The Allergic March

Earlier this month I wrote about the ups and downs of peanut allergy diagnosis in our family. On one medical visit for my son Dexter's lingering cough,  the doctor used a term I had not heard before, but have since come to know well, "The Allergic March". The Allergic March refers to a cluster of allergy-related diseases that occur in childhood. These often occur in a typical se­quence, appearing early in life, continuing for many years, but often disappearing or lessening with age.

Here is an example of a typical sequence of Allergic March conditions  and symptoms. My son's Allergic March followed this typical pattern:

1. Infant eczema
2. Food allergy
3. Environmental allergy and associated stuffy nose
4. Childhood asthma

In our case, the infant eczema was not severe. It appeared simply as very dry, chapped skin. Now, at age 7, he still gets very dry wrists and hands in the winter, but my home remedy of olive oil and aloe seems to help.

I have already written about the food allergy and while we had been cautious about introducing nuts early because of a familial predisposition to food allergies, I am sure we did not expect that he would actually have an allergy.

The asthma was a surprise and took several months to diagnose at the age of 5.

Dex never had what I would characterize as an asthma attack. It was simply a lingering dry cough for several months that bothered him at night and upon any, and I mean ANY, physical exertion. For instance, a 10 minute walk to school would set off a cough every 10 seconds for a good hour.

On a vacation to Mexico, I finally clued in to the cough's duration and implications when I kept asking him to sit down for a minute until he stopped coughing. At one point in my life I suffered from exercise-induced asthma, and genius that I am, I had never made the connection between my post-exercise coughing asthma fits and his.

Treatment with inhaled-corticosteroids (flovent in the orange puffer), was effective within 2 weeks and he stayed on the medication until the end of that winter.

Since then, the asthma seems to only show up after he has a cold. That annoying cough comes back. We have explored various treatments with both our family doctor and our allergist. We were given the following therapies to consider:

1) Singulair - a once daily pill

2) Flovent (fluticasone: orange puffer) - an inhaled corticosteroid taken once-daily

3) Ventolin (salbutamol: blue puffer) - taken as needed up to 4 times per week, sometimes more during a cold.

We looked at the various options. Singulair, while not a steroid and good prevention, has some rare mood-altering side effects. Our son is moody on his best days and this slight risk was a strong deterrent for us.

Inhaled corticosteroids were effective for us, but studies have shown that long-term use of Flovent can cause statistically significant differences in height. My husband wants my son to play in the NBA (or at least the NBL), so growing to his full potential is important to us.

We have chosen option number 3. Dex uses his blue puffer (Ventolin) during a cold to prevent coughing and bronchial irritation. He uses it no more than four times a week before hockey games or practices where the cold plus the exercise is likely to set him off coughing. So far this year, we are happy with this course of action.

So, asthma under control for now, we now march on to the next issues: the anxiety associated with the food allergy and the recommended influenza immunization (flu shot) which will bring on an anxiety of its own. Stay tuned.

While this describes our family's account of asthma diagnosis, treatment, and management, every individual is different. Please consult with your family physician for any asthma or allergy-related concerns.

References:

1. A Liu. The Allergic March of Childhood. Medical Scientific Update: The National Jewish Medical and Research Center. 2006; 23(1):1-7.
2. The Canadian Lung Association
3. BR Gordon. The allergic march: can we prevent allergies and asthma? Otolaryngol Clin North Am. 2011;44(3):765-77.

Liisa is mom to 2 boys, ages 5 and 7. She is a medical writer and a book lover. She blogs at FitforKid.net andLittleBookLovers.Wordpress.com.

Diagnosing a Peanut Allergy: One Family's Story

by Liisa It could be worse. That has been my mantra when it comes to my older son's possibly life-threatening, always manageable, but oh-so-annoying health conditions.

Before I get into the meat of my story, let me introduce myself – I'm Liisa. I'm the mother of two boys, ages 5 and 7. I am thrilled to be able to contribute to Kids in Capital on health and medical topics. In the spirit of this blog, I am going to make things personal, taking you on our family's journey to stay healthy and happy.

Part 1

In the summer of 2008, my three-year old son vomited immediately following a bite of his first-ever peanut butter cookie. We had kept him nut-free until then. My husband has an allergy to cashews and the doctor had advised us to wait until his third birthday.

We were referred to an allergist by our family doctor. Three months later, during a gruelling afternoon wherein the skin scratch test showed very little, but the blood test showed something more, we would learn that my son had a peanut allergy (and my little son would learn that sometimes moms lie (“it's not going to hurt much, just put your arm out”).

We were told that his levels of IgE were low and there was a good chance he would grow out of this allergy. We could retest in a year. If the test was still positive with low IgE, he could go on to do a food challenge (i.e. eat peanuts and see what happens). In the meantime, we were to carry epi-pens for him, avoid ALL nuts and traces of nuts and maintain a nut-free home.  You never know whether the next reaction could be an anaphylactic one with peanuts.

Part 2

Eighteen months later it was time for the next allergy test (on April Fool’s Day no less).  Much googling for journal articles on diagnosis of peanut allergies in children gave me hope.  We had experienced no further reactions. I looked forward to the results and to good news.

My son did not look forward to the appointment the way I did. He was convincing in his argument that testing was not necessary since he did not care for peanuts and nuts, and would not need to eat them now or in the future.

We prepared well for our trip to the allergist. My husband and I were both there for extra distraction and mutual moral support; we brought a treat for morning snack, and a promise of a toy store visit after the appointment.

The good news: We didn’t have to go for a blood test - what a relief.

The bad news: As we sat and read stories for 15 minutes, we glanced periodically at our son's arm. It was clear that the second “P” (indicating peanuts) on his arm was lighting up with a nice hive, a 6mm hive to be precise.

At that point we were, and would likely remain, a nut-free family. Our younger son, then 3, would also be tested as there is an increased likelihood of peanut allergy in siblings of allergic children.

We were glad to know where we stood, glad it was peanuts, an allergen that is common and simple to manage in North America. It could be worse!

Our allergist answered some of our questions and gave us some tips:

1) He recommended getting a Medicalert bracelet. We did though it was tough getting him to keep it on. We found disposable bracelets from Mabel's Labels that he was happy to wear when he was at birthday parties or occasions when his family was not with him.

2) We could eat at restaurants as long as we asked about the food; if a restaurant gave us the “we can't guarantee” speech, we must be absolutely sure we had an epi-pen with us.

3)  Though he was not allergic, almond butter (even with the peanut-free label), was not okay.  This would be too confusing for him and for others.  We should keep it simple and say absolutely no nuts or nut products.

4) We should go back in a year to test again.

Part 3

Late 2011: My son was now 6 years old. We visited the allergist again for the third round of testing in 3 years. The continued absence of reactions gave me hope that perhaps there was no more allergy.

We grabbed his Star Wars sticker book and off we went.

After a brief consultation, we went into the exam room for the drops and scratches, which this time would include environmental allergies. Shortly after the nurse left the room, my son began to feel uncomfortable itching in his arm:

• He reacted strongly to cats. We don’t have a cat. No biggie.
• He reacted to peanuts, not strongly but still significantly.

This time medical science had something new for us – a blood test (privately funded at $180) that can type an allergy to predict the likelihood of a systemic (i.e. anaphylactic) reaction. The test isolates the different types of protein in the peanut and the reaction to each.

In studies, there are certain proteins which have little association with anaphylactic reactions and certain proteins which have strong associations with anaphylactic reactions.

If there was no reaction to those proteins with the strong association to anaphylaxis, we could move to a food challenge.

Hope!

I hypothesized that he hadn’t had any reactions because he had the mild type of allergy, and now we could identify it.

Two weeks later the call from the allergist’s nurse came…He only reacted to one protein, the one to which 90% of those who have had anaphylactic reactions were positive.

[Insert expletive]

We had been doing a good job of keeping him nut-free and would continue to do so.

It could be worse!

Epilogue

My younger son was tested and has no allergies. He enjoys nutty treats when we are out of the house and away from his big brother.

My husband and I continue to go on “peanut dates” which include Vietnamese food with oodles of peanuts and peanut sauce, followed by a movie wherein we consume peanut M&Ms like they are about to be discontinued.

We are due to return for testing this month. I have put it on hold to deal with other more pressing concerns, but it will be done sometime in early 2013. The allergy diagnosis was just the beginning of what I have now learned is called “the allergic march”. In future posts I will describe the asthma and anxiety that followed.

If you suspect a food allergy in your child, talk to your family doctor. Only a medical doctor can diagnose an allergy. Diagnosis includes a patient history, skin prick test, and possibly a blood test and/or food challenge test.

References and Resources

Anaphalaxis Canada anaphylaxis.ca

Allergy/Asthma Information Association  www.aaia.ca

Allergy Safe Communities www.allergysafecommunities.ca

CSACI (Canadian Society of Allergy & Clinical Immunology) www.csaci.ca

CAAIF (Canadian Allergy, A

sthma & Immunology Foundation) www.allergyfoundation.ca

Ontario’s Sabrina’s Law www.ontla.on.ca/web/bills/bills_detail.do?locale=en&BillID=135&isCurrent=false&ParlSessionID=38:1

The Complete Peanut Allergy Handbook by Dr. Scott Sicherer (available through online retailers)

Liisa is mom to 2 boys, ages 5 and 7. She is a medical writer and a book lover. She blogs at FitforKid.net andLittleBookLovers.Wordpress.com.

Food intolerances in children

by Lara

I grew up with what I called allergies. They weren't really. I was never in danger of going into anaphylactic shock, but I did have a two page list of foods I couldn't eat because of the extreme rashes I got from eating them. (My mother believes that dairy could have been one of the major culprits but nobody thought that might be it so it was never eliminated for me).

I hoped my kids would never go through the same thing but after months of awful rashes I realized we had to try to figure out what was causing my son Quinn so much discomfort, and that it could be food related. I really didn't want it to be food related.

After trial and error we figured out that Quinn still has a reaction to cow and soy milk (I am fairly certain it is to the protein and not the lactose). All 3 of my children couldn't digest either as infants (which was it's own other fun issue to tackle) but we thought they had all outgrown it. Instead we are now trying to manage one child who can no longer have cheese, yogurt, cow's milk or ice cream.

We've been lucky - he has accepted that he can't have a lot of these things because of the rashes they give him.  He has embraced his "special milk" and his "special cheese". But managing it both at home and when he is at daycare and preschool adds an extra layer of challenges.

We're lucky it isn't an actual allergy but only intolerance.  If someone slips up and gives him milk it isn't the end of the world.  It's often a challenge but the change in not only in his skin but his digestive system has been well worth it.

Have you gone through trying to figure out food intolerances in children? Do you have any tips?

Flashback post: Being aware of food allergies: how to host a child with food allergies

by an Ottawa mom I am a mom who has been dealing with multiple severe food allergies now for two years (the anaphylactic-Epipen-ambulance rides to CHEO kind). These two years have been the most stressful period of our lives. It has turned me into a total Mama Grizzly on the topic of food allergies and awareness. I am always protecting my little cub at home and outside – constantly on the lookout for crumbs, suspicious food labels and food wrappers left in the park (and more).

The tricky thing with food allergies is that once you’re outside of your safe zone, you rely on your friends and the people around you to be sympathetic to your needs and demonstrate compassion by taking your child’s medical needs seriously.

Here’s a recent (bad) example. One day last month there was a birthday in my son’s daycare and the children had a surprise treat of ice cream (it was a surprise to me too as we have an agreement about giving notice for birthday treats). Because of my son’s egg, milk and nut allergies, he cannot participate in these special activities. When I collected him at the end of the day shortly after the ice cream had been gobbled up by his classmates, I found my little boy in a high chair eating one of his homemade muffins. He looked miserable. His emotions were on his sleeve and he reached up for a big hug and slung his head on my shoulder. I felt horrible for him. And guilt. Then rage. A birthday party shouldn’t be the worst part of your week.

You might not think it’s a big deal, but it is when it happens repeatedly. This is just an example from last month. Month. Typing this story out is making me cry at my computer screen. Food allergies comes with a lot of emotional baggage.

You can show your respect towards a child with food allergies (and their parents) by creating safe situations for them when you invite them to playdates or birthday parties. Hosting an inclusive get together doesn’t have to be complicated.

Here are some tips :

1. Ask your guests if there are any food or environmental allergies in advance.
2. Understand the severity of the allergies. Is it sniffles and red eyes? Or is it “911 epipen hives and can’t breathe ambulance ride to the CHEO” allergies? Does the latter scare you? It should.
3. Before the party:
   • Talk to the allergy parent about your menu plan. This allows the allergy parent to decide if they can allow their child to eat the same food or whether they will pack similar food to bring along. If you are the “allergy parent” offer to send recipes or even bake/cook something to bring for everyone.
   • Ask is there are any food items that should not be offered at all.
   • Let all of your guests know about any special considerations. Some parents may ask that children not have peanut butter or nuts before arriving or ask that they brush their teeth and wash their hands beforehand. You may also want to ask guests not to bring any food to avoid any awkwardness if their offering is not safe.
4. Make the party venue allergy-friendly. Give the place a good clean sweep. Wipe down surfaces such as play tables, kitchen tables and countertops with a clean cloth. Inspect any toys that will be shared for food residue and wash them if necessary.
5. Avoid cross contamination when preparing foods. If you are cooking a separate item for an allergy child, always use clean bowls, utensils and ingredients. Cover any baking sheets with tinfoil if you’ve baked with the allergen on them before.
6. Confirm any ingredients and food with the “allergy parent”. Allergens can be lurking even in products that don’t have the allergen on the ingredient list. Have you ever seen warnings that read, “This product has been manufactured in a facility the processes peanuts? ” To many (including our family), that warning is THE SAME as having the allergen included in the ingredient list. And here’s the tricky thing, that warning is OPTIONAL. Processed foods, even things like cereal, may not be safe.
7. Condiments. If you think there is a chance that a knife may have dipped into peanut butter and then into the jelly jar or onto the stick of butter, open a new package or jar. Play it safe.
8. Hosting a BBQ? Have you ever made a peanut sauce marinade for your meat and cooked it on the grill? Shrimp skewers? Maybe? Then your BBQ may still have that food protein residue on the grill. Cook any food for the allergy sufferer on a piece of tin foil and use separate tongs.

Make it a safe party for everyone. And have fun!

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