Going Nuts

Last month was Penny’s latest challenge: almonds. What can I say? Since the day her food allergies were diagnosed, her allergist had said that she would be O.K. if she consumed almonds. To be honest, the thought of introducing her to a tree nut, and potentially having a reaction to it, kept me from introducing her to this food. Her very first allergist had recommended introducing her to almond milk at the hospital (not in her office, but in the parking lot) in case she reacted, which confused me because if she was O.K. to eat almonds, why did she had to be close to the hospital? Long story short, we had been waiting to introduce this food until she was older and was able to vocalize if a reaction was happening.

Last year, she started seeing a new allergist, who is amazing. In the beginning, he told us that she might not be allergic to almonds, but that due to her past reactions to other foods that she shouldn’t have had reacted to, he wanted to introduce it in his office.

We got to the doctor’s office early in the morning…We, yes, the whole family. We have this tradition in which we support each other when big things happen, and for us, a Food Allergen Challenge is a very BIG deal. When it was time, Penny and I walked in, Paulo & my husband stayed in the waiting area. Why? In case she reacted, we would all be there, but not crowding the room, that way nurses and the doctor could do their job. The nurse checked her vitals, weight & height and informed me that she had tested slightly allergic to almonds. I took a deep breath and trusted Penny’s allergist’s decision. After all, she’s allergic to dairy and has been able to tolerate it in baked goods. Hooray for Oral Immunotherapy (OIT)!

A few minutes later another nurse came in with almond butter. It was time to get started. For the first time, I saw Penny be the one anxious about food. Usually, Paulo, being the awesome protective brother that he is, is the one that gets a bit anxious when there are allergens around. This time, I had to consider that not too long ago, Penny had experienced anaphylaxis due to a yogurt challenge. I had talked to her about this new challenge a few days ago, and after a little bit of talking and hugging, Penny was ready.

The first dose of the allergen was very little. I could see Penny tensing up, the white in her knuckles as she clenched her fists. She started scratching her arms and coughed every once in a while. I had remembered to bring books and toys to distract her, and it worked. She kept herself busy coloring and reading, she did great! She first tried the almond butter and pondered about its taste for a while, and told me that it tastes like chips. She loved it! ☺

Then a second dose was administered 10 minutes after, then a third dose, and so on until she tolerated 2 tablespoons (8 grams) of almond butter. Everything went well, but I wanted to be extra cautious because, on her last failed challenge, it wasn’t until an hour after the challenge had started that she reacted. I talked to the doctor about it and asked him if we could stay a little bit longer in his office. He acknowledged my feelings and told us that we could stay there as long as we wanted or 6 p.m. when his shift was over. 😂 After a full hour had passed by, we decided we were ready to go. From this day on, Penny has been able to eat foods containing almond daily, without a problem. Paulo is ecstatic as well, for he is now also able to eat new foods. ☺

I am so grateful that Penny is able to do these food challenges, and having her participate in OIT gives me hope that maybe one day she’ll be able to eat anything, anywhere without having to be worried about a life threatening allergic reaction.

 

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Challenges

It was the day before Penny’s 1st Dairy Challenge. A dairy challenge, in Penny’s case, meant that I would bring a homemade baked good that contained dairy to the Dr.’s office and she would eat this baked good under proper medical supervision- this to ensure that if a severe reaction occurred, the medical staff will have control of the situation. Also, per the allergist’s instruction, Penny had to stop any antihistamines and/or asthma medication 5 days prior to the test.

I got ready: went to the supermarket, got some gluten-free flour, enjoy life chocolate chips, eggs, coconut oil, and the most important ingredients for the challenge: cow’s milk. After everyone went to bed, I stayed up looking for dairy-full cupcake recipes and baked. I’m not going to lie-I was nervous, but positive.

We had decided that the four of us were going to be at the Dr.’s office on this BIG day. Not only to celebrate if Penny passed the challenge but also to give each other support. After all, isn’t that what family is all about?

On the day of the challenge we were there at 7:45 am. Penny was called in at 8:00 am. After having been examined for her asthma and everything else (height, weight, changes in health, etc), the Dr. ordered her to start eating the cupcake. First, they gave Penny ¼  of a teaspoon of the cupcake, slowly increasing the quantity every 15-20 minutes until she had eaten about ¼ of that cupcake. There was a high level of supervision throughout the whole challenge. The nurse would come in the room every 3-5 minutes to check on her, and to ensure that everything was alright. This gave me a sense of security- that if anything happened she was going to be ok. An hour and a half later the challenge was completed, and Penelope had successfully passed. In the weeks to follow, I had to slowly increase the portions (of a cupcake) that Penny ate by ½ every week until she tolerated 1 whole cupcake. This was a breeze; she loved the taste of the cupcake and never had a reaction. I came to understand, at this point, that the treatment that the allergist chose for Penny is called Oral Immunotherapy (OIT). Oral immunotherapy is a treatment that induces the immune system to tolerate a food that a person is currently reacting to. It involves introducing the food that causes the reaction to the person’s system in gradually increasing amounts, with the goal of allowing the person to eventually consume the food without experiencing a reaction.

From now on, Penny had to eat a dairy-full baked good daily. I got creative and baked bread, cakes, brownies, cookies, etc. Eating these baked goods for a month and a half was preparing Penny for the next step: a Yogurt Challenge. Seeing Penny eat things with dairy made me so happy. For 3 years her diet had been restricted, and thinking that she was going to be able to add more things to her diet and potentially eat anything with dairy altogether is pretty exciting.

Her yogurt challenge was scheduled two days after Christmas. A few days before, Penny, Paulo & I went to the grocery store in search of a good vanilla yogurt. Fast-forward 2 days and it was Challenge Day.

Just like the 1st time, we were there early in the morning. This time, I brought her breakfast to eat after the challenge was over. Around 8:30 am, the yogurt challenge began. She had ½ a teaspoon of yogurt. No reactions. Then, about 10-15 minutes later, she had 1 teaspoon of yogurt. Still, no reactions; however, Penny started complaining saying that her stomach hurt because she was hungry. Twenty minutes later, she had a tablespoon of yogurt. This time, a few hives appeared on her face, but after washing her hands and face, the hives went away. Again, according to Penny, the only thing bothering her was that she was hungry. The allergist walked in about 20 minutes after she had the tablespoon of yogurt and since she was cruising through the whole thing, he said that Penny could eat as much as she wanted. She was so happy and she kept saying: “Mommy, this yogurt is so YUMMY!”

Another 20 minutes had gone by. The allergist came back into the office, checked on her and was ready to discharge her with a successful challenge. Then all of a sudden, Penelope developed a cough. The allergist and I kept talking about the next steps to take, and I told him that she wasn’t coughing before, so he said that he was going to keep her in the office for 10 more minutes to see what was going on. I was fine with it: “better safe than sorry”. He also said that Penny could have the breakfast I had brought since she kept complaining about being hungry. She had one bite of her pancake, and then said she didn’t want any more. This was strange. As time passed by, her cough was more frequent, and her energy levels were dropping. She started telling me that she wanted to go home and that she wanted daddy. My husband and son wanted to be there for the challenge, but were both sick with a cold, and decided to wait for us outside.

The nurse came in and stayed with us, checking on Penelope constantly. I asked her to, please, check her lungs for wheezing. She said Penny wasn’t wheezing. At this point, Penny was curled up in a little ball in my lap. Then, as the nurse was going to step out of the room for a second, Penny coughed, but this time at the end of her cough, you could hear the wheezing. The nurse looked at me and asked me if I heard a wheeze. I certainly did. From that moment on, everything felt like it was going downhill: she was in anaphylactic shock. Her wheezing was very loud, and she was struggling to breathe. The nurse called other nurses for help and got the allergist to walk into the office. Penelope was connected to a blood oxygen saturation monitor. My head felt like it was spinning; I kept looking at the monitor: her heart rate kept going up and her oxygen levels kept dropping. I was desperate and felt helpless at the same time.

The allergist looked at Penny and ordered epinephrine be given to her. One of the nurses raced off to another room and came back with a syringe containing the epinephrine. Even though it had only been minutes since she started having the reaction, it felt like hours. Not even a minute after the epinephrine was given to Penny, everything started to change. Her breathing slowly normalized, wheezing subsided and Penny started looking better. Once she started feeling better, she also started having nausea, and eventually threw up the yogurt. At least she didn’t have what was making her sick in her stomach anymore. To be exact, 6 minutes after epinephrine was given her oxygen levels were back to 100%. The doctor ordered the nurse to give her oral steroids to avoid a biphasic reaction. A biphasic reaction occurs anytime from 1 hour to 72 hours after the initial reaction and can happen without any allergen exposure. He also ordered antihistamines because her throat was itching.

By the time my husband was able to make it to the room where we were, Penelope was stable. Everything happened so fast. We left the allergist’s office 4 hours after with instructions to keep giving Penny dairy in baked goods. I’m not going to lie, I was afraid that she was going to have a reaction to baked goods after the severe reaction, but she was fine.  The next step: a Cheese Challenge next month. How do I feel? Scared, but this is the only way we are going to know if her dairy allergy will ever be cured.

This has been one of the most difficult experiences I have ever lived. It left me heartbroken, and it has been difficult even to talk about. I know Penny’s all right and that everything is O.K., but I am still healing. I am grateful to know that epinephrine can save her life if used as the first line of treatment for anaphylaxis, and most importantly, I am hopeful that Penny will be able to surpass this.