When a Food Challenge is Unsuccessful

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Superman has had 8 food challenges, and 6 of them have been SUCCESSFUL.  He’s passed, soy, oat, cherry, strawberry, almond, and mixed tree nut.  The two that have been UNsuccessful have been baked egg.  You can read HERE about his first baked egg challenge when he had an anaphylactic reaction. Ironically, this time around it was almost an exact replay of his first baked egg challenge.  The one exception, is that it happened so much faster this time.

When a Food Challenge is Unsuccessful~Mom Vs. Food Allergy

 

At 9:20 I took a picture of Superman and I after his first “dose”, 1/4 of a cookie.

When a Food Challenge is Unsuccessful~Mom Vs. Food Allergy

Right after his first bite of baked egg cookie.

At 9:52 I took a picture of him right after he had his shot of epinephrine.

What happened in just 30 minutes, was something I want you to learn from, so you can see the progression of an anaphylactic reaction.

Superman first ate 1/4 of the chocolate chip cookie.

About 5 minutes later he got really sleepy.  I didn’t think much of it at first (except a flashback to his first baked egg challenge), because he had trouble falling asleep the night before due to being excited and a bit nervous.

He started rubbing his eyes here and there.

He complained that his stomach was hurting, and thought he might have to go to the bathroom.  My husband took him to the bathroom, since he hadn’t had a bowel movement in a couple of days (sorry, TMI….but part of this equation), but he didn’t have a bowel movement.

It was time for his  vitals check (every 15 minutes during food challenges) from the nurse and the doctor.  We alerted them to his sleepiness and the doctor said his heart rate was normal.  Normally, our allergist said, heart rate would rise in the effect of lethargy from an anaphylactic reaction.  Because of the stomach pain, sleepiness, and rubbing of the eyes we decided to wait an extra 15 minutes before we gave him the next “dose” of cookie, which would have been 1/4 of a cookie.

Superman went back to watching his movie, while we waited to see if he could have the next portion of cookie.

About 6-10 minutes later he was complaining of even more stomach pain.  We convinced him to try the bathroom again, still truly thinking it could either be hunger (food challenges are done on an empty stomach, so he’d had no breakfast) or a bit of constipation.

As he stood up to go to the bathroom, his face got pale and he said something to the effect of, “I don’t feel good” and “I need water”.  I got up to get the nurse or doctor, and as I walked out the door I could hear him vomiting behind me.

At that point the doctor was walking in and it was no question that he was experiencing an anaphylactic reaction as he vomited a second time.  Epinephrine was given immediately and the reaction stopped in its tracks.  I’m going to say that again.  The REACTION STOPPED IN ITS TRACKS.  I’m repeating that to remind you of the life-saving power of epinephrine and why you should carry TWO auto-injectors with you at all times.  (I’m pretty passionate about spreading that news.  Epinephrine has saved my child’s life 3 times now, and I’ll sing it’s praises until there’s a cure for food allergies.)

When a Food Challenge is Unsuccessful~Mom Vs. Food Allergy

After his shot of epinephrine, and asking for a band-aid.

Why did we go ahead with this food challenge?

Our allergist, my husband, and I, felt he was really ready.  His most recent blood test results were very low.  Despite a small positive reaction on a skin test last year, everything still showed a green light for a BAKED egg challenge.  According to this article on American Academy of Allergy Asthma and Immunology (AAAAI), those that can tolerate baked egg are more likely to outgrow their egg allergy and then tolerate regular egg.

His component testing results were:

Egg White specific IgE 0.75.
Ovalbumin is 0.89, and ovomucoid is 0.35.

Ovalbumin is the main protein found in egg white, making up 60-65% of the total protein.
Ovomucoid is a trypsin inhibitor found in raw egg white.

I found this article interesting as I was researching ovomucoid.

Do I regret doing the food challenge?

No.  I can’t beat myself up over something that I made an educated decision on.  I never would have agreed to it if there was any doubt in my mind.  Our allergist was completely surprised that he didn’t pass, and I know he wouldn’t have suggested the challenge if he doubted that it would be successful.  What I learned from this experience is that LETHARGY is his first symptom to an anaphylactic reaction upon ingesting baked egg.  We are to use his auto-injector upon known ingestion of an allergen, or suspected ingestion with the symptom of lethargy.

What’s the takeaway?

Food allergies are unpredictable.  Food allergies are different for everyone, including the type of reaction, and not excluding a person’s tolerance for an allergen.  What I DON’T want you to do is compare your child’s blood test results to my child’s and make a prediction, or base decisions off of our experience.  What I DO want you to do, is talk your board certified allergist about future food challenges and make a plan based on your set of allergies and testing results.

P.S. **Never do a food challenge at home.

The good thing is that he was able to still enjoy a birthday party that afternoon with friends at the local splash park.  He took it easy while I watched him like a hawk for a biphasic reaction.

When a Food Challenge is Unsuccessful~Mom Vs. Food Allergy

Having fun at the splash park!

**Disclaimer:  I am not a medical professional or doctor and this website is not intended for medical advice.  Please consult your board certified allergist for medical advice.  Do not attempt food challenges at home.  In an emergency, call 911.

Has your child had a an unsuccessful food challenge?  What did you learn from it?  Please comment below and share your thoughts!

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Preparing For A Food Challenge

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It’s hard to believe we’ve come this far.  Tomorrow, Superman will have a food challenge for the very first detected food allergy!  Tonight I’ll be cooking some oatmeal to take to his fourth food challenge.  In January he had a soy challenge, the end of February he did a baked egg challenge, and in June he had a cherry challenge.  I know the doctors say there is no correlation between what a pregnant woman eats and what their child is allergic to, but I ate oatmeal AT LEAST once a day, sometimes two.  I love the stuff, and I’m praying that he passes the challenge-so he has more food options and so he can enjoy such a healthy food.

I feel like an old pro with this being our fourth challenge, but I have to admit I’m still nervous.  Superman’s original reaction to oat was a come-and-go rash on his belly with itching, and he never had hives….so, I’m hopeful that tomorrow will go well.  Here’s how we prepare for a food challenge….

1.  No anti-histamines.  Superman isn’t allowed to have any anti-histamines (like Benadryl) within the four days before the challenge.  Check with your own doctor on their rules on this.  We are super careful with his food (like always!) so he doesn’t have any weird reactions that require Benadryl.  We don’t try any new products that appear to be safe in the 4 days before the challenge, but that’s just our thoughts.

2.  Pack the food to be challenged.  We’ve done Silk Vanilla Soy Milk, eggs baked in muffins, fresh cherries, and tonight I’ll make oatmeal sweetened with brown sugar and a bit of Earth Balance soy free margarine.  I’m doing instant oatmeal for two reasons:  I think it’s mushy and I’m worried about cross contamination with nuts….and because I already have 2 canisters of old-fashioned oats in the cabinet.  Your doctor may give you specific items to bring for a challenge, so just ask if you’re not sure.

3.  Pack some entertainment.  We usually take a portable DVD player, the iPad, and books.  I let my son pick what movie/DVD he wants to watch so that he’s happy.  Challenges typically take 2-4 hours so movies are good.

With his DVD player at his soy challenge

With his DVD player at his soy challenge

4.  No food/drink after midnight.  Our doctor says no food or drink after midnight the night before the challenge.  Check with your doctor for their rules on this.

5.  Pack a change of clothes.  It’s always best to be prepared, and to pack a change of clothes in the event your child vomits during/after the food challenge.  Oh, and don’t forget to pack a change of clothes for yourself….just in case!

6.  Pack a lunch.  After the challenge your child will most likely be hungry, so pack a favorite lunch or plan to go to a safe restaurant to fill that hungry tummy.

What should you expect during a food challenge?  Here’s some basics from our past 3 challenges:

*An initial check of vitals

*Increasing amounts of food/liquid every 15 minutes

First bite at baked egg challenge

First bite at baked egg challenge

*A check of vitals every 15 minutes before they eat the next portion

*Staying in the same room during the challenge (other than bathroom breaks as needed)

*Waiting after the last portion is eaten-this may vary from 30 minutes to an hour.

*Be prepared to be with your child the rest of the day.  We have always been advised to be aware of a possible reaction for 6 hours past the last portion ingested.

Here are a few more tips to make the day go smooth….

*Prepare your child by talking to them about what will happen.  It’s up to you whether to warn them that an Epi-Pen shot is possible if things don’t go well.

*Ask to rub the allergen on an arm first to see if there is a contact reaction-this can save some time and agony!

*Take your spouse or supportive friend/family member.  Extra support is never a bad thing!

*Leave siblings at home, especially young ones.  You’ll need to focus on your child doing the challenge, not be distracted by entertaining your other children or having to change diapers.

*Ask questions before, during, and after if you’re unsure about something.

*Stay calm.  You’re in a monitored environment with trained professionals, so no need to freak out and pass that anxiety to your child.

*Remember, I’m not your doctor, but I can share experiences.  Talk to your allergist for the final word in your situation, and don’t use this blog post as medical advice.

*Never do a food challenge at home-it’s just not wise!

I’ll leave you with one of my favorite pictures from a previous food challenge…..He was so proud to take his paper mustache from story time the day before…

MustacheEggChallengeHe’s grown up so much since then!

Let’s hear from you food allergy moms….what are your thoughts or tips on food challenges?  

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