Pictures

Here are some pictures from Thursday:

Digging a Hole

We were outside working in the yard all day yesterday, getting ready for the play structure. After DH got home he fed the kids and put them to bed while I worked on cleaning up the street and the neighbor's driveway where the tractor that brought the structure left traces of dirt.

When I finally came into the house around 8:30, I collapsed straight into bed without even checking e-mail. I have a feeling that as the weather gets better and we're doing more yardwork, I may not be blogging as much.

Digging the hole was an interesting project.

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I had measured out where it needed to go the night before, and marked off an area about a foot larger each way than the base of the little house that would be the centerpiece of the play structure.

DH went in to work a little late in the morning so that he could work with me to help peel the sod off the top and start digging the hole.

Then the girls and I worked on digging it out and getting it level. I told the kids that we were digging for treasure, and the play structure would be the treasure that would end up in the hole. Dirt and kids are a natural pairing on a mild, sunny spring day. They had a blast loosening the dirt in the high places and helping to cart away the dirt I dug up.

There's something deeply satisfying about digging a square, level hole. It takes a kind of craftsmanship that isn't all that hard, theoretically, but does require a good eye and a bit of skill. Taking the time to do anything well is artistically satisfying in a way, even if it's just digging a hole. I enjoyed it.

That's how I felt for the first four hours, anyway. Right about 4 hours and 15 minutes into digging, it stopped being fun and started feeling more like just plain hard work.

After lunch I was ready to get back to it. By then I had most of the bulk of the dirt out of the hole. Since we don't have a wheelbarrow that works, I was carrying the dirt across the yard one shovelful at a time until someone found a big flowerpot. It held 4 or 5 scoops of dirt, so I saved myself a few trips by using that as a bucket.

Getting a hole perfectly flat and smooth with a shovel is easier said than done. I'd check it with the level on a board laid across the hole and one end would be just slighly higher than the other. So I'd shave a little dirt off that area. Then another spot would be just a tad high.

Close to dinner time, I decided that a hole within 1/8 inch of level in all directions would have to be good enough. My hole wasn't perfect, but it was a pretty good hole.

The little house sat on it perfectly, without listing.

Digging a 5 foot square, nearly perfectly level hole felt like an accomplishment somehow. It was a good day's work.

The hole is not something of great importance in the grand scheme of life. I don't think it's something I can ever use on a resume. But it's a good feeling anyway.

Past my bedtime

Thanks so much for all the comments and suggestions. I'm so far behind on replying to comments right now.

I did manage to get most of the oil out of my hair. I rubbed about a cup of baking soda into it. Rather telling that all but about a tablespoon actually clung to my hair until I rinsed it out. I washed it three times with two different soapes, then followed with an apple cider vinegar rinse (but didn't leave it in since E reacts to apples)

Baby E got through the day with no reactions, and the kids were much more manageable today.

I think I figured out Baby E's wheezing. I noticed that her reflux was far worse than usual both times she had reactions, and she woke up sounding congested, wheezing, coughing/choking, etc. the next morning. Once she'd been up for a while she was fine. This has happened several times, always at the same time as a rash and other food reaction symptoms.

I'll bet the reflux made her congested and was possibly giving her fluid in her bronchial tubes and/or lungs. Given the timing, that makes much more sense than that it would be a direct reaction from something she ate.

We're being given a large backyard play structure by some friends who are moving. The kids and I are so excited about that. Morning and I spent much of the day attempting to stake out the location in the back yard.

It's going to be a challenge to get it positioned right to fit. We'll have to take off one element and not use it, I think, but it will still be a fabulous swingset without it.

The biggest challenge is going to be trying to carve out a large enough flat spot in our sloped yard before it arrives tomorrow. I'll be out there with a shovel and a level, bright and early.

Not Popeye

Well, Baby E had another "non-allergic" reaction at nap time. We ate lunch, then I put her down for a nap.

She slept very briefly and fitfully. When she woke up she was congested again and had baggy dark circles under her eyes and a bright spotty rash on her face, worst around her right eye. She even had tiny blister-like welts on her eyelid, as well as near both eyes and on her cheeks. She kept rubbing her eyes and chewing on her hand, saying "eye" and "mouf" to indicate they were bothering her.

These photos were taken some time later, after she was already beginning to look better. It's so hard to get rashes to show up well in photos, especially since my photo software is acting up and I have to do any photo adjusting in Paint (ha). You can see the dark circles and baggy eyelids best in the next photo.





The bright red welts show up clearly on my monitor, but if I look at the pictures on my DH's computer I can barely see them if at all. It must have something to do with the brightness of the monitor.

They were clusters of bright red raised welts like pimples or small blisters, ranging from about 0.5 to 2 mm in circumference. She had them under her eye, in the corners of both eyes and on one eyelid. Sometimes she gets them on her tummy or down her legs too. It's different than the red sort of scaly windburn-looking rash she usually gets on her cheeks, which I think is likely a form of eczema.

I don't know if this spotty rash would be considered tiny hives, eczema, or something else altogether. I'll be very interested to see what the dermatologist thinks of my growing collection of rash photos.

We changed all her bedding and everything in her bed just in case, but I think it's more likely something we have been eating.

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There are a few possible culprits, but at the moment the most likely seems to be the Wild Oats frozen organic spinach. We tried it for the first time in a soup I made this weekend. It wasn't on the safe list, and quite possibly it was treated or washed with some kind of corn derivative. When I saw on the bag that it was imported from China I seriously thought about not using it, but I went ahead and took the risk. It was organic, after all, and supposedly had no added ingredients or preservatives. Maybe I need to learn to listen to my instincts better.

I made the soup on Sunday, but I was the only one who ate it. DH noticed Sunday night that Baby E was getting red cheeks whenever she nursed, but we didn't pay too much attention to that since it was her only real symptom. Baby E and I both ate some of the soup Monday night. Her cheeks flared up more significantly after that, but at the time we'd blamed it on histamines in my milk from being around a friend's dogs. (She does seem to get symptoms after nursing when I'm having an allergic reaction to something, which significantly complicates issues.) This morning, of course, she woke up with a bad wheezing-type reaction and a mild rash. I had the soup again today at lunch (Baby E adamantly refused it), and she flared up after that again.

So this round of reactions seems to correlate best with the soup. Tonight we had known-to-be-safe chicken, broccoli and spelt noodles for dinner, which everyone enjoyed.

Anyway, she seems to be okay now and went to sleep easily.

Meanwhile, I'm still greasy after my botched attempt at OCM this morning. I'm wondering what would be the best way to remove this oil from my hair. I look like I went swimming in an oil slick.

Lessons of the Day

Things I have learned so far today:

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• The day you particularly need to run an errand will be the day it takes 5 hours to get the kids dressed and ready for the day.



• A certain 4-year-old knows how to get a cube of very expensive Kosher-for-Passover margarine out of the refrigerator, unwrap it, put it on a dirty and dairy-contaminated butter dish, and smear it a quarter of an inch thick on bread she toasted herself.



• When a preschooler drops a cereal bowl on your toe, she apologizes when you dance around yelling "ow, ow, ow!".



• When a toddler pinches your arm with all her might, yelping "ouch" only makes her giggle.



• My nearly-20-month-old knows how climb on chairs and other things to help herself to markers, breakfast cereal and anything else less than 3 or 4 feet off the floor.



• A just-turned-6-year-old thinks locking the 4-year-old into Mommy's bedroom is an appropriate response when the 4-year-old is in there playing with the lamp and other things on the bedside table instead of getting dressed as she was told.



• Any or all of the above items take less than a minute of Mommy's distracted attention to accomplish.



• The Oil Cleansing Method does not work well on hair. Unless you like the wet-even-when-dry, stringy, greasy look. Very stylish, I'm sure.



• Oil in your hair ends up on your clothes.



• If you smear oil on your face and then rub it with a hog-bristle brush and hot water, you get a red, raw face. And smell like a wet animal, too.



• Sugar ants don't mind baking soda, even if it's spilled widely across the floor.



• "No" and "mine" are a toddler's favorite words.



• A pair of footie pajamas soaked in spilled black cherry juice and laid across a pile of clean laundry is sure to be wet side down on top of a nice white blouse.



• When you remove the now-purple pajamas and formerly white shirt, a preschooler is likely to replace them within 2 minutes with a sunflower-butter smeared shirt. The sunflower butter will also transfer to the clean clothes beneath.



• The laundry tray in this house is not equipped with an overflow vent.



• When it overflows, it cascades over all sides of the sink equally, flowing into the cupboard, across the floor and under the washing machine.



• The upslanting metal strip separating the laundry room linoleum from the hallway carpet does not impede the flow of water.



• Kids, like animals, can sense weakness or distracted attention a mile away and know how to take advantage of it.



• A screaming toddler might eventually fall asleep when a 2-minute time-out in the crib (for defiant running the opposite direction when told "no" or "come here") turns into a much longer than intended time-out while Mommy mops up water. Or she may not.



• But if she does fall asleep, an older child is sure to make a very loud noise shortly thereafter and wake her up. Even if said older child is supposed to be having quiet time.



• Back or shoulder pain is a guarantee that one or more children will require more holding, lifting, and being wrestled with than normal.



• The level of Mommy's tiredness is inversely related to the length of a toddler's nap.



• The time when you have the least patience and energy is the time when you need the most patience and energy.



• The time when you most want to NOT cook dinner is sure to coincide perfectly with the time you've run out of previously cooked meals in the freezer. Especially when there is no take-out restaurant that has a single thing your family can eat.

Sleuthing Again

DH and the older girls have been sick, but finally seem to be on the mend now.

Baby E, after feeling great for the last several days, woke up this morning feeling miserable.

She had a rash on her cheeks, was extraordinarily grumpy and out of sorts, and kept wailing and crying in a hoarse, choky voice. I noticed that her face was slightly puffy (especially around her eyes), but not enough to be sure it wasn't from having just woken up. She was wheezing so much that I was worried she was having trouble breathing, and occasionally coughing too.

Since DH and the girls have had bad colds, I thought she might be coming down with the same thing. But she didn't have the fever the others had with it.

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By late morning, E was perfectly fine. She still had a bit of a stuffy nose, just slightly worse than the very mild stuffiness she's had for the last week or two. But she was in a great mood and feeling fine, with no hoarseness or wheezing. Her face rash was back to the barely-there state that's been her norm lately.

What's really strange is that the same thing happened last Tuesday morning. The congestion wasn't as bad and the rash and moodiness were worse and lasted longer, and took longer to build up, but it was a very similar occurrence.

Last week I thought it must be the Kosher for Passover margarine causing the reaction, but she hasn't had that since last week.

I've been racking my brain trying to figure out what was in common between last Monday/Tuesday and this one, and finally I did figure out one thing: latex balloons. The kids played with latex balloons last Monday, and then again last night.

I thought I had gotten rid of all the balloons in the house. I'd noticed that they were a possible factor in several of E's mystery reactions, and had read they were dusted with cornstarch, so I popped the ones I could find and threw them away. But I didn't communicate that with DH, so when he found a couple of balloons behind the couch, he gave them to the kids to play with.

There are a number of other things that could be the cause (for instance, we've been starting to trial new foods on Fridays, so a delayed reaction could be kicking in Monday or Tuesday). But the latex balloon theory was an interesting one. There certainly was a lot of white powder on the insides of these two balloons when I popped them to throw them in the trash today.

In addition to the corn angle, there's the latex possibility. Especially since she reacts to several foods that are commonly cross-reactive with latex.

But either the cornstarch or the latex should cause a more immediate reaction than that, I would think. So that makes me wonder about something like dust mites in her bedding.

Of course, it's possible that part of the wheezing was the "worse-in-the-morning" effect of a cold. But the fact that she hasn't been waking up like that except for a day or two last week when she was having a reaction seems more than a coincidence. We'll see what happens tomorrow morning.

The new addition of wheezing to E's set of reaction symptoms is worrisome, if that's really what's happening.

It's so hard trying to figure out this stuff.

My husband the miracle-worker

My wonderful, amazing, fabulous husband figured out how to recover the post I lost yesterday. He set up a script to capture the information the page was attempting to re-send to Blogger when refreshing the page. It took him a while and some fancy fingerwork, but there it was!

He is extremely talented with computers. No wonder his employers love him.

Thank you so much, DH. You're my hero.

What is Kosher for Passover, and why Kitniot-Free?

Friday morning I got an e-mail from someone at the Orthodox Union, the largest organization that does Kosher certification in the USA.

I had e-mailed saying:

Hello! I was just reading on your website that the OU sometimes certifies chometz-free corn syrup to be used in the manufacture of substances such as Kosher for Passover citric acid and xanthan gum.

I was wondering if the Kosher for Passover products such as candies which use the citric acid and xanthan gum grown on the chometz-free corn syrup would then be labeled OU-P or OU chometz-free?

The reason I ask is that my daughter has severe corn allergies. She reacts to even highly refined products such as citric acid and xanthan gum that are cultured on any kind of corn derivative. Even citric acid cultured on chometz-free corn syrup would be a problem for her.

Thank you very much,

[my name and contact info]

The reply from the OU said, in part:

We are very sorry, but yes, it would be labeled as OU-P (Kosher for Passover).

So I guess that answers that question. :(

Morning pointed out to me that I just suddenly started talking about Kosher for Passover food and kitniot-free status on my blog without really explaining what that means. So here's my feeble attempt at explaining. Those who are more knowledgeable, please feel free to correct me if I get any of the details wrong.

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When the nation of Israel was in captivity in Egypt, God sent Moses to lead them to freedom. Most people are probably familiar with the story of the plagues God sent when Pharaoh refused to allow the Children of Israel to leave.

The last and most serious of these plagues involved the death of all the firstborn in Egypt--even the firstborn of the livestock.

God told Moses to have the people kill a male lamb (sheep or goat) without blemish and put its blood around the door. When the Angel of Death came through Egypt, He would pass over the homes with blood on the doorposts and lintel. The firstborn of that household would be spared.

They were to roast the lamb and eat it with bitter herbs. They must eat hurriedly with their traveling clothes on, ready to leave at a moment's notice. Because there would be no time for bread to rise, God told them to bake unleavened bread.

It all happened just as God said. When all the Egyptian firstborn died in the night, Pharaoh drove the Israelites out of Egypt. They left in haste, taking their unrisen bread with them, and baked it on the way.

The book of Exodus in the Bible records the series of events, and God's instructions for commemorating it every year with the Feast of Unleavened Bread and the Passover Supper.

Exodus 12:14-28 (NIV)

"This is a day you are to commemorate; for the generations to come you shall celebrate it as a festival to the LORD -a lasting ordinance. For seven days you are to eat bread made without yeast. On the first day remove the yeast from your houses, for whoever eats anything with yeast in it from the first day through the seventh must be cut off from Israel. On the first day hold a sacred assembly, and another one on the seventh day. Do no work at all on these days, except to prepare food for everyone to eat—that is all you may do.

"Celebrate the Feast of Unleavened Bread, because it was on this very day that I brought your divisions out of Egypt. Celebrate this day as a lasting ordinance for the generations to come. In the first month you are to eat bread made without yeast, from the evening of the fourteenth day until the evening of the twenty-first day. For seven days no yeast is to be found in your houses. And whoever eats anything with yeast in it must be cut off from the community of Israel, whether he is an alien or native-born. Eat nothing made with yeast. Wherever you live, you must eat unleavened bread."

Then Moses summoned all the elders of Israel and said to them, "Go at once and select the animals for your families and slaughter the Passover lamb. Take a bunch of hyssop, dip it into the blood in the basin and put some of the blood on the top and on both sides of the doorframe. Not one of you shall go out the door of his house until morning. When the LORD goes through the land to strike down the Egyptians, he will see the blood on the top and sides of the doorframe and will pass over that doorway, and he will not permit the destroyer to enter your houses and strike you down.

"Obey these instructions as a lasting ordinance for you and your descendants. When you enter the land that the LORD will give you as he promised, observe this ceremony. And when your children ask you, 'What does this ceremony mean to you?' then tell them, 'It is the Passover sacrifice to the LORD, who passed over the houses of the Israelites in Egypt and spared our homes when he struck down the Egyptians.' " Then the people bowed down and worshiped. The Israelites did just what the LORD commanded Moses and Aaron. "

God reiterated his instructions for the Feast of Unleavened Bread and the Passover celebration a number of times, both when giving the Law and the Ten Commandments to Moses on Mount Sinai, and later when people had stopped following God's commandments and had to be instructed to begin again.

The avoidance of yeast became very important at Passover time. God's instructions were to remove all leaven from the house, and even from the entire land of Israel. Anyone who ate anything with leavening in it would be essentially excommunicated from the nation of Israel.

The week of Passover and the Feast of Unleavened Bread holds great significance for Jewish people. Many Jews who don't keep Kosher the rest of the year will even keep Kosher for Passover at this time of year.

The Passover is significant to Christians and Messianic Jews also, for additional reasons.

Passover figures heavily in the life of Jesus. He was a Jew, of course, and went with his family went to Jerusalem each year to celebrate the Passover when he was growing up.

The very important Last Supper that Jesus had with his disciples just before his death was a Passover Supper. Christians celebrate it with a ceremony we call Communion, with unleavened bread and wine commemorating both Passover and the death of Christ. The New Testament speaks of Jesus Christ as our Passover Lamb, the blameless and pure sacrifice to atone for the sins of the world, and compares leaven to sin in that context:

I Corinthians 5:6-8

"Your boasting is not good. Don't you know that a little yeast works through the whole batch of dough? Get rid of the old yeast that you may be a new batch without yeast—as you really are. For Christ, our Passover lamb, has been sacrificed. Therefore let us keep the Festival, not with the old yeast, the yeast of malice and wickedness, but with bread without yeast, the bread of sincerity and truth.

Most Gentile Christians don't celebrate Passover in the same way the Jewish people do, because we consider that Jesus was the fulfillment of that feast and of all the Law. We see ourselves as now under a new law since Jesus has fulfilled all the Old Testament and paid the penalty for our sins, instituting a new era of grace.

When we do celebrate the Old Testament feasts, it is generally with a strong emphasis on the Messianic symbolism, such as the lamb representing Christ's sacrifice on the cross. We do still see the Jewish feasts as holy and significant.

Today, the Jewish interpretation of the law for the Feast of Unleavened bread requires that they not be in possession of or receive any benefit from baker's yeast or any grain that might have leavening in it.

Since most bread grains begin to ferment and grow yeast soon after being moistened with water, they take great precautions with these grains. No wheat, barley, rye, oats or spelt that have touched water long enough to be tainted with yeast organisms before baking is allowed. As with sourdough bread, the grain captures and incubates yeast spores from the air when moist. The generally-accepted Jewish rule is that yeast may be present in the grain 18 minutes after contact with water.

Since grain is generally soaked before being ground into flour, using any normal flour or grain product is out of the question. Matzos (the traditional flat bread of Passover) and Matzo meal (a flour substitute) are made under strict supervision so that from the moment the grain touches water until it finished baking is no more than 18 minutes. Any product made from one of the 5 grains without this precaution is considered Chametz, and is forbidden during Passover.

The Jewish people have a tradition of going above and beyond the basic requirements of the law, drawing extra boundaries around it to make sure they don't come close to breaking the rules. This explains many of their traditions, including that of avoiding kitniot on Passover.

For some Jewish people, mainly those of Sefardic and Yemenite descent, they avoid only the five grains during Passover. But Ashkenazic Jews (from Europe) also avoid foods classified as kitniot, sometimes translated "small things" or legumes. Kitniot (qit'niyyoth [קִטְנִיּוֹת ,קטניות , קיטניות] also spelled kitniyot, kitnyot or kiniot) includes small grains and seeds that swell when immersed in water and can be used to make flour. These grains are often grown with the 5 grains and may be frequently contaminated with them. Corn, soy, rice, beans, anise and many other items are considered kitniot.

Jews who follow the tradition of avoiding kitniot need to be aware of which kosher-certifying agencies follow this practice since Sephardic agencies may certify something kosher for Passover which would not be K-P to an Ashkenazic Jew. The Orthodox Union (OU), Star-K, and many other certifying agencies follow Ashkenazi practices.

The actual kitniot list varies depending upon different authorities, but always includes soy and corn. That, of course, is important to us because of Baby E's adverse reactions to those foods.

However, since the avoidance of Kitniot is a minhag (tradition or custom passed down from the rabbis) rather than a law or commandment directly from God, there is much more leniency with the Kitniot rules than with the Chametz rules.

Basically, a Jewish person may not own or derive any benefit from Chametz during Passover. It's all right to own or derive benefit from Kitniot during Passover, but generally Ashkenazi Jews are forbidden to eat Kitniot. There are exceptions to this, though, especially for the very young, old or ill.

As I've recently learned, there is also a tradition of allowing the use of Kitniot as a raw material in things like fermentation processes. There's a rule of nishtaneh ha’teva (changed nature) that holds that if the kitniot has been completely changed both in chemistry and in taste, then it is no longer forbidden to use in a food. Some authorities hold that it must become inedible at some point during the process to qualify as nishtaneh, while others don't. There are certain rules about very trace amounts or accidental inclusion of kitniot in foods being allowed, too.

There is no such leniency for chametz. Nothing that has ever been in any way contaminated with chametz (or with any inherently unkosher foods) can be used, no matter how refined or changed, how tiny the amount or accidental the exposure.

That's why foods such as xanthan gum grown on corn syrup can be used in some products certified Kosher for Passover. The fermentation and refining process is considered to change the corn enough that it's no longer really kitniot.

Unfortunately, nishtaneh ha’teva doesn't change the corn enough to keep Baby E from having a reaction after eating it.

Ugh

I just wrote a big long post explaining the significance of leaven, chametz and kitnios for Passover. I'd been working on it whenever I got a few minutes, all day long. I even took time to proofread it.

Then I hit post and got an error message:

We're sorry, but we were unable to complete your request.

The following Errors were found:securityToken : Your request could not be processed. Please try again.

The post is completely lost. I kept the window open and keep hitting refresh every now and then to see if it will magically appear, but no such luck. With the old Blogger, hitting the back button would often recover the post, but not with the new version. Even the "recover post" button, if it recovers anything at all (half the time it doesn't), only brings back the first few paragraphs at most.

This is one of the things that drives me crazy about the new Blogger. Especially since I keep forgetting to copy my work before I post, just in case. This has happened to me numerous times lately, so you'd think I'd remember to save it before I hit post. But no. I could not be so sensible.

Sigh.

And do you work? They ask . . .

This post reminds me of a sign my mom hung above the shelves of homeschool curriculum in our house:

"I am the Administrator/Instructor of
an exclusive experimental multi-grade academy
designed with the express purpose of
enhancing genius and maximizing potential
in a select group of creative individuals.
And what do you do, Dearie?"

Better Already

Baby E was feeling much better by last night, after less than 24 hours off the suspect Kosher for Passover foods. She even went to bed at a reasonable time and slept through the night.

I stayed up far too late making French onion soup to freeze (wow, that's good stuff, and so easy to make--I just learned how to make it last week, and I'll never see the leftover stock from making a pot roast the same way again. Mmmm), non-cream of cauliflower soup for lunch and dinner today, and a sweet potato pudding for good measure, and then cleaning up the kitchen afterwards.

It's so nice to have food cooked and ready to heat and serve. The girls and I went shopping with Morning tonight. When we got home I just had to pop the soup and some cooked meat in the microwave and dinner was served.

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The sweet potato (yam) pudding was really good made with orange juice, tapioca flour, a touch of honey and allspice. Everyone liked it, but then Baby E stopped eating hers after a few bites and seemed to have a fresh (though more mild and short-lived) flare-up of (non)allergy symptoms shortly after that, and again the next few times she nursed after I ate it. So sweet potatoes are back on the suspect list.

Still, Baby E and I are both feeling much better. She's asleep now, and I'm heading to bed without even cleaning up the kitchen. Because I. am. really. tired. And tomorrow I'm going to go help a friend do some finishing touches with remodeling and painting her kitchen.

DH is still sick. AJ and M&M have a much milder case of whatever it is, and much of Baby E's congestion and discomfort magically went away when her (non)allergic reactions subsided.

Whatever was bothering Baby E made me feel a bit icky too. The really interesting thing was that, along wih the GI symptoms, itchiness and general unwellness, I got a nasty case of what seemed to be a localized and severe Candida infection, if you know what I mean. It was one of those unmentionable and highly uncomfortable things that would most likely normally require medical treatment (or at least Very Powerful OTC Medicine).

I thought maybe it was from eating too much sugar, but it went away as quickly and easily as Baby E's symptoms did when we stopped eating the margarine and other questionable foods. Very, very interesting.

A number of people on one of my allergy forums have talked about stubborn Candida and/or bacterial issues that kept recurring or didn't get better with any kind of diet or treatment, but resolved completely when allergens were discovered and removed from the diet. It's so fascinating how everything in the body is so interconnected with such a delicate balance.

Kitniot or Not?

So, can anyone who is familiar with Kosher laws and Hebrew terms tell me if this means what I think it means? Are these articles really saying that something certified Kosher for Passover and kitniot-free by a reliable organization like the OU, might still have certain corn derivatives in it?

I started looking into this after a commenter below said they reacted to K for P products, and then more after it seemed Baby E wasn't tolerating some of them well.

The "nishtaneh" loophole could be why Baby E seems to be reacting to some of the K for P products. I am pretty sure she's been reacting to the Kosher for Passover margarine and/or white baking chips, and probably some other things too.

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These articles from the OU website make it sound like the OU does certify some corn derivatives OU-P or Kosher for Passover if they are derived from certain fermentation processes:

"Another important issue regarding Passover is corn syrups. While corn syrups are from the legume family and accordingly by definition should not be acceptable for Passover, the OU does accept legume derivatives in the fermentation industry due to the extreme changes that happen during the fermentation, with the result that at the end of fermentation, the contents have completely changed. This only applies to legume derivatives, as the stricter nature of the prohibition on the “five grains” does not allow for similar acceptance.

The most common Passover applications for corn syrups are in fermentation products such as citric acid, microbial rennet, and MSG, among others. These corn syrups will be certified chametz-free, meaning that all ingredients, specifically the enzymes used in corn syrup manufacture, besides having the regular kosher requirements, are also kosher controlled to ensure that no derivatives of the five aforementioned grains are used."

I'm not sure whether these corn-derived products can be certified OU-P or if they would be labeled OU Chometz-free instead:

"The Orthodox Union certifies certain industrial products as “chometz-free.” This means that kitniyos (legumes) may be used as a raw material, although normally they are not used during Passover. These chometz-free certified products must meet very stringent criteria to convert the legumes or their derivatives from proscribed substances to acceptable ones. These changes include a complete chemical transformation from a sweet to sour taste. Chometzfree certification is granted only if there are no actual chometz-derived ingredients—namely no derivatives of wheat, rye, oats, barley or spelt—in the product."

". . . In order to maintain chometz-free certification on a product such as corn syrup, quality assurance personnel must constantly check that the right enzymes are received. Corn syrup/dextrose is then used to produce kosher for Passover citric acid, xantham gum, microbial rennet, etc."

"Now, xanthan gum bears absolutely no resemblance to corn syrup – it doesn’t taste like corn syrup or behave like corn syrup, and there is no plausible way that one could call it corn syrup. Is it, halachically, corn syrup? This question is relevant to Pesach, where Ashkenazim have a minhag to refrain from eating kitniyos including corn and many also refrain from eating corn-derivatives. . . .

Nevertheless there are Poskim who hold that as relates to Pesach, it is permissible to accept – and even certify – a kitniyos-based ingredient, like corn syrup, that was radically changed. Ashekanazim who refrain from eating kitniyos on Pesach do so merely because of a minhag, and these Poskim hold that as relates to a minhag one may even l’chatchilah accept such products as kosher (for Pesach). One famous example where this comes up is in Pesachdik diet soda. One sweetener used in diet soda is aspartame, which at least at some stages is made though the fermentation process, and most of the Pesachidk aspartame is made using corn syrup, based on the aforementioned line of reasoning.

Other Poskim hold that an ingredient can only properly be called nishtaneh if, before it was changed, the ingredient went through a stage where it was inedible—which is apparently true for musk. Since standard fermentation processes do not render the ingredient inedible, even a very dramatic change would not qualify as nishtaneh. Even this position would permit Pesachdik diet soda, b’dieved, because the kitniyos in such a context would be buttel. "

It sounds to me like Chometz-free corn syrup can be used to grow some items used in OU-P products:

"In recent decades, scientists have learnt to manipulate microorganisms to create and convert all types of enzymes and foods. This has had dramatic effects on the world of kashrus, including kitnios. What happens if one takes bland-tasting corn, and uses enzymes to liquefy and sweeten it – does the resulting corn syrup remain forbidden as kitnios? Is the halacha possibly more lenient if one takes the aforementioned corn syrup and uses enzymes to convert it to sour-tasting ascorbic acid?

These questions depend on a machlokes Rishonim cited in Mishnah Berurah 216:7 regarding the kashrus of musk – a fragrant byproduct of blood which is found in the abdominal gland of the male musk deer. Some Rishonim hold that since blood is non-kosher, musk is also forbidden, but others holds that once the blood is nishtaneh – changed – it loses its original identity and becomes an innocuous kosher liquid. Mishnah Berurah rules that as relates to issurim d’rabannan one may be lenient.

Accordingly, some hashgochos hold that since kitnios is merely a minhag (i.e. even less than an issur d’rabannan) one can be lenient and certify kitnios which was truly nishtaneh. In order to qualify as “nishtaneh” the kitnios must go through a significant change in taste; therefore in the cases noted above, they would certify the ascorbic acid due to the dramatic change in taste from sweet to sour but wouldn’t permit the corn syrup since it isn’t changed/nishtaneh “enough” from the corn which it came from. This rationale is the basis for some hashgachos’ certification and/or acceptance of certain productions of MSG, aspartame and xanthan gum for Pesach. Some argue that Mishnah Berurah’s ruling is limited to cases of b’dieved and doesn’t justify the l’chatchilah creation/certification of such an item, and others argue that nishtaneh may be limited to cases where the forbidden item becomes inedible in the middle of its conversion to the “new” item. We will see below that even those who take the strict position in this matter generally agree that foods created with these ingredients are b’dieved permitted on Pesach."

This is from the OK:

"Another ingredient we would like to discuss is Citric Acid. This is produced by fermenting crude sugars with Aspergillus Niger.

The above mentioned carbohydrates can be of wheat, corn or regular sugar source. If it comes from wheat of [sic] corn it would be problematic for Passover.

As Citric Acid is quite popular in the food industry - tens of thousands of tons are used annually - a source that would be Kosher for Passover is quite in demand.

For years the Rabbis have been lenient with the use of Citric Acid produced from corn. The severity of corn usage on Passover is much less than wheat usage which is strictly forbidden - even in the minutest amount - on Passover.

Since the Citric Acid is the result of a chemical changeover from the original corn some prominent Rabbis permitted its use on Passover. However, the trend recently has been to observe more stringently to the letter of the law so a demand has arisen for a 100% Kosher for Passover Citric Acid produced from sugar.

As a side note, alcohol fermented from corn is not accepted as a Kosher for Passover ingredient, as is Citric Acid, even though the chemical changeover is identical.

We, at the OK, have been successful, thank G-d, in helping make available a 100% Kosher for Passover Citric Acid from sugar. This comes from Sucromilles in Cali, Colombia (a Haarmann & Reimer affiliate) and is marketed by Haarmann & Reimer in the U.S.A.

. . . A bright point in Group 1 development is the removal of Citric Acid from Group 1 by one major Kashrus organization. We hope all other groups will move in their direction. "

Group 1 means the item is considered "intrinsically Kosher" and does not need special certification to be used. It sounds to me like they're saying most organizations have in the past and probably still do certify foods containing citric acid grown on corn as Kosher for Passover.

Here's a company that carries another citric acid grown on sugar cane, along with vanillin and a non-grain-based ascorbic acid, along with a number of other generally problematic ingredients grown on (to us) safer sources.

It does seem that, at least for some of the products generally produced using corn, there are viable alternatives. Now I just have to figure out which products do and don't use them.

I called last week to ask what the vinegar in the Manischewitz products is made from (apples are an issue for us) and what the citric acid, ascorbic acid and xanthan gum are grown on. The CS representative was going to check on it and get back to me, but I haven't heard back yet.

I also called Gefen this week to ask what their sour salt (citric acid) is grown on or derived from. They're supposed to be checking on it.

Streit's told me that their products made in the USA shouldn't contain any corn or soy, but they don't know for sure about the products they distribute that are made overseas.

I did also e-mail the OU to ask whether items containing corn-derived citric acid and xanthan gum could be labeled OU-P or if they would be marked "OU chametz free" instead, but haven't heard back yet.

I'm really afraid I may have wasted a lot of money (and I mean a lot) stocking up on Kosher for Passover foods we can't actually eat.

Back to Baseline

Well, Baby E is definitely reacting to something. She has what looks like thickly-spread acne on both cheeks, tiny raised red bumps on her body, and severely exacerbated reflux. She's having abnormal BMs, her stomach and head are bothering her, and she's just generally miserable. She's also quite congested.

Some of that seems to be a cold, but the rashes and other symptoms are typical for her reactions to foods.

Last night she was up every hour, and didn't really sleep between. Even when I finally brought her into my bed she just tossed and turned and grunted and moaned all night long. After weeks of sleeping through the night or waking once at most, this is quite unusual. She normally only does the not-sleeping thing when she's reacting to something. I'm just so thankful the sleepless nights are a rare thing now, instead of being all the time as it was for almost the first year and a half of her life.

It seems to be something in my milk that's bothering her this morning. She nursed just a bit and then refused more.

It's always a challenge to pinpoint what's causing reactions, but at least now we have a fairly varied basic diet that we can always go back to when we need to re-establish a baseline.

We only have to avoid corn, soy, oats, kidney beans, apples, banana, mushrooms, mold, eggs, dairy products, coconut, avocado, blackberry leaves, nuts/peanuts/seeds, fish/shellfish, all legumes, yeast, coffee, chocolate, millet, wild rice and all refined/enriched/bleached/fermented products. For our baseline diet we also limit sugars, rotate grains, and avoid artificial colors, flavors and preservatives. That seems to keep her fairly reaction-free when we can avoid incidental exposures to crumbs or food on other kids' hands.

That may seem like a lot of dietary restrictions, but compared to the time we were limited to just 5 foods it really does leave a lot of options. It makes for a pretty healthy diet, too.

School and Stuff

I gave AJ a new Boxcar Children book to read when the girls went upstairs for quiet time around 3:30 this afternoon. She had read the entire book by dinnertime. Her eyes sparkled as she told Daddy all about the book and how "very exciting" it was.

M&M has been doing great with her reading, too. She finished the Kindergarten level A Beka science book in one sitting, so I'm having her read a First Grade level Health, Safety and Manners book (A Beka). She is really loving it.

I'll tell her how much she has to read each day, but usually she wants to read more. I keep thinking that she finished her assigned section so quickly she can't really have read it thoroughly. But when I take the book and ask her questions about what she just finished reading I'm always amazed at her near-perfect recall and excellent comprehension.

AJ is really enjoying her Christian Liberty Press science and history books, too. In science she's learning about things like weather and the water cycle right now. I think her favorite project so far was making the various types of clouds (cumulus, stratus, cirrus, nimbus) out of cotton balls.

In history AJ just finished learning about the Pilgrims and the Declaration of Independence, and now she's studying the Colonial Era. She seems particularly impressed with George Washington.

Baby E's favorite activity right now is washing her hands. She begs to "osh hans, peeese?" constantly throughout the day. Of course, her idea of washing her hands is standing on a stool at the sink and playing in the water for an hour.

All three kids and DH seem to be coming down with a cold tonight. Baby E has been particularly fussy and high-maintenance the last few days. We had been trialing her on bread with yeast in it, and I don't think that's going well.

Today I didn't serve kids any fruit, sugars or grains, along with the dairy products and other foods we're already avoiding. We ate a lot of potatoes, carrots, parsnips, broccoli and green cabbage today. For dinner we had cauliflower topped with marinara sauce and hamburger, with sides of broccoli and raw cabbage. I'm not sure what we'll do tomorrow yet.

I've thought about going to mainly just green vegetables and meats for a while, as suggested by many of the hypoallergenic, anti-allergy, flora-balancing or intestine-healing programs. But I've discovered in my record-keeping that I have to eat at least 2200 to 2500 calories per day just to keep from dropping under 97 lbs.

There's just no way I could eat 50 to 100 servings of vegetables every day (the non-starchy veggies carry only about 20 calories per serving) even if I could pick up 500 or 1000 calories a day from meat and oils. Already we often eat more vegetables in one meal than most people eat in an entire day.

Being unable to eat so many foods like legumes, eggs, nuts and seeds, avocado, coconut, seafood and dairy products makes most of those diets unworkable for us--especially with such a limited selection of corn-free organic vegetables available this time of year.

Mostly, I think we need to go back to eating no or only very limited amounts of refined sugars and refined carbs. Those Kosher for Passover foods are exciting, but I don't think the sugar and cottonseed oil is good for us--especially when confined with all the artificial colors, flavors and preservatives. We hadn't eaten that kind of junk in ages.

Monday Memory: Lessons (Re)Learned

On Thursday after Baby E's specialist appointments, we went back to the store with the large Kosher for Passover section.

They had kitniot-free magarine that seems safe for us. Hooray! Now I can bake flaky biscuits and pie crusts without having to freeze vegetable oil as a shortening substitute. It seems such a small thing, but it really made my week. I even used some of the margarine and some coarsely-crushed Matzo crackers to make a Baby E-safe version of my mom's famous chewy oatmeal cookies. Yum!

The gentleman at the kosher deli is a Shomer Shabbos Mashgiach Temidi. (I'm not sure what that means, although I believe it includes that he understands kosher requirements and is Jewish. He's the one who supervises the kosher meat cutting each week in the butcher area as well as the deli.)

He confidently assured us that the cold cuts (Aaron's) were all kosher for passover year-round and completely kitniot-free. As he explained, they would be Kosher for Passover only if I bought the entire piece of meat and cut it myself at home, since as soon as he opened it and touched it with his knife it would no longer be Kosher for Passover.

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Of course, I was worried about the corn and soy (kitniot) content rather than the Kosher status. So I bought a quarter-pound of turkey lunchmeat and we ate it in the van after we finished our shopping.

The kids enjoyed it so much that we went back in to buy more. We were only going to be in the store a few minutes, so I didn't carry the diaper bag with me.

At the last minute I decided I'd better double-check the ingredients (yes, I know . . . AFTER we'd already eaten it). Squinting through the case, I saw that the turkey had dextrose in it. Okay, dextrose is usually corn-derived, but it can also be potato-derived. But then I saw that the smoked-flavored one next to it had corn syrup on the label, and all the meats in the case had just the OU certification and not OU-P.

The masgiach seemed a little offended that I would question the kitniot-free status of the meats, and seemed to think the corn ingredients on the labels must be a mistake. He kept insisting it was Kosher for Passover and couldn't possibly really contain corn. Then he went to show me the official OU passover guide and saw that only the unprocessed raw Aaron's meats were listed in the guide.

Right about then Baby E started getting really fussy, grunting and bending over grabbing at her tummy and diaper, and getting a bit of a rash on her cheeks.

I realized that the epi-pen was in the diaper bag and explained that if Baby E was having a reaction I wanted to be near the epi-pen, which I'd left in the van. The girls and I hurried out, leaving the masgiach gasping over the idea that epinephrine might be required and apologizing profusely behind us.

I gave Baby E a dose of Benadryl right away and kept an eye on her for a while before driving home to make sure the reaction wasn't getting too bad. Even taking the antihistamine before the reaction really got going, she was fussy and miserable for several hours and got a mild rash and slightly puffy face.

I'm so glad we have the compounded Benadryl to use in such situations. I can only imagine that the reaction would have been much worse without it, since we've seen that the Benadryl generally cuts a reaction down to just a small fraction of its original severity.

It was yet another reminder that I really do have to double-check everything myself, no matter how sincere and convincing someone is about the corn-free status of a food, or how offended they may be if I question it. I also need to remember that the one time I leave the epi-pen behind "just for a minute" may be the one time we end up needing it. I just can't take that kind of chance.

As DH pointed out, the masgiach's mistake would have been a big deal to most of his customers, not just to us with the allergy issues. Selling meat that is NOT Kosher for Passover with the claim that it was OK for Pesach use would be a Very Bad Thing for the Jewish people who frequent the kosher deli, too.

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Mid-March Weekend

It's been a good weekend. I got to go to a mini prayer retreat on Saturday, and we had a baptism service at church today.

The girls and I did some work on the yard this weekend. The weather has been beautiful, and unseasonably warm and sunny.

We're planning to have a garden this year, and the warm weather makes me want to get started on it now. The danger of frost isn't past (we still had ice in shady areas just a couple of days ago), but I think there are some things I could start doing now, if I could just figure out what they were and how to do them. Many flowers are blooming, and my herbs are beginning to renew themselves.

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I've never had a vegetable garden of my own before. Realizing this weekend that a good-sized spaghetti squash ends up costing close to $10 (even at a fairly low price per pound) has strengthened my resolve to plant one. Now that we have to buy almost everything fresh and organic, produce is by far the largest portion of our grocery bill. Having readily available fruits and vegetables that we know are safe and haven't been treated with corn or soy derivatives would be really wonderful for us.

This week I hope to cover the area where we plan to plant the garden with visquine and/or cardboard to kill the weeds. I've been told that should be my first step, anyway . . . but I'm wondering if I should do something to the weeds or the soil first.

I did start a compost pile a few weeks ago, but I'm not really sure how to best care for it so it will turn into good fertilizer as quickly as possible. For now I'm just feeding it all the fruit and vegetable scraps, and the dumpings from cleaning out the hamster cage.

Soon the girls and I will start some seeds indoors. They are so excited about the idea of a garden. Today they helped me cut the dead stems off some of the flowers in the front yard.

Baby E enjoyed being outside, too, and wanted to help with what we were doing. She is picking up a handful of new words every day. Some of her recent aquisitions include "please", "I do!", "don't" and "amen."

Week On the Go

We have had a busy week, with lots of doctor's appointments.

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On Monday, Baby E had a pediatrician appointment for her 18-month checkup. I made sure I had my purse by the door and clothes ready the night before, but when we went to leave my keys were not in the house where I put them.

After scouring the house several times over, I finally had to call and reschedule the appointment for the next day. I finally found my keys under the passenger seat of the van. They had apparently fallen out of my purse on the way to or from church on Sunday.

Tuesday, of course, we had the rescheduled appointment. Dr. B said that Baby E looked great, was growing well (staying at 50th percentile) and obviously healthy. He said to keep doing what we're doing with avoiding her problem foods, and commented that her level of sensitivity is the most reliable test we have for figuring out her allergies/intolerances.

Since we were out and about anyway, we went Kosher for Passover shopping Tuesday afternoon, which I've already blogged about.

Wednesday M&M and AJ had their yearly checkups. Dr. B said that they also seem healthy and are staying on their growth curves, although at much lower percentiles. M&M weighs 30 lbs and AJ 38 lbs at ages 4 1/2 and 6. They're certainly not lacking developmentally at all.

Today we drove over to the Children's Hospital to meet with the GI specialist nurse practitioner, the speech and swallowing therapist, and the nutritionist.

The nurse practitioner said that Baby E's stool test came back positive for lactose, so she's definitely dairy-intolerant. No wonder the "safe" yogurt was giving her problems.

Given Baby E's history and pattern of reactions, the NP feels that other sugars may be an issue too. So we will probably need to limit all sugars, including fruit and fruit juices--"sugar is sugar," she said. Hopefully she will grow out of this between ages 3 and 5. If kids don't grow out of it by age 5 they are much less likely to do so after that.

I still need to find out exactly what "limiting" sugars looks like, and whether or not I need to worry about sweet/starchy vegetables too. Just what we need--more dietary restrictions.

Both the NP and Dr. B suggested that the older girls' frequent stomach aches and diarrhea could be dairy-related also. We don't have many dairy products in the house, but we do allow the girls to have occasional dairy products and use butter on their bread. It doesn't seem often enough to be the cause of their stomach issues, though. We're also supposed to keep an eye on fruits, other sugars and any other possible food intolerances for them. Better record-keeping should help to sort it out.

I did ask the NP about the possibility of other eosiniphilic disorders, and asked about "leaky gut" and Candida as possible underlying issues. I really appreciated the way she took my questions seriously and explained with each one why she did not feel it was indicated in Baby E's case.

She looked at the photos I'd brought of Baby E's rashes and facial swelling, and felt they were significant. She is referring us to a dermatologist who should be able to rule out possibilities like mastocytosis and histamine sensitivity.

Gastrointestinally, the NP seems to feel we've figured out what's going on satisfactorily. We're supposed to keep E on the reflux medicine for a year and then try weaning her off it to see if she can do all right without it or not. I feel comfortable with that approach. It's nice to be done with seeing the GI specialist and with all the testing for GI issues now.

The speech and swallowing therapist was happy that Baby E was doing so much better, too. He said that he'd like us to wait a month or two until cold and flu season is over, and then gradually start weaning her off the thickener. Hopefully the aspiration will have resolved itself by then and she'll be able to drink normal fluids again.

The nutritionist discussed Baby E's diet with me and decided that she's probably getting enough of everuthing except calcium and iron. I'm supposed to work on finding supplements for those.

She was amazed at Baby E's issues and the way we have to handle them. She commented, "I should use you as a resource!" I said I'd be happy to help anyone with similar issues, and gave her the web address for Restricted Gourmet. I've thought of the possibility of starting a local support group for allergy/intolerance at some point, but it's not as though I'm in need of more demands on my time and energy at the moment. Maybe someday.

The nutritionist also suggested we try an elemental formula for Baby E--even if not to wean her completely, to have available as a supplement or for the times I accidentally eat one of Baby E's allergens and contaminate my milk.

She gave me samples of both Elecare and Neocate to try, although she thought it likely Baby E may not tolerate them. They both contain corn and soy, and Neocate also has coconut oil. Although the proteins are supposed to be completely denatured, it seems that Baby E may have a Non-IgE intolerance of some sort that might not be dependent on the presence of an intact protein to cause a reaction. Not to mention that corn proteins are apparently unusually difficult to completely hydrolyze--scientists found intact corn proteins in the supposedly hypoallergenic Nutramigen when trying to figure out why a few kids were having reactions to it and other hydrolyzed formulas.

This is the type of situation where an in-office food trial would be really nice.

There's more to tell about today, but I'll have to write about it later.

Too bad it's only once a year

Yesterday the girls and I drove to a neighboring state to find a grocery store I'd heard was the place to get Kosher food in the area. We went to visit my friend JT afterwards, since she lives over that direction. That was a lot of fun.

The trip was a great success. The store had quite a variety of Kosher for Passover items, almost all kitniot-free. Kitniot-free is a big deal for us, because it means that the food can have no trace of soy or corn, among other things. It was amazingly easy to find foods free of all our allergens.

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Most of these products are available only for a few week around Passover, and aren't produced the rest of the year.

I was so excited to find such a variety of foods and other household items we can use. Things like single-serving juice for the kids, ketchup, soda pop, breakfast cereal, candles, toothpaste, dish soap, potato chips, candy, pickles, marshmallows, canned goods and juice. I was especially excited about the ketchup and pickles. They're made with no vinegar at all, either apple or corn, so I'll be able to eat them for the first time in ages.

And the mixes! Cake mix, muffin mix, pancake mix and more. I thought I'd never be able to cook from a ready-made mix again. They were expensive, so I just bought a few for special occasions. The potato stix and the Crispy-O's cereal were the main things I bought quite a few of.

I even found some soups and pre-made meals we can have. You have no idea of the excitement and the feeling of luxury--to actually be able to eat food that someone else cooked! Hooray!

The store has a Kosher meat counter and a Kosher deli, and carries a lot of meats and other products that are Kosher for Pesach year round. That means I can get lamb, beef and free-range chicken that I can trust. Much of it is less expensive than the local butcher, and, unlike the meat in stores closer to home, the beef and lamb is grass-fed. We still have about a quarter to a third of the meat we bought from a local farmer in our freezer, but once that runs out the Kosher meat counter is going to be quite a boon.

The store didn't have some of the baking supplies I was hoping to find, such as vanilla, baking powder, white distilled vinegar, flavoring extracts and food coloring. But I found a lot of things. We've been sampling them over the last two days, and most of them are really good.

Baby E's favorite thing so far has been the juice. She is just beside herself with excitement that there are little squeeze packets of juice with little bitty straws, like she sees other kids drinking, and she can have them! The straws seem to be narrow enough to avoid causing aspiration issues, and Baby E loves them. I was a bit nervous giving her the juice because it contains ascorbic acid, which is normally something grown on corn that causes reactions for her. But she drank the whole packet and she didn't even get slightly red cheeks--amazing!

It was amazing to actually have so much selection that I couldn't buy everything they had that was okay for us. Usually when I find something ready-made that we can have, it's such an unusual event that I buy whatever it is. There's never more than a handful of available options to choose from.

I filled two shopping carts to overflowing with a year's supply of OU-P foods. The girls were getting tired and a bit whiny toward the end, but it helped that people kept stopping to talk to them.

I was so impressed with the other people that were also shopping in the Kosher for Passover sections. Most of them seemed to know each other and would stop to greet each other and chat. Many of them said hello to us and asked where we were from, since they didn't recognize us.

They were so very warm and friendly--happy to answer questions, engage us in conversation, and quick with offers of help. Even when they found I wasn't Jewish, they were sympathetic and eager to make suggestions for finding foods free of corn and soy, explain symbols on the packaging, and help me learn how to pronouce words like Ashkenazic and kitniot.

I tend to feel a kinship with Jewish people, because--at least from my perspective--we worship the same God, we read the same Torah, and our faith shares the same roots. Abraham, Isaac and Jacob are the forefathers of my faith too, even though I'm not descended from them by blood. I grew up on stories of the prophets and heroes like Joshua, Samuel, and David, and strong women worthy of emulation like Ruth, Esther and, of course, the woman described in Proverbs 31.

My Lord was a Jew, and His message and salvation came first to the Jew, and then to the Gentile. The New Testament speaks of those Gentiles who follow Christ as having been adopted or grafted in to the family of God's children. The Jews are God's chosen people, but we get to share in that heritage by His grace.

I'm afraid this must be highly offensive to those Jewish people who do not believe Jesus is the Messiah--the fact that I feel I have a kinship with them because of my faith. It must be a bit awkward to have someone feel such a brotherhood when, from your perspective, it's worse than non-existent. To them, I'm sure it seems a blasphemy. To me, the thought of sharing such a widespread and diverse family community is a lovely one.

Children's Prayers

I love sitting down with AJ and M&M at the end of the day to read them a Bible story, talk to them and pray with them. Today we read about Job, which turned into a really interesting conversation about real love, faithfulness, and Heaven.

I always ask them if there's anything they'd like to talk to God about. Until recently, they've wanted me to do the actual praying, although they've been willing to suggest topics.

AJ has been beginning to pray on her own after I pray for some time now, and it's so sweet to hear her talk to God in her own words. Just the last couple of nights, M&M has wanted to pray aloud for the first time, too.

Tonight, these were their prayers:

AJ: "Dear Jesus, I love you. Thank you for dying on the cross for my sins. Amen."

M&M: "Dear God, thank you for making all my favorite friends. And you're one of them."

PGR 1:24

Pediatric Grand Rounds 1:24 is up. The host of Blog, MD did an excellent job putting it together. It's obvious that he read each post listed and gave careful thought to the organization and comments in this edition of PGR.

I thank him for including my post, Allergy: I do not think that word means what you think it means, in the round-up.

Intolerances deserve attention too

[Note: this was originally part of the post titled Allergy: I do not think that word means what you think it means. I've moved it into a separate section to make the original post more manageable.]

"True" IgE-regulated allergies are often thought to be more important and more deserving of attention and research than non-IgE regulated adverse reactions. I think the current approach is a bit unbalanced, and here's why:

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It's often said that intolerances are usually milder than allergies, and that allergies can occur to trace amounts of foods while intolerances are usually dose-related. But that's not necessarily true.

For instance, gluten intolerance can be triggered by extremely trace amounts of gluten, such as cross-contamination from foods processed on the same equipment as items containing gluten. Corn intolerance is another "non-allergy" in which it seems particularly common for trace amounts of highly refined corn derivatives to cause severe reactions even in people who test negative for corn allergy. That's certainly the case with Baby E and many others on The Avoiding Corn Forum.

There's a misconception that intolerances only cause minor symptoms such as indigestion. But non-IgE food reactions can have all the same symptoms as an allergy, or others just as uncomfortable.

The consequences of an IgE-regulated allergy can range from mildly annoying symptoms such as an itchy mouth, mild rash or runny nose to a severe, multi-systemic debilitating or even life-threatening reaction. Likewise, non-IgE reactions can range from mild to severe. A person may just get a stomach ache when they eat too much of a certain food (as is the case with many intolerances), or they may experience symptoms such as severe vomiting/cramping/diarrhea, internal bleeding, itching, rashes, headaches, difficulty breathing, changes in heartrate or blood pressure, malabsorption, failure to thrive, or even anaphylactoid reactions.

A truly life-threatening adverse food reaction is rare with both an allergy and an intolerance. An intolerance may be less likely to kill you, but a fatal anaphylactoid reaction will kill you just as dead as fatal anaphlyaxis will. Untreated autoimmune or metabolic food intolerances can certainly be fatal.

Intolerances may be mild more often than allergies, but a moderate to severe intolerance can make life just as difficult and uncomfortable as a moderate to severe allergy can. A severe intolerance can be more debilitating and difficult to manage than a mild allergy. Intolerances can be especially difficult to manage since some of the most common intolerance triggers, such as corn and MSG, are less well-regulated and labeled than the top 8 allergens are.

A lot of people get up in arms about people lumping together food allergies and other adverse food reactions. How dare anyone think an intolerance could be in the same class as a REAL allergy? It's touted frequently that, while maybe 15-30% or more of people experience some sort of food intolerance, only a very small percent (somewhere between 1% and 8%, depending on the reporting source and the age range) have "true food allergies." Food labeling laws and other policies are largely based only on the IgE-regulated reactions.

Intolerances are harder to study than allergies, but they affect far more people than allergies do, and their consequences can be severe.

Things like research, accurate labeling, education, and effective treatments are important for all types of adverse food reactions. For both allergies and intolerances, the primary treament is to avoid the foods triggering the symptoms. Pinpointing the trigger foods and being able to avoid them is equally important for managing moderate to severe reactions, whether technically they are allergies or not.

Is it an allergy, or an intolerance?

[Note: this was originally part of the post titled Allergy: I do not think that word means what you think it means. I've moved it into a separate section to make the original post more manageable.]

When it comes to abnormal or unusual adverse reactions to food, most resources divide them into two categories: allergy and intolerance. There are also adverse reactions related to an element of the food itself, which may not really fit into either category. Some types of food poisoning, for example, have allergy-like symptoms.

Differentiating between different types of adverse food reactions can be complicated.

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The most commonly-known group of food intolerances is the type which involves difficulty or inability to break down certain food elements. Often this is because of an inherited missing enzyme. Lactose intolerance is probably the mildest and most common form of this. Other metabolic disorders that cause food intolerances can be much more serious and difficult to manage, such as Congenital Sucrase-Isomaltase Deficiency (CSID) and Phenylketonuria (PKU).

Many resources simplify allergy vs. non-allergy by saying that an allergy involves the immune system, while an intolerance does not. But I'm learning that this is not necessarily true. Some conditions, such as celiac disease, are triggered by food and involve an abnormal immune response, but are not allergies. There are also conditions such as eosinophilic disorders which damage cells or trigger production of abnormal cells by a person's body. These can be triggered by specific foods, but allergies may or may not be detectable.

I've often thought of allergy vs. non-allergy relating to whether the reaction involves histamine release or not. After all, allergy medications are antihistamines, right? An allergic reaction must be any adverse reaction that involves histamine, I thought.

Not so. There are actually a number of adverse food reactions that look and act like allergies, and involve histamine, but aren't actually allergies. Some of these, like scromboid fish poisoning or histamine intolerance, are from ingesting histamine in food rather than producing it in the body. Others, like mastocytosis or direct histamine liberation, may involve the overproduction of mast cells or the release of histamine within the body caused by something other than an allergic reaction.

Even the presence or absence of particular symptoms can't firmly differentiate between allergic and non-allergic reactions. Typical allergy symptoms such as hives, asthma, itching, swelling, changes in blood pressure, vomiting and diarrhea can all be caused by other triggers.

One might think that, at least, symptoms of anaphylaxis from consuming a food would be a clear indicator of allergy. I would have thought that if a person had negative allergy tests but got hives, wheezing, itching, and a life-threatening drop in blood pressure or difficulty breathing on food challenge, that would be considered proof that the test was wrong. Some allergists consider an anaphylactic-type reaction to be final proof of an allergy, but others may not.

I've recently learned that there's actually something called an anaphylactoid or pseudo-allergic reaction. It looks and acts exactly like an anaphylactic reaction. Same symptoms, same treatment. Both are life-threatening. The difference is that anaphylactic reactions include the presence of IgE antibodies, and anaphylactoid reactions don't. Anaphylactoid reactions are most common as reactions to non-food substances such as medications and contrast mediums, but anaphylactoid food reactions have been reported.

The more I learn, the less I'm sure I understand. Perspectives and approaches vary among doctors and researchers, which complicates matters even further.

What seems clear is that both IgE antibodies and a specific set of typical allergy symptoms need to be present for unanimous agreement that an allergy exists. You can read a bit more discussion of that as it relates to Baby E's situation here.

Allergy: I do not think that word means what you think it means

I thought I knew what a food allergy was. If a person consistently gets symptoms like rashes, swelling, itching and severe GI symptoms within minutes of consuming a food--that's an allergy, right? Or maybe not.

Maybe I don't know what I thought I knew about allergies.

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When I wrote the series of articles about allergy testing and treatment a couple of months ago, I was very frustrated with the lack of information, reliable testing, and treatments for allergies, as well as with some negative experiences we'd recently had with medical professionals.

That post was a compilation of some of the information I'd been reading. But it was also a venting of my frustrations, and my wording and some of my data interpretation was colored by those emotions. I later ended up wishing I hadn't submitted the post to Pediatric Grand Rounds, as explained here.

There were a few things I didn't understand at that point, which I am just now beginning to understand.

One of the most important is that "allergy" doesn't mean what I thought it meant. At least not to Baby E's allergists. In fact, to many allergists, "allergy" does not seem to mean what it means to the rest of the world.

Most people who are reasonably well-informed understand the difference between a food reaction that involves an abnormal response of the immune system versus a reaction that simply involves having difficulty digesting a food. Generally, we can accept that lactose intolerance is different from a milk allergy.

But most of us would assume that if a food consistently causes immediate severe reactions, especially if those reactions include symptoms like rashes or wheezing, it must be an allergy.

But I've learned that is not necessarily the case. Apparently most or all of the symptoms of allergies can also be triggered by causes other than a "true allergy." Differentiating between allergic and non-allergic adverse reactions to food is more complicated than one might think.

It seems that in order for the scientific and medical community to consistently agree that an allergy is present, two things have to be confirmed: IgE antibodies in sufficient quantity, and a set of typical allergy symptoms with sufficient severity and reproducibility. In the absence of either of those elements, many professionals will not consider the patient to have a true allergy.

That may be why so many people find themselves in a situation where they have adverse food reactions, but can't get anyone to take them seriously. They may have all the symptoms of allergy, but negative test results. No IgE, no allergy. Or they may have positive test results, but symptoms that their doctor doesn't consider severe enough or typical enough to qualify as a clinical allergic reaction. Many doctors and researchers feel that in the absence of certain symptoms such as hives or wheezing, even a positive test result and adverse reactions together don't add up to a "real" allergy.

Since, to some extent, the interpretation of test results and symptoms is subjective, the patient may get completely different answers from two different allergists. One doctor may believe the patient has a potentially dangerous allergy, while another will diagnose them as having no allergy at all.

Baby E's case is a good example of this difficulty in diagnosing allergies.

The first two times she had allergy testing done, starting when she was 11 months old, her skin prick tests had a combined total of 8 positive results.

As time has passed, it's become clear that to a couple of those foods (corn and soy) Baby E gets immediate reactions (within 5 to 90 minutes) to extremely trace amounts of even highly-refined derivatives. These reactions can include rashes, itching, facial swelling, congestion or runny nose, GI symptoms including stomach pain and diarrhea, loss of appetite, and extreme behavioral changes such as repetitive head-banging, regression in speech and other skills, screaming and flailing for hours or days at a time, becoming antisocial, and acting lethargic and unresponsive.

Since Baby E is only 19 months old, it's hard to tell exactly what she's experiencing, but it's obvious she's miserable. Dosing her with Benadryl significantly reduces her discomfort and makes the rash and swelling disappear within 10 minutes or so. Without antihistamine treatment the reaction may go on for hours.

The other 8 or 10 foods that cause adverse reactions for her seem to trigger primarily GI symptoms, often accompanied by behavioral changes such as those noted above. These may happen within minutes after initially consuming a small amount of the food, or may require a few exposures for a reaction to build up over the course of a day or two. Benadryl doesn't help as much with these reactions.

Baby E's various reactions can be tested multiple times by adding and removing the food, with similar results each time. We are by this point pretty sure that she reacts to all of the foods to which she tested positive, plus a few more. When not exposed to a triggering food, she is a completely different child. Thankfully, that's most of the time now.

We've now had two allergists tell us that Baby E does not have allergies.

The first allergist felt that all or most of E's positive skin-prick tests were "false positives" because her clinical symptoms did not match his definition of allergy: she didn't get asthma, wheezing or systemic giant hives. Her positive results had relatively small wheals (none more than 7mm larger than the negative control) and her rashes seldom appear over her entire body at once. In his opinion, that's not a real allergy.

The second allergist seemed to feel that her reactions were serious allergies, and even prescribed a second set of epi-pens because he felt we needed more than two readily available.

Then we did the ImmunoCAP blood IgE test. When everything came back negative on that, he did his own brand of skin-scratch testing using a different method than the previous two allergists had done. When that also came back negative, he decided E's previous tests were invalid, told us that E did not have allergies (although he diagnosed her with eczema), and said he couldn't help us since he didn't deal with non-allergy adverse food reactions.

I asked him what things other than IgE antibodies could mediate an allergic reaction, and he said, "None."

In both cases, the allergists agreed that Baby E had severe and complicated issues of some sort, but were not willing to continue treating her or trying to help us figure out and manage her food reactions. We were simply advised to figure it out on our own via trial and error and avoid any food that causes adverse reactions.

If Baby E truly doesn't have allergies, I would have thought the initial skin-prick tests would have been negative, or she would have had no symptoms to the foods that tested positive. Apparently I don't understand as much about allergies as I thought I did.

Skin-prick or RAST tests are considered fairly accurate in diagnosing IgE regulated reactions. But with non-IgE reactions they are basically useless. In the absence of an accurate test, researching and learning about other adverse reactions is much more difficult and probably less appealing to scientists.

There seems to be very little understanding of how non-IgE adverse reactions are mediated. For most of them, nobody really knows what causes them or how to treat them. There don't seem to be many people interested in trying to find out.

For the most part, it seems intolerances are minimized or thought to be relatively unimportant. That really frustrates me, as I discussed here.

I'm still not sure which category Baby E's reactions fall into. After the first allergist said Baby E's first reactions weren't really allergies, I was convinced he was wrong. So I got a second opinion. Now that two board-certified allergists have agreed that Baby E does not have allergies, I don't know what to think.

So far Baby E has tested negative for celiac disease, eosiniphilic esophagitis, and the other possibilities the GI specialist has considered. We're seeing the GI specialist again this week. The naturopath has some other ideas yet to try, too.

Whether the reactions are actual allergies or not, for now all we can do is try to identify and avoid the triggering foods.

Another day, another doctor

I've been thinking a lot about Baby E's food reactions this week. Since they don't seem to be IgE-regulated, that could be a very good thing. It opens up some possibilities that would be treatable, and that she would be much more likely to grow out of.

For instance, it's likely that the issue could be one with damage to her gut--perhaps something like an eosiniphilic disorder, where certain foods cause abnormal cells to grow in the esophagus, gastrointestinal tract, or elsewhere in the digestive system.

I'm not sure what the other possibilities are, but I know there are other things that can cause permeable or "leaky" gut--celiac disease is one we've already looked at. These things can be caused by adverse food reactions, but the gut permeability can also cause more adverse food reactions. We know she has higher than normal levels of candida and bacteria, which could also point to some underlying issue that's somehow weakening her digestive system.

The exciting thing is that if Baby E's reactions to some or all of the foods are caused by an issue with her digestive system, they may go away once the underlying issue is solved and her gut heals.

Someone from the GI specialist's office did finally get back to us yesterday. Our GI specialist, apparently, "has been very busy" for the last several weeks, which is why my phone calls were not returned until now.

An order for the "reducing substances" test was FAXed to the hospital lab, and I dropped off a lovely stool sample yesterday. So there's actually a chance the test results will get back before our GI appointment next week.

I saw my own doctor yesterday, too.

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I weighed in at a whopping 100 lbs fully-dressed. The appointment consisted mostly in a student taking a history and asking my symptoms (fatigue, dizzy spells, weight loss, low temperature, irregular cycles, digestive & swallowing issues, basically not feeling good, etc. etc.), asking me if I'd had my thyroid checked (I have), and asking why I'm there and what I think I want the doctor to do about my symptoms, since it's really nothing particularly new, only worse.

Then the doctor came in and asked me if I am anorexic or bulemic (again), to which I answered (again) that I am not, no I don't have body image issues (except that I know I'm underweight and would like to gain about 15 pounds), no I'm not purging, and yes I'm eating plenty of healthy food in normal-to-large quantities, but everything high-calorie is pretty much out because of Baby E's allergies (er, excuse me, adverse food reactions).

Basically, the verdict was "It's probably just your autoimmune stuff acting up and because of being underweight, and there's most likely nothing we can do about it. You just need to take care of yourself, eat right, get plenty of exercise, etc. etc."

They did send me for a few more tests and, depending on the results of those, my doctor said he may refer me to a rheumatologist to look further into the autoimmune angle. They drew blood to do a few more panels and are going to send me for a barium swallow.

Meanwhile, I'm supposed to be keeping track of everything I eat so the doctor can see exactly how many calories I'm taking in.

Deposits, but no return

We have apparently lost several more foods, including yogurt. That brings Baby E's total number of foods she can't tolerate to somewhere in the range of at least a dozen.

Today I made various phone calls between doing school with the girls, preparing meals and caring for a still-fussy Baby E.

I called allergist #1 to tell him about Baby E's most recent series of reactions and get his opinion. Of course he said he didn't think they were allergies.

So I guess it's official: Baby E has no food allergies.

Her consistent, reproducible, quick-onset GI symptoms, rashes, swelling, itching and general misery from specific foods are adverse reactions, not allergies. The tests say so.

Those first 8 positive skin-prick tests must have been false positives. Funny how she had "false positives" only to those foods which actually give her the not-allergic reactions.

I've called our GI specialist at the Children's Hospital at least four times over the past month or more, to ask three questions, and still haven't received a single return phone call.

The questions:

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1) Where did she send the orders for the stool test she ordered for Baby E, if indeed she sent them anywhere? Because none of the three labs we've used in the past has them.

2) Is it all right to switch Baby E to ranitidine (Zantac) instead of omeprazole (Prilosec) for her reflux, since she started getting rashes, itching, severe discomfort and diarrhea every time we gave her a dose of the omeprazole?

3) Could we please get the product code for the mask that was used for Baby E's endoscopy back in December, so the mask company can find out what was in/on it that might have caused Baby E's reaction to it.

The stool test isn't going to get done in time to get the results back before our appointment next week, we went ahead and switched Baby E's medication ourselves without the doctor's approval, and I'm not sure if we'll ever get the information about the mask, since we've been trying to get that since December with no success.

At least we already had a previous prescription from another doctor for the ranitidine--otherwise we would have had to choose whether to go for weeks with a reflux med that was causing increasingly severe reactions or no reflux med at all, which would also make Baby E miserable. Ugh.

I do really like the GI specialist, but we've consistently had a terrible time getting her to return phone calls. I've finally learned that we'll get an answer more quickly by making an appointment than by leaving a phone message. That could get real expensive real fast.