Friday, August 21, 2009

adjustments in progress: dairy

Yes, that was me, standing in the baking aisle and giggling. Possibly, that high pitched, slightly hysterical voice was also me, half-shrieking, half-whispering something incoherent about nonfat dry milk.

But I'm sure that it was someone else who stared at the milk in the dairy aisle, and said, it's been so long. Which one do we like? Any? All? and trailed off into a hiss of laughter. Nope. Definitely not me.

Dairy. In our home.

It's funny to think that after years of refusing to make myself nuts (ahem) by having an easily scattered, easily missed allergen in my home, I now have one. And the doctors think it's a good idea. Of course, they don't watch dry milk powder puffing into the air, and wonder where it's landed. And, until the stuff is baked into submission, it's still very dangerous.

For the next six months, the Eldest will have extremely specific kinds of dairy, heated to specified degrees. I have three whole recipes, and those alone I am to use for the next month. After that, we can have a few more options - but, yes. Calipers.

It's an odd thing, to be allowed something under such controlled circumstances, and not otherwise. It's almost a conditional allergy, a conditional concern. And when it is a concern, well, it's absolutely present, and looms large enough to highlight the challenges of the next month. The next six.

The floodgates have hardly opened.

The Eldest has proven that he can tolerate milk, in a pudding that was baked for 2 hours in the oven. Or dry milk powder, in a muffin that spent 40 minutes in the oven. Cheese, broiled on a slice of pizza. And I do mean broiled: when I followed the recipe from the allergy clinic, my cheese pizza was a brown cheese cracker.

Ice cream, feta cheese, cottage cheese, yogurt, sour cream, milk and oh yes, haloumi will cause a reaction. This, the doctors can say with certainly. But what about a grilled cheese sandwich? Cheese inside a lasagne? We walk the bounds of knowledge here, and we're staying inside an oh-so thin line of what is likely safe, what is nearly known and certainly guessed at. And the terms of the trial are that we don't experiment. The crack in our floodgates comes with a price - and a more specific awareness of the risks.

We're disinclined to test this farther, but oh, are we spending hours wondering and speculating.

We stayed late at the clinic after the trial's dramatic finish, asking questions. And, as best as I understand it, here's the deal:

Allergies, as you probably know, are a moving target. One day, a child's immune system may be mildly irked by an allergen, and another day, that child's immune system may start shrieking, like an under-caffeinated mother who has just stepped on some particularly tiny, spiky lego pieces. Or something.

An exposure to an allergen can cause the immune system to sharply hike up the degree of its response, without warning. Or not. An egg allergic child might eat egg after egg after egg with nothing beyond a slight itch, or a child might eat that seventh egg and the itch will metamorphose into a closing throat. Or not.

Different children react to different quantities of an allergen, and the nature of the reaction can be tweaked by whether they're also affected by oh, the pollen count. An immune system that's already irked and muttering about pollen, or dust mites, or whathaveyou, will roar more loudly over that egg, than an immune system that was quietly reading a book when the egg came along. How much pollen does it take to have a serious contributing factor? Dunno. Depends on the kid. But apparently, a virus can have a similar effect, and can prime the body to react harder, and more harshly, when the allergen comes along.

Okay, so that's not going to make things simple.

Now, some immune systems get all het up and go looking for trouble. The body recognizes it's chosen Evil Food by the shape of a protein in the food, but which one? Foods have tons of different proteins, and different people are allergic to different proteins in, say, a peanut. Which is why you can't really develop an allergy-free peanut, but that's another bitter laugh for another time.

So, the body identifies the protein, and maybe, maybe it then decides to go after some of the allergen's cousins, as well. Maybe. And when it does, that's how peanut allergy can lead to another legume allergy, like soy, or lentils, chickpeas, etc. But not every protein tends to sendthe body on a cross-reactive rampage: patterns of cross-reactivity vary widely from individual to individual, and are not really predictable. Mango, banana, latex and avocado all have proteins with related shapes, but the number of people who develop allergies to the group is much smaller than the number of people who, for example, are allergic to one nut and go on to be allergic to six nuts. Why? dunno. Why do some people cross-react/allerge to thirteen things, and others just have one allergy? At this point, allergists start muttering things about predestination, or preconcieved notions, or predisposition or prior authorizations, but it boils down to: dunno.

What we do know is this: the body has the capacity to pick one protein shape out of a crowd, and to hang Wanted posters for similar shapes. Maybe you have a laidback body on the poster-hanging, maybe you have one of those irritatingly energetic types with a stack of posters and a look of determination. But, if you reshape that protein somewhat with heat, say, by baking it in a batch of cookies, the body may not recognize it. Or, at least might not be troubled by it. maybe. Possibly. It's a big, honking 'don't try this at home' perhaps that the reshaped protein slides past our alert, cranky immune system. Why?

A biochemist-immunologist cross might be able to explain this better, but all I've got is: dunno.

But I think that's the reason that an egg allergic child can *sometimes* tolerate an egg, well-baked in a batch of crisp cookies. But not necessarily two eggs, because denaturing, or reshaping the protein doesn't seem to be an absolute fix. And, as the Eldest has proven, that's the reason that a dairy allergic child can sometimes tolerate a bit of milk, well baked in the oven. Perhaps the boiled milk was insufficiently heated, and its proteins insufficiently denatured. Or, perhaps it was too much milk, too fast. Dunno.

Even with the trial-approved foods, there are limits. Can't have pudding and pizza at the same meal - we learned that the hard way. Muffin and pizza? Muffin and pudding? unpredictable. But the worst it brings, thus far, is an upset tum.

Which means that we're proceeding with caution. No floodgates have opened, just a careful window. With oh, such a vista behind it....


Anonymous said...

So scary. So exciting!

Is it possible to do the puffy part outside?

Your explanation of "the deal" is fantastic.

Gillis said...

I am seconding this 'eating food and discussing pasties' idea. It sounds like a very good one.
Good luck with the powdered milk!

Amy said...

Wow! From now on I am referring everyone to this post when they ask me questions about why some people can eat some foods they are allergic to, and others not. Food allergies are one of the most complex subjects I know of, and it is sometimes next to impossible to try and explain these details to others. Thanks for such a great post!