Food Allergist Dr. Daniel Soteres’ “Eggs-Perience” – Third Entry
Usually when I get home from work Madeleine yells, “Daddy!” followed by the pitter-patter of footsteps across the house, then a wonderful and sweet hug. I’ve learned to drop my stuff and take a knee in expectation of this wonderful welcome home. Shortly after the hug Fletcher’s words float across the house, “Hi Dad”. This is how we roll.
However, on this day it was different. First, there was “Daddy!” then there was a pitter-patter, but it stopped short. I looked down the hall and there she was. One hand on her hip, head canted to the opposite side and a finger wagging at me. “Daddy, they wouldn’t let me eat the pizza at school today.” “Why? What’s that all about?” I responded. Madeleine’s retort, “They say it has eggs.” Oh-no! I had to do something. First, we discussed the attitude, hand-on-hip and finger-wagging. She bashfully apologized. Next, we had to come up with a plan on how to find out what would be safe for her. I had taken her to the lab a few days ago and now I had the results. The next morning we went to my office for a skin test. Fortunately we had a long weekend and I could try some informed experimentation with my daughter.
The RAST Immunocap IgE test showed positive reactions to egg white (1.1), whole egg (1.3) and egg yolk. The largest result was egg yolk at 3.45. Her skin test measured 8×16 millimeters. Dr. Sampson published the paradigm-setting study that indicates a high risk of severe reaction to egg if the Immunocap IgE level is greater than 7.). Other studies indicate that larger skin test reactions indicate a risk for allergic reactions. Now, I needed to prove to myself, my daughter and my wife that I actually had some useful experience in this area.
Again I have eaten eggs with my daughter several times. In fact, over Christmas we snuck several teaspoons of fresh cookie dough from one of mom’s batches. The week before her reaction we had one breakfast with boiled egg. I don’t remember the color of my socks that day. But I do remember watching her with fascination while she used the boiled egg cutter, one with plastic chicken décor, and then picked out ONLY the yolk. Two days later we had scrambled eggs on toast. But now, one week later, I am serving a child with food allergies. Where to start?
Let me first warn you: What I am writing here is not my professional medical advice and I don’t think you should be dabbling with this at home. I am a board-certified allergist. I’ve been doing challenges on other people’s children and adults for years.
It was an atypical Saturday morning in the Soteres household. We didn’t have to be anywhere. No basketball games, dance recitals or art classes. I made sure that I had the Benadryl (pre-measured the dose) and Epi-pen Jr. readily available. Next, I made my pitch. “Hey Maddie, do you want a chocolate chip cookie for breakfast?” “Yes!” she replied while running to the kitchen. I ate yogurt while she dug into her cookie and milk with a side of fruit. She devoured it. “Next, let’s watch a show this morning.” I think we watched PowerPuff Girls. Actually, she watched the TV. I watched her. 30 minutes later – no rash, no tummy pain. We spent the day together. She went on to enjoy a croissant and several other foods. Over the long weekend we went on to eat several foods that had egg baked inside. No problem. Over the past few years several studies have supported the idea of keeping food that is tolerated in the diet. In the case of milk and egg allergy keeping trace amounts (usually baked/heated form) in the diet improves the chance of outgrowing the allergy 16 times better than those on a total elimination diet. All my schooling did not go to waste. I sent a letter to the school. Baked products seem to be okay. Beware of raw egg. Lunch was back on. Whew! Still more questions persist. Why is food allergy increasing? Why is my family now part of this?