Nutshell: Oh, Nuts

Posted on August 30, 2015 by CNF • Posted in General • Tagged allergies, asthmatic attackes, CDC, Charlotte Oldham, chronic allergies, no nuts, peanuts • Leave a comment

By Charlene Oldham

Teachers can find ready-made signs on the internet that proclaim to kids, parents and passersby that a classroom is nut free. And it’s common practice for some schools to distribute handouts suggesting allergy-safe snacks along with school supply lists. The precautions have become a modern necessity for many given that more than 5 percent of children in the United States suffer from food allergies, a figure that has climbed from 3.4 percent since the late 1990s according to data from the Centers for Disease Control and Prevention. Experts say a number of factors could be contributing to the rapid increase, including the fact American kids’ immune systems aren’t exposed to as many allergens early in life.

“The simple answer is that we don’t definitively know why food allergy among children has risen at such a dramatic rate,” says Dr. James R. Baker Jr., chief executive of Food Allergy Research & Education. “What we can say, however, is that there is some general agreement in the scientific community that the rise could be attributed to a combination of genetic and environmental factors. Certainly, in countries without the level of food hygiene we have in the U.S., there are much lower rates of food allergy.”

The good news is that innovative treatments and a growing body of research now suggests avoidance won’t always be the only way to deal with food allergies, meaning peanut butter and jelly could eventually make a cafeteria comeback.

While experts say kids with allergies should still avoid foods that have caused bad reactions in the past, doing the opposite has proven promising for some patients participating in controlled research of oral immunotherapy (OIT). OIT involves giving children increasingly higher doses of the food they are allergic toward to gradually retrain their immune systems to tolerate it without an adverse reaction. Researchers at Johns Hopkins Children’s Center are conducting several studies related to OIT and are even working to develop a “peanut vaccine” for allergies that is derived from peanut proteins.

“I think there’s a lot of interesting work happening right now. I’m excited to hear more about the study of Chinese herbs and immunotherapy, the studies of the immunotherapy patch and studies using combinations of immunotherapy with other medications,” says Dr. Corinne Keet, an assistant professor of pediatrics who specializes in the areas of allergies and immunology at Johns Hopkins.

Keet cautions that parents whose children have diagnosed food allergies shouldn’t view immunotherapy as a cure, or even an accessible treatment option, for every kid, though.

“I think that immunotherapy for food allergy is becoming more widely used, and more and more parents are looking for it,” she says. “However, I think that it’s very premature for it to be used in widespread clinical practice now. In our hands and others, the rates of adverse reactions are high for a disease of this kind. I’m not convinced that oral immunotherapy, as is currently being practiced, is safer than avoiding the food.”

But for babies who aren’t at increased risk for food allergies – because they have conditions including eczema or a sibling with food allergies, for example – a growing number of medical professionals are recommending parents introduce eggs, dairy products and nut products like peanut butter right along with other age-appropriate table foods. It’s advice that runs contrary to longstanding guidelines from organizations including the American Academy of Pediatrics, which recommended avoiding certain foods until babies were older, or even until they were toddlers. Educational material from the AAP now states that, “many pediatricians recommend against giving eggs and fish in the first year of life because of allergic reactions, but there is no evidence that introducing these nutrient-dense foods after 4 to 6 months of age determines whether your baby will be allergic to them.”

In fact, the results of a study published earlier this year in the New England Journal of Medicine showed that feeding infants as young as 4 to 11 months foods containing peanuts could help protect them from eventually developing peanut allergies.

“The recent LEAP [Learning Early About Peanut Allergy] study, which randomized babies to early peanut exposure versus later peanut exposure, showed a clear benefit to early peanut exposure. We think, but don’t know, that this may be the case for other potentially allergenic foods, like eggs,” says Keet, who recommends parents talk to their doctors to evaluate individual infants’ risk factors. “In general, introduction of these allergens with other table foods is what I advise. “

Turns out, the advice may save babies from developing allergies to those PB&J they’ll encounter later in life.

***

Charlene Oldham is a St. Louis-based freelancer and teacher. She blogs about writing and life at www.charleneoldham.com.

Return to the September 2015 Issue

Water Bending

Posted on July 15, 2013 by CNF • Posted in Articles Page • Tagged allergies, bathing, motherhood, skin condition, special needs • Leave a comment

By Chris Fredrick

Anna fully reclines in the bathtub. Her body and face glide below the surface and her dark tendrils of hair spread out, softly filling the space. She smiles up at me from underwater. “Did my hair do the sunflower?” she asks expectantly, her hair now a sleek stripe along her back. I laugh and nod as we settle in for our daily ritual. I wrap the towel around her preteen body and sit on the edge of the tub holding the Stonyfield Farm yogurt container. But first, I turn on the portable DVD player we’ve nicknamed Little Movie.

Today we are watching an episode from the Nickelodeon series “Avatar, The Last Airbender.” Again. We’ve watched the full series twice before, but Anna’s audience at 9 isn’t what it was at 7, or 5. And, we are both big fans of Katara, the show’s female lead. We learn in the first episode that water bending isn’t magic, it is “an ancient art unique to [their] culture,” and what it means is that Katara can move water without touching it.

When Anna was just two weeks old, she had a large pimple on her face. We were at my dad’s for brunch, and Grandma interrupted a conversation to yell across the room, “Chris! Why does Anna have that thing on her face?” I cringed. I was insulted, or maybe just embarrassed. Anna was my baby girl. She was gorgeous and perfect, and I didn’t want to acknowledge the interloper that I already sensed was ominous.

The following week, to my great relief, the doctor said it was just baby acne and that it “would clear up in a month or two.” It was no longer a single pimple; her face had changed rapidly and now pimples completely covered both cheeks, giving her face a pink, sandpapery texture with some patches elevated to a glossy sheen. I asked again at her two-month and four-month appointments. At the four-month visit, the doctor said, “Well, it doesn’t look like baby acne anymore, it’s probably just eczema.” Just eczema, I thought. Just—just—eczema. It sounded minor and common. It would go away.

I don’t wonder now why she cried so much and had such a hard time sleeping, but at the time I was looking for other reasons. This, after all, was just eczema. I am also embarrassed to say that I didn’t want to take pictures of her when her face was red and sore. It seemed to ebb and flow, so I would wait until her face was clear—and then snap a bunch of shots, changing her clothes and location so it seemed like the pictures were taken more naturally. “Bathe her frequently and apply cream,” I was vaguely directed.

Watching our Little Movie, we are both absorbed in the story. In this episode, both Katara and Avatar Aang learn from a water-bending master in Katara’s sister tribe. They need to be able to “bend water,” to use any avail- able water in stylized kung-fu fighting. The enemy is the Fire Nation—the people who can bend fire. I pour water over Anna while she watches, pausing the show while she submerges, and glancing occasionally at the stopwatch. Katara’s smooth motions direct the responding water and Anna imitates them, dancing her hands on the water’s surface.

By the time Anna was nine months old, I was religiously and doggedly bathing her. But that December 23rd, I noticed a ping-pong ball-sized lump on her collarbone. Panicking, I drove to Anna’s daycare to ask if anything may have happened. I recalled with a sting how she had cried out as I buckled her car seat. A slight fever—how many days had it been? One? Two? I had ignored it because that’s what happens with teething … right?

The next day she had an X-ray that confirmed no broken bones, but an MRI showed an abscess in her lymph node. She had surgery the following morning, her first Christmas, to drain the abscess. After being hospitalized for five days and on strong antibiotics, the skin on her face was once again as clear as it had been during her first two weeks of life. The consensus among the attending physicians was that she had likely scratched an open patch of eczema on the inside of her left elbow. A staph infection had then entered the bloodstream but had been trapped by the lymph node. She would be fine.

We maintained the bath routine we knew, and I tried to think of creative ways to keep her happy. The biggest logistical challenge was keeping her from streaking around the house when I was trying to get the cream on her squirmy little body. She would run away or cry if I restrained her. I was often on edge, and sometimes joined her in tears. “We are in this together,” I confided to her, my 18-month-old. “It is sad for me, too.” Certainly, any place outside our soaking rite, hitting was a strict “no-no.” But many nights, in the small, sweaty bathroom, I let her pound on my legs with her tiny fists while I restrained her and applied the globs. I don’t blame you, I thought. I would hit me, too. This is how the Little Movie was initiated into our club.

In addition to the water-bending tribes, there are other nations that have bending powers. The Air Nomads are air benders, of which Aang is the only survivor. The Earth Kingdom has many earth benders. Of all the elements, though, water is the only one with healing properties, and fire is the most dangerous and the hardest to control. Anna alternates between dunking her head and receiving my Big Gulp pours. She doesn’t flinch when I pour the water; she simply lifts her head to meet it. The water runs as a river, bending around the contours of her face. I watch her cheeks as I pour, and I can see the red drain away. I imagine the healing as the water cools the flames.

When Anna was two, she stopped sleeping through the night and would be up, sometimes for several hours, incessantly scratching. I rocked her, rubbing her arms or legs or back–wherever she was scratching. It was around this time she also starting having problems with her hands. They were so itchy that she would scrape them on furniture or carpeting, trying to get more leverage but tearing off sections of epidermis, revealing raw red patches and what looked like tiny white pearls.

Our allergist gave us new tricks. I was logging daily in a notebook— exactly what body parts (or parts of body parts) were flaring and how I was treating them—so I could perhaps look back and find patterns. The Notebook gave me very few answers, but it did help me identify some of Anna’s more elusive, though inconsistent, enemies. Some of the troublemakers seemed to include: the neighbor’s black lab, the month of April, and the wind.

When Anna turned three, she had worked her way through the allergist’s ideas and had even done a stint on anti-depressants to help us all sleep. She was then referred to the outpatient program at National Jewish Health in Denver, Colorado. During the week we were there, she received a more specific diagnosis: chronic atopic dermatitis. A symptom of this condition is that her skin does not have natural antibiotics, so if her skin is “open,” then it is open wide to infection. The “tapioca pudding” on her hands was diagnosed as dyshidrotic eczema, which was described as stubborn. Her atopic dermatitis, being chronic, was described as debilitating. These words made it into The Notebook in large print, boxed for emphasis.

While at National Jewish, I was trained by nurses as I bathed Anna. I was timed and critiqued. “You missed the top of the toes.” “You missed the eyelids.” “You need to apply that cream as if you were frosting a cake.” At the hospital, I felt relieved when I saw how much better Anna’s skin looked compared to other patients’, followed quickly by a hot flash of guilt. These babies, some seven, eight months old and some as old as Anna were all mummy-wrapped head to toe. Unrecognizable in their wet wraps, they wore bows of pink or blue on their heads. They were little cupcakes toddling through the hospital’s hallways.

Once she comes out of the chest-deep tub, I have three minutes to seal her skin in a combination of ointments and creams. Any reddish patches will get triamcinolone .025% cream, or .01% ointment depending on how stubborn the blotches have been. Her hands will get fluticasone, but only if she hasn’t had it more than three days in a row. These were the everyday sorts of applications, without the complications that would come with infections, scalp patches, molluscum, travelling, illness, stress, or head lice. The application is done as a patchwork quilt—the medicated ointments are not covered with non-medicated, but every centimeter must be covered, and all within three minutes.

By age four, Anna was a much happier child. Twice a day we soaked and sealed her skin as I had been trained. The full process takes over an hour from start to finish, so it took approximately 16 hours a week. The results were astounding, and it was then that our family came to know the real Anna. We had thought of her as high strung, hard to please, and crabby. But now, a new being emerged. She was compassionate, intelligent, and hilarious.

The stopwatch is crossing the 18-minute mark. I pause the Little Movie and move it to the counter while Anna shampoos her hair. Research shows the soak should be longer than 20—but shorter than 30—minutes. If we are outside that window, we aren’t helping and may make matters worse. When she gets out of the tub, her hair is wrapped up high off her face and ears so I can get the cream into every crevice.

Anna knows that she has sensitive skin. “Does anyone else have sensitive skin?” she asks.

“Lots of people have sensitive skin.” I am thinking now of the other cupcakes.

“Not as sensitive as mine. Mine is the sensitivest.” Anna has a large handful of cream that she is using to apply a base layer to her trunk—she has been finger painting “a rabbit holding a carrot” on her belly at this point in our routine. It started on Easter, over a year ago.

As I use the final Q-tip to check her ears, we are done—until tomorrow. And as long as we maintain our vigilance, we will keep the flares at bay. But the face of our enemy changes. I keep adding new hazards to The Notebook: swimming lessons, night- gowns, hand sanitizers, sweat. Now that she’s nine, I brace myself for what will be around the corner. She knows that when all the other girls are lined up for face paint, she needs to find something else, but how soon will she want to wear makeup? How soon before she is invited to a sleepover?

Tomorrow, as today, she will sit in water as deep as the tub allows. The towel will shroud her, and I will pour the water as she gently closes and then opens her eyes. I will bend the water as it flows over her forehead, over her cheeks, willing it to reach and heal every centimeter of skin, every part of her. We will both watch the next challenges that Katara will conquer, another courageous girl, another master of water.

Author’s Note: Tonight, Anna is filling her own bathtub for the first time. She is nearly self- sufficient with her routine. We still love The Last Airbender, but we’ve moved on to TV episodes of “Once Upon a Time” and “Burn Notice” and we’ve started playing Washcloth Basketball, where I shoot the washcloth to her over the shower curtain rod “rim.” And she still pauses to finger paint the rabbit on her belly.

Chris Fredrick spent 20 years writing technical documentation, marketing pieces, training, and (in darker moments) website code. An avid runner and mother of two, she initiated a creative writing sabbatical in the summer of 2012. Chris is currently working on a book chronicling her husband’s life–his childhood in Vietnam and his escape to the US after the fall of Saigon. Her work has appeared in Literary Mama. Read more of her work at: chrisfredrick.wordpress.com.

Illustration by Jane Heinrichs

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Peanut Butter Stinks

Posted on February 20, 2013 by CNF • Posted in Articles Page, Highlights • Tagged allergies, growing up, Morgan Baker, peanut butter, safety • 2 Comments

By Morgan Baker

I can smell peanut butter a room away. I know where the open dish of nuts is at a party, and it’s not because I’m salivating for the food.

When I gave birth to my oldest daughter, I knew I’d teach her safety tips like how to look both ways before crossing the street, but I didn’t know I’d teach her how to read ingredients on food packages, and to remember her EpiPen (a shot of artificial epinephrine to jump start her system should it shut down) when she left the house.

When Maggie was 11 months old, I slathered peanut butter on some crackers, tossed them on the high chair tray and watched her lick the crackers clean. I left her in the high chair (something mothers are warned not to do) and ran to the bathroom. When I returned, she was unrecognizable. Her face was swollen to twice its size and covered in hives. Her eyes were almost swollen shut and her lips were puffed out.

I poured liquid Benadryl down her throat and called the pediatrician who was at lunch. The answering service recognized the significance of my call because the pediatrician called back and asked, “Is she breathing?”

Maggie, I learned later, is anaphylactic to tree nuts and peanuts. If she eats one by accident her body can shut down. Her blood pressure can drop, her heart rate can slow and her throat can swell up without a shot of epinephrine in the first 15 minutes of a reaction, she could die.

I know this from meeting with doctors, reading lots of literature and watching my husband almost die several times as his allergies continue to change and develop as he ages.

I grew up on peanut butter and Fluff and ate Snickers bars throughout my pregnancy, but when Maggie was diagnosed with these life-threatening allergies to peanuts and tree nuts, I tossed our half-eaten jar of peanut butter in the trash. We haven’t had another jar in the house in twenty years. My younger daughter doesn’t know what it tastes like.

I spent much of Maggie’s childhood trying to control her environment. She took her own piece of cake when she was invited to birthday parties. We chose her schools partially based on where my husband and I thought she’d be best protected. We avoided those with huge cafeterias and she ended up at a small school where I advocated for her class to be nut-free, for the middle school lunchroom to have a nut-free zone and eventually in high-school for the students to eat on trays to avoid cross-contamination. In one case it took an obituary to motivate the administration to give me what Maggie needed.

But I didn’t just educate her school and friends, I also taught Maggie how to keep herself safe. She doesn’t eat any food if she doesn’t know what the ingredients are. She carries her EpiPen with her at all times – she has a huge collection of purses – and she needs to identify herself in restaurants.

Maggie didn’t always like being singled out, but my zealous behavior has kept her from harm. She has had only two accidents since the original incident. When she was 13, she ate a congo bar at her grandmother’s memorial service on Martha’s Vineyard thinking I had made it. The caterer had made it – with nuts. A 30-minute ride to the hospital and an EpiPen later, Maggie was fine.

My job as her official advocate, however, ended when she started college. The last call I made on her behalf was to food service at Vassar. On move-in day, two kind administrators showed us around the dining center and explained which food stations would be more, or less, safe for Maggie. They also showed us the Peace of Mind station where Vegans or those who are lactose intolerant, or those who keep Kosher, could find safe food.

I knew letting go of Maggie was going to be hard, but I didn’t expect to choke up in the cafeteria when I saw the individual cream cheese containers for her in the refrigerator. While everyone else could slap cream cheese and peanut butter on bagels without paying attention to the neighboring open-air containers, Maggie could enjoy one of her favorite foods safely.

As a sophomore, she lived in a teeny-tiny single, which she obtained on her own through The Office of Disability. Now as a junior preparing for senior housing, she’s discovering not everyone can or wants to live without peanut butter. Vegetarians rely on it as a source of protein, and others depend on it for easy meals, but she’s navigating this journey with her friends, not me.

As she departs for a semester abroad, I try not to think about how she’ll communicate her allergies in a foreign language away from home.

I’m not with her all the time anymore, but when I smell peanut butter or see nuts, I catch my breath and think of Maggie. I keep my fingers permanently crossed and hope I’ve been aggressive and proactive enough, that she’ll continue to take care of herself the way I would take care of her.