Food challenge tests when children outgrow food allergy

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Special to the NNPA from the St. Louis American

Starting kindergarten marked new beginnings for Joy Haire and her parents, Will and Lisa Haire. Just before the school year started, through a Food Challenge, Joy’s doctor determined she outgrew the serious and potentially life-threatening dairy allergy that surfaced a few weeks before her first birthday.

Food allergy is an immune system response. The body’s immune system identifies a food protein as dangerous and tries to protect itself by creating antibodies against it and releasing histamines and other substances in the blood.

Common food allergies in children include peanuts, milk, eggs, tree nuts, such as pecans, almonds, cashews and walnuts, and soy and wheat. In adults, peanuts, tree nuts, fish and shellfish (especially shrimp) are the most common foods that cause food allergy, according to the USDA Food and Nutrition Service.

In Joy’s case, she was taking one antibiotic for a stubborn double ear infection and was prescribed a stronger antibiotic to clear it up. Thinking back on the incident, Joy’s mother said within 30 minutes after taking the antibiotic and eating Greek yogurt (to prevent stomach upset and diarrhea, as a pharmacist suggested), the allergic reaction began. Joy was a breast-fed baby and had never had dairy products or formula, in addition to taking to a new medication.

“She was restless almost immediately after ingesting the two new substances tossing, turning, hitting, and very uncomfortable. All unusual behaviors at the time,” mom Lisa Haire said.

They soon realized they were dealing with much more than a cranky baby.

“God orders things. Will was awake. If the entire house had gone to bed, we might not have caught her reaction for six to eight hours instead of two,” Joy’s mother said. “At two hours, she was not having breathing difficulties and we were able to get her reaction stopped before it progressed further.”

The Haires rushed their daughter to a nearby emergency department.

“When we got to the ER … she was unrecognizable with severe facial swelling, having full body hives, and skin hot to the touch,” she said.

Benadryl and steroids eventually counteracted the frightening reaction. Doctors suspected that baby Joy was allergic to dairy as well as to the antibiotic. Joy’s dairy allergy was not confirmed for several months after her initial reaction.

“We had to wait for the swelling to go down. It took nearly two weeks. She still had facial swelling for her first Christmas. We had follow up appointments with her pediatrician,” she said. “During her annual lab work, a blood test confirmed the dairy allergy.”

The Haires were referred to a pediatric allergist, who later confirmed her dairy allergy with a skin test. The Haires went to St. Louis allergist and pediatrician Ray Davis, M.D.

A food allergy and anaphylaxis website provided a list of food ingredients containing dairy in it that may not be as obvious to most people. It was copied for grandparents and caregivers. Everyone read food ingredients. Joy’s mom and dad carried an EpiPen (epinephrine injector) wherever they went and each grandparent’s home had an EpiPen, as well as the preschool she attended. Fortunately, they never had to use them. If someone does get an epinephrine injection, seek emergency medical help immediately to prevent the return of the reaction and to stabilize the patient medically.

The “no butter, no milk, no cheese” rule applied to all home cooking and recipes were adapted accordingly. At restaurants, dining could be frustrating.

“You got to get the menu, the food list and find out what type of ingredients. When we sat down, we had to get that before we ordered,” dad Will Haire said. “We’d have to tell the waitress or waiter 900 times that she can’t have anything with milk products and they seemed like they didn’t know what milk products were.”

That wasn’t their entire experience. They found some restaurants who actively work to avoid food allergy reactions in patrons are quite accommodating, with menu notations about dishes containing possible problem foods and using separate utensils, prep and cooking areas.

Fortunately, doctors said dairy allergies are usually outgrown by age five, time for kindergarten. When an annual blood test reveals negligible levels immune response to the food protein in question, the child is scheduled for a Food Challenge evaluation.

The Food Challenge, developed at National Jewish Health in Denver, is used by physicians to evaluate whether a child developed immunity to a food allergy.

It takes a few hours to complete the challenge. In Joy’s case, her parents brought in soy yogurt, a food that Joy safely eats. The nurse started by adding small amount of frozen dairy protein powder into a small amount of soy yogurt before Joy would eat it. The amount of protein and the amount of yogurt would double in intervals of every 15 minutes, until she has the equivalent to a full serving of milk. She received five doses.

For two full hours after eating, the doctor and nurse monitored Joy’s vital signs for any sign of allergic reaction – a drop in blood pressure, changes in pulse, oxygen, breathing, pupils, redness or swelling of the face or throat, trouble swallowing, rash or hives.

“Staying the same, that’s what we like to see,” said Nurse Lesa Carrera, after taking Joy’s vitals.

After sustained non-reaction, Dr. Davis determined that Joy no longer had a dairy allergy. The doctor told her parents to give Joy a dairy food three times a week to build up the immunity.

The next day after the challenge, Joy’s first dairy treat she wanted to try was a “pink” ice cream cone, like the ones she would see in some of her favorite children’s books. She loves it – but does not like the taste of dairy milk. Her parents provide rice milk for her to drink at school.

For more information about food allergies and anaphylaxis, visit www.foodallergy.org.