Well, we did it today. We did the egg challenge. The way it turned out was not at all what I expected. I documented the whole thing as it was happening, not knowing what the outcome would be as I scribbled my notes.
I brought my daughter in to the doctor at 9:15, one scrambled egg in tote (to find out why I decided to have her do an egg challenge, please read Adventures in Food Allergy Testing Part 1). I was also armed with ketchup, salt, some bread (egg-free) and some turkey, just in case she didn’t like the egg and I had to doctor it up. The taste of the egg wasn’t a problem at all. Here’s how the rest of the egg challenge went down:
9:25 am: She eats a tiny amount of egg. “Yummy,” she says and the doctor says, “She likes it — that’s good.” I am surprised she likes it so much.
9:35 am: Doctor comes in and examines her throat, face, skin and breath. There is no reaction. He says to eat a larger amount, so she eats about a teaspoonful. After a few minutes she says her ears itch inside a little and her tummy hurts a teeny, tiny bit. But after another few minutes, she doesn’t seem to be having any problem and continues to watch the movie on the DVD player I brought. She is even singing with the movie. 15 minutes later she says her tummy hurts again, but then she gets a drink of water and says she is fine.
10:00 am: Doctor checks her again, sees no sign of reaction and says she can eat 3 bites of egg. She again says “It’s yummy.” The doctor says again that the fact she likes it is a good sign.
10:25 am: Doctor checks her again. So far, so good. Now I am starting to get a little excited, thinking we are in the clear. She is excited too, but I tell her that we are not done and that she gets to eat the rest of the egg now. She doesn’t really want to, but she is motivated by the possibility of getting to eat eggs in the future. She takes a few bites and then says that her tummy hurts. She finishes the egg at 10:35.
10:45 am: She scratches her chin and I see that there is a little hive there. She is using her upper teeth to scratch her lower lip, where I see another hive and she is simultaneously scratching her lower arm where there is another hive. I go get the doctor. He checks her throat and says it is okay. She is feeling more and more itchy and uncomfortable. He gives her allergy medication (Zirtec) and wants to give her an adrenaline shot. I look at him wide-eyed — really? A shot of epinephrine? Is that necessary? I don’t want to freak her out and he says okay, we can wait and see and gives her an asthma pill just in case. By now, her eyes are really red and itching like crazy. Her tummy is hurting, she’s feeling awful and starts crying, “I want to go home!” As she is deteriorating before our eyes, the doctor says she needs the shot to reverse the symptoms more quickly. The nurse gives her a small dose (.5mg) of epinephrine in her arm. The regular epinephrine shot, most commonly known as the Epi-Pen, is .15mg and is administered in the thigh muscle for the fastest absorption into the body. When given in the subcutaneous fat level of the arm, it is absorbed more slowly. The doctor felt that this was all she would need. Nope.
11:10 am: She is lying down, feeling a little better. Her eyes are still itching like crazy, but she refuses to try eye drops to relieve them. She is really congested and begins to cough. The doctor checks her and finds that she has swelling in the right side of her throat. The coughing is a sign that her airways are being affected. The doctor orders another adrenaline shot, this time .1mg. I ask if this is a considered an anaphylactic reaction. The answer is yes, and this is why you do food challenges in the doctor’s office. No eggs for her, in any way, shape or form. I am feeling shocked. I thought she might have a rash today at most.
11:35 am: She is a little hyper from the adrenaline and feeling better. The doctor warned me that she might get pale lips from the epinephrine. Yes, her lips are looking pale.
11:50 am: I am reading a book to my daughter who is sitting on my lap when the doctor comes in for another check. “Flushed,” he says. I turn her around and my eyes must have bugged out of my head. Her face, chest and back are flushed so red she looks like she has a really bad sunburn. She also has a few hives on her back. “I think her reaction would have been much worse without the medication,” says the doctor. He checks her heart rate and it is okay, but because she is so flushed, he orders a third shot of epinephrine, this time .5mg. The red is traveling slowly down her body, and eventually reaches her legs, which eventually also look sunburned. She is cold, so they bring her a blanket. She is feeling much better and is in good spirits, but we have to stay another hour.
1:00 pm: After a few more checkups, the doctor determines that nothing is progressing any further and that we can go. She is still really red, but other than that, she is okay. She wouldn’t resume her normal color for another hour.
Before we left the doctor’s office, I confirmed with him that had this happened out in the world, I should have given her the Epi-Pen. Absolutely. “And even if you aren’t sure, just give it.”
So many thoughts have been swirling in my head since this experience. The first is, I can’t believe I didn’t cry. I was quite unemotional and I’m not sure why — maybe I was in shock? Or maybe because I felt like I was part of a science experiment. Or was it because I was playing it cool for my daughter’s sake so she wouldn’t freak out? It is sad news: my daughter had an anaphylactic reaction to an egg. So… we will continue to avoid egg, but be even more careful about it.
Another thought: Did I have false hope? With the 50% chance given by my doctor, I figured it was worth the gamble to try the egg. If we could have added it back into her diet, it would have been like winning a jackpot.
The most important realization of all: THIS IS REAL. FOOD ALLERGIES ARE REAL. Dare I say that part of me has at times wondered if she really was allergic to all these foods, that maybe the tests are overdiagnosing as several past news articles and editorial pieces have suggested, that maybe her tests weren’t accurate, that since we’ve never had to use the Epi-Pen, maybe we wouldn’t really need to. Even though this day did not bring me the happy results I wanted, it did bring me clarity. It brought me resolve to stay vigilant in protecting my daughter. It brought me confirmation that we need to continue to raise awareness about food allergies. After what I saw happen right in front of me today, I know for sure that they are real.
Related reading: Diary of a gluten poisoning