.  She has reacted to peanuts once, on one ingestion. She had swelling of the lips and vomitting from one bite of a peanut butter cookie. She hasn't had exposure to nuts (that we are aware of) since then.  We have not done a food challenge at this point to see if she is able to ingest other types of nuts and the allergist said he isn't concerned about those and won't worry about a challenge until a later (unspecified date).  At this point we treat her as though she were allergic to all nuts.  It simplifies things for us and for her at this point.

[Jess4879]

If he's really insistent, maybe tell him he can set up oral food challenges for nuts in the office for your nonallergic kids. Twice a week .

[twinturbo]

Then the allergist has some inconsistencies he should work out on his introduction schedule first before hanging it on you.

Why?

Tree nuts are not related peanuts, although there is some correlation to sensitivity along with sesame and lupin. Tree nuts aren't even all related to each other. Therefore you have many cases where a peanut (legume) allergic individual can tolerate one, two or all tree nuts. Almonds are more closely drupaceous seeds in the rose family. Cashews and pistachios are related to mangoes. One of the challenges most peanut allergic individuals face is getting tree nuts free of peanut contamination in order to in-office challenge.

Why am I telling you this? If an allergist pushed on kids must eat peanut or it's mom's fault for not introducing it sooner then it would be logical for doctor to help patient determine if all, some or no tree nuts must be avoided. So simpler for him doesn't translate to goals if the goal is to not delay introduction of allergenic food. Why push you solely on peanut? That makes no sense.

[jschwab]

Thank you for responding.  She has reacted to peanuts once, on one ingestion. She had swelling of the lips and vomitting from one bite of a peanut butter cookie. She hasn't had exposure to nuts (that we are aware of) since then.  We have not done a food challenge at this point to see if she is able to ingest other types of nuts and the allergist said he isn't concerned about those and won't worry about a challenge until a later (unspecified date).  At this point we treat her as though she were allergic to all nuts.  It simplifies things for us and for her at this point.

I think that is kind of bizarre. Wouldn't it be just as important for her to "dose" tree nuts to avoid developing that common allergen, too? That does not make any sense to me that your allergist would push it for the siblings and not for a kid who is already predisposed to food allergy. I am assuming this is the inconsistency twinturbo is referring to.

[Jess4879]

If an allergist pushed on kids must eat peanut or it's mom's fault for not introducing it sooner then it would be logical for doctor to help patient determine if all, some or no tree nuts must be avoided. So simpler for him doesn't translate to goals if the goal is to not delay introduction of allergenic food. Why push you solely on peanut? That makes no sense.

This was my thinking too.  It just didn't make sense. 

[booandbrimom]

We have two kids. My son has peanut allergy; my daughter has no known allergies.

We did keep the house peanut-free (and nut free at the time) when they were both small, but around age 6, my daughter wanted to start having access to foods her brother couldn't eat. She was trying things at friend's houses, so we had to make up a protocol:

- Peanut butter was always on a paper plate, with disposable utensils. (No worries about shared dishes/pans, or bad dishwashing.)
- It was always at the table. No carrying it around, no eating in other rooms.
- It was always stored on a special pantry shelf that was labeled unsafe for him.
- When she was young, hands had to be washed right after.

We didn't have too many problems with this, although we really had to work on reinforcing it with her and she was really bad about keeping candy in her room for a while. But a lot of it is predicated on whether you have a child with a touch allergy. Our son just wasn't that sensitive.

Later, we challenged each tree nut individually and we do keep the nuts in his diet that he's able to eat. I am a believer in having kids consume the foods they can consume. My gut feeling is that there are "incidences" that can trigger new food allergies and having foods in the diet during one of these times is protective. But really - it's just a crap shoot at this point. Mostly I just hate to see parents avoid anything their child doesn't absolutely *need* to avoid, simply because it's so restrictive.