The Atopic March

Today we’re going to get a little more scientific and talk about the atopic march- which is the link between eczema, food allergies, and asthma. Eczema (or atopic dermatitis) is pretty common in kids and is characterized by inflammation, redness, and irritation of the skin. We don’t know the cause, but if you have eczema as a baby, you are at more risk for allergies (including food allergies) and asthma.

The ants go marching one by one, womp womp, womp womp.

Step two in the march is food allergies. We know about that here- it’s an immune over reaction to food. But how does that relate to eczema? Well, there’s been research that exposure through the GI system by eating the food allergens promotes food tolerance while exposure to food allergens through the skin can lead to food allergy. Eczema can affect the skin barrier, which can effect a baby's exposure to food. There’s also an overlap of causes of the two diseases- genes, the environment, etc that I'm not going to pretend to understand.

The best advice now is: early treatment of the impaired skin barrier and early introduction of food allergens (through eating) to try to prevent the development of severe food allergies. This is different than a lot of advice I’ve seen online that warns against early introduction of common food allergens in kids with moderate to severe eczema. I get it- if you have eczema and there’s an increase likelihood of developing food allergies, the last thing you want to do is give your kid something to try and have them react to it. But right now, there’s no cure for food allergies, and the only thing we have is prevention. The only way to do that is early introduction.

Third on the march is asthma. Asthma is a chronic respiratory disease characterized by recurrent wheezing/shortness of breath due to irritation causing swelling and narrowing of the airway. Food allergies and asthma are common together, though there doesn’t seem to be as straight of a path from food allergies to asthma as there is from eczema to food allergies. The normal association of asthma with allergies, focuses on environmental allergies like dust and cat dander. There has been some research looking at how breathing in aerosolized food allergens can cause asthma exacerbations. Most of this research has been on adults, but one study did find that a child’s asthma was worse when the family cooked with the foods that they were allergic to and improved when they stopped.

There also appears to be some connection of asthma to IgE levels. Usually, kid’s asthma is less controlled in the spring (due to pollen) and fall (due to dust mites) and this matches with higher levels of IgE in the blood. There was also a study that found that higher levels of IgE at 6 months age was associated with early onset asthma.

Whatever the connection between food allergies and asthma, one thing if for sure- it’s not good to have both of them. If you have both, your risk of severe reaction to food (anaphylaxis) increases AND your risk of severe asthmatic episodes also increases. So, make sure you have both your epinephrine and your rescue inhaler.

TL;DR

• With moderate to severe eczema, it’s important to take good care of the skin AND early introduction to food is still best.
• If your kid has food allergies and asthma, cooking with their food allergens can irritate their lungs.
• Always have your epinephrine and rescue inhaler with you!

Some references:
Atopic Dermatitis and Food Allergy
Food Allergy and Asthma

Was it Worth it? Air Fryer Edition

Was it worth it is back baby! I’ve bought a lot of new kitchen appliances since my kid was diagnosed with food allergies, but after running out of cabinet space, I had to hold off on something I had my eye on for a while- an air fryer. But Christmas came around this year and guess what was waiting for me under the Christmas tree? (Thanks, bro!)

Air Fryer

Was it worth it? An air fryer is essentially a small convection oven. It doesn’t really fry, just bake with a fan. But “small oven” doesn’t sound nearly as exciting as an “air fryer” so I’ll give it to the marketers on that one.

Oh, she may just be a tiny oven, but she's a shiny, new, tiny oven!

Is it helpful in the kitchen?

Yes! It is really good at roasting things quickly. It preheats way faster than my oven. With the fan circulating the hot air, it crisps up food really well. It’s easy to clean and since you clean the entire removable drawer, you don’t have to worry about crumbs burning and setting off your smoke alarm. So far, we’ve made a sweet potato hash (delicious), tofu (amazing), frozen chicken patties (way better than the microwave), fish filets (so easy), and frozen French fries.  Anything that is good in the oven seems better (and quicker) in the air fryer.

I asked my wife to take a picture of the fries and this is what she came back with. It's like a Rorschach fries test- I see a tree.

Downsides

The main downside is it’s another, completely separate kitchen appliance. Which brings my kitchen appliance count to… a number so high I don’t even want to think about. While it’s really large to store in a cabinet, as far as cooking space goes it’s a lot smaller than our oven. When we made french fries, it cooked them quickly (8 minutes!), but we had to do 2 rounds.

What allergies is it helpful for?

I don’t know that it’s good for any one specific food allergy, but it's a great alternative to a deep fryer. Because oil in a deep fryer is not often changed, we were told by our allergist to avoid anything deep fried at restaurants. Fries should generally be safe for our kid to eat, but when they are tossed in the same vat as chicken tenders that may be dredged in buttermilk, it's not worth the risk. Wheat, egg, milk, flake fish, shellfish, soy may all be floating around in a deep fryer (not to mention they could be floating around in peanut oil!). So having a at home (healthier but still delicious) easy alternative so our one kid doesn't feel left out is great.

So, is it worth it?

Honestly, for french fries alone, yes it is worth it. French fries are something that both my kids love. My older kid gets them a lot from restaurants and it’s not like we can just warm up some frozen ones for the younger one in the microwave. And it doesn’t seem worth it to turn on the oven for a few fries (especially now that we know that gas ovens are terrible for us). So delicious, frozen french fries in 8 minutes? The little one not feeling left out? Definitely worth it.

Food Allergies: They're Everywhere You Read

I had no idea how much food allergies would affect my kid’s life until she had her first reaction. I knew about epipens and the rising prevalence of peanut allergies, but I didn’t realize how it would seep into every part of my kid’s life. Having to pack separate snacks for her. Not getting to eat the special Friday pizza at school. Making her big brother wash his hands each time he eats cheese. Extra planning for other kids’ birthday parties.

But you know when it really hit me? When I was reading Yummy Yucky to her when she was a baby. Yummy Yucky is a great book (as are all of Leslie Patricelli’s books!)- fantastic pictures and really fun to read with kids. We loved reading it with our oldest, but reading it with a baby with food allergies was a completely different experience. Out of the 18 yummy foods, 15 of them have top allergens, and 11 of them my kid couldn’t eat. This means that over half of them I would say, “Yummy! But… not for you.” Being reminded of all the things she can’t eat really did suck the fun out of that book.

A quick selection of books that I read differently after feeding a kid with food allergies

It's not just Yummy Yucky, though. The amount of kids’ books that have top allergens in them is really surprising. You would expect books like The Hungry, Hungry Caterpillar to have allergens in it, after all it’s centered around foods. But there are a lot of books out there that don’t seem to have anything to do with food that include really common allergens. Llama Llama Mess, Mess, Mess- why do you have to bring peanut shells in to the mix? I get it, you are trying to teach kids not to have a messy house, but can we keep the number one cause of anaphylaxis in young kids from being thrown around? Even I Love You Stinky Face, a book that my in-laws saved over the years that my kid loves to read every time we visit, that should really not need to talk about food at all has a couple of pages dedicated to a peanut butter sandwich (not, might I add, a PB&J sandwich, which I think would be excusable since it is such a classic kid meal... but just peanut butter? Who eats just a peanut butter sandwich???)

I just want my kid to be able to do things without being constantly reminded of things she can’t have. I guess that’s impossible when food is such an important part of life.

All About Baked Milk

It’s time to celebrate! For the first time since embarking on this food allergy journey, we’re adding a food back rather than taking more away! We’ve been slowly increasing the amount of baked milk muffin our kid eats over the past few months and a couple of weeks ago, she finally passed the baked milk food challenge eating an entire muffin made with 1/6  cup of real, true, cow's milk. Since milk was the first thing she had anaphylaxis to, this is a huge deal for our family.

But what exactly is baked milk? It’s not just pouring milk into a casserole dish and baking it (yummy, a pot of warm milk!). It’s baked goods with milk in them (with very specific restrictions, of course). It can include:

• Store bought foods that have cow’s milk listed as the third ingredient or lower in the ingredients list
• Home baked recipes that have less than 1/6 a cup of milk per serving
• They must be cooked thoroughly
• The milk must be cooked in a wheat (or wheat alternative mix)- like breads, crackers, cookies, cakes, and muffins

It does not include: 

• Pancakes, waffles
• Pudding, custards, and other milk products that are "cooked"
• Chocolate chips with milk in them even if you bake them
• Any cheese flavoring added after the cracker is baked (oh Goldfish, why do you have to look so tasty, but still be off limits?)

AND you have to account for any other allergies you have which can be pretty limiting.

But why can she tolerate milk in a muffin now but not cheese?

Well, when milk is baked in the oven, it denatures the milk protein, or changes it shape, making it less likely for the body to recognize it as dairy milk. By changing the shape, the body’s milk IgE doesn’t necessarily recognize the milk protein as milk protein and no allergic reaction is triggered.

Ways to denature a protein: heat, acid, or having a toddler help with laundry

Okay, so pancakes have milk that are exposed to heat, why aren't they safe?

I couldn’t get a super clear answer, but from reading a few studies, it seems like it’s not just the heat that denatures the protein, it’s the time that the milk is exposed to the heat. Higher heat AND longer exposure to that heat increase the number of milk proteins that are denatured. Delicious pancakes and waffles that cook quickly are out, but quick breads, muffins, cupcakes, and cakes that bake for longer should all be okay.

In reality, this didn’t really open a door to new a lot of new food; more of a tiny window that will hopefully, in the future, lead to growing out her milk allergy. Because if she can tolerate baked milk, there’s a good chance (cross our fingers, knock on wood, say a short prayer) she will eventually tolerate all kinds of dairy. Only muffins now but maybe yogurt and ice cream and pudding and custard and cheese and icing and birthday cakes and whipped cream in the future! So, cheers to tricking her little body into learning that dairy is safe! One tiny, very specific, baked muffin bite at a time.