Friday, March 6, 2009

Big news: Leighton appears not to have food allergies!

Because Leighton is almost one, we took her to Ainsley's allergist yesterday for skin testing to determine whether she has food allergies. The allergist told us that siblings of severely food allergic children have 10 times the risk of having food allergies as kids without a food-allergic brother or sister, so we were nervous but still optimistic because she has shown no signs of having food allergies other than her bout with eczema a few weeks ago. He tested her for egg, milk, soy, peanut, almond, cashew, hazelnut, walnut, fish (aka "fish mix"), & shellfish ("shellfish mix"). If you're not familiar with skin testing, the allergist takes a large area of the body - usually the arm, leg, or back (in both my girls' cases, the doctor tested for a lot of things so he used their backs), writes identification numbers (1, 2, 3, etc.) on different parts of the back, and applies a tiny pinprick's worth of the designated allergen next to the appropriate number. Leighton's back looked like this:

1 (prick with egg) 5 (prick with almond)

2 (prick with milk) 6 (prick with cashew)

3 (prick with soy) 7 (prick with hazelnut)

4 (prick with peanut)

Aside from these substances, the child gets two more pricks. Below the numbers, the allergist writes an "H", which stands for histamine, and a "C", which stands for control, spaced several inches apart. By the "H", the allergist pricks the skin with a substance that would cause a hive on everyone. By the "C", the child is pricked with something that would not cause a hive on anyone. These are just to ensure that the child's skin prick tests, in general, are accurate.

So after the kid's skin is pricked with these various substances, you have to sit in the exam room for another 15-20 minutes to see if any hives develop where the pricks are. When we had this done with Ainsley (last August), the pricks and the waiting were a completely miserable experience because she developed large hives to practically all of the ~20 substances (mostly different kinds of tree nuts) she was tested for. She was crying and complaining the entire time about how itchy her back was and how much the pricks hurt. I was so traumatized by the skin testing we did with Ainsley that I made Dave come with me yesterday so I wouldn't have to endure 20 minutes of a screaming baby by myself.

Well, I am thankful to say that with Leighton, it was a completely different experience. She barely noticed the pricks themselves (whereas Ainsley started screaming when the nurse did the pricks, probably because the substances actually did cause pain since her skin is very sensitive to them). She played happily for the next 15 minutes until the allergist and nurse came back in. Her back looked amazing - there was no hive except by the "H", where there was supposed to be one. Everyone was so relieved to see that she had no hive to any of the foods they had put on her. (Had she had a hive to anything, they would have measured the size of it - predictably, the bigger the hive, the more allergic one usually is to something. She would have then had a blood test to determine what her "CAP-RAST" number, a number between 0 - 100, was to the allergen. Generally, the higher the number, the higher risk that she would have a serious allergic reaction to the substance if she ingested it.)

The allergist told us that, based on these results, Leighton can basically eat anything we want to feed her. Interestingly, he even gave us clearance to feed her fish, shellfish, peanuts, and tree nuts. He said that there is so much evidence now that delaying introduction of an allergen does not prevent a child from having an allergy to it, and may actually increase the chances of the child being allergic to it, that he no longer recommends avoiding food allergens until a child is older. He did warn, however, that if we choose to introduce something like peanut butter into her diet, it is a good idea to try and get her to consume the food regularly so her body will stay tolerant of it. Since we told him it's near impossible to guarantee we can feed her peanuts/tree nuts on a regular basis because we don't have it at home and her preschool is nut-free, he said we can just not worry about the nuts right now and she can be introduced to them later, whenever we feel comfortable doing so.

The allergist then talked with us about the logistics of managing a home with a child who is severely allergic to so many things and with a child who appears to be allergic to nothing. To maintain Ainsley's safety, he suggested continuing with our current arrangement of not eating anything at home that she is allergic to, and instead sending foods that contain dairy and eggs to preschool for Leighton so she can eat them away from Ainsley. We will also allow Leighton to eat these foods at restaurants (we can actually feed her off of our plate!) and at birthday parties.

Because Ainsley was our first child, we have never known what it is like to have a kid who is able to eat anything she wants. It is a whole new world and I am very nervous, especially about whether Ainsley will feel jealous that Leighton can eat anything while we have to feed her special food. The two scenarios I am most worried about at this point are (a) when we eat at a restaurant and Leighton wants something Ainsley can't have, and (b) when we're at a birthday party and Leighton can eat what is being served while Ainsley has to have her homemade cupcake. But, on the other hand, I can't imagine denying Leighton these things in the name of protecting Ainsley's feelings, because it is also important for Leighton to have as normal of a childhood as possible and I think that includes allowing her to eat normal foods. If anyone has any advice on juggling food-allergic and non-food-allergic kids, I am all ears.

Despite my worries, I am still over the moon about this news!


Jennifer said...

We have a 6-year-old boy, Max, who is severely allergic to dairy, eggs and shellfish, and a 4-year-old girl, Claire, who has no allergies. It's tricky, but we find Claire is pretty sensitive to Max's feelings. We give her choices and let her order what she wants when we're out but we also talk about not gloating and how Max might feel. When we go to McDonald's, for instance, she often chooses to get apples instead of fries since the fries have trace amounts of dairy. We also make a point of taking her out alone every once in awhile when Max is doing something else. I think she really appreciates being to eat what she wants. Sometimes the allergies are a blessing and provide a great life lesson!

Leigha said...

Thanks so much for the advice, Jennifer! I didn't even think about how Leighton might, of her own accord, want to preserve Ainsley's feelings. She already adores her big sister so I am sure when she's older and understands the situation she will be sensitive to Ainsley's feelings.