What’s that smell? Episode 8

17th October 2018 0 By Allergendad

I dream of a day when I can walk into a restaurant with my son and wife, sit at the table and order anything I damn well want from the menu. My son with his vanilla milkshake, me with my baked Camembert and my wife with a Chicken Chow Mein. Actually, that’s not true: having avoided cheese for so much of my life, a baked Camembert makes me wretch and I could happily live without milkshakes or Chinese take-away. What I really want is to have some level of comfort and security that my son (or me for that matter) won’t have an allergic reaction. In Episode 7, I talked about how we try our best to manage that by avoiding the allergens; but the ideal solution is that we just don’t have to avoid them at all. (My wife reliably informs me that what she’d actually want would be chicken and cashew nuts in black bean sauce anyway).

I once read that 60 to 80 percent of children with a milk allergy will outgrow it by the time they are 18. However this is less likely for those who have hayfever and other food allergies which unfortunately is a tick for both for Piglet. Adults with food allergies are less likely to grow out of them. So considering that Piglet will fall at the lower end of the probability who are likely to grow out of it and has a dad who (probably) has it for life; I’m not overly hopeful.

Clare Abshire: “I never had a choice!”

It’s not something we’ve really be able to do yet, such is our intermittent success at making sure Piglet avoids the allergens in his day-to-day life, but eventually we would plan to test his reactions by re-introducing food at a later date. This is often called the “milk ladder”, although the same concept exists for many allergens. I feel I should give a fast-paced end-of-advert small-print disclaimer here… What I’m writing about here is what we plan to do for our specific son with our knowledge of his allergens and reactions. Specifically, he has a non-IgE allergic reaction which is non life-threatening. The ladder process is the same for more acute allergic reactions and you should probably take medical advice before deliberately introducing allergens in such a case. Markets can rise as well as fall. Previous performance is not a reliable indication of future expectations. We may have to repossess your home if you do not keep up payments on your mortgage.

The idea of a milk (or soya) ladder, is to introduce a small amount of the least reactive form of allergen first and then, assuming no reaction presents itself in the usual time frame for them, increase both the dose and intensity of allergen until (ideally) they can eat full portions of the most potent form of the protein. For example, for Piglet, we believe he even reacts to soybean oil which, due to the way it’s extracted, is not actually required to even be labelled as a allergen under EU law (effectively there shouldn’t be any protein in the oil – making it not a “soya” risk). Interestingly some people say the same of soya lecithin (an emulsifier) although this is required to be labelled and is the pain in the ar%e that stops us eating most dark chocolate. Either way, we would probably introduce a small amount of soybean oil as the first rung on the ladder and work up slowly through different concentrations of the protein until he (ideally) can eat a full portion of edamame with a soya sauce dressing!

A portion of soya with soya, anyone?

For milk – the general idea is that you’re starting with a low-concentration processed milk and working up to just pure cow’s milk. My gut feel (no pun intended, have I milked that joke enough yet do you think?) is that there is potentially some confusion here between lactose intolerance and cow’s milk protein allergy. Lactose breaks down under heat (i.e. cooking) and so people with such an intolerance may find that they can cope better with (hot) pizza than cream. However there also a breakdown of the proteins under heating so baked cheese goods (where the milk protein is often kept in liquid that doesn’t go above 100oC) might have a higher allergenicity (intensity of allergen) than a biscuit where the temperature gets much higher. Most milk ladders suggest starting with a small piece of digestive biscuit or something similar and then moving up to fish pie/lasagne etc…

The hysterical thing about this is that with me unable to eat milk (and not much hope of ever successfully attempting a milk ladder, I fear), my wife sensibly reluctant anything that would pass on the allergen through breast milk and Piglet being the one tested; the second stage of the milk ladder would probably mean cooking a tiny fish pie, giving him a tiny slither of it and then waiting 2-3 days to confirm whether we think there has been a reaction or not. All the while cooking another meal that the three of us can eat in confidence. Do Le Creuset do a one-teaspoon size casserole dish?

But we will try and I will hope, even if it feels slightly beyond reason, that one day he moves up the ladders to meals that are currently off the table. Funnily, with me always likely to cook meals without milk in, soya is the allergen I would choose to be successful with if I had to pick one of the two. I used to love going to Chinatown in London with my wife and I even dream that we might take Piglet to Bali or Singapore (key places in her family’s history and for relatives). But such journeys, even if the allergen menus were good, are always likely to be difficult – purely on the reliance on soya in certain types of food. I doubt I ate very much milk at all, on the other hand, the one time I went to Singapore.

But whatever happens with Piglets allergies and however many more time he cries through the night because we haven’t protected him enough; I will always love him and also my wife for the sacrifices she makes to do her best by him. Who knows, maybe one day, when he’s older, he’ll find this blog and forgive me everything in reading this paragraph? Or more likely, he’ll read the rest of the blog and be beyond mortified to find out that I told the world about his smelly nappies and idiosyncrasies. Either way, Piglet, know that I did it for you.