The following is the second post in series on food allergies and their treatment at Children’s Hospital Boston. Written by Joshua Feblowitz, a research assistant at Brigham & Women’s Hospital and a freelance writer for Children’s, the series chronicles Joshua’s severe food allergy history and his life-long treatment at Children’s. In this entry, Joshua recounts a recent test conducted at Children’s to determine whether or not his body has naturally outgrown his severe egg allergy.
7:00 AM: It’s the day of my food challenge and I wake up (naturally) from a dream about breakfast. I get ready and then hop on the green line headed towards Longwood Medical Area.
7:45 AM: I arrive at Children’s Hospital and head up to the Center for Ambulatory Treatment and Clinical Research (CAT/CR) on the 4th floor of the Farley building. I’m a little bit nervous (and also hungry, no breakfast before a food challenge!).
I haven’t taken my regular allergy medications for over a week and I’m feeling itchy and sneezy already. For many years, I’ve taken three different medications each and every day for my asthma and allergies. However, some of them could mask the initial symptoms of a severe reaction so it’s better to perform the test off medications.
As instructed, I have my EpiPen with me. There will also be Benadryl and other medications on hand just to be safe. Because of my negative blood tests and skin test, I know that everything should be OK, but I’m still feeling apprehensive.
8:00 AM: I check-in at the CAT/CR and meet Miriam Gorman, RN. She takes my blood pressure, temperature and weight and explains how the challenge will work:
1) In six containers, pure egg protein powder has been carefully measured out by one of Children’s Hospital’s nutritionists. Each “dose” is bigger than the last. In total, it is the equivalent of about 2 eggs. A few years ago, this would have been a terrifying prospect and would have undoubtedly sent me into a fit of wheezing and hives.
2) Every 15 minutes, I will mix a dose egg protein powder in applesauce and eat it. Most patients mix it with pudding, but my milk allergy precludes that option. I was hoping for some scrambled eggs or one of the other breakfast items I’ve been longing for all these years. Instead, the egg powder is used for a more controlled test.
3) To monitor me for an adverse reaction, a nurse will take my temperature, blood pressure and pulse oxygenation with each dose and check my skin and breathing.
8:10 AM: I meet with Joseph Zhou, MD, PhD, the physician in charge of my food challenge. He explains the process again as well as the risks of the test, including the potential for anaphylaxis, a severe reaction that can involve symptoms like breathing trouble, hives, stomach cramps and swelling in the throat. Now I’m feeling even more nervous because anaphylaxis is, unfortunately, something I’ve experienced before.
It’s just about time to get started.
8:25 AM: First dose. This one is tiny so I eat it without applesauce (not too tasty). My heart starts racing but I convince myself it’s just the anxiety of the test itself. Miriam takes my vital signs again.
8:50 AM: Second dose. I learned my lesson from the last one: this time Miriam mixes the egg protein powder with applesauce. I feel a tiny bit itchy but I think it’s just my imagination.
9:10 AM: Third dose. Starting to get a little bit of a stomachache but it may just be the result of eating spoonful after spoonful of salty applesauce. It’s hard to tell but it makes me worried. Another member of the CAT/CR staff, Lauren Desharnais, RN, takes my vitals.
9:25 AM: Fourth dose and everything is going fine still. Dr. Zhou comes to check up on me again.
9:50 AM: Fifth dose. Almost done. At this point, the only challenge is chowing down on my third consecutive cup of applesauce.
10:15 AM: Last dose (and it’s a big one)! Now all that’s left is to wait for an hour so the CAT/CR can observe me and make sure that I don’t have a reaction. Miriam records a last set of vital signs.
11:30 AM: My food challenge is complete and there’s been no sign of a reaction! My allergist, Lynda Schneider, MD, stops in to visit me. Technically, I’m cleared to eat eggs right away, but Dr. Schneider and I agree that that is probably enough for today. I’ve already got the celebratory meal planned out: this weekend, I’m heading out to my favorite breakfast place with my parents. It’s been a long road (20 years!) but I think it’s finally time for some scrambled eggs!
Check back next week to learn about Josh’s life with eggs and his reflections on the challenges of food allergies for kids growing up today.