Allergy Baby: May 2012

This week I realised that we are fast approaching the 1 year land mark birthday. Where did that year go? He has completely uncurled. The baby stage is gone. He is shuffling on his bottom from room to room, exploring the world. Fighting for his toys, demanding his sibling toys and full of cuddles and kisses.

But in the background he lives with allergies, where his body doesnt like dairy, egg, soya, tree nuts and some fruits. The MMR vaccine concerns me as evidence in literature shows there is a trace of egg protein. Some reseach states the vaccine is cultured in egg but the egg trace is so low it is safe in the use of children with egg allergies.

Professor John Warner, Chair of the BSACI Paediatric Allergy Group and Professor of Paediatrics at St. Marys Hospital, London said "Egg-allergic children who have not had problems with other vaccinations can safely be given the MMR in primary care. Specialist asssessment is only required if any previous vaccinations have resulted in severe allergic reation (including any breathing problems or collapse)" http://www.politics.co.uk/opinion-formers/royal-college-of-physicians/article/rcp-new-recommendations-for-mmr-vaccine-in-egg-allergic-chil
In addition the British Society for Allergy and Clinical Immunology guideines for the management of egg allergy agrees that all children with egg allergies should receive the MMR. They explain that large number of studies of egg-allergic children show there is no increased risk of severe allergic reactions to the vaccines. Children who have documented anaphylaxis to the vaccine itsself should be assessed by an allergist. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2222.2010.03557.x/pdf

So I understand why my allergist is not concerned about Thomas recieving the MMR in primary care.

On http://www.patient.co.uk/doctor/Measles-Mumps-and-Rubella-%28MMR%29-Immunisation.htm it advices that if a child is allergic to egg. Immunisation under supervision by a paediatrician is advisable.

So what if he does react? What then? These are factors I have to consider in my decision making process
1. The closest A&E is 1 hour in ambulance
2. Majority of ambulance technicians are not paramedics.
3. Primary Care is not set up for such emergencies.
4. Very importantly the GP is not happy to administer the MMR to Thomas.
5. Experienced mothers to egg allergic children say that even though their children did not react to the MMR they would have certainly considered paederiatic supervision if they were aware that there is a trace of egg in the MMR.
6. A medical colleague suggested single dose of the MMR.

Even though the research is clear that the MMR is safe to administer to egg allergic children. I have to consider the huge flashing factor here is my GP is not happy to administer the MMR to Thomas. My instinct tells me to take all precautions and go with the safe, security of the hospital environment.

On the introduction of this blog I write "Questioning is the door to knowledge". You are your child's advocate. You need to develop your knowledge make informed discussions. I am writing this piece to show you;
How I reached MY decision.
How I problem solve.

This decision is not right for each individual child. You as the parent need to write down the pros and cons and come to your own decision. You need to research! Ask for support and advice! Question!

So I have asked my GP to organise that Thomas has his MMR in a hospital environment under the supervision of the paediatrics.

I will keep you posted but need to organise a dairy, soya and egg free birthday party first!

This is not medical advice!

Friday 4 May 2012

One month back at work and I am sorry I have been neglecting you all. Sometimes as a working mum some times something has to give and I am afraid it was this blog. But I am back, I have settled back into working, the kids have settled and I have finally organised childcare.

Can an "Allergy Mum" return to work safely? Yes! you can

It is not easy; it is not free from stress, worry and anxiety but it can be done. I felt sick with nerves because I have always been there. I knew exactly what he ate, drank and touched. I was in full control, the only person who could administers his drugs, when to administer his drugs and when not too. I was handing full control over to my lovely efficient intelligent aupair BUT and its a big BUT she was leaving at the end of the week. She knew Thomas, knew his allergies, the speed of an reaction and what to do!

So first day at work and I returned to an organised house and happy, excited children. And bang out of no where he reacts and his symptoms escalated quickly. With in minutes Thomas was barely recognisable. I used the emergency action plan step by step.

As a coping mechanism i convinced my self that he would be fine! I stared to worry about how this girl could watch three children and deal with Thomas promptly. I would have to re organise child care or was it worth returning to work?

In hindsight you to step back and reassess the situation, try to avoid making emotional decisions. I know this sounds very clinical. But time is a great healer. I looked at all options

Sending Thomas out of the home to a childminder to be cared for on his own by a lady who had allergies. (But i didn't want to separate him from his sister as they love each other company. Also my work shifts don't allow this as I am a nurse)
Hire another aupair so have two aupairs (sanity alone wont allow this and after our french aupair it surprising I am allowing another enter the house)

So my decision is to keep one aupair long term contract and during the summer or holidays and local girl comes in to care for the other two. The eldest boy is in play school Monday to Friday and my husband is working from home.

Is this the right decision? For us it is the correct decision for now ! Along the way we will have to reassess and maybe change it around.

But the basics have helped

Emergency Action Plan
This blog the aupairs use to learn about allergies
Pre-cooked and frozen food for Thomas
Thomas shelf in the fridge and cupboard
Strictly no food should be given to Thomas unless it has been trialed and tested by me.
Strict hand washing and preventing cross contamination

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Allergy, Sensitivity or Intolerance

Allergy – this is a reaction produced by the body’s immune system when it encounters a normally harmless substance.

Sensitivity – this is the exaggeration of a normal side effect produced by contact with a substance. For example, the caffeine in a cup of coffee may cause extreme symptoms, such as palpitations and trembling, when it would usually only have this effect when taken in much larger doses.

Intolerance – this is where a substance, such as lactose, causes unpleasant symptoms (such as diarrhoea) for a variety of reasons, but does not involve the immune system. People with an intolerance to certain foods can typically eat a small amount without having any problems. In contrast, people with a food allergy will have a bad reaction even if they come into contact with a tiny amount of the food they are allergic to.

Step by Step Advice

This is step-to-step advice on what to do in the initial stages of diagnosis.. This list is not finished as I am still on the journey of discovery too!
1. Medical Assessment and Treatement
2. Do you need anti-histamine and steroids? Do you require an anapen or adrenaline? Get training and education on how to use the equipment for you and your partner.
3. An Emergency Action Plan. What is your plan if your child has another reaction? I used this action plan as a template. I customised it.... Drugs to administer and how much, putting in the directions to the house, phone numbers, name age and diagnosis. http://www.anaphylaxisireland.ie/downloads/ManagingChronicHealthConditonsatSchool.pdf
4. Change milk product or soya product. Thomas was prescribed neocate hypoallergenic http://www.cowsmilkallergy.ie/product/availability-of-neocate/
5. Store your medication in a safe secure area where there is no change in temperature. (like a good bottle of wine) Also you know where to find it when needed.
6. Dont leave home without your medications.
7. Carry an extra one in your car but be aware in the cold of winter or the heat of summer it can cause the adrenaline to crystalise.
8. Practise using your anapen/epipen or drawing up the medication.
9. Talk to your pharamactist, take the adrenaline out and check it against the prescribtion. I found as the administration of adrenaline was very rare they gave me the incorrect concentration. Discuss how you will draw it up, do it and check it with someone else... check and check and check again not when you in the middle of an emergency. If you have a epipen or anapen look at how to use it, you can buy practise pens. Famaliarise yourself with it.
10. Your baby is covered by the neocate for calcium and iron. But you need to find alternative ways of introducing them into the diet.
12. Avoidance is the safest form of treatement.
13. Ask for dietican involvement.
14. Start a food diary - This will help you track what the triggers are and how to avoid them. More importantly it will help you to plan a diet plan for your baby.

Allergy Baby

Friday 4 May 2012

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