Oral Food Challenge for Milk: Passed (My Final Blog Post)

Milk food challenge
Last month, Swissinfo.ch published an op-ed I wrote about living with food allergies. Here’s an update to that piece and my final post on this blog:

I have good news! My 3-year old son recently had his seventh oral food challenge—this time for cold cow’s milk. According to his pediatric allergist, he “passed” the test. Going forward, he must consume no more than 150 ml of milk every day for the next 3 months.


Evaluating the Results

Similar to the results for my son’s food challenge for raw egg, the little guy broke out in hives around his mouth almost immediately after the first dose of cold milk. After each subsequent dose (five in all), I made sure to wash his face with cold water. Thankfully, the hives lessened, but midway through the test, my son’s demeanor seemed to change a bit. He started to look tired, laying down on the bed. I was sure the test would be a failure.

Then another food allergy parent, who was also at the hospital monitoring a food challenge, pulled out an iPad. My little guy perked up, and we seemed to be back on track. All other symptoms seemed normal—blood pressure, heart rate, etc. We continued with the test.

For the last dose, the nurse kindly mixed the milk with Caotina (a popular Swiss chocolate powder for making hot cocoa). My son used a straw and slurped it up in record time. He was happy and back to his normal rambunctious self.

When it was all over, my son’s pediatric allergist declared the test a success, describing his current condition as atopic dermatitis (i.e., eczema) with a contact reaction to milk. Apparently, he no longer has a true food allergy to milk. Even though he can safely consume milk (at least in small doses, to start), his skin can still react when it comes into contact with milk.


Next steps…

At this point, my son doesn’t have any food allergies. The allergist told me it’s no longer necessary to carry along two epinephrine auto-injectors, everywhere we go. He needs to maintain his daily dose of milk, to avoid recurrence of the allergy. It’s what we’ve been waiting and hoping for since we first learned of his milk allergy in 2012. I still can hardly believe it.

Given these latest developments, I will no longer maintain this blog. Our son’s food allergy journey has ended (fingers crossed!), but I know it continues for so many others. If you ever have questions about living with food allergies, please don’t hesitate to send me an email. I’m happy to try and help.

I want to say a huge thank you to everyone who has been reading Dairy-Free Switzerland and sharing your advice and kind words. I started this blog as a virtual support group because I didn’t know anyone with food allergies in Switzerland when we moved here nearly 3 years ago.

It’s been such a pleasure connecting with you all and learning from your experiences. I’ve heard from so many wonderful people living with food allergies both here in Switzerland and around the world. Also, I have to mention all the other food allergy bloggers out there who’ve helped me along the way. Your support has been invaluable.

As always, I hope you get some good news about food allergies too—whether it be outgrowing them, participating in a clinical trial or hopefully, one day there will be a cure!

Finally, if you’re looking to reach out to others living with food allergies in Switzerland, please contact the aha! Swiss Allergy Center or check out my recent blog post on Swiss support groups.

Many thanks, and best wishes to you all!

-Heddi

P.S. I will still be running the Royal Parks Foundation Half-Marathon in London this fall to raise money for Allergy UK. For more information and to make an online donation, please check out my JustGiving page. Thank you so much!

P.P.S. If you’re interested in continuing to follow my cooking and baking adventures in Switzerland, I’ve started a new Swiss food blog: Cuisine Helvetica.

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Homemade Dairy-Free Chocolate and Marzipan Penguins for Valentine’s Day

The professional version of chocolate-marzipan penguins

Our local chocolate shop always makes these cute little chocolate and marzipan penguins for Valentine’s Day. This year, I decided to tackle a homemade version.

After my son’s successful food challenges for eggs and almonds last year, marzipan is one of my new favorite ingredients (remember the Swiss Stollen at Christmastime?). Even thought it’s a major improvement, his milk allergy still prevents him from enjoying store-bought chocolates at this time.

To prepare for my confectionery experiment, I bought some dairy-free marzipan and food coloring. After shaping the penguins’ bodies and wings out of the marzipan, I spread some melted Enjoy Life Foods chocolate on their backs. Then, I dotted some chocolate on small drops of powdered sugar icing for the eyes (they seem a bit scared, don’t they?). My family of penguins certainly look homemade, but they taste really good, and the kids are excited to try them on Valentine’s Day.

My very homemade-looking penguins

If you’re looking to make some allergy-friendly Valentine’s Day treats, here are some recipes I’ve shared during the last few years. All of them are dairy-free, egg-free, peanut-free and tree-nut free.

And, for another super-easy and no-bake recipe, check out Allergy Shmallergy’s Sweet Strawberry Hearts.

What allergy-friendly treats are you planning on this year for Valentine’s Day? Please share your suggestions and recipes by leaving a comment below. Thanks so much! 

Oral Food Challenge for Baked Milk: Passed

Baked Milk Food Challenge

My son’s final doses of baked milk

“Milk in the batter! Milk in the batter! Stir it! Scrape it! Make it! Bake it!” – From In the Night Kitchen by Maurice Sendak

On Thursday evening, I read In the Night Kitchen to my sons at bedtime. It’s one of my favorite children’s books. I hadn’t planned on it, but I when came across the brown-hued cover on the bookshelf, it seemed appropriate timing considering our plans for the morning—my son’s physician-supervised oral food challenge for baked milk.

This would mark his sixth food challenge, and I feel the same way every time—nervous, worried, happy and excited. After our unsuccessful attempt at baked milk back in July 2014, when my son refused to eat all the required doses of cake, we decided to try a new approach. This time, as recommended by his pediatric allergist, I modified the recipe and baked the cake at home.

I’m elated to report that my son “passed” the challenge with a negative result—no reaction whatsoever. This is huge. I baked Zopf with milk and butter for my family on Sunday, and we all ate it together. My hope is that every child with a milk allergy can get to this point. We feel so incredibly lucky once again.


Why is baked milk okay?

When milk is extensively heated (i.e., baked), the proteins change somehow so my son’s immune system no longer considers it an allergen. From the various articles I’ve seen and our own experience, the heating standard for food challenges with baked milk is generally 180 degrees Celsius (350 degrees Fahrenheit) for 30 minutes. One recent study estimates that the majority (75 percent) of children with cow’s milk allergy can tolerate eating baked milk products, like cake and bread. Another study has found that consuming baked milk products helps to increase children’s tolerance for drinking unheated cow’s milk.

Sources:

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Have you participated in a baked milk food challenge? What was your experience?  Please leave a comment below.

My son will have another milk-based challenge coming up this spring. More details soon… In the meantime, I’m making sure he has baked milk in some form every day until then. I’m thrilled to be baking with milk and butter again!

Thanks for your continued support and advice! I hope you’re getting some good news about food allergies too.

Updated: If you would like the recipe I used for the baked milk challenge, please send me an email for more information. February 2, 2015.

Recipe: Swiss-French Red Cabbage Salad with Apples and Raisins

It’s that time of year again, when I try to serve more vegetables to my family after weeks and months of feasting on baked goods—and I’m usually the worst offender!

My latest plan involves trying to work vegetables into all three meals, and ideally in at least two dishes. For breakfast, that means scrambled eggs with spinach. At lunch or dinner, we’ll have a salad and steamed green beans with lemon, for example. With more and newer options, I’m hoping my kids’ interest increases so they actually like eating vegetables, instead of viewing them as a necessary evil.

After a recent Sunday walk, I tried out a new a new red cabbage salad recipe from a local Swiss-French cookbook. I served it as part of leisurely brunch during our last day of the holiday break. My husband, who usually HATES mayonnaise, liked this salad. Unprompted, my 7-year old said it tasted good after his first bite. My 3-year old gave it a thumbs up, but I think he really only liked (and ate) the raisins, to be perfectly honest. We’ll keep this cabbage salad in our mealtime rotation, and I’ll have to try another one I saw recently from Migros’ Saison.ch made with orange juice (here’s yet another salad recipe with cabbage, orange and fennel that also looks good).

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Sunday walk on Mount Vully


Salade de Chou Rouge (Red Cabbage Salad)

Recipe adapted from Recettes du terroir neuchâtelois by Francis Grandjean (2002).

(dairy-free, egg-free, nut-free)

Serves 6-8

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Salad:
500 grams red cabbage (about 1 cabbage)
1-2 apples, diced
about 1/2 cup raisins (I like golden raisins)
Optional: finely chopped chives and lettuce leaves

Sauce:
100 ml vegan mayonnaise (use really mayo if you can!)
3 tablespoons sunflower oil
2 tablespoons red wine vinegar
2 tablespoons shallots, finely chopped
2 teaspoons mustard
salt, to taste (I used about 1/2 teaspoon)

Instructions:

1. Slice the cabbage into thin strips and place in a large bowl.

2. Prepare the sauce by whisking together all the ingredients until smooth. Pour the sauce over the cabbage and toss until well-incorporated.

3.Stir in the raisins and diced apple(s). Best served the same day. Top with chopped chives and serve with fresh lettuce leaves, if desired.

For 2015, we have lots to look forward to in terms of managing my son’s milk allergy, like a food challenge next week and starting school in August. I hope you do too! Happy New Year, and Bonne Année, everyone!

Recipe: Swiss Pumpkin Pie – Tarte à la Courge

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Are you looking for a dairy-free dessert for Thanksgiving? If so, please check out my recipe below for an elegant Swiss tart that can be made with either squash or pumpkin.


Our Third Swiss Thanksgiving

Thanksgiving week has arrived, and 2014 marks our third time celebrating this very American holiday in Switzerland. This Thursday, my son will go to school and to his piano lesson. My husband will go to work. In the evening, we’ll all meet back at home for a small-scale version of Thanksgiving—although this year our turkey may be in the form of Fondue Chinoise (the boys love it, and it’s easy for a weeknight!).

I feel thankful this year for many things, but in terms of food allergies, I’m overjoyed that my son is “only” allergic to milk, and there’s a good chance he’ll outgrow it. We had three food challenges this year, two of which were negative and allowed us to introduce new foods into his diet—almonds and raw/undercooked eggs. Then, in January 2015, he’ll begin a new round of milk-based food challenges, starting with baked milk. With cautious optimism, I’m beginning to imagine what life could be like for my son, if he outgrows all of his food allergies. Fingers crossed!

In the meantime, we’re still living dairy-free in Switzerland for him. Our Thanksgiving will be free of milk products again this year, but I love being able to use eggs without any concerns—especially when making a Swiss-style pumpkin pie: Tarte à la Courge.

Courge actually means squash in French, but you can use pureed citrouille or potiron (pumpkin) instead. When I made it this week, I used one large potimarron squash, like those shown in the photo below. This tart has a delicate squash flavor that’s complemented by a cinnamon and sugar topping and a thin, sweet layer of crushed speculoos cookies underneath.

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Please note: If you’re looking for a dairy-free, egg-free and soy-free pumpkin pie, we used a recipe last year from the Kids with Food Allergies Foundation’s online community.


Tarte à la Courge (Squash Tart)

Recipe adapted from Recettes du terroir neuchâtelois by Francis Grandjean (2002).

Makes one large tart in a 28-cm (11-inch) diameter pan.

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Crust:
350 grams dairy-free pâte brisée (i.e., an American-style pie crust. My husband makes this for me, as I have absolutely no patience to do so. His favorite recipe calls for vodka and comes from Cook’s Illustrated.)

Filling:
50 grams dairy-free speculoos biscuits, crushed (I used Biscoff cookies)
2 eggs
50 grams sugar
7 grams vanilla sugar (or 1 teaspoon vanilla extract)
200 ml almond milk
50 ml soy cream (or another non-dairy cream)
50 grams all-purpose flour
700 grams squash or pumpkin puree (I roasted and pureed a potimarron squash)

Topping:
A few dashes of cinnamon
100 grams sugar

1. Grease the pan with dairy-free margarine and line it with parchment paper. Roll out the dough for the crust and gently lay it in the pan. Using your fingers, press the dough into place in the pan, making sure it’s evenly spread out.

2. Prick the crust in several places with a fork, and then sprinkle and spread the crushed cookies on top of the dough—only on the bottom, don’t worry about the sides.

3. Whisk together the eggs, almond milk, sugar, vanilla sugar, soy cream and flour until well-blended. Then, stir in the squash or pumpkin puree. Pour the mixture gently into the prepared pan, and spread evenly.

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4. Sprinkle some cinnamon over the top of the filling, and then sprinkle the sugar evenly over the cinnamon.

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5. Bake at 200°C/400°F for 35-40 minutes until filling has set, and the crust has browned slightly. Allow to fully cool and then serve with a generous dollop of dairy-free whipped cream.

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Happy Thanksgiving, everyone! If you have any allergy-friendly recipes to share, please leave a comment below. I’m still planning our menu for Thursday…

Oral Food Challenge for Raw Egg: Passed

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After discovering my son’s milk allergy when he was about 9 months old, we found ourselves identifying more potential allergens he needed to avoid, including eggs, peanuts, tree nuts and sesame. Even though he had never eaten these foods, blood and skin prick tests indicated a positive result—the possibility an allergic reaction could occur. His allergist in the United States recommended avoiding these foods until further testing could be done with a new allergist after our move to Switzerland in 2012. Today, I’m happy to report that my son passed his most recent oral food challenge, which means he only has one allergen now: milk—the original inspiration for this blog.


Eating Raw Eggs at the Hospital

On Halloween, my 3-year old son had his fifth food challenge at a Swiss hospital. Scheduling a food challenge on a holiday—although not widely celebrated in Switzerland—probably wasn’t the best idea. It can be hard to get an appointment though, and I was feeling optimistic. After passing a baked egg food challenge in April 2013, my son’s pediatric allergist decided it was time to try a food challenge with raw egg.

The rationale for using raw egg—as opposed to lightly cooked egg that’s been boiled or scrambled—was that if he “passed” the test, he could safely eat eggs in any form. Spaghetti carbonara? Chocolate mousse? Swiss meringues? A food challenge with a negative result for raw egg would give a clear sign that any of these egg-based dishes would be okay for him, as long as they’re made without milk.

Based on our son’s last food challenge for baked milk, when he refused to eat his third dose, I knew we needed a different approach. My thoughtful cousin suggested giving him “prizes” after each of the five doses, so I picked up some little Matchbox cars. I don’t normally bribe my kids (to this extent, anyway!), but for this particular test with raw egg, it seemed especially necessary.

Even though the final dose was mixed with applesauce, the look of that large bowl of runny, yellow egg made me grimace for a moment when my back was turned. The nurse suggested using the oral syringe for this last dose (see the photo above), so it could bypass his taste buds and arrive more quickly to his throat. As he was halfway through that final dose, I reminded him that the last prize was the biggest of all, and it was his favorite color (red). The prizes certainly did the trick, and thankfully he finished the test.


Evaluating the Symptoms: A Contact Reaction

Altogether, my son consumed over 35 grams of raw egg during the test. After the fifth and final dose, he developed a little redness and a few raised hives around his mouth where the raw egg came in contact with his skin, but he did not experience a systemic reaction. As usual, the allergist and nurse were monitoring his heart rate and blood pressure throughout the test, and he had no other symptoms. When the egg on his face was washed away with water, the redness and hives disappeared almost immediately.

Since it was a non-severe and late-phase reaction, and because my son has mild atopic dermatitis (excema), his allergist determined he only experienced a contact reaction to the raw egg, and therefore he had a negative test result. He can now safely eat egg in all forms. I was given the go-ahead to start serving him eggs, and this time they don’t have to be baked for 30 minutes in bread or cake at 200°C.

Back at home, he’s been gobbling up the egg-based version of already familiar foods, such as waffles, pancakes and crêpes. He’s a little more reluctant to try savory eggs, like in one-eyed monsters sprinkled with salt and pepper. With time, I’m sure this will improve.

As with every negative food challenge, I’m thrilled to start cooking and purchasing new foods. Once again, we’re feeling incredibly lucky.

What was the result for your food challenge with raw or lightly cooked egg? I’m always curious to hear how our experience in Switzerland compares to others. Please leave a comment below, if you have the chance.


Next Steps: Baked Milk Challenge in 2015

In January 2015, my son will repeat a food challenge for baked milk. This time, I’ll be making the cake with a recipe provided by his allergist. A successful test would mean he could move on to food challenges with other forms of milk, like baked yogurt and baked cheese. I don’t know what the future will bring, but there’s a good chance he’ll outgrow his milk allergy as well. As usual, I’m cautiously optimistic, and as I’m required to do, I still always carry two adrenaline auto-injectors, an antihistamine and an allergy action plan with us at all times, just in case.

Thanks for your continued support, advice and encouragement! I hope you’ll be getting some good news about food allergies soon too.

Finally, don’t forget that Bundt Day is November 15! Here’s a video to inspire some Bundt cake baking. I hope to share a new dairy-free Bundt recipe later this week.

Food Allergy and Anaphylaxis Meeting 2014: Dublin, Ireland

As a parent of a child with food allergies, I am always seeking out the latest news and research in an effort to improve my son’s overall health and quality of life. For this reason, I attended Europe’s leading conference on food allergies: the Food Allergy and Anaphylaxis Meeting (FAAM) in Dublin, hosted by the European Academy of Allergy and Clinical Immunology (EAACI). With about 600 participants from roughly 50 countries, the multidisciplinary seminars at FAAM 2014 covered various topics related to managing food allergies, as well as prevention and finding a cure.

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EAACI represents doctors, researchers and other medical professionals. It has over 7,800 individual members and also works with National Societies and patient organizations, such as the aha! Swiss Allergy Center in Bern. Most recently, I wrote about EAACI’s efforts to raise awareness of food allergies via a written declaration on allergic disease presented before the European Parliament.


FAAM 2014: A Few Highlights

The FAAM 2014 seminars spanned over three days, and nearly 200 abstracts were presented as part of the conference. In the coming weeks and months, you’ll notice that these seminars will be informing many of my future blog posts, as well as the management of our son’s allergies (e.g., requesting a consultation with a nutritionist). In the meantime, I just wanted to share a few of the key findings presented at the conference that I found especially interesting.

Public Policy

  • Mr. Jerry Buttimer TD (Ireland), a member of the Irish Parliament, said that if President Barack Obama can sign into law a bill encouraging schools in the United States to have access to epinephrine (a.k.a. adrenaline) auto-injectors, then surely a similar law could be passed across Europe. Mr. Buttimer was referring to the School Access to Emergency Epinephrine Act (H.R. 2094), which enables states to pass legislation requiring schools to carry “stock” epinephrine auto-injectors for emergency use.

Socioeconomic Costs

  • Dr. Audrey Dunn Galvin (Ireland), a registered physiologist and lecturer at the University College Cork, presented her research on the socioeconomic cost of food allergies. She discussed the high levels of stress and anxiety that parents can experience due to the constant monitoring of their child’s food allergies. In particular, she discussed how parents must balance the need to protect their child’s environment, while ensuring their positive development. In addition, she mentioned several recent studies socioeconomic costs, including a study of adults with food allergies in Sweden.

Oral Food Challenges

  • Dr. Carina Venter (United Kingdom) talked about food challenges as the best way to identify a true food allergy, and questioned the reliability of self-reported data to determine the prevalence of food allergies. Overall, she stressed the need for more and better data on food allergy prevalence, particularly to evaluate changes over time. As part of her presentation, Dr. Venter discussed her research on trends in the prevalence of peanut allergies in the UK.
  • Dr. Galvin’s research on the socioeconomic impact of food allergies found that routine oral food challenges help to improve health-related quality of life for families living with food allergies. From our own experience, I certainly find this to be true, as food challenges have either allowed us to introduce new foods into our son’s diet or have provided us with greater knowledge and awareness of his allergies, even though he didn’t “pass” the test.

Anaphylaxis

  • Dr. Margitta Worm (Germany) discussed her research examining an anaphylaxis registry for German-speaking countries, including Switzerland. Her study found that adrenaline was rarely used. More specifically, for the emergency treatment of anaphylaxis among 197 children and adolescents between 2006 and 2009, adrenaline was used in only 22 percent of the registered cases.

Oral Immunotherapy

  • Dr. Kirsten Beyer (Germany) described oral immunotherapy (OIT) as a promising treatment for allergies, but highlighted that it is not yet ready for clinical practice. She said that many different protocols exist for OIT, which makes it difficult to compare results and assess its effectiveness. Generally, researchers agree on three primary phases for this treatment: 1) a starting dose, 2) dose escalation and 3) a maintenance dose. During her presentation, she cited a recent study on the side effects of OIT for peanut allergy.

You can also review the tweets from other FAAM 2014 participants by searching for the event hashtag via Twitter: #FAAM2014.


EAACI Food Allergy and Anaphylaxis Guidelines

Throughout FAAM 2014, presenters referred to the EAACI Food Allergy and Anaphylaxis Guidelines, which were published earlier this year. The purpose of these guidelines is to translate knowledge of food allergies into clinical practice, and in particular, for such areas as diagnosis and management, prevention, quality of life and anaphylaxis. EAACI included a hard copy of these guidelines as part of the printed materials I received during the conference, and I will be sharing what I learn as I review them. While the full document is only available for EAACI members to download, sections of the guidelines are also via the EAACI website.

I will continue to provides updates on the research presented at FAAM 2014, and next week, I also plan on sharing a recipe from our excursion to Northern Ireland. Bon week-end, everyone! Thanks for your continued support.

Baked Milk Food Challenge: Refusing to Eat

I have a really hard time hiding my emotions. Yesterday morning, in particular, was challenging for me. After finishing off two small pieces of cake made with powdered milk, my 3-year old suddenly refused to eat another bite during his food challenge. We had to stop the test. After only two doses, even though he didn’t have a reaction, the results were inconclusive because he wouldn’t eat all five doses. While I tried to remain upbeat and cheerful, my frustration was clearly visible.

Food challenge doses

This was his fourth food challenge, so we all knew the routine pretty well. Of all the scenarios I considered, my son refusing to eat wasn’t one of them. All of us kept talking about how wonderful the food challenge would be, since my son would get to eat cake during the test. Compared to his 3-year check-up a few weeks earlier—which required a painful finger-prick for a blood sample and a vaccination injected in his thigh—the baked milk food challenge would be so much easier.


Signs of Trouble

Once at the hospital though, the signs of trouble appeared early on. First, I was disappointed to learn the cake contained chestnut flour, instead of an all-purpose flour made from wheat. My son doesn’t have a wheat allergy or gluten intolerance, but this was apparently the standard cake the hospital used for a baked milk challenge. While I didn’t mind the taste of the cake, my finicky son wasn’t loving it.

While his first small piece of cake went down relatively easily, the second almost made him vomit. As he started lurching, the doctor quickly grabbed a bowl for him. Thankfully it stayed down, but I started wondering how he could possible manage the final and largest dose, if such a small piece caused this type of response.

For the third dose, the nurse suggested crumbling the cake and mixing it with applesauce. We did this during his food challenge with baked egg, and he gladly ate it up. Today was different though. When the spoon was presented, he refused to open his mouth. He really didn’t want to eat it, but at the same time, he had a little sparkle in his eyes, like we were playing a game—and he was winning. Did I mention our son is 3 years old?

We waited an hour after the second dose with all of us attempting to feed him the cake and applesauce mixture. Airplane spoons were flying into his mouth. I tried dancing and singing with him, while sneaking in a spoonful. His older brother even tried to help out. Nothing worked, and so the doctor said we should stop. You can’t force someone to eat, and our attempts just seemed to strengthen his determination.


How often does this happen?

According to my son’s pediatric allergist, this certainly wasn’t the first time a child refused to eat during a food challenge. It happens—especially with kids around our son’s age. I poked around for some data on the prevalence of situations like ours, but haven’t come across any yet. I’m curious about this, so if you have any info—either stories from your own experiences or quantitative data from a peer-reviewed journal article, for example, please let me know.


Next Steps

In 6 months, my son will repeat the food challenge for baked milk—except this time I may be bringing a homemade cake. The pediatric allergist will be sending a recipe, so I’ll practice it a few times with all-purpose flour, along with a little cocoa powder or some Enjoy Life chocolate chips. I’ll do whatever it takes to make sure we don’t have the same result!

In the meantime, while we’re waiting to redo the test, we’ll be scheduling another food challenge for raw/undercooked egg as soon as possible. We’ve already been serving our son lots of foods containing baked eggs, so I’m really hoping for a negative test result in the coming months.

Have you ever repeated a food challenge because your child refused to eat? If you have any advice to share with us and others about food challenges with children, please leave a comment below or send me an email. Thanks in advance for your help!

Third Birthday and Upcoming Food Challenges

Dairy-free birthday cake

Our youngest son turned 3 years old this week. As we celebrate his birthday, there’s a lot to be thankful for in terms of his food allergies. We’ve had some good news this year. Here’s a quick summary:

Now I can use eggs in my son’s birthday cakes. For his party, I opted for a traditional yellow layer cake with a rhubarb swirl and chocolate frosting. The Kitchn has an easy recipe for this traditional birthday cake, which I adapted by using dairy-free margarine and rice milk.

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We will be scheduling a food challenge for eggs in the upcoming months. If our son passes this test, he’ll be able to eat scrambled eggs, french toast, frittata and all those other egg-based dishes I’ve been anxiously waiting to make again. To prepare for this challenge, I’m making sure he eats some form of baked egg every day—like dried pasta, homemade cake or bread—to hopefully build up his tolerance and increase the likelihood of him passing the test.

We also have a new testing plan for his milk allergy, developed in partnership with his pediatric allergist. This involves a series of food challenges, starting with baked milk. If there’s a negative result (i.e., no reaction occurs), then we move down the list to the next test, and so on, until he completely outgrows his allergy. If there’s a positive result (i.e., a reaction occurs), then we’ll repeat the test after a certain period of time and hope he eventually passes it.

For each of these food challenges, here’s what he’ll eat:

  1. Baked milk: Cake baked with powdered milk. Looking at the data, there’s a good chance my son will pass this test. For example, a study published in the Journal of Allergy and Clinical Immunology (2011) reported that approximately 75 percent of children with a cow’s milk allergy can tolerate eating foods with baked milk.
  2. Baked yogurt: Cake baked with dairy-based yogurt.
  3. Baked cheese: Pizza baked with cheese on top.
  4. Cold milk: Cold milk or possibly petit suisse again—to be determined.

From what I’ve read, our son has a good chance of outgrowing his milk allergy. I recently came across the milk allergy guidelines from the British Society for Allergy and Clinical Immunology (BSACI), which indicate that the majority of children will resolve their cow’s milk allergy and recommends individuals “be reassessed at 6-12 monthly intervals from 12 months of age to assess for suitability of reintroduction” (p. 643).

Instead of our selected approach, we could have chosen to skip all these additional tests and go straight to the cold milk test for a second time, as our son could outgrow his milk allergy on his own, without any intervention. This was the other option we considered, and it could also work.

Even though my son could outgrow his milk allergy on his own, I’m just too impatient to wait. Plus, the study cited above found that for children, consuming baked milk products can accelerate the resolution of their allergy. Knowing this, our pediatric allergist suggested this incremental approach, and my husband and I agreed with the recommendation. I would much rather actively do something and test these different forms of milk, than wait another year, have the same result and find we can’t make any changes to our son’s diet.

Being able to add powdered milk to baked goods would be such a major improvement, and it may be something we can start doing soon, should my son pass this first test. If so, our family would no longer be living completely dairy-free in Switzerland, so once again, I may have to change the name of this blog (which I would be overjoyed to do!).

Questions: Do you or your child have a cow’s milk allergy? What approach are you taking to try and resolve it? Please leave a comment below or send me an email at dairyfreeswitzerland@gmail.com. If you have a moment to do so, I would really appreciate it.

Many thanks, and bon week-end!

Food Challenge Success: Almonds

An amazing thing happened last week. My nearly 3-year old son ate almonds for the first time during his food challenge at the hospital. He started with a small dose of ground almonds mixed in applesauce. In all, he had five increasing doses—a total of 28 grams of ground almonds (more than a 1/4 cup). Thankfully, he had absolutely no reaction.

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With this test behind us, our allergist said we could start feeding my son almonds at home and should continue to do so regularly in order to build his tolerance. I was thrilled to start making one of my favorite almond recipes again—Scandinavian Almond Cake.


Avoiding Almonds

To give you some background, we started avoiding almonds for my son, along with peanuts, other tree nuts and sesame, after he had a positive blood test for peanuts back in the United States in the spring of 2012. Then, he had a positive skin prick test in December 2012 specifically for almonds, so we continued to avoid them, while also getting the go-ahead from our allergist to start introducing other tree nuts at home, like hazelnuts and pistachios. Even though he had never experienced an allergic reaction to almonds, we made sure he didn’t eat any food that contained them as intended or unintended ingredients.

Why did we wait to schedule an oral food challenge for almonds? In comparison to milk and eggs, almonds were easier to avoid and a lesser priority in terms of daily nutrition. For these reasons, and in consultation with our allergist, we focused his first two food challenges on baked eggs and cold cow’s milk. They were conducted at a local hospital and under the supervision of our son’s pediatric allergist and other medical staff. With these behind us, it was finally time to try out almonds, and thankfully, he had a great result.

Was my son ever really allergic to almonds? I can’t help but ask myself this question. We will never know for sure. Even though he had a positive skin prick test, these results are not always accurate. According to Food Allergy Research and Education (FARE), apparently 50-60 percent of these skin tests have “false-positive” results. In other words, you can eat the food without a reaction, even though you have a positive test. From what I’ve heard and read, food challenges serve as the best indicator of whether a person is truly allergic to a particular food.

While it bothers me to think we could have unnecessarily avoided almonds because he was never really allergic, I understand how we got to this point, and I’m just so grateful for the result. People typically hold onto their tree nut allergies for life. While he hasn’t tried every single tree nut out there yet, we can say confidently now that he doesn’t have any (known) tree nut allergies. He’s already been so lucky.

Furthermore, there’s a good chance my son could outgrow his egg and milk allergies in the coming years. With this most recent food challenge for almonds completed, it brings us another step closer to my goal. I’ll continue to be cautiously optimistic. In the meantime, I’ll just keep making and eating cake!


Recipe: Scandinavian Almond Cake

My dear mother introduced me to Scandinavian Almond Cake years ago. It’s a sweet cake that doesn’t need any icing. Just a dusting of powdered sugar and some almonds, served alongside a strong cup of coffee. Here in Switzerland, it reminds me of the almond-topped Financier cakes I see in the bakery windows around our neighborhood. I had a bottle of almond extract left in my cupboard from the United States that hadn’t yet expired, so I made this cake last weekend to celebrate the happy news about my son’s food challenge. We ate it up!

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(Dairy-free with baked egg, but can be made without eggs.)

1 1/4 cup sugar
1 egg (or one tablespoon flax meal mixed with 3 tablespoons water)
1 1/2 teaspoons almond extract
2/3 cup rice milk
1 1/4 cup all-purpose flour
1/2 teaspoon baking powder
1/2 cup dairy-free margarine, melted and cooled

1. Grease an almond cake pan or another loaf pan. If using a non-stick pan, also dust the greased pan lightly with flour.

2. Whisk together the first four ingredients: sugar, egg (or egg substitute) and rice milk. Then, whisk in the flour and baking powder—just enough to make a smooth batter.

3. Add the melted and cooled margarine. Stir, just until blended—do not overbeat.

4. Pour into the prepared pan and bake at 180ºC/350ºF for about 45-50 minutes, until a toothpick inserted into the center of the cake comes out clean.

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5. Cool cake for about 10 minutes, loosen it gently from the pan and invert onto a cooling rack.

Optional: Before serving, dust with powdered sugar and sliced almonds.

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Tomorrow marks the last day of Food Allergy Awareness Week (May 11-17). According to FARE, 1 in 13 children has a food allergy in the United States—about 2 students in every classroom. If you’re wondering how to get involved, there’s still time to participate! Bon week-end, everyone.