The day of Kal’s peanut challenge in April finally arrived,
and Kal had miraculously remained healthy for more than a week prior to the
test. Zax even had an extended school
day so we didn’t have to pick him up in the middle of the test, which meant
that hubby and I could both attend the challenge. We were psyched for a potentially three-hour
test. We had toys and games, the office
had toys and movies, and we had chocolate to help make the medicine go
down. Everything was aligned.
The first thing they said upon our arrival was that it had
been nearly a year since Kal’s peanut skin test, so they wanted to perform
another one. Even as I consented, I
began to feel irritated. We were ready
for a three-hour test, but I knew that if the skin test yielded higher results
this time around, they would halt it right then and there--and just like with
Zax, I was going to need to know whether the allergy was real no matter how big
the number. What was even more annoying
was the fact that Kal and I could easily have come in prior to challenge day
for a skin test and gotten that part over with.
Over the next several minutes, I knew that things were not
going well. The welt on his back grew to
quite a large size. When the aides came
back in, they were shocked at the size of his reaction. As was entirely predictable, they were
unwilling to perform an oral food challenge now without the doctor’s approval.
What followed was a whole mix of emotions for me. Just like with Zax, I needed to know whether
the reaction was a false positive or indicative of a real allergy, which meant
I needed to have him do a food challenge.
But more than that, I felt horrible about having waited so long. I’d heard that delaying introduction could
actually increase the chances of an allergy, and that seemed to be exactly what
had happened. It hadn’t seemed like a
very big concern until now. I tried not
to get too preoccupied with this theory--after all, it was possible that his
first skin result was small and all subsequent results would be larger, much like
an initial oral reaction can be minor but later oral reactions can be
increasingly severe. In fact, this
second theory has comforted me somewhat.
It makes me feel less like I created a preventable peanut allergy in
Kal.
But at any rate, we weren’t done yet. I spoke at length with our allergist, having
the same argument I’d had before we did Zax’s peanut challenge. I’m not comfortable saying that my children
have allergies without a reaction. Kal
would be starting preschool in the fall, and I wanted to know before then. I had a history of false positives, and I
wanted to make sure that Kal’s reaction was real and not a false positive of
his own.
Because of the extreme nature of Kal’s skin reaction, our
allergist was even less willing to let Kal do the challenge than she had been
for Zax. “Aren’t we the anomaly?” I
asked. “Don’t most people come to you
only after having a real-world reaction, rather than doing testing before eating a food?”
“Yes,” she replied.
“And some of them go straight into anaphylaxis the first time they eat a
food. Do you really want to risk that?”
“If it means his first exposure is in a controlled
environment where all the drugs are readily available, thereby reducing the
chances that we would find out by accident in a much more dangerous setting,
then yes.”
The allergist finally granted us a reduced sort of food
challenge. The first thing she wanted to
do was spread peanut butter on his skin and wait to see if anything
happened. Then we would proceed to
spreading some on his lips. Even if he
failed to react to this, she didn’t want to take the test any farther. We would be assured that he wouldn’t react to
casual contact, and thought that ought to be enough for us.
It wouldn’t have been, of course. I knew that if Kal passed this challenge, I
would be back on the phone, pushing for another challenge to still find out
whether or not Kal had an allergy. But
one thing at a time. This might be all
we would need in order to confirm an allergy.
So shortly after Kal’s third birthday, we performed the challenge.
Kal had no reaction to the peanut
butter on his skin. Next they brushed some
on his lips. Unlike with Zax’s test,
they told Kal not to lick at his lips--a feat he managed fairly well for a few
minutes.
About ten minutes later, Kal said
that his lip hurt. Upon inspection, the
skin below his lower lip was turning red.
Well, darn. Another allergy
confirmed. We ended the challenge and
they gave him Benadryl. Then we stayed
for observation.
Zax and Kal’s peanut challenges
weren’t exactly equal, since Zax licked his off right away and Kal only licked
a little bit, but I still found it interesting the differences between their
reactions. Both of them had level 4 skin
reactions, but Kal’s was much larger.
However Zax was screaming within a minute of the peanut butter touching
his lips, and Kal took ten minutes to complain that his lip hurt. In fact, hubby and I couldn’t help but
observe that Kal’s challenge was a bit anticlimactic. After all the warnings and concerns that he
was going to drop dead the moment peanut butter touched his skin, his reaction
was much smaller than his brother’s.
Which is a big part of why I pushed for the challenge--because no matter
how helpful they are, skin tests aren’t infallible, nor a perfect indicator of
what will happen.
The hardest part about Kal’s
diagnosis has been the fact that we haven’t been thinking of him as allergic
until four months ago. The safety
routines we’ve done with Zax since infancy have helped Kal by association, but
we’re only just beginning to teach Kal the vocabulary he needs to use, and
helping him to realize that certain foods can hurt him.
The good news about Kal is that
at the same time that we confirmed his peanut allergy, we also got him a
prescription for albuterol in an inhaler.
We’d been concerned about what we would do if he needed treatment during
preschool, and they told us that some little kids can get the hang of an
inhaler with a spacer and mask, and that he could take several breaths through
the spacer--he didn’t need to get it all in one breath. They demonstrated the method, and we took our
new prescription home.
I have to say that I LOVE giving
Kal his inhaler. It makes life so much
easier. No more making Kal wait for
treatment in the morning. No more trying
to figure out how to schedule another 20 minute TV session for another
neb. The last few times Kal has gotten a
cold, I’ve been able to set a timer for 4 hours and give Kal treatment the
maximum number of times during the day.
And in my opinion, it has helped a great deal. He’s gotten over the last few colds much more
quickly than before. Of course, because
he’s only 3, Kal doesn’t do every puff as well as he ought, but it still works
much better than previously. I love
using the inhaler so much, I’ll be asking for his Pulmacort in this form the
next time I take Kal to the doctor.
Kal is just beginning to learn
how to deal with this life our family lives.
We have high hopes that he will turn into a good self-advocate, just
like his brother.
Thank you for this post/blog! When I push my allergist for food challenges, I'm always made to feel like I'm being reckless, when I feel like it's the responsible thing to do. I wish that more allergists took the family's preference for a food challenge into consideration. After all, if it isn't actually safe, why are they doing them at all? And until you live with a food allergy yourself (diagnosing them is different) you can't possibly understand all of the stress they cause. Even a positive reaction to a food challenge is informative (we've had some that he's passed and some that he hasn't) and my son is fine afterwards.
ReplyDeleteThanks for your comment! We've felt the pressure when asking for challenges too, but I always persist. (I think our allergist is relieved that both boys' allergies are confirmed now.) My view continues to be that it is much safer to find out in a challenge, and that way you know whether you need to panic if they get their hands on the food by accident--well, act first, panic later! (if you can)
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