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.