Friday, July 27, 2012

All I Know About Food Allergies, I Learned From Baseball

1. There's No Crying In Baseball! No wishing for a life without food allergies. No thinking about how easy vacations would be, or how limited restaurant choices are. No looking at the neighbor's horrible brat and wishing you could transfer the allergy to him. No pity parties, period. Every kid gets something, and you can't always see what they're dealing with. Just play the game.

2. Cover Your Own Territory. Yes, I'm sure I'm a great shortstop...and left fielder...and even pitcher. But I have my own game to play at my own position. I cannot save the rest of the team. (Repeat it to yourself, FAB - you cannot save the rest of the team! Stay off those unmoderated chat boards!) I cannot change how they play their game. A "you go, girl!" or a positive, very respectful tip once the inning is over is all I can do. When I start telling other players they're doing it wrong, or there's only one way to do it, it's probably time to take a time out.

3. Keep Your Eye On The Ball. It's not about food additives, or vaccines or GMO. It's about food allergies. We need to avoid the foods we need to avoid. On the other hand, I need to commit to giving him every last food he can have, even if it makes me uncomfortable. Even if he used to be allergic and outgrew it (especially this -- keeping foods in the diet may be protective).

The day I start controlling through food is the day I start losing the game. It takes all my energy just to be a good food allergy player.

4. Give Up On Not Getting Dirty. I want everyone to like me! I don't want to slide into 2nd . But...let's face it. The other mothers in this game want their kids to win too. I need to come ready to play, focused on my own team.

It doesn't do any good to vilify the other team. It just sucks away my energy and focus. They don't care, or even know, that I'm wasting time hating on them. Let it go and save the energy for what happens on the field.

On the other hand, competition gets the juices flowing. Right? (And if your cleats are up...she probably deserved it.)

5. Games Are Won Because Skills Are Solid. It takes time to master a skill. It takes comprehensive accurate instruction, followed by years of practice.

First, I need to understanding the theory. That means learning and finding a good coach. Just as we don't learn baseball from only listening to the other kids in the dugout, we don't learn food allergies by only listening to the other mothers who may know less than we do.

Then, we need to practice, practice, practice. Malcolm Gladwell theorized that it takes 10,000 hours of practice to master a discipline. It's going to take 10,000 outings (and probably 5000 reminders) before my kid always takes his meds with him. It's going to take 10,000 meals to feel comfortable with ingredients and substitutions. I need to cut myself a break if I'm not in the Major Leagues after my first year. Everybody's a rookie at some point.

6. Respect the Ump. Umps are human. Doctors are human. They do the best they can with the information in front of their eyes. They have the best interest of the players in mind. Question the plays, not the man. (Or woman.)

Asking for one change of ump in a league might be understandable. But, when you're complaining about umps over and over, you gotta ask where the problem really lies.

7. When It's Your Turn At Bat, Give It All You Got. There are a lot of bad pitches. You do have to have a good eye to avoid NAET, and hazelwood necklaces and special, magic blood tests. But, when the right treatment comes along, swing for the fences. Don't let the fear of getting hit by the ball stop you.

Lots of people get hit by the ball. It's part of the game. A reaction during a food challenge is not the end of the world. The coaches and umps will throw you an ice pack and the game will go on.

If you never step up to the plate, you're definitely never going to get on base.

8. Call The Ball. Does it feel like you're catching everything that's even remotely in your territory and the guy standing next to you is asleep? WAKE HIM UP! There's nothing wrong with saying "that one's yours!" as long as there's enough time for him to prepare for it. If you don't call them, how is he ever going to know?

By the same measure, if it's in your space, a clear "I got it" is never a bad idea. Yes, it saves duplicate effort...but it also reminds the team of your value.

Seriously. I've been seeing a lot of "food allergy divorce" type searches creep up lately in my blog stats. Call the ball. 

9. Celebrate The Victories. Nobody wins every game. Some teams simply have an advantage. Winning is really not what the game is about. It really is only about doing the best you can do. 

Don't forget to celebrate together. You don't have to have an outright win to celebrate. Celebrate learning to run. Learning to just stand at the plate as the ball whizzes by your head. Learning to hold your mitt solid against the ground, even when the ball goes between your legs. If you are getting better every day, you're doing o.k.

10. Remember...It's Supposed To Be A Game. When you look back on these Glory Days, what will you remember?

Will you remember how hard it was? All the tears? The games you missed out on because you didn't have the right equipment or uniforms? The other players who taunted you and then beat your pants off?

Or will you remember the sunlight in the field? The glance between fielders and the trust that the other guy would catch the ball? That great feeling when the littlest kid on the team finally smacked it for a base hit?

This is the game. Get out there and play — and have fun!

Summer doesn't last forever.

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Tuesday, July 24, 2012

Walking the Street of Imaginary Grief

I really don't want to write about Aurora. But...I also haven't been able to write or think about anything else since the shooting. It cuts a little close to home for me, literally, as I lived about five blocks from both the killer's apartment and the movie theater after I graduated from college. I've thought about why that even matters to me, 25 years later, and the answer is simple: all tragedies are about me

It's human nature to personalize it all. We see ourselves in the shoes of the victim (and maybe even a little in the shoes of the killer, based on the amount of speculation about why he would do this). It's just a little easier in this case for me to put myself in those shoes because I actually walked those streets.

My guess, though, is that you ALL are putting yourselves in those shoes, way more, perhaps, than other mothers are right now. And, again, the reason is simple   you've walked those streets. Not the streets of Denver around the med center, but the streets in your mind of having a child suddenly, senselessly, taken from you.

Does it do any good to walk those streets? Does it somehow keep our children safer to envision them dead? Do we try harder as a result, perhaps, to keep them safe? The answer, of course, is no. And yet, we all walk down foggy Whatif Avenue way too much.

My mother is a clinical psychologist, so I have a built-in go-to resource for this type of thing. She says the trick is to recognize when the negative thinking is occurring and then to re-frame it to a more positive thought. In other words, when you find yourself daydreaming about your child dying from an allergy, STOP the thought and substitute whatever works for you:
  • I've taken every precaution and trained him well, so the likelihood of him dying is extremely small
  • Most children do not die from anaphylaxis, even in situations when it's left untreated
  • Only a handful of kids die each year, and the vast majority of them did not have epinephrine with them
Or, simply, "my child will not die." 

No parent wants to think about death. But thinking about it all the time is like a little death, again and again. It doesn't make us more prepared, should the worst occur. It just makes us afraid, and therefore less able to cope in an emergency.

We're surrounded by negative stories. Negative stories build web site traffic. But there's a huge irony in living in a world that is the safest it's ever been, with technology like an Epi-Pen that can save lives, yet being more afraid than past generations. Our movies are filled with shootings and deadly viruses and global warming catastrophes. Our fiction (especially our children's fiction) is increasingly dystopic.

I don't know what motivated this man to kill so many, but I do know the line between fiction and reality was awfully blurry for him. It's not realistic to only watch re-runs of The Waltons...but maybe a little less Contagion and 24-hour news would help.

It's these little things, they can pull you under 
Live your life filled with joy and thunder 
Yeah, yeah, we were altogether 
Lost in our little lives 

All of us will have cause to grieve at some point in our lives, so in that respect, we are the same as the Aurora families. However, there will be time enough for grieving when the day comes. We know we're especially vulnerable, so that's all the more reason to protect ourselves emotionally.

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Wednesday, July 18, 2012

Food Allergy Vigilantism

I recently joined Twitter. I was disturbed the other day to see a whole series of posts targeting a local bakery that apparently had a "nut free" sign, yet served cookies with M&Ms.

I'm not saying restaurants should declare themselves nut-free if they're not. However, in this particular case, the Tweeter targeting the restaurant had not even spoken with the owners. She had emailed them once without response and decided to take her case to the Twitterverse and blogworld. Hey, she might have saved a kid from a reaction, so no harm done, right? Except to the restaurant's reputation...the same restaurant that was trying to accommodate us (even if doing it badly).

Another incident from this week. one of the boards (don't remember which) posted a picture of the new Smarties candy label. Instead of just the regular ingredients statement, there's also now a statement on the bag about what the candy does NOT contain.

Half a dozen moms immediately piled on with comments like "I would never feed my child all those artificial colors!" Sort of misses the point.

So maybe I'm oversensitive. I think we've established by now that I'm a slacker mom when it comes to this stuff. Before my son was born, I embraced formula, harsh cleaning products, non-organic foods, Big Agra and just about anything else killing our planet and the life on it. I was blissfully unaware.

But still. Are food manufacturers really the enemy? Especially the ones who are actually trying?

Over the years, there have been a couple of food producers who have really been hung out to dry by our community. The two that immediately come to mind for me are Subway and McDonalds. A brief recap for those of you who are new to FA...

In 2006, Emily Vonder Meulen had a fatal food-allergy reaction after eating at a local Subway. The cause of the reaction was never determined. It may have been cross-contamination from the peanut-butter cookies; Emily's parents have since theorized that it may also have been a suddenly-apparent cross reaction to the soy in the chicken sandwich (the sandwich had no known peanut ingredients).

Today, Subway is one of the best, most allergy-aware restaurants my son eats at. The cookies and bread are baked on different pans. Every line worker will change gloves if asked. Yet, I am still seeing posts from parents with no awareness of the original incident who have heard "from the friend of the nephew of my neighbor's postman" that Subway is bad for food-allergic people.

McDonald's, the second company that's gotten hammered, at least brought the situation on themselves. Before the 2004 Food Allergy Labeling Consumer Protection Act (FALPCA), consumers such as my family were left guessing or calling about natural flavorings in foods. After the passage of the act, manufacturers were required to disclose food flavorings and additives derived from the Top 8. (Hallelujah!)

However, we were shocked to find McDonald's suddenly disclosing the milk origin of the flavoring in their French fries. To add insult to injury, the en vogue theory at the time was that total avoidance was the best way to outgrow a food allergy. Was it possible that us giving our son McDonald's fries all those years had made his allergy persistent, even though he showed no reaction?

We fired off an angry letter. McDonald's responded that, although the flavoring started with hydrolized milk protein, by the time they were done with it they were confident the flavoring no longer contained enough protein to cause a food allergy reaction. We thought it through, shrugged, and continued giving the fries.

So, you see, we're slackers again. I just don't have that pristine approach to food allergies, or foods in general. I won't give my son foods with a "may contain" peanut label. But, in the case of McDonald's, their people swear the food DOESN'T contain the protein, despite the ingredients statement. It's akin to labeling anything with soybean oil as "soy", even though the vast majority of people with soy allergy can tolerate the amount of soy protein left in oil.

Like Subway, McDonald's is one of the companies we really trust for food awareness. I was not happy that they did not disclose ingredients, but the bottom line was that they were right  even my very-sensitive-at-the-time son could tolerate the fries.

There are a lot of sloppy manufacturers out there, food companies that really don't dedicate themselves to the food-allergic community. I just wish we would stop vilifying the companies who truly do make the effort.

Yes, Smarties contain crap. But that doesn't bother me, as long as they don't contain peanuts.

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Friday, July 13, 2012

50 Shades of Food Allergies

The day he walked into my pharmacy, time stood still.

Tall...dark...beautiful. Everything you would expect from the proverbial hero. From his rich, raven locks to his crisply tailored suit, to his European shoulder bag?

"Christian Gray," he said, looking me up and down as if I were a streetlamp. I must have hesitated too long, because he cocked an eyebrow, leaned forward and whispered "PreSCRIPtion?"

I felt as though I had been shot. With a syringe. And, God knows, I knew what that feels like.

"Oh, yes, sorry," I mumbled.

"Sorry, WHAT?" he barked, a glint in his eye.

"Sorry, Sir?" I offered, backing away from the counter. I could tell my life had changed. I just couldn't tell yet exactly how.

As I handed him the box, his eyes traveled yet again over the length of me, like I was a piece of wood he was measuring for a a spanking paddle. As he tucked the box into his beautiful, Italian leather bag (which was growing on me by the minute), he again leaned forward and whispered.

"You will write your email address on my receipt. NO - no talk. Just do it now. Slowly."

And so I did. I don't know why. There's just something so compelling about a shoulder bag on a man.


TO: Anastasia Steal
FROM: Christian Gray
RE: What you WILL do

Miss Steal:

I want no argument about the following. You WILL meet me for dinner at the Palmer House. You WILL be there at 6:00. And you WILL do whatever I ask you to do for the next 12 hours. 

Christian Gray

TO: Christian Gray
FROM: Anastasia Steal
RE RE: What you WILL do

Um...look, I think you're hot and all, but the Palmer House probably doesn't have a lot that I can eat. Do you think we could make it the Outback instead? 


TO: Anastasia Steal
FROM: Christian Gray
RE RE RE: What you WILL do

Miss Steal:

I do not think you understand the nature of our relationship. When I say "jump", you will jump. Me. Now, if that is what I wish.

Palmer House at 6:00. No questions.

Christian Gray

OMG. Now what? I had only attempted to eat at the Palmer House once before and had a horrible reaction to shrimp. Was this man worth risking my life for?

I thought about the shoulder bag and sighed to myself: Yes. Oh, yes!


When I arrived at the restaurant, he was already seated, with drinks and appetizers on the table. I slid into my chair, apprehensive for so many reasons, but still tingling with...

Excitement? Anticipation? Expectation?

But then I realized that it was probably the fumes from the shrimp appetizer.

"Oh, Christian, I have to tell you " I started to sputter, but with that, he placed a hand over my mouth and said, "There are rules, Miss Steal, and you would do well to start learning them now, while the lessons involve no pain."

I didn't have the nerve to tell him the pain was already starting. I could feel a tightening sensation in my throat, and it wasn't solely from admiring the form-fitting jacket he was wearing (although that didn't help matters).

"I know you must think this is unusual," he murmured, extending a glass to me. "But there was just something about your eyes that told me you were going to do whatever it was I asked of you." I swallowed.

"Whoa, wait, what was in that gl—" was all I could get out before he again clamped a hand over my mouth.

"Shhh!" he managed to whisper both forcefully and so those at the tables around us didn't stare. "I told you: no talking, no arguing, no thinking."

Regardless of what he wanted from me, I couldn't help but think. The taste on my lips was sweet...unknown...something I couldn't match to any previous experience.

Except the one that sent me to the hospital as a child. Almond.

"Your lips are so beautiful," he expelled, gently tracing the outline. "So luscious. Like an overripe apple, just be..."

He trailed off. Based on my previous anaphylactic reactions, I knew I had probably exited the Angelina Jolie stage and moved into the puffer fish stage. From voluptuous to vile in the space of a minute.

"I'm gonna...need..." I started to croak, but Christian was quicker. Like a flash, that European shoulder bag was on the table and the contents were pouring out.

Benedryl, asthma inhaler...ah. Epi-Pen!

"Lift up your skirt," he barked, kicking his chair over in his hurry to get to me.

"But I don't have any underw—"

"Just LIFT IT UP!" he shouted, ensuring that every single eye was on me as he exposed my most private parts to public view and jammed his long needle into my quivering thigh.

The elderly man at the table across from us fainted.

My heart was racing. I felt flushed and fevered. For God's sake, my teeth were chattering. It was unbelievable what this man could do to me.

OK, maybe the epinephrine was affecting me a little too.

Christian was close enough to me now to lick, if I chose to lick him.
I didn't.

His look was intense, smoldering. His lips parted and I waited for the next command, which I knew I would follow, no matter how difficult, no matter how demeaning.

"We have to go to the emergency room," he breathed.

"Um...o-o-o-o-k-k," I managed to squeak. Christian withdrew the Epi-Pen from my thigh. Only 10 seconds had gone by? I thought. Every moment seems like a lifetime with this man!

"Do you need my inhaler before I call an ambulance?" he sighed into my ear, clearly disappointed that the skirt had been readjusted to hide my creamy thighs from his sight.

"How do you KNOW what I NEED without asking?!" I wheezed. "It's like you're INSIDE me, inside my, my, MIND, listening to MY, every THOUGHT!"

His hand gently held out the inhaler, allowing me to sip from it as I had sipped from the Frangelico snifter just a few moments before.

"I am your fate, Ana Steal," he said, the intensity in his eyes like a burning ember. "Oh, and I have a peanut allergy."

As they wheeled me toward the waiting ambulance, Christian at my side, I thought about the irony of giving myself so fully to a man who should have known enough to read the label first!

Oh well, I concluded. Perhaps total surrender is overrated.

But, oh, the things this man could do with latex! I looked forward to the next six hours in the ER with the anticipation of a six-year-old on Christmas Eve.

I was pretty sure I was going to get everything I desired. Once the vomiting stopped, of course.


The End. 
Or is it only the beginning?

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Thursday, July 12, 2012

Pediatricians Cause Food Allergies!

You may have seen media references to a new study out this week: Infant Feeding Practices and Nut Allergy over Time in Australian School Entrant Children

The headlines have been quite sensationalistic:

Children With a Regular Doctor More Likely
To Have Food Allergies!

Seeing The Pediatrician Linked To Allergies

Child Have An Ear Ache? Think Twice About That
Routine Trip to the GP...

I'm sure you've seen these headlines splashed across your various news feeds.


Well, how about these then?

Oh, yeah, those you've seen! 

Here's the thing: the study referenced above actually found a correlation between both things. Children who were nursed exclusively during the first six months of life were slightly more likely to have a nut allergy. About the same level of risk was found for children who regularly visited their doctor

I know news organizations are desperate for controversies that will pump up readership...but this just seems so WRONG and STUPID! Now there will be another round of new mothers afraid of breastfeeding, afraid of peanuts...all because of a study that has, buried in all the biased language, an important line:

Also, the study design does not allow causality to be inferred.

Stop and think beyond the sensationalism for a moment. We KNOW there is a sensitizing agent/experience involved with food allergies. Somewhere along the line, a baby's immune system is encountering proteins to which it develops a response that later becomes a food reaction.

These sensitizing proteins may very well be in breast milk. However, those same proteins may be on Mom's hands after she made that peanut butter sandwich, or inhaled as pollen that has potential for cross-reactive immune mix-ups. They may be trace amounts in baby foods or baby products. There may be some other entire mechanism for sensitization that we do not yet understand.

This study from the early 90's took the issue of sensitization and breast milk on directly. Mothers were asked to avoid milk, egg and fish while nursing. While initially the babies in the avoidance group showed lower levels of IgE antibodies (in other words, sensitization), over time, the avoidance had no effect on whether the babies demonstrated an allergy. (Here's a comprehensive  and far less biased  review of studies related to maternal avoidance of proteins and the effect on food allergies.)

The point is that the set-up for the sensitization is already in place by the time the protein is introduced. Withholding foods probably doesn't prevent an allergy, but simply delays it. And the fear is that, the longer we wait to expose children to foods, the more opportunity the body may have to develop that environment/trigger/mysterious occurrence that leads to sensitization. That's why doctors shifted back to telling moms to eat the peanuts. Keeping them in the diet seems to do less harm overall. Perhaps they advice will shift yet again with this study...but does it really even matter?

The bottom line is: humans have been nursing babies and eating nuts for hundreds of thousands of years and very few of those babies became sensitized. 

Sensitization is not the answer, or really even a large part of the puzzle. The question is why some children become sensitized and why it is happening now, in the last 20 years, in so many children. The protein involved (like peanut) is also not a large part of the puzzle, because the common allergens change as a culture's food changes. We know babies tend to become allergic to foods that have the right molecular weight and allergenic properties that are most commonly eaten by the population into which they are born. 

This study seems to be implying that somehow changing the window of solids introduction from four to six months is enough to tip Mother Nature over into suddenly creating an epidemic of food allergies. Am I the only one that thinks that conclusion is just flat-out stupid?

It's almost as stupid as looking at the data in this study that was JUST AS STRONG in favor of a link between visiting the doctor and food allergies...and concluding that doctors cause food allergies.

But, then, the Mommy Wars don't revolve around doctor visits. They do revolve around the decision to nurse. Easy to see why these publications would focus on one and leave the other behind.

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Wednesday, July 11, 2012

Mommy Guilt, Or How I Caused My Child's Allergies

I caused my son's allergies.

I know I did. I just don't know how I did it yet.

Was it the peanuts I ate (or didn't eat) during pregnancy? The medication I took? The hospital birth I chose, where my child was a) exposed to horrible bugs, and b) delivered via c-section, putting him at higher risk for allergies? Was it the formula the nurses gave him while I slumbered away, oblivious, sleeping off the effects of the anesthesia and pain killers?

What about the ear infections he had? We must have given him gallons of antibiotics. Or that horrible illness he had when he was so very little and the doctor told us to alternate Tylenol and Ibuprofen until the fever finally dropped? Did I damage his gut with all the medication so those sensitizing proteins could find their way in?

Or maybe it was the vaccines. Vaccines just feel wrong and they were given right around the time of that first allergic reaction.

Or maybe it was just our yuppie lifestyle. We live in the suburbs. We painted and carpeted his first room. We exposed him to all that urban pollution.

Or what about the things we used in our house? We could have restricted all those processed foods, those kitchen cleaners, the additives in his bath soap and diaper cream. All those baby products...did they contain sensitizing proteins that caused a cutaneous sensitization, setting him up for a food reaction later?

And how SELFISH of my husband and I to conceive in the spring so he was born in the winter! A summer birth would have been so much safer.

Oh, and let's just get down to it: my choice of spouse. After all, he's the one with the environmental allergies. So yes, I caused it, but clearly my husband laid the genetic foundation.

Maybe I introduced solids too early! I was right there with that spoon and jar of applesauce the day he turned 4 months old. I loved the idea of feeding him solids. Maybe it was that simple.

Or not so simple...maybe I didn't feed him solids fast enough. After all, kids in Africa and Israel eat peanuts as babies and THEY don't have nearly as many allergies as we do in the US or Canada.

Or was it the sunscreen? I sunscreened him every day. All those chemicals on his little baby skin...maybe it was the chemicals. Or the Vitamin D! Now they're finding out that allergies and Vitamin D deficiency are tied together! Maybe I sunscreened him TOO much and his body didn't make enough Vitamin D.

Or was it the cat? Or that we didn't have a dog? Did we need barnyard animals? Should I have let him play in the dirt more? Should our house have been cleaner? Dirtier? Was it the dust mites in the pillows? Was there mold or fungus we didn't know about in the walls? Should we have lived in an older house? A newer house?


I types that entire passage in less than 3 minutes. Really. If I let it, the mommy guilt literally POURS out of me. And, every single one of those things I mentioned above has been on the table (or still is on the table) as a possible cause or contributing factor for food allergies.

I think I need a minute.

OK, I'm back. 

I love the "what causes allergies" game. I really do. I've played it for years, read all the research, listened to every crackpot theory and the not-so-crackpot ones. I've considered infecting my child with worms, searched out probiotics not grown on milk culture, considered the trip into Chinatown with the Chinese-speaking friend to hunt down huang bai and ling zhi to concoct my own FAHF-2, EVEN CONSIDERED SWAPPING POOH FOR HEAVEN'S SAKE!

I love it because I hate what I have to face if I stop playing. I hate that my kid may have to go through life with these allergies and there's nothing I can do. I'm not going to be that dad from Lorenzo's Oil who camped out in medical libraries until he figured it out and then badgered more than 100 companies to make the medicine he needed. 

I've heard for so long that "a cure is just 5 years away" that I can't undrink the Kool-Aid. He shouldn't have to be going away to college with this burden.

But he is. He is.

I wish on every star. Every penny in the well. Every dandelion. How do you ever stop wishing?

I caused it.

I should have been able to fix it.

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Friday, July 6, 2012

What Causes Food Allergies? The Smoking Gun.

I've always thought the hygiene theory, at least as most people interpret it, was pretty stupid.

Supposedly, the story goes, our immune system is bored and therefore misbehaves. Like a kid in the classroom watching the clock, it focuses on the wrong things because it doesn't have enough stimulation (illnesses and germs) to keep it busy.

Keep in mind that this is the same immune system that has evolved over 100,000 years of humanity. Surely in that time, some of our ancestors experienced periods of relative boringness, immunologically-speaking.

But there's another way to interpret the hygiene hypothesis, one I've mentioned before in my blog. Instead of theorizing that the immune system is bored, some scientists believe the immune system is missing a key component as a result of our overzealous hygiene.


People are not singletons. We are a conglomeration of organisms, including many bacteria  100 trillion of them, to be more or less exact. The purpose of the 5-year Human Microbiome Project (HMP) has been to catalog the bacteria a healthy gut contains.

The project has its challenges. Foremost among these is that bacteria often do not even grow outside the gut. Medical catalogs contains literally thousands of options that scientists can use to grow various bacteria. Some bacterial require solutions that are something like soup. Others grow only in blood. The odds are very good that many of the bacteria we'd be interested in knowing about are simply not growing in the lab for the HMP.

My daughter had one of these
cuties in her room when she
was small. Yes, we're total nerds.
But there's something else to consider. In the early 90's, hospitals started having a big issue. Patients were coming down with a nasty bug called MRSA  — methicillin-resistant staphylococcus aureus. You may be more familiar with it by its media name: flesh-eating bacteria. MRSA was a huge problem because hospitals didn't have many antibiotics that would treat it. More concerning, the bug was becoming endemic in hospitals and the cause was soon apparent: healthcare professionals were moving from patient to patient and spreading the bug. In some cases, healthcare professionals were actually colonized by MRSA. The solution? Enforce strict hand-washing routines using hand soaps that contained agents strong enough to kill MRSA.

The primary additive used? Triclosan.

How do I know all this? I started my career in healthcare marketing in 1988, the same year a very well-known medical hand soap brand was first launched. Over the years, I did quite a bit of the marketing and advertising for the brand, including hand-care hygiene continuing education and scientific effectiveness studies.

I had the soap in my office bathroom. In my house. Always.

Today, I saw for the first time the study I've been dreading: a direct tie between triclosan levels in children and allergic diseaseFor years, I've suspected the tie between antibiotics and a loss of gut bacterial diversity, but this is the first study that shows the direct link. It makes so much sense! 

"But I didn't work in healthcare," you say, "so this can't be the answer for my family." Not happy news for you: triclosan is literally in every room of your house.

There have been several tantalizing studies over the years that have hinted at an association:

  • Winter babies have more food allergies. The hypothesis put forth in the study is that food allergies are tied to gestation that occurs during tree pollen season, yet another study demonstrated that sensitization does not occur in utero. Could it be as simple as winter babies are in inside more, thereby exposed to a greater level of environmental contaminants?
  • People in developed countries have more food allergies. Except in Japan. Despite having a very hygiene-centric culture, Japan has a low level of food allergies. They also ban the use of  triclosan in cosmetics and other products.
Triclosan is about as altering a substance as you can imagine for bacteria. Think of a field after a wildfire goes through. Once the ecosystem that grew up slowly and harmoniously is wiped out, new species colonize the field. They're the hardy ones, the ones that can find root in inhospitable soil. The weeds. You can bet that once triclosan moves through the body, the bacteria left to grow will not be the microbial version of daisies.

What else contains triclosan? A whole lot

"Where else did the study focus?" you ask. (Yes, I know you're sick of links and studies by now and probably sick of this blog post...but hang with it.)

The other chemicals the study cited were propyl and butyl parabens. I didn't work hand-in-hand with these chemicals (excuse the pun), but Wikipedia is my friend. The second sentence jumped out at me: 

It is used as an antimicrobial preservative in cosmetics such as eye shadow, foundation, sunscreen, facial moisturizer and skin anti-aging treatment. 

If you read through, the Wikipedia author does not seem overly concerned about ingested parabens, as they apparently metabolize pretty quickly. However, parabens are a major component of baby products that are absorbed through the skin. We've been literally dousing our kids in parabens from the day they were born.

Why do I find this so theory so compelling? 
  • The timing fits. There have been many other causal agents proposed to explain the sudden rise in food allergies, but none of them fit the early 90's timeline needed to explain the explosion of allergies right around 1993-95.
  • The weird, outlier research fits. What other explanation covers the Vitamin D link, the redesigned nursery link (which also explains why higher household education might be associated with allergies - simply more money to redecorate), the tie between allergies and developed countries (except Japan), even winter babies. 
  • There's the start of an explanation for mechanism. Scientists are starting to explore how gut bacteria and the gut lining "talk" to each other. Research seems to show that the gut mucosal layer can actually become more permeable in the presence or absence of key bacteria, and that's one possible area where food allergy sensitization might occur. 
I may read this whole thing tomorrow and think "Nah!" But today, it makes sense to me and the research comes together in a way it hasn't for other theories. 

One thing I did do a couple years back was to start watching the products I bring into my house. I am by no means an environmentalist! (I didn't even know until I wrote this blog post that the EPA is reviewing triclosan.) However, going back to just plain soaps without antimicrobials seemed a prudent move. We also think a lot more than we used to about our sunscreen and other products that are absorbed by the skin.

In the meantime, I'm sure scientists will be busy comparing existing caches of food-allergic cohort samples to see whether the triclosan data hold up over a larger population.

Honestly, I hope it does. No one wants to look down the barrel of a smoking gun...but it's much worse to know there's been a shooting victim and have no idea where the bullet came from.

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On the Threshold of...

AllergyMoms reposted this week about the SLIT interview Gina Clowes did with Dr. Demetrios Theodoropoulos from Associated Allergists of LaCrosse. It's an interesting interview. You should read it. 

SLIT is something that has a lot of history in Europe, particularly for environmental allergens, and there has been some compelling research about the sublingual area being a better way to introduce proteins for tolerance induction.

The main criticism (or strength, depending on your viewpoint) of SLIT is that it generally uses very small amounts of protein for desensitization. The thought process behind it seems to be almost homeopathic  that somehow a greatly diluted poison will cure an ill. In this case, the theory seems to be that the immune system has to "get used" to the protein, and can do so through very small exposures.

Two SLIT studies, both published this year, show an interesting contrast. The first found that, after therapy, only one of the kids in the SLIT group passed a challenge.

A different study shows much more promising results  after 12 months of SLIT therapy with just 2mg of protein, kids were able to eat an average of 1710mg of peanut. That's about 5-6 peanuts  the same result as the oral immunotherapy approach, but with far fewer side effects. (The abstract for this study, however, does not indicate how many of the 18 reached this level or whether a food challenge was required to get into the study, and both of these studies involves only a handful of children.)

I've read about SLIT for years. Our allergist does not support it; my husband and I are on the fence. When FAHF-2 came along, it seemed a better bet. 

SLIT is not really what the column is about, though. As usual, what I'm interested in is the psychology of the response to this therapy. Even the headline for the AllergyMoms article — "Why Doesn't Everyone Know About This" — underlines my point: many of the same mothers who make a religion out of scrupulously avoiding every. last. particle of protein are the ones who are now embracing the miracle cure. Isn't SLIT essentially the same as eating "may contain" food? Yes, I know, varying vs. consistent dose, medical supervision vs. DIY — but still!

Which brings us to threshold.

Each kid has a threshold level at which they will react to peanut. We know thresholds change with age, other stressers on the immune system, illness, hormones, even the amount of fat in the food that contains the peanut protein. However, if these things are all constant, a child's reaction to peanut will also stay relatively constant. 

Consider clinical trial challenges. The whole point of the FAHF-2 trial we're in right now is to feed my son peanut at the beginning and end and see if his response changes. If food allergy reactions were really dramatically unpredictable, this methodology would not work. Based on the FAHF-2 study, my son's current threshold seems to be somewhere between half a peanut and three peanuts. The researchers indicated this was a pretty typical threshold. 

More or less. Depends on
the peanut you weigh.
However, a sub-population of peanut allergic have a very low threshold. According to this studyabout 1% of the allergic population reacts to micro doses of less than 2mg. Another 16-18% will react to less than 65mg.

So my kid (and probably your kid) are in the other 80% of kids — the ones that typically don't react without eating overt peanut. Here's what one doctor had to say about this:

The benefits of a strict avoidance diet seem limited: reactions to the low doses and to the peanut oil refined are rare and most often slight. It is not proven that a strict avoidance facilitates the cure of allergy. On the other hand, strict avoidance could induce a worsening of allergy, with deterioration of quality of life, creation of food neophobia. In case of cure of allergy, it is difficult to normalize the diet after a strict avoidance. Outside of the rare sensitive patients to a very low dose of peanut, for which a strict avoidance is counseled, the report benefits risk is in favor of the prescription of adapted avoidance to the eliciting dose. For the majority of the peanut allergic children, it seems to us that the avoidance can and must be limited to the non hidden peanut.  

Arch Pediatr. 2006 Jul 5, Feuillet-Dassonval C, Agne PS, Rance F, Bidat E. 
Which avoidance for peanut allergic children?

I'm not as cavalier as these guys, and I'm certainly not counseling you to run right out and start feeding your kid "may contain" foods! It's important to remember that thresholds can change over time, especially at adolescence. 

On the other hand, if you have a micro-reactor, you probably already know it. These are the kids who react to the trace amounts on toys, or get the full-out reactions from kisses on the cheek, or who have had a known reaction to trace ingredients. Let's face it since cross-contamination labeling is voluntary, we don't know what's in our food. That means people with these levels of allergy are going to have reactions. A history of serious, mystery reactions is a good indicator you're dealing with a low-threshold child.

What I do hope is that this blog post can reduce some of the anxiety around peanut allergy. There are too many people who think of reactions as completely, wildly unpredictable and even the smallest amount of peanut as life-threatening. That's not an easy (or healthy) way to live! Understanding where your child is on the threshold continuum will hopefully help you put the risk in perspective.

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Wednesday, July 4, 2012

Food Allergy Bitch: Top 10 Posts Index

Your Favorites: 

1. Hello, Muddah
A food-allergy version of the classic camp song involving schools, Cupcake Queens and social posturing.

2. The Ethics of Converting Allergy Slacker Moms
About the Mylan "let them eat cake" ad and the necessity to get all moms to carry an Epi-Pen.

3. Weed the Peanut Kids Out of the Gene Pool
Why people who make horrible comments about food allergy kids need to start seeing food allergies as a warning for all of us.

4. Exclusion, Accommodation, Inclusion: Three Choices
Sure, our schools may "accommodate" our children. But is that really the same as fully including them? This post includes a matrix of typical school activities and the options for schools.

5. Competitive Parenting And Blue-Ribbon RAST Scores
Is a high RAST score the same as a serious allergy? What do RAST scores even mean? (And do we really use them to compete against other mothers and "prove" our child is more allergic?)

6. Why Cupcakes Trump Children
What in the world is going through the heads of these Cupcake Queens to value treats at the school party more than children? Here's a psychological dissection of the errors between their ears.

7. A Letter to The Mom Whose Son Just Died
The food-allergy community uses the deaths of kids to motivate others to do what we need them to do. But do we owe privacy to parents who didn't choose advocacy? 

8. The 5 Stages of Parenting a Food-Allergic Child
Every parent hopes their child will outgrow their allergies, and when they don't...the crash into anger and despair happens. The emotional stages we go through as our allergic children age.

9. Food Allergy Deaths At School: The 10 Commandments
A child dies at school from a food allergy. Have you ever wondered what happens after? This post looks at what the schools involved in these tragedies did to make future kids safer. Shouldn't your school learn from them?

10. A Peanut Allergy Cure Has Been Discovered!
No, it's not today's headline. But it probably will be...someday soon. However, most of the treatments currently being explored require some risk and discomfort, something our community does not typically embrace. Will you have the courage to consider a cure if it's offered to you?

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