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Monday, May 5, 2008

Name That Allergen

Yes, we have a new game show over here. Not one we like playing, either.

As those of you who keenly follow the vicissitudes (really, I should say 'downs and ups') of Hallie's vomiting know, we had a great week last week. A nearly unprecedented one, really: other than a woops moment on Monday (coincidentally following speech/feeding therapy?), we had 4 glorious days where we could claim to be living up to the credo of Earth Day by not using more than our fair share of paper towels. Hallie sounded clear, felt good, was talkative, and was doing nicely. We added a couple of foods back into her diet (flax seed meal and oil and avocado) on Thursday (that should never have happened this way---we should and will hold faithful to the one-food-at-a-time for three days rule here on in). BUt nothing untoward happened on Thursday or Friday. She was a bit fussy with me at mealtime on Friday, but everything stayed down and on Saturday, her only incident was not food related but related to ingesting a wood chip from one of her puzzles.

Sunday and Monday: back to old patterns for us. What happened that was different? Well, on Saturday and Sunday, she did have avocado at every meal and flax seed at about half of her meals. She had both this morning, too. But the real problems seem to have started after speech/feeding therapy yesterday. Hallie's therapist, in her well-motivated but not terribly respectful of what we parents have to say kind of way, insisted that Hallie try some dried fruit (the sort of stuff that you put on top of cereal when, for some reason, you don't wish to eat the much better tasting fresh stuff). The flavor she had was strawberry/banana. Hallie happily consumed her fresh chevre but refused to eat any of these chips and kept pushing them away. The therapist was not satisfied, so she snuck one in to the middle of the goat cheese and was thrilled when Hallie ingested it. Hallie of course noticed it right away and began coughing and gagging but nothing came up. The therapist considered this a victory.

Us, not so much: thereafter, Hallie was congested, sneezy and fussier than she had been in the morning. After lunch (avocado, carrot and flax meal, and goat yogurt), she upchucked and was okay when we refed her. She was also sneezy and wheezy last night and was fussy this morning and seemed to have an edemous, certainly itchy eye and a sneezing jag at breakfast, after I gave her avocado (preceded once more by carrot and flax). But everything stayed down. Hallie did not take a morning nap today, but instead just had some milk, followed by some time in the park, her reglan, and a couple of ounces of goat yogurt. After we got home, I gave her a proper meal of prunes, pears, and carrots, this time nothing added (Sharon and I had talked and decided to return to square one, let her system clear out, and then try avocado and flax meal/oil independent of one another later this week). Hallie fought me during lunch, but I mostly attributed this to her being overly tired. Right after lunch, she settled down on the couch and Classical Baby for a nap, drank a couple of ounces of her milk, and fell fast asleep. But she sounded junky---that old, awful upper airway noise she had last spring. And about twenty or thirty minutes into the nap, she coughed that terrible cough, I ran over to her from the dining room, and by then she was upright, with that look on her face. Since we are a bit out of practice, no vessel for vomit catching was nearby and instead she projectile vomited several times in a row (that stomach emptying kind with which we are all too familiar) across the room. Thankfully she hit the floor (and the entertainment cabinet a good three feet away) and not the couch. She was remarkably well behaved during my solo cleanup act (it's MUCH easier when this happens with two of us at home rather than one) and stayed out of the goo. I stripped her down, changed her diaper (she pooped at the same time as all this happened; this happened yesterday, too) and cleaned her up and got her into fresh clothing (though she still stinks) and put her down again with another bottle. She has feeding/speech therapy at 6:30 and we need to get her rested. It took her a good hour to fall asleep and lots of cuddling from me. But she sounds clearer now, and is asleep, thank goodness.

Me, I'm a bit restless: is it the strawberry (also snuck in, but rejected by Hallie last Monday night)? Is it the banana? Is it the avocado? Is it the flax seed meal? All can be major allergens and Hallie had a rough time with bananas when we tried them, and a similarly rough time with avocados. The first few attempts all involved vomiting, though she has not vomited consistently with these foods. Still, given the frequency of vomiting and that the vomiting need not be immediate but can happen two or more hours after ingestion (I think because everything inside her GI and respiratory tract gets inflamed after the ingestion of a food that releases histamines), we don't really know that these are OK foods. Flax seed meal could also be the culprit. So, we need to trial all of these things one at a time and hope that at least one of them DOES NOT provoke an allergic response in our girl. And we need to prevent the therapist from giving Hallie anything not mama and mommy approved. And, finally, we need to respect Hallie: she knows when her system hurts and when she cannot eat something. We need to heed these signals and not see them as some sort of perverse food aversion but rather the sensible response of a very attuned to her own system little girl with an extremely strong survival mechanism but without the speech she needs to convey precisely what's going on. Hallie is perfectly eager to eat when she is hungry at this point, but is also clearly telling us something when she is not. Sharon and I both realize that we need to do a better job of listening to those messages.

Meanwhile, we know that Hallie is already allergic to cow milk, egg, wheat, barley, and buckwheat. We think she's okay with pear, plum, prune, apple, carrot, potato, and of course, goat milk. And we know that we are just at the beginning of discovering the extent of our kid's allergies. And we are all praying for her to get over at least some of these at some point.

So, back to the beginning of the post: if anyone out there cares to guess which food or foods are triggering Hallie's allergies, please do so. I promise to mail a box or bag of a favorite (hypoallergenic) snack to the first correct responder!


Anne said...

I'll be the first to guess: the strawberry. Why do I guess this? No real medical reason, mostly because I am hoping she can continue to eat bananas and yummy avocados, my favorite.

23 weekers said...

Poor girl. Are you thinking it's an allergy because of the wheezing and/or breathing issues? I'm just curious. Does she get a rash? Has an ENT scoped her throat to see if everything looks good? My little ones had such bad acid reflux that anytime something came up, the esophagus would get so swollen that it caused a lot of wheezing and rough breathing. Don't know how you feel about the fundo plycation, but would it be an option to help keep things down?

Sarah said...

I'm with Anne, I'm guessing strawberry, since egg allergies can also cause strawberry intolerances.

Is chevre goat cheese? I wonder if Sydney could tolerate sounds like it'd have a nice amount of calories :)

abby said...

We've done the scoping and fortunately she is negative for any allergic cells (which would indicate EE, I think) and damage from acid (which is fortunately controlled by prilosec--until we get to the bottom of this, there is no way we come off of reflux meds). They never scoped her mid allergy attack (this would be impossible, I think, given restrictions on intake before scoping) so they are guessing here. But her allergic responses seem consistent with GI anaphylaxis--not to be confused with the much more terrifying systemic anaphylaxis, but I suppose the two are related. She does have some skin reactions to eggs and wheat, and perhaps other substances, but these are mild in comparison to the GI responses to allergens.

I, too, hope it's strawberry. It's a lot less caloric and yummy than avocado and flax seed and banana. We'll see. Meanwhile, our speech therapist is getting increasingly annoying. Too bad (well, not really), the speech results are very good so far. The approach that works for apraxic kids works for Hallie.

Chevre is goat cheese---fresh kind (the white stuff often sold in logs in the grocery store---need not be fancy shmantzy grocery store, either. I think places like the big chains have it, at least in the northeast). Hallie LOVES the stuff. It's creamy and tangy and has anywhere between 50 and 75 calories an ounce, so it's packed with good stuff (also high in calcium and such). The irony of our lives is that Sharon HATES goat cheese and the thought of it makes her barf (really). But she's gotten over this, and as long as she doesn't have to eat it, is happy to serve it to Hallie. I think it's yummy!

laura619 said...

Hi, I have been reading your blog off and on when I came across it from my friend, Keet's flickr. I am throwing in my allergen guess because I myself am allergic: did these chips have coconut oil? I am thinking you should put coconut on your lists of suspects.

Kirsten Wood said...

I would tend to agree with breaking the speech therapist's hands....but that's just me. Has she offered _any_ justification for experimenting with foods when you are trying a very careful allergen-testing regimen? If this were a life-or-death situation, I would say it's worth a little vomiting, and clearly, getting her to speak more and better is urgent, but the poor kid -- and her moms! -- needs to be able to eat without fear of barfing attacks. And is it possible that she would develop an aversion to speech therapy itself if it keeps coming with coercive or sneaky food attacks that irritate her system?

PS I vote for strawberries, too, but I agree that it's a good idea to look for what else went into the strawberry surprise. Unless it was pure freeze-dried strawberry, for example (which we love around here when we are feeling flush, but which used to give G. a rash around the mouth).

BusyLizzyMom said...

We were told strawberries release a histamine and were a fairly common allergen. Elizabeth vomits with strawberries. She also has an egg allergy and the 2 are related. As for avocado and bananas I have 2thoughts having reflux for a decade I know that if I eat either I can guarentee a full day of excruitating abdominal pain and a feeling as if someone had kicked me in the stomach for week. Another thing with avocados and banana's they are linked to latex allergies, if one has a sensitivity to certain foods (banana, pineapple, kiwi, avocado and other foods) they may have an allergy to latex. If she is stuffy it must be an allergic reaction to something. Also allergies are bad right now and when you are fighting seasonal allergies your sensitivity to other allergens is increased.
Do I win a hypoallergenic snack?

Niki said...

I'm gonna go with avocados. Why? I have NO idea.

I really hope you guys can get to the bottom of it soon.