Lions and Tigers and Food Allergies... Oh My!

It was so difficult deciding what my first blog post would discuss. I suppose it’s overhyped because it sets the tone for your blog moving forward. Today I’m feeling extra sentimental, as it’s my daughter’s 3rd birthday (born exactly an hour ago, three years ago as I type). My daughter also happens to be my food allergy babe, who has a life-threatening food allergy to peanuts and tree nuts. In the spirit of it being her birthday, I decided to share a story about our food allergy journey—one many food allergy parents and individuals can likely relate to. So before you read on, I’ll reveal a bit of a spoiler: I’m going to talk about the mysteries of food allergies (how they can morph/change on a dime), what to expect in an oral food challenge, and what it’s like going from being labeled “life-threatening allergic” to “no allergy to…” overnight.

Fast forward a couple years ago to the exact day my daughter was diagnosed peanut and tree nut allergic. Like very allergic. She had a couple reactions, we got her into an allergist, and two weeks later we had the diagnosis on paper (and several epi pens at the ready). That day, still spinning from her diagnosis, we go home to eat lunch. One of the things I gave her for lunch was hummus, because she loves hummus. She ate hummus multiple times each week. Within 15 minutes of ingesting the hummus, she started having a pretty severe allergic reaction (think croupy cough, lips turning blue, etc.) We inject her with epinephrine and get her to the emergency room ASAP. At the ER it’s confirmed that she is having a reaction. They give her a couple inhaler puffs of Albuterol, an oral steroid and Benadryl, and continue to monitor her for four more hours (which is standard protocol in case a biphasic reaction occurs.)

Still confused why she had a reaction to hummus (that she’d eaten a hundred times with no issue) we go back to the allergist to get blood testing done that confirms her positive test to sesame and chickpea antibodies (aka allergic). Sesame and chickpea? But she’s had these hundreds of times with no issue?! As a mom I’m starting to get scared as we’re adding on more allergens, and ones the FDA doesn’t require stringent labeling for. We later come to find this brand of hummus, which we had never bought before, is processed on a shared line with tree nuts (definite allergy). Sigh…. As reference, the FDA only requires ingredient declaration for the “Big 8” on nationally distributed packaged goods: peanuts, tree nuts, fish, shellfish, wheat, eggs, milk and soy.

From that day on, we decided it safest to operate under the assumption that our daughter was in fact very allergic to sesame and chick peas. Over a year later, upon switching allergists, our new provider recommended we consider an oral food challenge (OFC) to hummus in his office. For those that aren’t familiar, an OFC is really the only definitive way to know if a food allergy is really a true food allergy (if no definitive diagnosis is made after a skin prick or blood test). An OFC is usually held at your doctor’s office over a few hour period. In our experience, the doctor divided a full serving of hummus into eight measured bites, titrating the amount up by double every 15 minutes for two hours until she reached a full serving (two TBSP). Then we waited for two hours to ensure no reaction occurred. It’s important to note that the food challenge continued because no signs of a reaction were present. If signs of a reaction become present, the food challenge is stopped immediately and the patient is treated as needed. So what’s the benefit to OFC? The upside is that you have a more concrete diagnosis. The downside is that you may find a positive diagnosis and have an allergic reaction. Game over. That’s why it’s so important for a doctor to “start low and go slow” in case a reaction does occur. We also learned that it’s imperative when you do a food challenge to call the product manufacturer (as applicable) to ensure any other known food allergens aren’t present around the OFC food so that cross contact can be ruled out if a reaction does occur. In our case, I heavily vetted the hummus we brought to the food challenge to ensure nuts weren’t even in the manufacturers facility.

The OFC process is of course nerve wracking. From the mom perspective, it felt like I was watching her under a microscope—waiting to see what we would discover. While my innocent toddler is busying herself with the countless toys and games I brought to entertain her from 10-3, I found myself just staring at her. Watching for hives, for her lips to turn blue, for her to vomit. BUT SHE DIDN’T. It turns out our daughter does test positive for the chickpea and sesame antibodies, but doesn’t have an allergen. Our best guess is that her reaction a couple years ago can be attributed to cross contact with tree nuts in the facility during manufacturing. Since this food challenge, we have given her hummus a few times each week with NO issue.

As a dedicated food allergy parent, it felt SO strange to feed my child what I avoided like the plague for so long. But in some ways, it feels really good that I don’t have to restrict a food (a healthy food!) from her diet anymore. For as much as we know about food allergies, so much mystery still surrounds them. If she’s not allergic, why does she consistently test well into positive ranges for these foods? Is it important that we now expose her often so that her immune system continues to recognize sesame and chickpea as a non-threat?

I know there are lots of FA families and individuals out there with similar stories to share, and I’d love to hear your experiences and opinions. And if you’re wondering where my blog title came from, it’s also a tribute to my three-year-old. She loves the Wizard of Oz:) 

Until next time!