One Year

Happy (belated) birthday, little man!

If you could say anything besides "all done," I think that you would agree that it has been quite an eventful year.

Here's to you, sweet boy, and all of the wonderful things that await you.

We'll do our darndest to keep you alive.

The RAST Test, or Tree Nuts on Board

At Pete's mid-August appointment, Dr. P ordered a RAST test. The RAST test, or radioallergosorbent test, provides information about the specific IgE concentration in a person's blood. From About.com:

Laboratory technicians add the likely allergen, bonded to a solid polymer, to the patient's blood. While there may be a large quantity of immunoglobulin E (IgE) -- the major antibody that binds to allergens in allergic reactions -- in the blood, the type that binds to each allergen is slightly different, and is referred to as allergen-specific IgE.

If the patient is allergic to the allergen being tested for, allergen-specific IgE will attach to the allergen and other IgE (from anything else the patient is allergic to) will float freely in the blood. The blood is then "washed," leaving the allergen and any of the patient's attached allergen-specific IgE.

A serum of radioactive anti-IgE, which is derived from people who are known to be allergic to the allergen being tested for, is then added, allowing technicians to determine the concentration of allergen-specific IgE in the patient's blood.

With about a half an hour to closing, we walked into the LabCorp that was most convenient to Dr. P's office, in one of the lower circles of hell. I'd like to take this opportunity to offer some advice to parents of babies and small children.

1) Don't take your little one in for a blood draw at the end of the day - and this goes double for the end of the day on Fridays. The lab techs will be tired and distracted - as will your child.

2) Don't knock your child's head on the HVAC register cover while walking down the hallway to the draw room. He/She will begin crying and will not stop for the duration of your visit. It's all about setting the mood.

3) If the techs look at all uncomfortable or make mention of their discomfort at sticking a small child, walk away. It will only get worse from this point.

4) If, after placing the rubber tourniquet on your child's arm, the techs aren't able to locate a vein, don't let them stick your child.

5) Give the techs one chance only. If they stick your child and don't hit a vein, they may not continue to slide the needle in and out of your child's arm and/or then try the other arm.

Our LabCorp experience was sheer agony. Usually laid-back Petey screamed the entire time - so desperately that it left him hoarse - and I actually had to restrain myself from slapping away the hands of the incompetent techs. Finally, in tears, we walked out. In retrospect, Sug and I agreed that we should have stopped their unproductive prodding much sooner than we did. We were so upset we almost decided not to go to Chipotle for dinner.

All kidding aside, it took me two weeks before I could fathom the idea of testing Pete again.

This time, we went to the LabCorp most proximate to our home, located in a hospital. I knew that our previous experience had been bad, but I didn't realize how truly horrendous it had been. We did have to wait quite a while before the lab could take Pete, but it was so worth it.

"Saint Beth", the lab tech, located Pete's vein within seconds of our sitting down. She showed me how to hold Pete securely so that his safety wasn't compromised. And when she drew his blood (on the FIRST stick) HE DIDN'T CRY AT ALL! Such awesomeness. And then she gave him a sticker which he promptly ate.

So, in addition to the wisdom above, I would add this:

6) If your child needs to have blood drawn, take him/her to a hospital where an experienced lab tech, well versed in sticking people of all shapes and sizes, will make it a relatively pain-free experience - both for your child and for you.

And the results? First, here's a chart for reference explaining the score given an allergen based upon the concentration of IgE in the patient's blood:

Score....IgE Count

0 ..........0-500 (no antibodies detected)

0/1 ......501-750 (low equivocal)

1 ..........751-1600 (equivocal)

2 .........1601-3600

3 .........3601-8000 (scores 2-6 indicate increasing antibody levels)

4 .........8001-18000

5 .........18001-40000

6 .........40000+

Pete scored:

1 Pecans (low, but all tree nuts are off limits)
4 Cashew
4 Wheat
4 Almond
4 Peanut
5 Milk
5 Egg White

From this point on, Pete will be tested annually to determine whether or not his IgE levels drop to the point where we can challenge a low/negative result with actual food. Sheesh.

Testing 1, 2, 3, or How I Became a Meat-Eating Vegan with Celiac Sprue

"We're pretty sure he's allergic to milk," I told Dr. P, Pete's allergist.

It was skin prick testing day. As per doctor's orders, we had ceased using hydrocortizone for the three days preceding this first appointment, and we omitted Pete's daily lotion schmear following his morning bath. Any medications with antihistamine-like actions (these include those taken internally and applied externally) can skew the testing results by preventing a reaction. The slickery nature of moisturizers can cause the allergen extracts to run into one another.

While skin prick testing is most commonly done on the forearm, children younger than two years are generally tested on their backs to prevent them from itching and thereby smearing the extracts. The nurse first wiped Petey's back with alcohol and then pricked him with tiny lancets that had been first dipped in specific allergen extracts. The allergen is thus introduced under the surface of the skin where an allergic reaction is triggered. The prick itself is not painful, the only discomfort is the itchiness from the reaction.

Keeping in mind that I majored in English, here's my understanding of the process by which an allergic reaction occurs. The immune system produces many immunoglobulins (also known as antibodies), one of which is immunoglobulin E, or IgE. It is the primary player in allergic reactions. IgE antibodies are incredibly specific and respond only to their own allergen. For instance, an IgE antibody for peanuts will react only against peanuts and not hazelnuts or Brazil nuts. When IgE antibodies recognize the allergen against which they are programmed, they trigger the body's mast cells to release defensive chemicals (including histamine) into the body's tissues. These chemicals cause allergic reactions.

After 15 minutes, the nurse returned and checked for wheals (little lumps like mosquito bites) on Pete's back. A milk allergy was confirmed and allergies to wheat, egg whites, and peanuts discovered. While skin-prick testing can determine one's allergens, it is unable to indicate the degree to which one is allergic. That's where RAST blood testing enters the picture. It measures the amount of IgE directed against specific allergens.

Dr. P's advice at this point was to continue breastfeeding for as long as possible and to delay the introduction of solid foods. This, however, would require that I eliminate all of Pete's allergenic foods from my own diet until he is weaned. Sign me up; I'd do anything for this kid.

In Which Stonyfield Farms is Vindicated

We were struggling to find the common denominator. What ingredient(s) did the teething biscuits and yogurt have in common? We did copious research while waiting for our appointment with the allergist.

Pete has four older siblings, none of whom have had any trouble with food. The transition, for them, from breastmilk to food was a simple matter of serving up baby friendly portions of our meals on the highchair tray; they ate what we ate. Obviously, we stayed away from known no-nos like honey (botulism), hot dog circles (choking hazard), and peanut butter (potential allergen). However, our investigation into the source of Pete's illness turned up some surprising results.

Until this point, I had been using What to Expect the First Year only as a means of checking Pete's monthly development: "He's looking for a dropped object, that's a '... may even be able to!' He's a genius!" or "He '... should be able to' lift up his head by now. Where did we go wrong?!" (In Pete's defense, our babies' craniums tend to be larger than average. Big brains, we assure ourselves.) Anyway, while reading about Feeding Your Baby: Starting Solids, I came across a box on page 315 entitled Not This Year, Baby. And I quote:

These foods will have to stay off baby's menu for at least the first year:
Nuts and peanuts
Chocolate
Egg whites
Honey
Cow's milk

Some doctors okay these foods during the last few months of the first year; others recommend holding off on them until baby's birthday, especially if there's a family history of allergy:
Wheat
Citrus fruit and citrus juice
Tomatoes
Strawberries

Strawberries?! What the hell?! No one ever told us that babies shouldn't have strawberries! Isn't there someone at the hospital in charge of distributing this information - couldn't an information sheet be pinned to the car seat during the all important installation check? What about those parents who don't own What to Expect?! They could be feeding their baby strawberries at every meal, slowly killing their child with the greengrocer's equivalent of arsenic! And Stonyfield Farms is putting poisonberries in its yogurt - FOR BABIES?! Good God, people! What about the children? This set off a flurry of Googling.

And now is the point in the post where I apologize to Stonyfield Farms. I'm sorry I assumed the worst of you. And that I badmouthed you to all my friends and my mother. You pasteurize your strawberries, thereby destroying the substance responsible for reactions. You are good people who make a good product, and I'm sorry that I ever blamed you. Carry on.

No, the real culprit was milk. Hindsight being 20/20, this seems like a real no-brainer.

And There's Your Sign

It was the end of April and we were on our weekly shopping trip. There, in the Wal-Mart (don't judge me, I'm feeding five kids) dairy case I noticed a yogurt (plus fruit and cereal) six-pack emblazoned with cherubic, smiling toddlers, their arms outstretched to embrace floating clusters of fruity goodness. Ever the discerning consumer I thought, "I have a baby! He smiles! He reaches out for things! This yogurt was meant for him!" I even did a quick check of the ingredients to make sure that there wasn't something that might possibly turn Pete into a swollen, itchy mess. Organic milk, organic fruit, blah, blah, blah. Nothing to fear here.

So that evening, we opened up a container of strawberry-banana and Sug and I began spooning the stuff into Pete's mouth. He took the first few bites without incident, but then began to avert his mouth and squirm. Experienced as we are with this parenting thing, surely we could cajole him into taking a few more bites.

"I think he's starting to get a rash around his mouth." said JC, our eleven year old.
"Nonsense," we assured him.

But there was a rash. And it got worse and worse and worse.

Remembering that the pediatrician had asked whether I had administered Benadryl with Pete's first reaction, I promptly gave him a quarter teaspoon and a bath. Sug consulted Dr. Google to research what ingredient could have caused the rash and we debated about whether to take him to our pediatrician's after-hours clinic.

And then Pete lost consciousness.

It took us a few beats to recognize this for what it was. At first, we actually thought that he had fallen asleep. A warm bath and some Benadryl will do that. But we couldn't rouse him and Sug, a Behavior Specialist at a local hospital for children and adolescents, noted that Pete's extremities had turned white - a sign of shock.

Sug and I decided that JC and I would take Pete to the Convenient Care clinic while he stayed at home with the other kids. As I buckled Pete into his carseat, he regained conciousness and began to vomit all over himself. By the time we reached the office, around three minutes later, the vomit, which had soaked into his clothing, had caused him to break out in such terrible hives that he appeared to have blisters all over his body.

Fortunately, our pediatrician was the doc on call, and with the administration of some more Benadryl (a baby his size could take three times the dose we gave him) she sent us home to give him another bath (he continued to vomit throughout the consultation) and return within the half hour.

Upon our return, and after assuring us that Pete was stable, Dr. C presented the option of taking him to the emergency room. The worst of the anaphylaxis was over, she said, and the Benadryl would help to quell the reaction inside his body. While the prolonged vomiting had expelled most of the "trigger food" from his body, a certain amount of it was still going to travel through his digestive system. It was unlikely that he would have another reaction as severe as the first. I was paralyzed and totally overwhelmed; I couldn't make that call for fear of the consequences of a wrong choice. I made a tearful call home to Sug and we decided that, the worst being over, we would monitor Pete through the night. Dr. C advised us, should he have a reaction like this again, to forgo "bravery" and take Pete to the emergency room. Brave, my ass - more like ignorant.

If, at the time, we had understood that Pete was having a severe and life-threatening allergic reaction, we most certainly would have taken him to the hospital. We knew of anaphylaxis, we just never expected it to come for dinner.

In the Beginning

Thinking back, I don't think that there was ever a time that Pete wasn't itchy. We had to keep his nails trimmed so that he didn't gouge his scalp and leave bloody tracks along his torso. With every diaper change or bath, he would furiously scratch any and all bare skin that he could reach. Infantile Eczema, our pediatrician diagnosed. (Our skin is composed of epithelial cells and these same cells line the mucous membranes in our mouths and noses, as well as our lungs. When the cells in the skin get irritated, one has eczema. Irritated mucous membranes are what we call allergies. Asthma results from irritated lung cells.) We were told that Pete's eczema was just the way that my allergies and asthma were manifesting themselves in his body - same cells, different place. Sorry about the genetic kick to the crotch, buddy.

Okay, this was manageable. With a free Christmastime consultation from my dermatologist cousin (Thanks, Jim) we settled into a nightly routine of slathering Pete with hydrocortizone and Aquaphor. Most babies outgrow infantile eczema within 18 months; this was completely manageable.

And then we decided to start food.

Check out that rash around his mouth, and the swelling of the lower lip. The eyes that seem to scream, "Mom, why are you trying to kill me?!" (In my defense, I didn't mean to document the allergic reaction - hell, his baby book is a bunch of papers and his hospital bracelet crammed inside a blank spiral bound notebook. Despite my best intentions, I don't scrapbook well.)


I had given him a teething biscuit to keep him occupied while I was baking and he seemed to be digging the solid food thing.



Okay, he does look a little concerned in the picture on the right. Which was roughly the same time that I became concerned. Or hysterical. Call it what you will.


Pete got a thorough cleansing (while I placed an incoherent call to his pediatrician) and then we hightailed it to her office. After asking whether I had given Pete any Benadryl (I hadn't, but this will become important in the next "chapter"), we tried to isolate what could have caused his reaction. Let me tell you, there were so many unpronounceable ingredients in that baby biscuit that I didn't hold out any hope that we would ever know.

We now know. Would that it were one of those funky food additives that we could avoid by cooking from scratch. And, of course, we had to find out the hard way.

Petey and Four of the "Big Eight"

Free from:

milk
egg
wheat
peanuts

since May 2008.