IT’S BEEN a year since we last had Sidney skin prick tested and in that intervening period we’ve come on in leaps and bounds.
The wheat allergy bit the dust this summer and, since having a succession of negative and low skin prick results, we’ve been able to introduce some new foods: cannellini beans, butter beans, baked beans, coconut, mango, pineapple, melon, kiwi… The culinary world is opening up, and for that I am hugely grateful.
I didn’t invest an awful lot of thought into what this latest round of tests would show. I know that at three he would be exceedingly young to have outgrown his egg allergy (the median age is seven, although kids can and do outgrow egg into adolescence) and I know that the likelihood of shaking off the nut and sesame allergies is fairly low (ten to 20 per cent chance for nuts, unknown but unlikely for sesame).
But I suppose a tiny part of me wished, secretly, for some miraculous turnaround: that the nurses would exclaim excitedly that there was NO wheal; the doctor would pronounce him “egg/peanut/whatever allergy FREE!” and we would be sent off with instructions to feed him many cakes and peanut butter.
His eczema is so beautifully under control, we are so super-vigilant with everything he eats that there has never (touch wood) been any accidental exposure and we’ve only had to administer antihistamines once in a year and a half (a mystery outbreak of hives on his face after he scrambled around a hotel garden in Rome earlier this year). But, of course, allergy cannot be controlled, only managed. How his immune system behaves is out of our hands.
So I’ll start with the positives: chickpea and green pea and green lentil all scored very low, or zero, which means we are free to try some oral challenges for them. The green pea we’ll be trying in hospital, as he’s scored zero before but gone on to react after a taste test.
Also good news: he’s continued to score either pretty low, or zero, for almonds, walnuts, pecans and macadamias, which means we can follow up our successful hazelnut trial with taste challenges for all four of those tree nuts, at home. If he passes, we’d still be restricted when out as nuts can be cross contaminated with other nuts, but we could buy them in their shells and whip up dishes for him at home. (Note to self: Must find recipes for marzipan and walnut whips.)
Not so good news: peanut, cashew, pistachio and brazil are still definite no-nos, and the skin prick tests to egg and sesame threw up ginormous wheals that left us in no doubt; bigger, in fact, than last time. Boo.
On the up side (up and down like a yo-yo here), Sidney’s SPT results have always see-sawed, perhaps slightly unusually, so we can’t yet read too much into the sudden blooming of the egg and sesame reactions. It doesn’t change anything, anyway; we knew egg and sesame were biggies. Now they are slightly bigger biggies. Maybe.
But, interestingly, we have still been given the go-ahead to attempt a baked egg challenge under hospital conditions, probably in the New Year. According to the most recent research 70 to 80 per cent of egg allergic children can tolerate baked egg, and the general consensus is it is no longer necessary to wait until children are five before giving it a shot.
We will be given a recipe for muffins to prepare at home, with around one third of an egg in each, and bring into the hospital to try out under supervision. If he passes, he will be able to eat some egg-containing baked goods (homemade, of course, to guarantee they are nut and sesame free) but there would be an optimum amount of egg per serving. Anything too eggy, like this (!), would probably tip him over the allergy edge.
There is also some discussion – but no definitive proof – that consuming baked egg (after a properly supervised oral challenge) might then build tolerance in egg allergic children.
It’s exciting, of course, but my pessimistic side would almost rather trudge on as normal than take the challenge and find he can’t tolerate baked egg after all. But that, of course, is silly.
And how did Sidney cope with his ‘skin prickle tests’ a full year after his last bout? Amazingly well, although the telly in the nurse’s room helped. With Peppa Pig along for support, he was happy to tinker with the toys, admire his new sticker and dash around the yellow wendy house.
And at bath time we were categorically NOT allowed to wash off his “scribbles”.
* Dr Lisa Bartnikas of Boston Children’s Hospital, published in the Journal of of Allergy and Clinical Immunology