Sibling Revelry and Rivalry

posted April 27, 2012
04/27
2012

 

When we walked into the house after Lucy’s yearly appointment, her brothers (Sal, age 6, and Gino and Milo, both age 5) clamored to hear the news.  Dressed in her mint green owl shirt, little 2 year-old Lucy looked admiringly up at the boys and said one word, “Egg”.  Sal, who has no known food allergies, gave her a big kiss on her cheek.  Gino, who required 2 doses of injectable epinephrine after he ate egg and who probably has reacted to more foods than he is able to eat, ran to her and threw his strong, tan arms around his sister. “That’s great!  You get to try eggs!”  He couldn’t contain his smile.  His joy for her was palpable.  Milo, who is only allergic to egg and soy, sulked.  There was no celebratory embrace from him.  He shuffled to the family room and sat at the edge of the couch with his serious eyes focused away – away from what he wanted to happen to him, away from the egg talk.  I sat next to him.  “It’s not fair, Mommy.  It’s not fair that she gets to eat egg and not me.”  He couldn’t contain his tears and so they flowed.

I brought Lucy to my mom’s house the morning after the appointment and in a clean pan, my mom scrambled up a fresh egg for Lucy and served it to her in her pink bowl.  I fed her a bite that was smaller than a grain of Kosher salt and we waited.  There were no hives.  There was no redness.  There were no symptoms.  I let her have another small bite and we waited.  We repeated this until she had eaten a good amount of that pale yellow scrambled egg.  She was fine.  She was happy.  She was not allergic to egg.  I breathed a deep sigh of relief and gratitude to the food allergy goddesses but then I felt my heart sink a little.  How would the boys react to this?

I picked up the boys from school later that day and I told them that Lucy ate an egg and that she was not allergic to it.  As the boys walked past her car seat to get into their own, Sal rubbed her head in a way you would expect the oldest brother would and told her she did a good job.  Gino gave her a tender high-five followed by a tickle to express how happy he was for her.  Milo went straight past her and buckled himself into his seatbelt.  Gino asked Milo if he heard that Lucy could eat eggs.  He confirmed that he did indeed hear the news.  Sal asked him why he didn’t smile at her but Milo didn’t have an answer.  I wasn’t sure he really knew the answer.  He is only 5, after all.  He wasn’t mad at her for being able to eat eggs.  He was only able to focus on the fact that he wasn’t able to eat them.  I could sense his frustration and conflict.

As I thought about the twins’ differing reactions to this news, I contemplated if their individual food allergies played a role.  Gino, who may never be able to eat wheat, milk, egg or many other foods, reacted selflessly.  He knows that this opportunity may not present itself to him any time soon and still he was able to feel genuine delight for his sister’s stroke of luck.  He has learned through living with his food allergies to be happy for others even if you can’t have what they have.  He has learned to accept that his life is distinct from everyone else’s and in doing this, rarely compares himself to others or feels cheated.  Milo, however, sees himself as the twin who is hardly allergic to food.  He relates more to the food allergy-free world.  His more self-focused reaction was motivated by his own intense hope to lose his egg allergy.  He feels like he is just shy of being like “everyone else” so his competitive drive and his need for equality are intense, often creating a strong sense of rivalry.

I compare these differing reactions to a tennis match.  If you are defeated in a match with a score of 6-0, 6-0, 6-0 then chances are you are able to acknowledge that your opponent won fair and square.  You didn’t stand a chance against him.  In these games, usually one player applaudes the other for his prowess, and moves on, accepting the outcome.  This is in stark contrast to the player who loses a match 7-6, 7-6, 7-6 with every game a battle of deuces and every set a battle of tiebreakers.  The loss of that match may cause one player to dwell on a serve he should’ve made or a call that wasn’t right or a backhand that had a bit too much muscle on it.  This kind of match leaves the loser just barely out of the competition.  It leaves him hungry for another round.  It leaves him knowing he could easily be the winner next time.  See what I mean?  It’s like the more foods that allergy stacks against you, the more likely you are to accept your fate.  The fewer foods that are seen as victorious opponents, the more likely you are to feel you should be able to overcome them.  I am obviously not equating having food allergy to losing but after years of playing tennis matches like the ones I have described, I have felt how I think Gino and Milo are feeling.

We also left Lucy’s appointment that day with a future milk challenge in place.  Lucy had anaphylaxis to cow’s milk at 4 months and like her brother, required 2 doses of injectable epinephrine in order to decrease her airway swelling.  So as excited as we are for the chance to knock yet another allergen off of her avoidance list, I am sick over the thought of her having a reaction.  But I am also a little sick over the thought of her being able to eat cow’s milk. (I cringe as I write that because it is almost too honest to share.)  How could I possibly feel that way?  The truth is that I am concerned how her brothers will feel.  The kids find refuge in having shared food allergens with their siblings.  There is something safe about that.  Something sacred.  And not having a food allergy that another one has gives the one without the allergy a very important role as a protector.  See how complicated this gets?

Well, if she is able to eat cow’s milk, Sal will be thrilled even though he does pride himself on keeping an eye on Lucy whenever there may be milk around.  There will be an adjustment for him because he takes this role on with intense and instinctive responsibility.  I know how Milo will see this.  He is not allergic to milk so there will be no sense of rivalry there; he will get the chance to celebrate with his sister and boy, do I hope that he has the opportunity to feel this emotion.  It is so important for siblings to feel pure excitement for another’s success.  It’s that sort of empathy that forges long-lasting friendships between brothers and sisters.

But what about Gino? This is where my sadness comes in.  With Lucy’s ability to eat cow’s milk, the gap begins to widen between Gino and his siblings.  As happy as we would be for Lucy to have one less allergen, Gino will also have one less ally in avoidance. Right now, they make a great team.  At Starbucks, they both order an orange juice, while the other two drink their cow’s milk. If Milo and Sal get a cookie, Gino and Lucy share their own safe cookies.  Her milk allergy plays a critical role in the balance of power among the siblings.  Will Gino handle a milk victory as well as he did the egg? And what if he can’t?  That possibility breaks our hearts.

Of course, I want few things more than for Lucy to be able to eat cow’s milk with no reaction.  But the truth is, with that ability to drink cow’s milk comes a change and it will be a change that has a lot of emotional strings attached. It’s a change that I desperately want for her, but one that I don’t know if I want for Gino.  Although chances are that if she is able to have cow’s milk that he will graciously throw his arms around her and revel in one more food allergy victory with her – because he has learned not to see his limitations as punishments, because he has learned to be happy for what he has, and because, well, that’s just the kind of kid he is.

Here’s hoping that next Tuesday afternoon I get to see that victory hug.

What a perfect moment that would be…

Sarah | 44 Comments | Permalink
Family, Observations

The $40 Quesadilla

posted April 1, 2012
04/01
2012

We recently went on a vacation to Florida.  It really could not have been better; the weather was idyllic, the ocean had the perfect waves, there was a giant water slide and constant poolside activities for the kids.  One early afternoon they offered face painting.  Milo got right in line to get his face painted like a vampire.  The red paint around his mouth was dripping down his chin like blood in the hot sun.  Gino was next.  I checked in on him then I went to put something at the chairs.  As I was about to walk back to watch his face painting progress, I saw him speed walking, stiffly toward me.  I noticed one of the staff members racing behind him.  As he threw himself into my chest, she stood in front of me, shaking.  My heart thumped hard, was it food?  When I pulled him away from me, would he be covered in hives?  Would he be covered in vomit?  Would he be coughing and gasping?  I pulled him away, and all I could think was Thank God, he was only covered in blood.  I mean, how sick is it that I reveled at the sight of blood?  His lips were pursed to catch the drops trickling from his nose.  He had fallen into a very deep and rocky flowerbed.  He was fighting hard not to cry in front of everyone so we hurried to the room and got him cleaned up.  We placed the obligatory band-aids on the scrapes on his chest, covered his nose in a thick coat of Neosporin and put an ice pack on his face.  He was sad.  Not because he fell into the flowerbed but because he may have missed the face painting.

When we returned to the pool, the face painters had waited for him and since his face was pretty beat up, they drew a huge snake up his arm.  I saw the woman who witnessed the fall approaching us. She was holding an apologetic smoothie in her out-stretched hands… a peace offering.  I mean, as if he hadn’t been through enough already.  I walked away from Gino as he finished getting the snake tail painted and let her know that he was allergic to milk.  When she asked about a cookie, I told her he was allergic to egg.  When she suggested a bag of pretzels, I told her he was allergic to wheat.  I stopped her in the middle of her litany of food suggestions, knowing that it was futile, and I suggested instead a non-food item.  She returned ten minutes later with an orange Ugly doll and a t-shirt that burst into colors in the sun.  Gino was suddenly the happiest kid in town.  The fall became his very favorite part of vacation.  You can ask him!

Every game that the kid’s club hosted, Gino would win.  When he won the limbo, instead of an ice cream cone, he won an orange juice and three Chai tea bags (I think my mom had some influence on that prize)! When he won the balloon hula-hoop toss, instead of getting a bag of goldfish, he got two free movie rentals.  For a guy who couldn’t indulge in the poolside refreshments, he sure was making out like a bandit.

Toward the end of our vacation, Sal and Milo were feeling a bit slighted from all of the attention that Gino was getting.  In fact, Milo was so desperate for the same kind of attention from the staff that he wanted me to tell them that he nearly broke his neck in a wave.  The wave barely covered his head, but he could not have been more serious.  Sal felt like he deserved a cheese quesadilla from the poolside restaurant because frankly, it was safe for him and he wanted it.  I said no many times but somehow I turned around and he had weaseled his way into getting one.  As Sal was licking his bean-and-cheese-filled fingers, Milo honed in on this and begged me for a quesadilla too.  He felt that being able to eat one without Gino would somehow level the playing field.  I couldn’t muster up the energy to talk to the chef and find out if the quesadilla had egg or soy or if there may be any cross contamination issues.  I knew this wasn’t fair of me but we had great alternatives and I simply didn’t want to take the chance.  As a consolation, I told him that I would bring him to Chipotle the day we returned to Chicago.  It wasn’t a great deal and he knew it, but it would be good enough.

The instant the plane’s wheels hit the concrete a few days later, Milo piped up, “Mommy, remember you promised me a cheese quesadilla?” but when we pulled into the garage, the kids were exhausted.  We had been up at 4am and it was showing.  I put them on the couch in front of an episode of Bubble Guppies and hoped that they would sleep.  I set off to the grocery store.  As I was about to head out though, Sal jumped up and said he wanted to go with me.  He knew that going on this trip would likely result in food.  I could see hunger in his eyes, and of course, he was right, he would get food.  He hadn’t forgotten Milo’s cheese quesadilla promise and suggested that it would be totally unfair if he didn’t get one too.  A large cheese quesadilla with a side of black beans and chocolate cow’s milk.  $5.

When we returned home through some sixth-food-sense, Milo could tell Sal had eaten at Chipotle.  Maybe he could see the satiety in Sal’s eyes.  Milo insisted, in no uncertain terms, that it was his turn.  I could not have been more exhausted.  He couldn’t have been more insistent.  As Milo got dressed, I saw Gino’s eyes gaze downward.  Despite all of the spoiling on vacation, this was different for him.  His expression rode directly on the border between sadness and anger.  I don’t even think he knew which emotion that he felt more.  He wasn’t sure if he wanted to cry or slam a door. Even though the quesadillas were meant to even out some inequality from vacation, vacation was over.  We were back home and suddenly things didn’t feel fair.  I told him to think of something special he wanted to do with me when Milo and I got back.  At Chipotle, Milo joyfully shoved down his cheese quesadilla with a side of black beans and a chocolate cow’s milk.  $5.

When Milo and I got home, Gino was sitting on the stairs with his coat on.  As we headed out, from the couch, Lucy yelled out, “Me?  Pink surprise?”  I couldn’t believe that she was in on this too!  Gino chose to go to the toy store.  We first picked out the cheapest but cutest pink surprise we could find.  A pink bracelet.  $10.  Then I encouraged Gino to choose a small toy, perhaps a multicolored pen or a puzzle or a deck of cards.  He, instead, found a build-it-yourself transistor radio and once he set his sights on that toy, nothing else could measure up.  $20.

It cost me $40 that day to make things feel fair.  Obviously, I am not the master negotiator.  But boy, if a build-it-yourself radio helps ease the ache of a quesadilla-less world and make things feel right and just, so be it.  I know that there will come a time when all of this overcompensation simply won’t be enough and no matter how many toys or color-changing t-shirts that I shower over him, he will come to the very true realization that it just isn’t fair.  I hope that when all I have left to offer him is a big hug that somehow that will be enough for both of us.

Sarah | 36 Comments | Permalink
Travels

Like Mom, If I Could Be Like Mom (or The Power of Starbucks)

posted March 5, 2012
03/05
2012

So, I have been called upon to write a post that won’t make you cry.  I thought, oh, that’s easy, I’ll post a recipe but then I thought that would sort of be cheating.  Here is my attempt at a non-tear-jerking post but I can make no promises…

If the kids are good (well, even decent) in church, on the way home, we bring them to Starbucks.  I get my grande, no water, no foam, extra-hot soy chai. Gino, Lucy and Daddy get an orange juice. Milo and Sal get a cow’s milk.  We wipe down the table and chairs, and while doing so, we usually get a few what-in-the-world-are-they-doing glances.  Then we sit.  We sit in such a way that the baby, Lucy, can’t have accidental access to the cow’s milk.  Gino is now old enough to know he doesn’t want to drink the cow’s milk but still he sits closer to Lucy and can act as a buffer.  Milo knows he can’t take a sip of my drink because of the soy.  As soon as we are settled into our complicated and assigned, wiped-down seats, we open the orange juices first and then move on to poking the straws into the cow’s milk boxes.  This preparation takes awhile which is why I order my chai extra hot.

On the way home one Sunday a few weeks ago, Gino had a revelation.  From the rear of our minivan, he yells over a cranked-up Adele song, “Mommy, now that I am not allergic to soy anymore, can I order a chai from Starbucks like you next time?”  Luckily we were pulling in the garage so I could take him aside to explain the complicated concept of cross-contamination to a five-year old.  I explained to him that when they make the drinks at Starbucks, they make them really fast because there are always long lines.  He understood that.  I told him that when people are making drinks really quickly that they do not have the time to clean the equipment that they use to make the drinks.  So, if they don’t have time to clean between a coffee with cow’s milk and a soy chai, then cow’s milk could get into your soy.  Did he understand what I was telling him?  Was it going to disappoint him that he couldn’t get the same drink as I do?  He was quiet for a moment.  Then, ah-ha, he got it.  “Okay, Mommy.  Yeah, I do not want cow’s milk in my soy chai.  But I still want to be able to have a Starbucks soy chai like you.”

The mind-racing we all experience kicked in, racing to find an alternative, racing to figure out how I can make a drink that was somehow the same, but different.  When I remembered that they sold the same Tazo Chai Tea at the bookstore, we took a quick walk and picked up a container.   If I warmed that up with the newly-safe vanilla soy milk, voilà, a Starbucks soy chai.  When we made the soy chai together, I put a small amount in a plain white coffee mug.  I made a similar rice milk chai for Milo who has FPIES (food protein-induced enterocolitis syndrome) to soy and they each took their first sip of a lukewarm chai. After the first sip, Milo guzzled his.  Gino drank it more slowly, maybe he liked the experience more than the actual flavor but he would never admit to that.

When I put Gino to bed that night, I could tell he had something on his mind.  When I pressed a little, he said, “Mommy, I loved that chai today but I am trying to figure out how I can make it like yours.  Can I make it and then bring it to Starbucks and pour it in a cup that matches yours?”  I had an epiphany.  I grabbed my phone and brought up a picture of the ceramic Starbucks mug that looks exactly like the paper to-go cup.  He took the phone out of my hand and used his thumb and pointer to make the picture as large as he could and then he giggled.  “Oh, Mom, I love that lid.”  (The lid is a simple black travel mug lid.)  He fell asleep dreaming about the possibility of having one of those mugs with that amazing lid all for himself.

When I picked Gino up from school the next day, I had a Starbucks bag with two mugs wrapped in tissue paper inside, one for him and one for me.  Before he even opened the bag, he threw his arms around me in pure joy.  He thanked me over and over.  “Now I can drink a soy chai in a cup just like you!!  Can we make it as soon as we get home?”  And so we did.  But when I was putting him to bed that night, he again seemed like he was thinking about something.  When I asked him what it was, he quickly explained, “I’m really happy that I got to have a soy chai in that Starbucks cup but do you think Saturday you could make us both one and then we can go do some running around like you like to do with your chai?”  “Yes, Gino, we can do running around with your chai on Saturday.  Good night…”

 

 

 

 

 

 

 

 

 

 

There is something powerful about the desire for a child to emulate his parents and something equally as powerful in the Starbucks brand.  It means acceptance to him.  It means doing what everyone else is doing.  It means fitting in. And he found a way to do all that but still do it safely.  As I looked down at him as we did some running around that Saturday morning and he held that heavy ceramic Starbucks mug clumsily in his little hands I realized that I, too, loved that Starbucks mug and that silly black lid.  As I was pouring love over him, he looked up at me, took a sip and smiled… and I suddenly felt a powerful desire to emulate my son, his purity, his easy satisfaction, so I did the same.  Soy chai never tasted so good.

 

Please remember to sign up for website updates (to the bottom right of the site) and check out The Allergist Mom on facebook or twitter (follow links at the top right)!            I appreciate that so many of you share the links to my posts.  Please continue to share.  Thank you!

Sarah | 98 Comments | Permalink
My Stories, Observations

Child, Heal Thy Mother

posted February 8, 2012
02/08
2012

I rode in an elevator with four other mothers of food allergic children on our way to a Food Allergy Initiative (FAI) luncheon a couple of weeks ago.  As we rode up to the 24th floor on an unusually warm midwestern January afternoon and upon finding out that I was an allergist, one of the mothers asked me desperately, “So, what did I do wrong?”  Another mother echoed her, saying, “I ate so many peanuts when I was pregnant.”  And yet another mother with a sad downward gaze said quietly, “I feel so bad.”  The conversation was steeped in guilt and blame.  Wearing my physician hat, I held the arm of one of the mothers and told them all that they did absolutely nothing wrong, that it was not their fault that their child had food allergy.  I am not certain how convincing I was however.  Even though, as a physician, I whole-heartedly believe a parent cannot be blamed for pediatric disease, as a mother, I still, in every chamber of my heart, blame myself too.

During my pediatric residency I saw guilt literally destroy parents in front of my eyes – I have watched their spirits crumble, I have heard their hearts break, I have witnessed their hands wringing in pain and their lips trembling in fear.  How could I have done this to my child?  And it didn’t matter how many, “It’s not your fault”, that I poured over them, they didn’t believe me.  They couldn’t let themselves believe me.  What their child was about to endure had to be someone’s fault and it made complete sense to them that they had to own the blame. After all, we are completely responsible for the well-being of our children and so, of course, we feel equally responsible for their disease.

I have found a way to blame myself for every food allergy of each of my children.  I can pinpoint the moment I did it to them.  Rationally, I know that it is not my fault.  Emotionally, the guilt weighs heavily on me.  And on top of it, every other article that comes out feels like it is blaming me too – too clean, too little sun, no pets, not enough nuts, too many nuts, nuts too late, nuts too early…  But I guess it doesn’t really matter how I did it, I have still managed to make their life so much harder for them.  They can’t eat pizza.  They can’t eat out at a restaurant. They have to bring their own food when they go to their friend’s house.  They have to carry medications with them wherever they go. So, yeah, I feel pretty terrible about it. And because we all want our children’s lives to be easier than our own, the burden on a parent of a child with a chronic disease is heavy and perpetual.

A few years ago when my sister graduated from college, my parents threw her a party at one of our favorite restaurants downtown.  I had the four kids packed in the car and my mom drove with me through the Friday afternoon traffic so she could help me get the kids into the restaurant.  When we sat down, I did my standard preparations, wiping the tables and the chairs at our end, moving food and items they couldn’t have down to the other end.  Just as I finished, the waiter brought the baskets of bread.  My oldest son, without food allergies, swiftly grabbed up a piece of bread, warm and soft, covered it in butter and started eating it.  Enter guilt, stage left.  If I wouldn’t have waited so long to introduce Gino to wheat, maybe he wouldn’t have had anaphylaxis to four penne noodles and could be joining his brother in this bread indulgence.  Instead, he grew impatient and hungry.

I grabbed into the food bag and found the broccoli I had prepared for Gino and Milo.  I didn’t bring anything comparable to a breadbasket so they had to dig into their meal.  When the appetizers arrived at the other end of the table, the twins ate their pasta and when the pasta and meatballs arrived at the other end of the table, the twins ate their rice krispie treats.  I clearly did not bring enough food.  They were still hungry and everyone else was still eating.  When they repeatedly asked for more, I had nothing to offer.  They kept asking anyway.  Again, I had nothing.  Nothing.  On the other end of the table, everyone was celebrating and eating, and on this end, we were struggling.

Then, with unfortunately impeccable timing, Lucy vomited and no, it wasn’t just a little spit up that could be soaked up by a bib.  Her outfit was sopping wet.  The car seat that she was sitting in had a puddle of puke.  She looked sick.  She was sick.  I had to get her out of there. I felt so overwhelmingly responsible for the isolation that Gino and Milo were experiencing that when the baby got sick, it was sort of a relief to be forced out of that situation.  I grabbed the baby and told the twins to follow me.  I left Sal there, eating.  Happy and eating.  On our way home, Gino was sullen.  He would not speak to me, let alone look at me.  He stared ahead with glassy eyes.  I tried everything to get him to smile, to laugh.  I begged, I bribed.  He would not break.  When we got home, I took him in my arms and he pushed me away.  I could feel that he was blaming me.  Then he spoke, “You should not have made me come home.  I wouldn’t have eaten their food.  I was having fun.  You made a mistake mommy.”  And big, juicy tears fell from his giant, brown, three-year-old eyes.  You see, he was not blaming me for having food allergies.  He was blaming me for ruining his fun.  He doesn’t blame me for having to eat different food.  He doesn’t feel angry at me for not being able to eat what everyone else is eating.  He only blames me for limiting what he is able to do because of his food allergies.

I’ll never forget how I felt when that three-year old boy was able to articulate his disappointment in me.  He was disappointed because I let my feelings of guilt and sadness affect him.  This was the first time I took a serious look at this blame-game I was playing with myself and realized that it was not only unhealthy for me but detrimental to my son as well.  What if he saw this in me and began to feel angry and resentful about his allergies?  I realized at that moment that I absolutely had to stay positive.  I had to keep him involved no matter how hard it was for me.  I had to lead with optimism.  And so, from that moment on, that is what I have tried to do.  This is not to say that I never fail at this and that I don’t still have to deal with my feelings of guilt but I do try and I think it makes a difference.

We like to take the kids on “dates” so they get some alone time.  Gino was going on a date with my sister last Saturday.  When my sister asked him what he wanted to do, he said that he wanted to bring his own lunch and go out to eat, maybe he would be able to get chips and pop.  He could’ve picked anything – a movie, the bookstore, bowling, but no, he wanted to go to a restaurant from which he could basically eat nothing.  He was beside-himself excited.  At school lunch, a teacher approached me and said, “Gino is an amazing child.  He is so excited to go to a restaurant to eat knowing he can’t eat any food from there.  He just wants to have a good time.  It’s beautiful.  He just doesn’t feel sorry for himself. “

He is amazing.  This child heals his mother and her guilt-ridden heart every day.  I have tried to see myself through his eyes and I can see that he doesn’t blame me for any of this.  We must try not to blame ourselves anymore.  It holds us back from being the best that we can be for them and if you aren’t able to give your kids the best of you that would be the only thing for which you could truly blame yourself.  So go forward, friends.  We must leave the guilt behind and stop trying to figure out what we did wrong.  Then we can be free to celebrate all of the things that we do right. After all, for me, the guilt was just not getting us anywhere and my kid wants to go places – whether he has to bring his own food or not.

Sarah | 108 Comments | Permalink
My Stories, Observations, Parties

The Science of Anaphylaxis – An Allergic Storm

posted January 12, 2012
01/12
2012

“Education leads to enlightenment.  Enlightenment opens the way to empathy.  Empathy foreshadows reform.”  -  Derrick A. Bell

The death of Ammaria Johnson is heart-wrenching for all of us.  An innocent 7 year old dies at school from peanut-induced anaphylaxis because her life-saving medication, epinephrine, was not available to her.  This is a grim reminder of the life-threatening nature of food-induced anaphylaxis and a very serious reminder of the critical need for massive food allergy education.

So, here’s what I am going to do.  I am going to teach you what happens in your body during an allergic reaction.  I want to do this for two main reasons:

1.  TO EMPOWER YOU.  Science is power.  It’s the proof.  And because food allergy is a term used relatively loosely, food allergy families and friends often find themselves feeling like they have something to prove. If you can use the words “mast cell” and “histamine” when you are describing food allergy to someone, they will have less opportunity to question you, to doubt you.

2.  TO HELP YOU EDUCATE OTHERS. If you have a clear understanding of how food allergy works and why epinephrine will save the life of someone who is experiencing anaphylaxis then you can be a better and more confident educator.  You will become an authority on food allergy.  You’ll have the facts in your back pocket.  People will listen because science is power.

I was at a kindergarten social for Sal and two fathers asked me why Gino and Milo didn’t go to the same school as my older son.  I explained that for preschool we hired a teacher for the boys because they have life-threatening food allergies and we didn’t think they were ready for a traditional food-filled preschool setting.  They just looked at me.  I felt doubt.  I felt judgment.  I felt misunderstood.  So instead of continuing with the normal, “So, anyway, I grew up in Bourbonnais.  What about you?” conversation, I thought I would give something else a try.  I asked them if they would mind if I took a few minutes to explain, scientifically, what happens during an allergic reaction.  They agreed, mostly to humor me.  (How could I blame them?  It was a pretty nerdy opening line.) As I spoke, the way they looked at me changed.  Their body language shifted from cross-armed and distant to relaxed with their body’s leaning in toward mine.  They were shifting from doubt to empathy before my eyes.  They were engaged.  As I was teaching them, they had no choice but to learn.  It was a powerful moment for me and later, I found out, for them too.  I am going to tell you what I told them.

The human immune system has an extraordinary eloquence and precision.  Nothing man-made can compete with its beauty and power. With that being said, this is a greatly simplified version of what happens during an allergic reaction but I think it is all you need to become an empowered educator.  Okay, friends, are you ready?

There are two main allergic cells in your body, the mast cell and the basophil.  These cells contain within them pockets (or granules, seen in red in image below) filled with chemicals that mediate allergic disease.  Mast cells are found docked in tissues whereas basophils are floating around in the blood.   Both of these types of cells have receptors on their surface.  Some of these receptors have IgE (immunoglobulin type E) antibodies attached to them. Think of the IgE antibody as a hand that projects out from the cell (seen in dark blue, shaped like a “Y” in image below).  Each of the hands will only grab onto specific food proteins.  They have a favorite food, so to speak.

Those are the main cellular players.  Now here’s what they do.  An individual eats a food to which he or she is allergic.  Let’s say it is a peanut but it could be virtually any food.  The peanut enters the gastrointestinal (GI) tract, whether it is peanut residue that cannot even be seen or an actual piece of a peanut.  At some point, the tiny allergenic peanut protein passes thru an insecure barrier in the wall of the GI tract.  The peanut protein then finds its way, through a series of events, to the blood stream and tissues.  Here is where the peanut protein finds the mast cells and basophils.

Now, there are those “Y”-shaped IgE antibodies (the hands) on these mast cells and basophils, remember?  The hands on some of the cells of a peanut-allergic person are looking for peanut protein.   When these hands make contact with the peanut protein, they grab onto it and in turn, the cell becomes “excited”.

The pockets of chemicals (granules) found within the cells quickly move to the edge of the cell and pour their chemical contents out into the bloodstream or tissues (degranulation). The chemicals spewing from these cells (seen in red in image below) include histamine and tryptase, among others. This process of degranulation can occur very rapidly and does not just occur in a few cells but instead in many cells all over the body.  This process occurs even if there was only a miniscule amount of peanut protein that originally started the reaction, even if the blood test showed a low number for peanut, even if all of the past reactions were minor.  If this process were not deadly, I would say that the efficiency and rapidity of the reaction borders on fantastic.

Histamine, tryptase and the other chemicals that are now swirling in the blood and the tissues start to wreak immediate havoc and the signs and symptoms of anaphylaxis are quickly evident.  Anaphylaxis hits as sudden as a summer storm.  The damage is frightening and widespread.  Histamine causes many changes to occur in the body.  Some of these effects are more considerable than others.  Histamine causes smooth muscles to contract leading to abdominal pain, cramping, nausea, vomiting and diarrhea.  It can lead to wheezing (like asthma) from airway constriction that can ultimately lead to respiratory distress, respiratory arrest and death.  Histamine also causes vasodilatation.  This is when blood vessels get bigger and have less ability to contract to get blood back to the heart.  This can cause a decrease in blood pressure that can lead to dizziness, feeling faint, shock and death.  Histamine also induces microvascular leakage.  This means that both cells and fluid that are supposed to stay in the blood vessels are able to leak out of the blood vessels.  This can lead to hives, itching, and swelling of the throat leading to suffocation.  If enough fluid leaks out of the blood vessels, there can be accompanying decrease in blood pressure leading to shock and death.  Histamine can also cause marked mucosal edema and mucus secretion.  It can cause the airways to become swollen and filled with mucus making it difficult for oxygen to get from the air we breathe into the blood that circulates around our body.

Now we are in the midst of anaphylaxis, WE MUST STOP IT.  YOU MUST USE INJECTABLE EPINEPHRINE.  How does epinephrine work to stop an allergic reaction?  You need to know this.  You need to understand WHY you must carry this everywhere you go.  You need to know WHY you must use this medication when your son or daughter, parent, grandchild, student, or friend is having a serious allergic reaction.  I told you how fast these reactions occur (and many of you have seen the speed of a reaction first hand) so there is no time to waste. If someone is experiencing anaphylaxis, injectable epinephrine must be given immediately.  Be a hero. Save a life. Don’t be afraid. Once you give the injectable epinephrine as instructed, here is what it does…

Epinephrine constricts blood vessels.  This is important because it curbs that microvascular leaking that leads to decreased blood volume and plummeting blood pressure, potentially leading to shock and death.  Epinephrine relaxes airways.  So while histamine is trying to make the airways tight, epinephrine tries to relax them in order to allow air to pass more easily.  Epinephrine helps to decrease swelling in the upper airway so that air is not obstructed from getting to the lungs.  It decreases cramping of the GI tract.  It helps to block the hives and itching that accompany an allergic reaction.  Epinephrine can help to stop anaphylaxis from progressing to death if given early and appropriately.   It is the only thing that can.  Antihistamines can relieve some of the skin symptoms (hives, itch) but they do not have the ability to save a life from anaphylaxis.

To summarize:  The food that one is allergic to enters the body.  It finds its way to allergic cells (mast cells and basophils) that recognize only certain foods through their IgE antibodies.  Once the allergic food protein binds to that IgE, the cell pours out chemicals (histamine and tryptase) that cause swelling, itching, decreased blood pressure, and can ultimately lead to death.  Epinephrine counteracts these effects.  It decreases swelling, increases your blood pressure, makes your heart pump better and helps to prevent a fatal reaction.

That is anaphylaxis in a nutshell, so to speak.   This is why it can be deadly and this is why epinephrine can save a life.  Please share this post with your friends, families, teachers, administrators, school nurses, physicians, and anyone else you can think of.  I know it is a long post but it is so very important.  If we do not push to educate others, I’m afraid that we are going to continue to lose our sweet and innocent food allergic children to anaphylaxis.  We simply cannot stand for this and, if I know anything about families who have children with food allergies, I know we won’t stand for this.  There is too much at stake.

Sarah | 87 Comments | Permalink
Anaphylaxis, Observations, Science