Book Review: Allie the Allergic Elephant

One of the things our daughter most enjoys is reading. She just loves books.

Allie the Allergic Elephant is an engaging kids book, and it is a great addition to the bookshelf for any child, but especially those young children who have food allergies.

Our daughter was engaged from start to finish and was amazed that Allie wears a 'special bracelet' to tell people she's allergic'. She also enjoys finding the bracelet on Allie's leg as it repeats throughout the book. This has been particularly helpful in getting our daughter to wear her Medic Alert bracelet. Whenever we encounter resistance we simply remind our daughter that Allie wears her bracelet whenever she goes outside, and she should do the same.

The book is written well for kids, moves at the right pace and is quite educational. It provides examples of what happens to an elephant who is having an anaphylactic reaction. Allie also shows children how to say 'no thank you' when offered a peanut and gives examples of foods that are safe or unsafe. Though other books incorporate similar allergy concepts, Nicole Smith and Maggie Nichols have successfully translated these concepts into terms that a three year old can understand.

It is very hard for parents to comprehend food allergy and even harder for young children. Allie the Elephant is a staple in our regular reading rotation and I would encourage you to pick up a copy if you have a child with food allergies. Our daughter has latched onto Allie as a soul mate and I have already put in my order for a stuffed Allie (complete with Medic Alert bracelet) should one ever come onto the market.

We're Eggstatic!

I blogged earlier this week about our recent Eggsellent News and that we were expecting an upcoming egg challenge for our daughter. Well today was the big day. This morning I made French toast for Madeleine for the first time. We put the French toast in a container and headed to see the allergist.

The thought of sitting with a three year old for over three hours while she ate French toast in tiny increments was something less than optimal, but given the circumstances I was excited.

Our allergist started her with one small bite of French toast. We waited fifteen minutes with bated breath ... no hives, no redness ... we were in the clear! Or so we thought ... the second bite was double the first. After 5 minutes my heart sank. There on Madeleine's cheek was a single, large wheal. I was very disappointed.

I was afraid that the challenge would be stopped at that point, but after fifteen minutes where no additional hives appeared our allergist decided to keep the challenge going.

The portion of French toast was doubled again ... up to a quarter slice. We were ecstatic to see the first hive disappear and no additional hives surfaced, save one small dot on her hand.

Things had really turned and it was now safe to be very optimistic!

After waiting another hour after Madeleine ate one more half slice of French toast, we were given the all clear and in her honour Saturdays will officially be "French Toast Day" in our home!

The next steps are to ensure that she eats egg at least three times a week and to monitor any reactions. The addition of egg to her regular breakfast routine will help her develop tolerance.

This is huge news. Though I knew I would be happy, I have to admit that I was surprised by the wave of relief I felt once we were fairly certain that her anaphylaxis to egg had finally dissipated. I think that after two years you just learn to live with the allergy. In some strange sort of way I actually miss it a little because it was part of the fabric of who our daughter was. That being said, we will happily kiss the egg allergy goodbye!

Let's hope to have a similar result in two years when we revisit the peanut allergy.

Education Crisis (Averted?)

I read an article tonight about an apparent 'crisis' situation in one Australian school region. It seems that in New South Wales "nearly every classroom" has a child with a serious allergy. I have blogged before about the fear that teachers have in dealing with serious allergy. It can be very traumatic even to imagine that you would have to give a child an injection from an epinephrine auto-injector during an emergency.

That being said, I was surprised to read the following passage. "'From a legal point of view, we would advise teachers not to medicate because they do not have qualifications,' Ms O'Halloran said. 'Obviously, if there's an emergency, the teachers need to act but ... it's very problematic.'"

It is no wonder that there is a (perceived) 'crisis' given that the teachers' federation leadership is implying that teachers need formal medical training to administer an EpiPen. That just adds to the anxiety teachers already feel. The teachers' federation is likely taking this position to bolster its efforts to secure a dedicated nurse for every school.

While it would be helpful (for a variety of health and safety reasons) to have a nurse in every school, teachers need not fear an EpiPen or Twinject. They do require training of course but the device is easy to use, and it is generally pretty clear when an emergency situation requires its application. Furthermore, there is minimal risk associated with administering an 'unnecessary' EpiPen dose in a less-serious situation that did not actually require epinephrine, but was 'mistaken' for anaphylaxis.

Though I am not a lawyer I would also question the validity of the legal advice the federation offers to its members. Teachers likely have 'duty to rescue' exposure should they be equipped to aid a child in an emergency situation and take no action. I think they would have no choice but to help.

In addition they would likely (hopefully?) fall under some degree of 'Good Samaritan' protection, codified or not, should something untoward happen during the attempted 'rescue'. I did a quick search for the presence of said legislation in Australia and though it appears that some form of law has been passed, it was not clear whether it extends to teachers.

There is also non sequitur in the federations legal advice to abstain from giving medical treatment. Why would a teacher administer emergency treatment in a situation other than an emergency?

Eggsellent News

It seems that our daughter's egg allergy is gone. We made a switch to a new allergist in November and not only do we prefer our pediatric allergist, we have good news to report on the egg front.

First of all, find a pediatric allergist!
Back in November we took our daughter in to see a new allergist. We did not hit it off with our first allergist and I left the office very concerned about the level of care our daughter received. I discussed my concerns with a pediatrician that I know, and he confirmed that given the rapid rate of change in allergy research a pediatric allergist was the way to go. He also knew an allergist in our area that was very current with respect to her knowledge and helped us get an appointment.

In our first visit with our new allergist we did a new skin prick test (SPT). The first allergist did a SPT when Madeleine's arm was covered in so much eczema that there was barely enough room on her arm to do the testing. Many people (including us) have questioned whether we should not have been sent home to return another day.

Our first allergist also did not break the skin when he did the skin prick test (SPT) for peanut. Apparently current research indicates that the chances of a SPT triggering anaphylaxis are sufficiently low to allow the skin to be broken, especially since the test is administered in the care of an allergist.

Our new allergist is great with our daughter and very current in her research (at least from our vantage point). I am very glad that we made the switch.

Eggsellent News!
Of course it helps that in our first visit with our pediatric allergist that Madeleine did not react to egg in her skin prick test, though dogs and peanuts are still a concern. The negative SPT for egg was followed up with a blood test that confirmed that the egg allergy does appear to be gone. Let's hope that's true!

On Monday we have our egg challenge ... stay tuned for the results!

Mixed results on peanut
Though we were excited about the results on the egg front, it was interesting to learn the results of the peanut allergy. Though the SPT produced a 14mm wheal, which is very large, it has been shown (1) that an 8mm wheal is a reliable indicator of a peanut allergy incidence, but has a weaker correlation with the allergy's severity. "The positive predictive accuracy of the (SPT) is only in the range of 50-60%, meaning that a positive reaction will only predict a positive food challenge in 50-60% of patients." (2)

"No Peanuts, Please"
So it appears that we are in the clear on egg and given the mixed results for peanut, we may have good news there in a couple of years. In the interim, it's "No Peanuts, Please" for Madeleine.


References
1 - Hill DJ, Heine RG, Hosking CS, Pediatr Allergy Immunol, Oct 2004
2 - A. Ives, J. O'B. Hourihane, Current Paediatrics, Oct 2002

Bisphenol, Say What?

Over the past year and a half I have read countless articles on the possible risks of early exposure to the severe food allergens. You ask yourself questions ... is there a risk due to soy being in formula? when should we introduce cow's milk? etc, etc, etc. All parents ask questions like these but as parents who manage a severe food allergy, we have certainly seen this self-questioning intensify.

The irony is that we spent all of this energy on optimizing the contents of our baby bottles, while it might actually be the bottles themselves that are a greater concern.

The news media and blogosphere have been heavily engaged in the debate on bisphenol A (BPA). The concern is that BPA mimics the hormone estrogen and even in minute quantities might lead to several health concerns. The only good news in the article referenced above is that once our Gerber and Avent bottles cool it appears that the BPA no longer leaches in to the liquid. In other words, though BPA would possibly leach in the dishwasher, the fact that we steam our bottle milk using an espresso machine, versus 'nuking' the bottles in the microwave, might possibly limit the exposure.

It strikes me that the BPA scare has a parallel with the concerns over the apparent increase in the incidence of childhood food allergy. We do not know whether early introduction of peanuts causes peanut allergy, nor do we know whether the use of bottles containing BPA really causes early onset of puberty or cancer over the long term.

The chemical industry contends that BPA in baby bottles "is not a risk to human health at the extremely low levels to which consumers might be exposed."

Forgive me if I do not take your word for it.

We will be replacing our bottles today.

Rounding To Zero

There has been recent press about the fact that the rise in the incidence of food allergy may not be based on sound data. Authors have referred to anaphylaxis fatality estimates as a 'wild guess' or cited research that indicates that "the incidence of food allergy is not on the rise".

Does this matter? Yes and no.

It matters insofar as increasing food allergy incidence makes for good press and has generated significant awareness. It matters insofar that as food allergy becomes more common children with severe food allergy would be be afforded protection for their life threatening disability.

On the flip side the statistics do not really that much in our home. Though food allergy incidence in children is in the 5-6% range, it is 100% in our children. (Our second daughter has had a mild allergic reaction to mushrooms). Which number do you think is more important in our home?

The math is also less relevant since even a single child should be afforded protection in a school setting. It is critical that food allergic children participate equally with their peers at school and in social gatherings.

Overall I do hope that the incidence of allergy is lower. Though we have become comfortable with the management of out daughters' allergies, it would be great if fewer parents have to manage a severe food allergy. Though the allergy is a key part of what makes our daughter who she is, living with a constant fear of an anaphyalctic reaction is very difficult for parents.

Martha Stewart Living (With Allergies)?

The staff at Martha Stewart are considering ideas for new publications.

One of the ideas being considered is a magazine dedicated to people who are living with food allergies or sensitivities. Here is the summary from Alexis, the Deputy Home Editor: "a special magazine that offers delicious allergy-friendly recipes, making life for people with food allergies and sensitivities easier and more delicious ... I’d like to empower people to make great recipes even if they can't use all the standard ingredients."

To vote head to the Martha Stewart blog.

Right now the allergy publication leads the way with 58% of 543,000 votes. A pet lovers magazine is in second place with 26%.

Surely awareness of food allergies would continue to grow, should there be a publication on the shelves with the Martha Stewart marketing machine behind it.