Jack's Food Challenge

As I have written before, Jack has food allergies.  Specifically, eggs, peanuts, and shellfish.  We discovered the egg and peanut allergies around the time he turned 1 and we introduced the foods.  With eggs, he got a very bright, red, hive-like rash around his mouth (up to his nose, down to his chin).  With peanuts, he got hives over his entire body.  We never introduced shellfish, they randomly tested him for it, along with the other common food allergens and we got a positive. We were told he would most likely outgrow the egg allergy, but probably not the peanut.  I started researching food allergies and learned that, contrary to the old school of thought, not every child outgrew egg and some children (around 15%) did outgrow peanut.  He was diagnosed 3 years ago, so we've been wondering what course his body would take ever since.

His pediatrician in Virginia made the diagnosis, based on our reports (and one ER trip after the peanut exposure--when I say covered in hives, I mean covered in hives).  We first saw a pediatric allergist when he turned 2, at the time we were living in Tennessee and used the University of Memphis medical system.  They performed the skin tests to determine if he was actually allergic.  He was.  His wheel for peanuts was huge, they cleaned it off well before the time was up.  For those who are curious, they draw a grid on the back, test for all the things that you might be allergic to (Jack had about 12, including some non-food like dogs (unfortunately, yes) and cats (nope)).  They inject a tiny amount of the allergen under the skin and wait to see if you get a reaction.  Jack had reactions for peanuts, shellfish, dust and dogs.   They didn't test for egg, since he had had multiple exposures to both baked egg (i.e. egg as an ingredient in a muffin) and straight egg and didn't feel like they needed a baseline for that one, plus they said it was better to limit his exposure (he had recently had a reaction after taking a sip of my water after I had eaten some egg).

Enough history.  When we moved to Maryland, I was excited to take him to Johns Hopkins allergy clinic.  They are leaders in the pediatric allergy arena.  They were surprised no RAST had been done.  A low enough RAST score would mean he qualified for a food challenge.  Unfortunately, I lost the paper where I wrote down his RAST scores.  I believe that less than 5 or 6 meant he could take the challenge.  His shellfish was highest at (I think) 4.7.  Egg and peanut were around 2.7 and 2.4 (can't remember which was which, I'll ask next time we go).  According to Wikipedia the 0.70 - 3.49 range translates to "moderate level of allergen specific IgE".  However, it can exceed 100 (in extreme cases, of course).  We were told he qualified for a food challenge for all 3 allergens.  I was super excited.  One of the scariest things about food allergies is you don't know what to expect, every reaction can be different and even though he never had an anaphylactic reaction in the past, didn't mean he wouldn't in the future. 

Jack recently had his baked egg challenge and passed with flying colors.  It took place in a regular exam room.  There were 3 other kids doing challenges at the same time (tree nuts, baked milk, and ?).  Everyone was in a different room.  Jack was all geared-up and anxious to eat his cupcake.  He was MAD when they brought in the first piece, about 1/5th of a cupcake (or about 1/32 of a baked egg).  He was expecting an entire cupcake and at first refused to eat what they gave him, insisting his mom had made him big cupcakes.  Every 15 minutes they brought in another, progressively larger, piece.  His final dose was 1/2 cupcake (1/16th of a baked egg).  Over the course of the challenge he ate 3 cupcakes with no reaction.  That means we can now introduce baked eggs into his diet. There are 4 phases.  Right now, he can have up to 1/4th of a baked egg a day in well-baked form (cookies, muffins, cake).  In 2-3 months, he can have egg in less baked form (pancakes, brownies, casseroles).  If that goes well, 2-3 months later he can have higher egg concentrated items like egg noodles and french toast.

Finally, 2-3 months after that we can try and introduce straight egg.  In 8-12 months Jack could be eating a scrambled egg! 

His peanut and shellfish challenges are scheduled for Feb and March (scheduled in March, so almost a year wait).  We are on the cancellation list for peanut (not allowed for shellfish), so I am hoping we will get in sooner (egg was originally also for February). 

Today is Thanksgiving and among the many things I am thankful for this year is that Jack will be able to enjoy a dessert that has egg as a (minor) ingredient (I am planning a Thanksgiving post at some point).