This blog post is the third in a series of posts exploring our family’s journey with food allergies. Today, I’ll share the next steps in our journey, and exposing my toddler to her allergen – on purpose.
Disclaimer: This post is for information purposes only and should not be a substitute for advice from your medical team.
You can catch up on our Journey with Food Allergies posts here and here, but briefly, we found out that our daughter was allergic to eggs, walnuts, and pecans when she was about 9 months old, though she wasn’t officially diagnosed until a few months later.
Since this time we’ve been careful to avoid anything containing her allergens and discovered many sneaky places that these allergen foods can be found. I did screw up a few times and accidentally gave her egg-containing things without thinking. Like that time that we shared a tuna sandwich at a restaurant —- oh yeah. Mayo is made with eggs. Or that time she gobbled down her Nonno’s fresh Italian pasta and broke out into hives —- right. Eggs in there too. As any allergy parent can attest, ingredients like eggs (and other high risk allergens, like soy, wheat, and dairy) can hide in very unexpected places. Reading labels very carefully is not just important, but can be life saving for some kiddos. We have had to be those parents who bring their own food to parties or even to restaurants if there’s nothing that she can safely eat. And, I’ve definitely been that person at the restaurant who asked 5000 questions about every item on the menu and asked for things to be made special, items on the side, etc, to ensure that my daughter’s portion would be ok for her to eat. I will also add, breakfast restaurants are the actual worst for egg and tree nut allergies. On at least three occasions we have gone out for breakfast where literally the only thing on the entire menu that didn’t have eggs was yogurt – and even that had a walnut-containing granola on top.
Now, we are quite fortunate that Miss V’s allergic response is not life threatening. She has not had an anaphylactic reaction to anything (though we have an Epi Pen just in case, because she has multiple allergies and in some cases, allergic reactions can become worse with time). She reacts to all of her allergens with hives and a rash, more severe with the tree nuts but still itchy and uncomfortable with eggs.
The good news is that many kids with egg allergies will outgrow it – 9 in 10 will outgrow the egg allergy by the time they reach school age. Egg is also a rather unique allergy. Usually the treatment for food allergies is strict avoidance, however about 70-80% of individuals with a diagnosed egg allergy can tolerate egg products when baked at a high temperature. Sadly though, not so for tree nuts, which only 1 in 10 will outgrow, and there are no levels of tolerance that I’m aware of.
At our first visit with the allergist, it was suggested to start climbing the “Egg Ladder”, a series of instructions to reintroduce egg protein back to Miss V’s body in small doses. We didn’t know what level of tolerance she had, so we were avoiding anything containing egg ingredients altogether (though we didn’t need to be as cautious about cross-contamination risk). With the encouragement of our allergist, we started to reintroduce.
The “Egg Ladder” basically involves eating a small amount of products containing baked egg, and gradually increasing the amount consumed to build up tolerance of the egg protein, as well as to assess the level at which an allergic reaction still occurs. The steps along the egg ladder might vary from person to person depending on their baseline level of allergic reaction and tolerance. For example, “officially” it starts with a crumb of cake. In our case, Miss V had previously tolerated a couple of products containing small amounts of egg products (that I didn’t realize until it was too late), so our allergist suggested we could continue using that and other packaged goods where egg was near the bottom of the ingredient list (meaning only a small amount), and that we could skip ahead a few steps along the ladder since Miss already had a small known tolerance.
The egg ladder starts with eggs baked into a product made with wheat. When eggs are baked with wheat, the proteins denature and create a “matrix”. Though there is still egg protein in the end product, it forms a compound that is not digested as well as it would be normally, making it less allergenic. “Baked egg” counts as products that are baked at 350 degrees F for 30 minutes or more, which is a high enough and long enough heat exposure to denature the protein to a more safe level.
After avoiding eggs for so long, it seemed so counter-intuitive to give my daughter an egg-containing product on purpose. We first tried muffins, baked with one egg divided across 12 muffins, and Miss ate 1/2 of one. Unfortunately there aren’t many muffin recipes that I’ve ever come across that call for 350 for 30 minutes, so our muffins had to stay in the oven a bit longer than called for making them a bit dry. But luckily, she didn’t mind, and ate it happily. I watched with bated breath ready to respond to any reaction, but nothing happened. Hooray!!! *sigh of relief* She later was able to eat the whole muffin with no problems. About a week before our next allergist appointment I mustered up the courage to make muffins with 2 eggs divided across 12 muffins, again, overbaked to ensure we got to 30 minutes. And again, she tolerated just fine!
We recently followed up with the allergist to discuss our ascent on the Egg Ladder. She was very pleased with Miss V’s progress so far, and suggested that we could now try baked items that don’t contain wheat (such as meatloaf or breaded meats), and if tolerated, progress towards less-cooked egg containing products (like pancakes and fresh pasta). This is when my face went pale and I broke into anxious sweats, because these are some of the items that she DID have a reaction to previously!
This week marks one year since we first discovered that our little girl had a food allergy. I reflected the other day on how much we’ve learned in that time about being allergy parents, about advocating for our child in the face of food pushers and people who just don’t get it, about the frustrations and anxiety of child care with an allergic kid. We’ve learned to adapt our own eating habits to keep her allergens away, to get creative with recipes, and reading labels very carefully (which, while I always read labels anyway, I have more things to look for now).
In the next installment of the series, we’ll continue along the egg ladder and continue learning to live in an allergic world.
The Family Table Nutrition Services 