Home from the Allergist

Well, we saw the allergist. Baby E had skin-prick testing done for all the foods she previously tested positive for, plus coconut and chocolate.

All the tests were negative. The only one that was bigger than the negative at all was coconut, and it was a difference of 1mm--not enough to be considered a positive by any standard.

As the nurse said, "Maybe avoiding those foods for all this time has given her a chance to grow out of the allergies." As the doctor said, "It does seem pretty clear that at least some of her symptoms were food-related, but probably not all of them were. Some of those foods may never have been true allergies in the first place. Others, she's probably growing out of."

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It certainly seems to me, and the allergist agreed, that E's issues with apples, bananas and a number of other fruits seem to be more related to whatever sugar she's malabsorbing, than to allergy.

Since her reaction to bananas consisted of only one especially soft stool, with no other real symptoms, we've been continuing to give her banana in small amounts. Each time she has an unusually soft BM shortly after (usually within an hour or two), and possibly some mild stomach discomfort, but nothing severe.

The allergist thought our plan was sensible: basically, we're going to continue to limit fruits (at least the ones that seem to bother her) and try not to overdose on them, but we're not going to avoid them completely. We'll allow E to have moderate amounts while trying to keep from letting her eat enough to make her miserable. I also plan to check in with the GI specialist on that issue, and see what she says.

As for the other foods, we're going to continue introducing one per week, more or less. The allergist said that we may or may not find that she can tolerate them all now, so if she has problems with one just remove it from her diet again and try again in 3 months or so.

At first, it felt like the allergist was assuming that I was overreacting and planning to withhold foods for the rest of Baby E's life if she looked a bit off after eating it once. But I was able to explain that I don't really consider it a conclusive reaction to a specific food unless essentially the same thing happens after eating the same food on about three different occasions, and that I don't consider it a significant reaction unless there are multiple symptoms (i.e. I don't consider it a big deal if she gets just red cheeks or just diarrhea). We've tried most things at least 3 or 4 times before deciding that the symptoms we were seeing could fairly conclusively be attributed to that particular trigger. And then like to test it again after a period of time avoiding the food.

I try to keep detailed records of what she's eaten and what's going on surrounding Baby E's rashes or bad spells, but I do try to not assume causality unless it's warranted.

When he finally understood the approach we were taking, the allergist visibly relaxed. He said that seemed very sensible.

Regarding corn, at first he suggested that we start with trialing some of the more refined corn derivatives. But I asked about doing an in-office challenge. Corn is the only food I'm really worried about the possibility of a severe reaction, and that was part of the reason. But if she really could tolerate corn, I'd like to know. Also, if she did have a reaction to whole corn, it would be extremely helpful to know the severity of the reaction in a controlled environment.

After we discussed it a bit, the allergist said he thought it seemed quite reasonable to do an in-office challenge for corn. He suggested that we trial all the other foods first, since corn is the most severe. Then, in a month or so, we'll schedule a full morning to go in and do the challenge.

He said he'd never done an in-office challenge for corn before, but he'll use the same procedure he generally uses for challenging peanut.

We'll bring in corn in several different forms--fresh corn, corn chips, and something like cornbread or polenta. They'll start by rubbing it on her arm, then her cheek. Then they'll have her take some in her mouth and spit it out, or just lick it. Then we'll start giving her tiny amounts, gradually increasing the amounts over the course of several hours until either she has a reaction or she reaches a normal serving size without reaction. The whole time, they'll be monitoring her blood pressure, pulse, breathing, skin, etc.

I tried to maintain a very calm, factual, professional demeanor during the visit, and I think that helped a lot. He seems to be finally getting past his initial perception of me as a somewhat hysterical, paranoid, overreacting mom. Never, never cry during a doctor's appointment. I'm just saying. It could take the doctor a long time to start taking you seriously again once you start bawling.

He did suggest again that I consider weaning--well, more like encouraged me that I've "already nursed longer than most women ever would" and that it's okay if I feel like I want to wean Baby E. That she'd be fine if I weaned her, and it's a lot for me to manage, trying to nurse her and avoid allergens for her sake, and, and . . .

I just smiled and told him that if I felt I needed or wanted to wean her, or she wanted to wean herself, I would feel free to do so.

In compiling records in preparation for the allergist visit, I was struck with how often on this roller coaster there hasn't been any clear cause for Baby E's difficult spells, or even her rashes. I always rack my brain trying to make connections or guess what caused it, but much of the time there is just no answer. With some foods the reaction has seemed consistent and clear, but other reactions seem to have no easily-discernable trigger. Of course, even when it's clear that a certain food is triggering a symptom, we could be seeing a sugar malabsorption issue rather than an allergy issue. Or a certain food might exacerbate her reflux.

But I'm increasingly aware that--even when the timing seems to suggest it--things often may not be food-related at all. Sometimes it could be that she's ill or teething. Or it could be that her reflux is acting up, which could be food-related or not. Or she could be hungry, tired or frustrated. Some of the rashes, too, could be caused by a variety of triggers--illness, contact with an irritant, etc.

The allergist did point out today that eczema tends to be worse in the winter than in the summer, so the fact that it's so much better now could have as much to do with changes in the weather as with dietary changes. Whatever the cause, Baby E hasn't had a rash since March. Almost all the symptoms we've seen in the last 6 months could be attributed to anything from reflux to illness, with the combination of just being a toddler. Most importantly, the symptoms are much milder and less frequent now than they were before. Baby E is happy and healthy most of the time. She's thriving.

She's definitely doing ever so much better. Is it because she's growing out of many of her issues? Is it that we've gotten good treatment for her reflux and aspiration issues? Has her body been able to heal itself on a diet of safe, healthy food? Is she just doing better because we've gotten so good at avoiding the things that trigger her symptoms? Or is she doing better for some other reason?

Anyway, I'm looking forward to seeing how the upcoming food trials go. We'll be introducing mushrooms, kidney beans and other types of legumes (she already seems to do fine with green beans and lentils), soy, coconut and then the in-office challenge for corn. The allergist recommends that we avoid nuts/peanuts and fish/shellfish for another year.

Our list of foods to avoid is getting shorter and shorter!