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.

EAACI Allergy Awareness Campaign

Are you “trapped by allergy”? A new allergy awareness campaign has arrived in Europe that focuses specifically on food allergy and anaphylaxis during the next two months.

The European Academy of Allergy and Clinical Immunology (EAACI), which hosted the Food Allergy and Anaphylaxis Meeting I attended in Dublin last fall, launched its allergy awareness campaign in June 2014. It started in Copenhagen, where EAACI hosted its annual congress, using a street marketing campaign that featured the message of people being “trapped by allergy.”

“Allergy is a condition that affects people’s lifestyle and ability to work. An allergic person can fear insignificant things with which we come into contact on a daily basis, such as plants, pets, insects, food or drugs, and this leads them to feel trapped in their condition.” —EAACI President Nikolaos G. Papadopoulos

For more information about the June 2014 launch of this campaign, check out EAACI’s press release or see the video below that highlights the street campaign in Copenhagen.


EAACI’s Food Allergy and Anaphylaxis Wave

On March 9, 2015, EAACI released a third press release (the second press release focused on asthma) to begin the food allergy and anaphylaxis wave of its allergy awareness campaign.

In all, EAACI estimates that over 17 million Europeans have a food allergy. Furthermore, it reports that 1 out of every 20 children has at least one food allergy. Over the last decade, food allergy cases have doubled, with a 7-fold increase in the number of hospitalizations caused by severe allergic reactions. Given these numbers, EAACI finds that “more awareness and education is needed to improve management of food allergies and anaphylaxis.”

During March and April 2015, according to the campaign website, EAACI will have an online campaign targeting five countries: Italy, France, Germany, Spain and the United Kingdom. It also plans to disseminate printed materials via primary care organizations, patient organizations, national allergy societies and pharmacist organizations.

What are your initial thoughts on EAACI’s allergy awareness campaign? I’m curious to hear what you think about it. Please leave a comment below, when you have the chance. I’ll continue to share information via Facebook and Twitter, as I learn more about this campaign.

Finally, if you are interested in getting involved with this EAACI’s campaign, check out the campaign website for additional resources and information.

Beware of Allergy

Swiss Retro Recipe: Riz Casimir

Riz Casimir 2736x3309

An easy meal for kids, I’ve created a dairy-free version of a popular Swiss dish from the 1950s: Riz Casimir.

I first discovered Riz Casimir at Zurich’s Hiltl Restaurant in December 2013. When I saw it on the menu, I didn’t realize this curry dish was actually over a half-century old and known throughout Switzerland. Only after trying Hiltl’s vegetarian version did I start noticing this dish in other restaurants and among the prepared meals from Coop and Migros. Finally, after I came across a simple recipe for Riz Casimir in my Swiss cookbook for public schools, Croqu’menus, I decided to try making it myself.

Riz Casimir Coop 2951x2045.11

According to Betty Bossi, Riz Casimir is often mentioned as a favorite dish by people of all ages in Switzerland. The founder of the Mövenpick restaurants, Ueli Prager, developed this recipe in 1952 with ingredients considered exotic for the time: curry, pineapple and banana. Ultimately, it seems Riz Casimir is the Swiss interpretation of Kashmiri Rice, a northern Indian dish.

Instead of using cream, I’ve been making Riz Casimir with coconut milk. I also added a few other ingredients, like fresh garlic and ginger, and some optional toppings, like chopped cashews and cilantro, to give it a little more flavor and texture. My 3-year old isn’t a huge fan of curry, but this is a very mild recipe.

In terms of presentation, I modeled my version after the photo in my Swiss cookbook of a wreath of rice decorated with banana, pineapple and cherries, and the curry nestled in the center. Honestly, it feels a little ridiculous arranging the fruit like this on the platter, but if it helps my finicky kids find it more appealing, I’ll continue to do it!


Riz Casimir

Recipe adapted from Croqu’menus (9th edition, 2005, p. 91).
(dairy-free, egg-free)
Serves 4-5 people

Ingredients:

1-2 teaspoons sunflower or canola oil
2 shallots, finely chopped
1-2 garlic cloves, finely chopped
1 thumb-sized knob of fresh ginger, peeled and finely grated or chopped
4 chicken breasts, sliced into thin and bite-size pieces
100 ml white wine or allergy-friendly chicken/vegetable broth
250 ml coconut milk
1 tablespoon curry powder
1-2 teaspoons cornstarch
salt, to taste

Optional toppings: chopped cilantro and cashews, pineapple rings and apple slices

Serve with hot basmati rice

Instructions:

1. Heat the oil in a large pan over medium-high heat. Saute the shallots, ginger and garlic for a few minutes until tender and fragrant.

2. Cook the chicken for about 5-10 minutes, stirring frequently, until its nearly done. Remove from the pan and set-aside. Add the wine (or chicken/vegetable broth) and simmer for a few minutes.

3. Add the coconut milk and curry powder to the wine in the pan, and whisk it together until well-incorporated.

4. Whisk in the cornstarch and return the chicken to the pan. Simmer for about 5 minutes more until the sauces thickens slightly.

5. Serve immediately with basmati rice and optional toppings.


Food Allergy Clinical Trials in Switzerland

Peanut allergy was in the news again recently, due to a study out of Australia using a treatment that combined probiotics with oral immunotherapy. The study offers some promising results, as 80 percent of the enrolled children could tolerate eating peanut by the end of the clinical trial. At the same time, 45 percent experienced an allergic reaction, which according to Food Allergy Research & Education (FARE) is similar to other studies using oral immunotherapy. If you didn’t see all the media coverage, here are a few links to get you up to speed:

Nuts

When I posted an article about this Australian study on Facebook, someone asked if I knew of any similar clinical trials being conducted in Switzerland. To address this question, I contacted a pediatric allergist working in Geneva via email. He wrote to confirm that no such study is currently being conducted here.

This inquiry made me curious about other food allergy clinical trials in Switzerland, and the pediatric allergist I contacted recommended an online database that’s maintained by the US National Institutes of Health (NIH): ClinicalTrials.gov. When I searched the database, I found three relevant studies that are currently open and recruiting participants. You can click the links in the table below for more information about each individual study.


Food Allergy Clinical Trials Currently Recruiting Participants in Switzerland
Study title Sponsor Types of allergens Estimated completion date Eligible ages
Molecular Analysis of IgE Antibodies in Walnut Allergic Patients University of Zurich Walnut November
2015
1 year to 70 years
Integrated Approaches to Food Allergen and Allergy Risk Management University of Zurich Peanut, hazelnut, walnut or celeriac February
2017
5 years and older
Tree Nuts Allergies: Does a Single Nut Allergy Necessitate the Dietary Eviction of Other Tree Nuts? University Hospital, Geneva Peanut and tree nuts January
2016
12 months to 16 years

Source: Search results obtained on February 16, 2015 from ClinicalTrials.gov for Switzerland when the condition entered was “food allergy.”


Additional resources:

  • For some helpful background information on clinical trials, check out the Frequently Asked Questions prepared by FARE.
  • In the United States, Vanderbilt University maintains ResearchMatch, an online patient registry. FARE and NIH worked together and used ResearchMatch to create a special food allergy sub-registry for patients interested in volunteering for clinical trials.

 

Have you ever participated in a food allergy clinical trial? If you have any experience or advice to share, please leave a comment below. Many thanks!

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:

2015-01-15 20.34.45

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.

New Requirements for Food Allergen Labeling in Switzerland

In the coming year, you will start seeing some changes in how food allergens are labeled in Switzerland. For people living with food allergies and intolerlances, for whom label-reading is a daily activity, here’s a quick summary of the new federal requirements.

Food labels allergens scottish oat cakes

Food allergen labeling on a package of Scottish Oatcakes from Northern Ireland (and in braille)


What is the purpose of the new Swiss labeling requirements for food allergens?

On November 25, 2013, the Swiss Department of the Interior and the Federal Office of Public Health revised the federal ordinance concerning the labeling of food allergens: Ordonnance du DFI sur l’étiquetage et la publicité des denrées alimentaires (817.022.21). These revisions mean that food labels must clearly indicate 14 common allergens by using a special font, character style (e.g., capitalized letters), background color or other appropriate means. Even though Switzerland is not a member of the European Union, these revisions are consistent with the requirements of Article 21 under the EU Labeling Directive.


When will these new requirements become effective?

The revised ordinance came into effect on January 1, 2014, but there is a 2-year transitional period. Companies have until December 31, 2015 to become fully compliant with the new requirements, or until they exhaust their inventories of food products that comply with the previous ordinance (see Chapitre 6: Dispositions finales, 817.022.21). As such, it’s possible you may still see products in 2016 that don’t meet the new requirements, but still can legally be sold to consumers.


What potential allergens must be labeled on food products in Switzerland?

There are currently 14 common allergens that must be identified on food labels in Switzerland. Please note: The 2013 revisions to the ordinance for labeling food allergens did not make any changes to this list.

  • Celery

  • Crustacean shellfish (i.e., crab, lobster, and shrimp)

  • Eggs

  • Fish

  • Gluten (i.e., wheat, rye, barley, oats and spelt)*

  • Lupine

  • Milk

  • Mollusks (i.e., oysters, clams, mussels, or scallops)

  • Mustard

  • Peanuts

  • Sesame (FYI: There’s a new petition to include sesame among the required allergens for food labels in the United States).

  • Soybeans

  • Sulphur dioxide or sulphites

  • Tree nuts

*Please note: The category of “gluten” includes wheat, which is considered one of the “Top 8” allergens in the United States.


How did the Swiss government make companies aware of the new requirements?

The Federation of Swiss Food Industries organized a “food legislation continuing training day” in 2014, according to written responses I received earlier this month from an official from the Federal Food Safety and Veterinary Office (FSVO) at the Federal Department of Home Affairs. At this event, FSVO provided detailed information about the revised ordinance for labeling food products. In general, “companies are responsible for ensuring that their products conform to current legislation (self-monitoring).” At this time, FSVO does not have any information on the extent to which companies are currently complying with these new requirements.


Who is responsible for monitoring the labeling of food allergens in Switzerland?

In Switzerland, federal agencies do not have the responsibility for monitoring food products on the market, according to the written responses I received from an FSVO official. Instead, cantonal executive authorities fill this role: Contrôle des denrées alimentaires en Suisse. In particular, these cantonal agencies “are responsible for monitoring the conformity of food products that can be marketed without regulatory approval.” If you have questions or concerns about a particular product that may not be in compliance with the current regulations, you can contact these authorities for assistance.


Where can I learn more about the revised requirements for labeling food allergens in Switzerland?

For detailed information about these revisions in French, German and Italian, here are some helpful links from FSVO:

  • Revisions 2013

  • Communiqué de presse: Révision de la législation sur les denrées alimentaires : protéger la santé et éviter les tromperies (December 3, 2014)

  • Dossier de presse: Révision annuelle de la législation sur les denrées alimentaires—Les points forts de la révision (December 3, 2014)

 

In my opinion, it’s great seeing these new requirements for food labels in Switzerland and throughout the European Union. Anything that can help keep consumers safe, without creating an unnecessary burden on companies, seems like a welcome change.

Updated: January 15, 2015

Peanut Allergy, Air Travel and Public Policy

A friend of mine was recently on a flight. Her son has a peanut allergy. Once she took her seat, she heard an announcement that flight attendants would not be serving peanuts or any other nuts because of a passenger with a food allergy on the flight. All passengers were asked to refrain from eating these products. Afterward, my friend noticed the person next to her opening a bag of trail mix full of nuts. Thankfully, her son wasn’t flying with her that day.

Would a federal law banning peanuts on all flights prevent incidents like these and keep passengers with food allergies safe? Peanut bans and peanut-free buffer zones have been suggested before, dating back to at least 1998, but none of the proposed accommodations for passengers with food allergies have been passed into law. As such, airlines lack consistent policies when it comes to flying with food allergies.

Congress has actually prohibited the US Department of Transportation (DOT) from making rules restricting the distribution of peanuts, unless a peer-reviewed scientific study finds that airborne peanut dust can cause a severe allergic reaction. To date, studies have been conducted, but none have found this link. Therefore, DOT currently has no authority to establish rules with regard to peanuts and airlines (see the infographic I prepared below; you can click on the image for an interactive version with links to the relevant federal laws and notices).

2015 Peanut Allergy and Air Travel

Allergic Living recently interviewed Dr. Matthew Greenhawt about flying with food allergies, after two high-profile cases in which airline passengers experienced severe allergic reactions while in-flight. According to this expert, five studies in the last 10 years have looked at airborne peanut dust. However, none of these studies seem to have found the evidence necessary to fulfill the Congressional mandate in Public Law 106-69.

“…it is highly unlikely for a passenger to inhale nut protein from someone consuming nuts a few rows in front of him/her. There is no evidence that has been able to show that such dust circulates.” —Dr. M. Greenhawt, Research Director, Food Allergy Center and Assistant Professor, Division of Allergy and Immunology, University of Michigan

While this current research should bring some comfort to people with peanut allergy, an open bag of peanuts or trail mix on a plane can be a scary thing, even though the risk may be very low. Also, the Congressional mandate for a peer-reviewed study only focuses on airborne peanut dust, but what about allergens that might linger and accumulate on surfaces within a plane, like tray tables or arm rests, an issue Dr. Greenhawt raised in his interview with Allergic Living. (That’s why Food Allergy Research & Education and others recommend passengers with food allergies wipe down their seat area on the plane.)

Weighing both the evidence and the concerns, why not ban peanuts from all flights? At the same time, we know that even in peanut-free classrooms, people still make mistakes and bring in unsafe foods. Would a peanut ban or peanut-free buffer zones provide a false sense of security? And, how should airlines handle other food allergies?

In my opinion, more consistent policies for all airlines on how to accommodate passengers with peanut or other severe allergies would be an improvement. What do you think? Please share your thoughts in a comment below.

Additional resources:

For a detailed comparison of the various allergy policies of 11 major airlines, Allergic Living has compiled a 4-page chart to help people understand what accommodations they can request and receive.

Finally, there are at least two online petitions related to food allergies and air travel. One of these petitions was started by Elizabeth Goldenberg who authors the Onespot Allergy Blog. Her petition supports a total ban on peanuts. It’s earned over 15,000 signatures. Lianne Mandelbaum authored the second petition I came across last week, and it requires airlines to institute an allergen-free buffer zone for passengers with food allergies. To date, this second petition has earned over 30,000 signatures.

Update: I made revisions to the inforgraphic above on January 19, 2015 to include a key policy action from 2003 that came to my attention after reading The Not-So-Friendly Skies – Allergic Passenger Rights by the Allergy Law Project (ALP). For a more detailed analysis of your rights as an airline passenger with food allergies, I highly recommend you check out ALP’s post.

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.

2014-10-11 08.27.52

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.

BBC’s Horizon Explores Potential Causes of Allergic Diseases

New research suggests that changes to the bacteria inside our bodies may be linked to the growth in allergic diseases. Horizon, a BBC Two science program, covered this topic during a recent episode entitled, “Allergies: Modern Life and Me.” By profiling the experiences of two UK families living with various allergies and asthma, this program tests the hypothesis that bacteria living inside the gut, or a lack thereof, are affecting the development of allergies. (Click here to view the full program, if you’re interested).

Researchers think environmental factors have played a role in the growth of allergic diseases in the last few decades, and daily practices of modern life may be the culprit. High bacterial diversity in the gut has been associated with lower levels of allergic disease, according to several recent studies. For example, researchers have found connections between lower levels of allergies and things like having plants in your house, living on a farm or spending time outside, as these can increase bacterial diversity. Furthermore, the Johns Hopkins Children’s Center reported last month that an estimated one in 10 inner-city children in the United States has an egg, milk or peanut allergy (and researchers contend the actual number could be higher)—a finding that seems to lend support to the bacterial diversity theory.


A Swiss Connection

As I watched the Horizon program on allergies, I was pleased to see Switzerland mentioned, as there’s a prominent researcher here who’s leading some work examining the relationship between bacterial diversity and allergic diseases. Dr. Ben Marsland, an Associate Professor at the University of Lausanne, was interviewed about his work with “germ-free mice.”

While these mice are normal in their appearance, they are free of bacteria, fungi or viruses. Dr. Marsland and his colleagues found that when these mice were exposed to dust mites, they were more prone to an allergic reaction. (Similar results were found recently by a team of researchers led by Dr. Cathryn Nagler at the University of Chicago that exposed germ-free mice to peanut.)

I sent Dr. Marsland an email following the program, to thank him for his research and inquire about current and future work. He passed along three recent publications from his team’s research this year. The citations appear below, if you’re interested in a more detailed description of his findings:

Dr. Marsland added that his current work includes fundraising for a birth cohort study in Norway involving some basic interventions, such as introducing certain foods at an earlier age. In the future, he hopes his basic research can be translated into effective clinical practices to treat allergic diseases.


Living a Modern Life

During the program, I couldn’t help but think about our own family. How would we fare in a similar experiment like the one conducted with the two families for Horizon? How often do we spend time outside? How many plants do we have in our house? I didn’t have a c-section when either of my sons were born (a vaginal birth results in higher exposure to bacteria). Neither had antibiotics during their first year of life.

I’ve certainly wondered at times if there’s something I could have done to cause my son’s allergies, and this episode of Horizon definitely raised those concerns again. While it may not be possible to determine one specific thing as the root cause, it made me question our current practices. What are some practical ways we can increase bacterial diversity in our lives? I’m already planning to take the boys hiking more often on one of my favorite routes—through the forest and alongside an organic farm with goats, pigs, donkeys and chickens!

Swiss hike

Hiking with the boys on one of my favorite local trails last fall

For further reading on this topic, check out “Horizon on Allergies,” an excellent post from Michelle’s Blog, written by UK food allergy and intolerance blogger, Michelle Berriedale-Johnson.

Did you watch this episode of Horizon? What did you think? If you have any thoughts or questions to share, please leave a comment below.

Updated: January 24, 2014

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!