The Flu

I had half of what I thought was a really great post written for you today, and then all my plans were thrown out the window.  Hubby and I had hoped to do some exciting stuff for our business too, but that also was thrown a curveball.  Instead of doing the things we'd hoped, we went to the ER instead.

Zax started coughing Sunday night, but not overwhelmingly so.  We figured he was getting a cold.  He said he felt okay Monday morning, but rapidly slid downhill.  A few hours after school was supposed to start, he not only said he didn't feel well, but complained of a headache too.

Now, Zax sometimes get headaches that we figure are migraines.  They haven't happened frequently enough to see a specialist, but migraines run in the family and they seem to fit the pattern.  During these headaches, he cries constantly unless he's asleep, and just totally shuts down.  Especially if we don't get him painkillers the moment he first complains.

So that's all we thought was happening, but Monday he just kept carrying on.  Finally, he'd been crying for so long, even an hour after painkillers (which should have taken effect), so I started digging for more.  That's when he revealed that it hurt to breathe.  I listened to his back, and definitely heard wheezing.

I gave Zax a dose of his brother's albuterol in the nebulizer, and it helped.  Shit, I thought.  I mean, good that it helped, but I really felt down at that moment. I showed signs of asthma before my 2nd birthday, Kal started showing signs of asthma right after he turned 1, so I'd been hoping that Zax had dodged that particular bullet by making it to age 6 with no signs.  Feeling depressed, I made mental plans to call our allergist's office in the morning while finally feeding Zax and then getting the boys ready for bed.

Two and a half hours after Zax's neb, as I was laying beside him in bed, I realized that he was wheezing again.  He was also taking short breaths, and his breathing was making it impossible for him to settle down to sleep.  It was too soon for another neb, so I briefly consulted my husband and took him to the ER.  Not a moment too soon, either, because his breathing got worse in the car and he started his incessant screaming again.  (Among other things, I felt bad about how long he had probably been in distress before I noticed.  He'd had a headache, but it was secondary :(

I didn't feel too horribly worried until we got to the ER and they raced him into a room after barely taking his vitals.  It's that bad?  Oh shit!  They gave him all sorts of meds, including magnesium-something in his drip, somewhere around 6-8 vials of albuterol, and even epinephrine.  But the thing that scared me the most was the speed at which they worked. *shudder*

They got him stabilized and then looked for what might have brought us in.  It definitely wasn't anaphylaxis, he'd barely eaten anything all day.  I'd been thinking enterovirus, but I was wrong.  Apparently, that's waning.

The culprit?  The flu.  "Influenza A."  And this, after his allergic reaction to his flu shot.  It didn't even protect him.  According to the hospital staff, something has mutated or deviated this year, so the flu shot isn't providing full immunity.  Brother.

After Zax's allergic reaction to the shot, the allergist had said that since his reaction wasn't systemic, they would probably still advise getting a flu shot next year, they would just spread it out more. They'd put it in his thigh rather than his arm, because it's a bigger muscle, and probably do a half dose in each leg.

I'll be honest.  I wasn't sure what I thought of that suggestion.  What if the next reaction was worse?  At least I had a year to decide what to do.  However, after seeing Zax hospitalized and struggling for breath from the flu, I will continue to get him a flu shot unless he starts having really serious reactions to the shot.  Hopefully next year the shot will hit the mark again, and I'd much rather deal with redness and itchiness for a day than spend part of three days in the hospital, watching my child's heart rate soar because of all the stimulants they've given him but still seeing that he has a long road to recovery.

I write this just before going to bed Tuesday night, listening to Zax breathe in the hospital bed.  His respiration is slow and easy now, without the aid of supplemental oxygen.  I'm thankful that he bounced back so fast.  This afternoon, I went from consoling him, to simply being with him, to doing my best to keep him out of trouble.  He took several unassisted walks and figured out the controls for the hospital bed (which occupied him for at least an hour.)

We'll be heading home in the morning, hoping that hubby and Kal don't get this (especially Kal, since his lungs are already compromised.)  As for me?  I laid in a bed and shared other close contact with my poor, sick child.  I started getting symptoms Tuesday.  Hopefully with early application of Tamiflu and aggressive treatment with albuterol and Flovent, mine will be mild (and not land me back in the hospital.)

Be wary of the flu this year!  Get lots of rest and wash your hands a lot.

Sour Cream Sugar Cookies

My mom came to my rescue this weekend, doing some holiday baking with my kids and providing me with a Christmas recipe!

Sour Cream Cookies
(Contains wheat and dairy)

Ingredients:

• 1 cup margarine
• 1 1/2 cup sugar
• 1 Tbsp Energ-G egg replacer whipped with 4 Tbsp water (2 egg equivalent)
• 1 cup sour cream
• 1 1/2 tsp vanilla
• 5 1/4 cups flour
• 1 tsp baking soda
• 1 tsp baking powder
• 1 tsp salt (optional)
• 1/2 tsp nutmeg

Directions:

Cream margarine, sugar, and egg replacer.  Add sour cream and vanilla and beat until smooth.  Mix dry ingredients in a separate bowl, then add incrementally to wet ingredients.  Mix well.

Cover dough and refrigerate for 1 hour.

Roll dough out on a floured surface and cut into shapes.  Bake at 375 degrees for 8-12 minutes.

Butter Frosting

Ingredients:

• 1/4 cup butter or margarine
• 2 cups confectioners' sugar
• 1 tsp vanilla
• 2 Tbsp cream or evaporated milk (we used half and half)

Cream together butter or margarine and sugar.  Stir in vanilla, add cream gradually and beat until frosting is of the right consistency for decorating or spreading.

This made for a great grandparent-grandson weekend activity!

Yum!!

Linking up at Allergy Free Wednesdays

It's getting harder to squeeze in time for holiday baking.  What kitchen endeavors are you still making time for?

Medical and Asthma Apps

This isn't an all-inclusive list of apps by any means.  I actually don't use much in the way of medical apps, but I use the two below on a daily basis.  It's so great to keep track of everything in one place!

Asthma Tracker
I found this app last spring, when my asthma started flaring up far more regularly.  I dug out my old peak flow meter, but knew that I wouldn't keep track of it with pen and paper.  I needed a way to compile my peak flow data in the pocket-sized computer that was already taking over my life.  A search in the play store revealed Asthma Tracker!

This app allows you to record peak flows, medications, and attacks, based on immediate time stamp (or you can change the time if needed.)  You can also compare pre-med peak flow with post-med peak flow.

I haven't used this much with medication tracking, because I don't want to do that in two places and all my meds are in the second app, but it's very useful in keeping track of my peak flow for me.  I do keep track of pre-vs-post-meds peak flows when I have a cold, and that's very handy to see.

This app has a pro version, which is not terribly expensive.  I find it very likely that I will buy the Pro version once Kal is old enough to do peak flow tests (multiple users is one of the Pro features not included in the free version.)

I really like this app!

Med Helper
When I found this app, I was looking for a way to keep track of medications.  Particularly, I wanted to easily be able to input medications for myself and the boys, and be able to keep track of who could get more medication when.  I looked at a lot of apps, and most of them seemed to be exclusively medication reminders for meds that you take at the same time every day.  While that's all well and good, I needed something to help me keep track of as-needed medications more than anything else.  After several false starts, I found Med Helper!

Mostly, I use med helper to keep track of medications.  We have a handful of asthma meds that Kal and/or I use daily, and then we have allergy meds and painkillers that we use when we need them.  When inputting a new drug into the app, you have the option of scheduling it regularly, taking it as-needed, or scheduling it plus adding as-needed.  You have the option to have it give you reminders when you're supposed to take something.  And you can have multiple users.

It's very easy to make a few taps and input a medication when you're taking it, and when you pull up a medication it automatically tells you the last few doses you took--so if it's too soon to take more, you'll notice.  For scheduled medications, you can select whether you took it at the scheduled time, skipped it, or you can change the time you took it.

This app also allows you to keep track of vitals, so if you're trying to keep track of blood pressure or weight, those can be inputted as well.  You can also make notes, so you can jot down the circumstances leading to a migraine or something.

I like this app a lot, and I really can't stress how helpful it is to keep track of as-needed medications.  More apps may have been added since I did my search, but this was the only one I found that keeps track of as-needed meds in an easy-to-use and intuitive format.  Highly recommended!


(I'm receiving nothing for these reviews. I just wanted to share what I use to keep track of our health.)

Food Allergy Nature versus Nurture

I honestly didn't think I would be blogging about the science of food allergies this often, but the articles keep coming!  This article is about a study by a prominent food allergy researcher, Dr. Kari Nadeau, and involves newer, more revealing food allergy blood tests:

http://allergicliving.com/2014/12/04/new-blood-tests-aim-to-predict-food-allergies-and-severity/1/

There can be arguments in the food allergy community over how reliable current food allergy blood testing is, but there's no doubt that it is far from 100% accurate.  Most allergists recommend skin testing as more accurate, that that still falls short of being fool-proof.  From the article:

“The IgE blood test only represents a protein which is 1/100th of all the items we think are involved in allergy,” explains Dr. Kari Nadeau...“IgE is important, but it is not the only marker.” A high level of IgE can indicate an allergy, but it may not; and some severely allergic people have low IgE scores.

Clearly, something more accurate would be nice.  The "gold standard" is still considered by many to be the oral food challenge--particularly if the food has never been ingested, or the triggers haven't been clearly identified.  Performed in a specialty room of an allergist's office, an oral food challenge involves eating a potentially problematic food (often in increments) in order to see if the person reacts.  If they do, trained personnel have all necessary drugs on hand, so response is swift and complications are generally minimal.

I insisted on peanut challenges for both of my sons, because through various circumstances both of them were skin tested (and were positive) for peanut before they'd ever so much as sniffed an open jar of peanut butter.  Both challenges revealed that they boys did have allergies.  I was disappointed, but felt more confident knowing for sure that they were allergic.  In my opinion, strict, life-altering food-avoidance routines are totally not worth it if the child isn't actually allergic to peanut (or whatever food.)

A lot of parents don't share my views on this, however, or even if they do, they encounter obstacles that stop them before they reach a food challenge.  Allergist resistance and fear of what might happen can stay the hand of many who might otherwise admit that a food challenge would be a wise choice. The new blood test Dr. Nadeau is developing might give more accurate results without the stress of a food challenge:

Nadeau (in collaboration with ...[others]...) has recently patented a new diagnostic test that could be easily done with a few drops of blood from the heel stick of a newborn. 

The diagnostic allergy test (DAT) involves mixing the blood with 90 different potential allergens...to measure the reactions in various types of white blood cells. ...Pilot studies so far suggest that they can identify allergies with 95 percent accuracy.

95%, that's pretty darn accurate.  Nearly everybody I know who deals with food allergies would like something like this.  But one little detail makes me wary--this being done from the heel stick of newborns.

Don't get me wrong, every time I read an account by newly-diagnosed allergy parents who watched in horror while their child swelled up like a hivey, red balloon and barely made it to the hospital, I agree that it would be nice to be able to predict and prevent this.  Nobody wants that to happen to a child, and most parents aren't expecting any such reaction and are totally unprepared.

However, this makes it sound like a person is either predestined to have allergies or is not.  And that seems unlikely.  Nearly every science article I've read involves identifying factors that increase or decrease chances of developing food allergies.  And Dr. Nadeau herself is known for her oral immunotherapy studies, in which she aims to change people's reactions to allergenic foods.  How does this blood test relate to the arsenal of environmental factors that a baby comes into contact with after leaving the hospital?

In fact, since "food allergies require an exposure to the food in order for the immune system to mount a response," I find it hard to believe that most newborns can be allergic to much of anything.  Unless food proteins are able to cross the placental barrier, newborns generally can't be allergic to a food until they're exposed to it, whether through ingestion, in mother's breast milk, or sometimes through skin contact.

That makes me wonder what adding heel-stick allergy tests would mean to most newborns.  The test, so far, is showing 95% accuracy, but if performed on a large chunk of the population, would that number hold?  Would an increasing number of families adopt strict food-avoidance routines simply because a test told them so, only to realize years later that their child either quickly outgrew the allergy, or it never existed in the first place?

Conversely, would parents disregard symptoms of food allergies as something else, because the newborn heel-stick test told them their child didn't have any allergies?  In this way they might miss an initial, minor reaction and only catch it when it progresses to something much worse.  Heck, that happens to enough parents just because they aren't familiar with food allergies!

Clearly, I don't know enough about this.  I'll be curious to hear about further advances in this test, and maybe get some questions answered along the way.

And as if this blog post wasn't enough like a term paper, there's still more to discuss.  Dr. Nadeau has also developed another blood test aimed at predicting the severity of food allergies:

Nadeau has developed another new blood test called the therapeutic exam for allergy (TEA) that examines genes that play a role in the allergic response. One such gene, called FOXP3, is found in a type of white blood cell whose job it is to modulate and suppress other cells that are becoming inflamed or overactive, as happens in the case of an allergic reaction.

Nadeau has discovered that in food-allergic individuals this gene is disabled by a chemical coating that prevents it from being expressed (a change not in the genetic code itself, but in the way the gene functions, known as an epigenetic change).

People who have been diagnosed also often wish they could be told how severe their (or their children's) allergies will be, but unfortunately, that usually isn't possible.  Countless times, someone who only reacted with mild hives the first time around goes into full-blown anaphylaxis the second or third time they're exposed to a food.  There's been no way to predict whether this will happen, or if the extent of the reactions will always remain at hives.  Strict avoidance is the order of the day for the vast majority of food allergy families.

This test seems like it could be very useful, indeed.  If there are actually markers in the body that would indicate whether or not a person will progress to anaphylaxis, knowing that would bring peace of mind to a good many families.

I'll be eagerly awaiting more information on this test as well.

Dark Chocolate Cherry Fudge

The holiday goodies continue this week with homemade fudge!

This was pretty fast to prepare, but you have to do it in advance because it needs to chill for a couple hours.  Chocolate is always a hit in our house, so I don't think these will last for very long!

This recipe contains milk and soy (it could be soy-free if you can find chocolate chips without soy lecithin.)

Dark Chocolate Cherry Fudge

Ingredients:

• 1 1/2 cups granulated sugar
• 2/3 cup (5 fl. oz. can) evaporated milk
• 2 Tbsp butter or margarine
• 1/4 tsp salt
• 2 cups mini marshmallows
• 1 2/3 cup (10oz package) dark chocolate morsels
• 3/4 cup dried cherries, coarsely chopped
• 1 tsp vanilla extract

Directions:

Line an 8 inch square baking pan with foil.  Don't skip this step.  Seriously.

Combine sugar, evaporated milk, butter, and salt in a medium, heavy-duty saucepan.

Bring to a full rolling boil over medium heat, stirring constantly. Boil 4-5 minutes.  Remove from heat.

Stir in marshmallows, morsels, dried cherries, and vanilla extract.  Stir vigorously for 1 minute or until marshmallows are melted.  Pour into prepared baking pan.

Refrigerate 2 hours or until firm. Lift from pan, remove foil, and cut into 48 pieces.  (I had to run hot water over the bottom of the pan in order to get them out.)

Yum!  Wait, we're only allowed how many pieces?

Linking up at Allergy Free Wednesdays and Gluten Free Fridays

 

Are you getting into the holiday spirit?  What are you baking this week?

The Case for Hand Washing

I recently read a comment from a member of the food allergy community who watched a salesclerk eat nuts and then ring up a customer, touching the money and register without washing their hands. The person making the comment sounded appalled, and while I can see that reaction, I can't also help but think "well... that's how the world works."

There are potential dangers everywhere when you're dealing with food allergies.  Sometimes you see them, as in the case above, but oftentimes you don't.  Someone could have been eating your allergen right before touching the doorknob you just used.  The person whose hand you just shook could have been eating your allergen prior to greeting you.  Someone could have spilled your allergen all over the shopping cart you're now pushing.  I have no doubt that allergens can lurk on money.  I once heard that the two most common substances found on money were feces and cocaine.  I'm too lazy to look that up to see if it's an urban legend, but the idea behind it--that money passes through too many hands to be considered "clean"--is well taken.  Allergens could lurk anywhere.

We can reasonably expect risks to be mitigated in schools, as public schools are required to provide access to a free and equal education, but we can't expect society to accommodate our dietary needs anywhere and everywhere.  If I saw a sales clerk snacking on nuts I would shudder too, but the bagel with cream cheese I just ate might be just as deadly to her.

Why aren't we both washing our hands as soon as we're done eating?  Well heck, I've seen plenty of adults who leave public bathrooms without stopping at the sink, and all parents know that it can sometimes be hard to get kids to wash their hands when done using the toilet.  I think I can safely say that the world will never reach a point when everyone washes their hands after using the toilet, much less after eating.

All these potential dangers could be enough to paralyze a person, but I can't live that way. Yes, there's a chance I could come into contact with tree nut residue just about anywhere, but probably a much greater chance that I'm not going to.  I mitigate that risk by carrying Benadryl and an EpiPen, and also by washing my own hands a lot.  If they don't wash their hands, then I need to.

There's a lot to be said for washing hands.  I'll confess that I'm a bit of a germophobe, and that my hand-washing routine came from a job where we all shared workstations and I started getting sick (colds) a lot.  This is when I began washing my hands more often than just bathroom/food prep, and being scrupulous about not eating or touching my face when out and about.  Or at least without cleaning up first.

Becoming a parent strengthened my hand-washing conviction.  When my kids were toddlers, it seemed like they came down with a cold every time we went out somewhere (swimming pool, library, park, etc.)  We established the rule that we wash our hands the moment we get home from anywhere else.  Kal is a finger sucker, so I also use wipes on him in the car to make his hands a bit safer before we get home.

Hand washing kills many birds with one stone, getting rid of plain old dirt, germs, and allergens in one go.  That, coupled with fostering an awareness that touching one's mouth, nose, eyes, or ears with dirty hands could make one sick (viruses or allergens) is the best defense against the dangers that lurk invisibly out in the world.

We can't control all of the conditions we're exposed to.  Even if we try, we have to leave our comfort zone sometimes.  Especially with children--sooner or later we have to trust our training and give them rein to explore the world.  But if we practice (and teach) good habits, we can minimize our risks!

Peanut Dust Exposure Linked to Peanut Allergy

Time to analyze another study on a potential cause of food allergies.  These articles made the rounds on social media a few weeks ago:

http://www.abc12.com/story/27421124/aaaai-study-shows-peanut-in-house-dust-linked-to-peanut-allergies-especially-for-children-prone-to-eczema

http://www.jacionline.org/article/S0091-6749(14)01476-6/abstract

The gist is that they studied babies (3-15 months) who were already considered higher risk for developing a peanut allergy because they had milk and/or egg allergies or they had atopic dermatitis (eczema.)  They took dust samples from the babies' homes (in the carpets) and analyzed it for peanut protein.  Peanut protein levels were higher in the dust of homes in which other family members consumed higher amounts of peanut products.

Is there peanut in that carpet?

The babies who were exposed to higher levels of peanut through the skin, through an "impaired skin barrier" (impaired because the skin doesn't keep as much out when compromised with eczema) had larger reactions to peanut on skin-prick tests and therefore a greater risk of allergy.

The second article was more technical, and I wish I could have read more than the abstract.  I'm not a member of the site so I didn't have access to the full text.  I appreciated how it described the allergy as "likely allergy," because the babies showed positive skin tests but presumably had never consumed peanut--and false positives are possible.  It sounded like the study did not go on to challenge the babies on peanut to see whether the skin test results played out--and it also did not sound like the study followed the babies as they got older to see what happened next in their lives.


The studies of food allergies can be so contradictory sometimes.  Mounting evidence is suggesting that early ingestion of highly allergenic foods can decrease chances of developing allergies, but skin contact can apparently increase risk, even as young as 3 months.  (Of course, these babies already had higher-risk conditions and may have been heading down a path towards food allergies anyway, traipsing along the "allergic march.")

As always, I have to think about this one in terms of my family.  Zax had eczema as a baby (not to mention an allergic mother) so he already had risk factors for food allergies.  And hubby and I did (and still sometimes do) consume peanut products, but I can't imagine there being much "peanut dust" in our house.  I tend to think of peanut dust as coming from peanut products that are, well, dusty.

The peanut in our house has primarily been in the form of peanut butter which, while quite sticky, doesn't really generate any dust.  Other peanut products are largely absent from our house, and always have been.  Although I was one of those kids who anecdotally might have suffered from malnutrition without peanut butter, it always had to be the creamy kind.  I hated chunky, and I never liked eating peanuts in their whole form.

I think this was an emotional reaction--an unexpected "crunch" in my food is a sensation that has always sent me into a panic.  "What just crunched?  Was that a nut?  Am I about to have a reaction?  Should I spit it out?  Am I being paranoid?  Am I going to die?  HELP!"  That emotional reaction translated over to peanuts crunching, and so I never ate them out of the shell at baseball games, or purchased bags of peanuts, or baked with them or anything.  And while hubby prefers chunky peanut butter, he's never brought whole peanuts into our home so they must not mean too much to him, either.  What all this amounts to is that our home was probably low on the peanut dust scale.

None of this is to say that Zax couldn't have replicated the study's findings by coming into contact with sticky peanut butter residue rather than peanut dust.  (He also got exposure through breast milk, until his diagnosis saw me cut peanut butter out until he was weaned.)  So did skin contact contribute to Zax's food allergies?  It's always a possibility--but since he had several other risk factors it was definitely not the cause.

But what about Kal?  Our home was free of most peanut residue by the time he came around, and he never had eczema.  I guess he proves that there is more than one factor involved in developing food allergies.


ETA:  In searching for "crawling baby" photos, I remembered that we took Zax to a Colorado Rockies game when he was 9 months old--two months before his egg and peanut diagnosis.  There was certainly peanut dust at the game!

What do you think of these studies?  Do they just add unnecessary guilt to the parents of allergic kids, since none of us knew these things were risk factors?  Or are they adding to the library of information that will one day lead to a cure?

ETA:  I found more information on the study, and it looks like it was longer term than I'd thought.  Some more interesting tidbits in this link:
http://www.webmd.com/allergies/news/20141024/childhood-peanut-allergy-may-be-linked-to-skin-gene-mutation