Oral Food Challenge #1 - Baked-in Egg

By this time, two years had been spent following the advice of our allergist, Dr. M. Which, essentially, was to do nothing. Avoid. Carry your epi-pen, hope for the best, and bear the burden of your fear.  

It was, of course, inevitable that Penny would suffer an allergic reaction.  It happened when she was 3 years old.

The culprit was royal icing on a homemade sugar cookie.  Unbeknownst to me, royal icing is made with raw egg whites. Her lip swelled up, epi-pen was used, 911 was called, and she ended up in the Emergency Room of our local hospital.  She was no worse for the wear, thankfully, and was discharged to home 4 hours later.

In retrospect, I am glad that it happened.  It validated that strict avoidance of her allergens was necessary.  It also proved the efficacy of epinephrine for the reversal of anaphylaxis. 

Best of all, it spurned the idea that this do-nothing, hope for the best, prepare for the worst approach was no longer acceptable.

One week after the anaphylactic fiasco, we had her yearly appointment with Dr. M for routine SPT to egg whites, peanuts, and tree nuts.

The results revealed that her peanut and tree nut skin wheals were more severe; however, strangely enough, her egg white wheal was reduced by 50%.  

Dr. M said this was great news, "avoidance is working," and that we would continue to monitor her.  

How is this possible when she just suffered anaphylaxis to egg white a week ago? 

I thought to myself - I know she is allergic - I saw it with my own eyes.  Why is this not reflected in testing? Are the other skin prick tests even accurate?

According to FARE, "about 50-60 percent of all SPTs yield 'false positive' results, meaning that the test shows positive even though you are not really allergic to the food being tested." Source: https://www.foodallergy.org/resources/skin-prick-tests

The incidence of false negatives is overwhelmingly low - 95% of negatives have a negative predictive value - meaning they are accurate 95% of the time. 

Still, we soldiered on and strictly avoided egg for another year; holding out hope that another year of strict avoidance would result in a sustained decrease in Penny's egg white SPT. 

I felt my stomach, and perhaps my heart, hit the floor when Dr. M reported that Penny's skin wheal had worsened.  Even with strict avoidance, even after previously decreasing 50% - it had went back up. Why? Global warming?  

We were given no answers.  But we did get two options: order blood work for IGE egg whites and determine if the ovomucoid protein (the protein in egg that causes anaphylaxis) was elevated or proceed with the oral challenge and hope for the best.  

My husband and I decided that pushing ahead with the oral food challenge for baked-in egg was what we wanted to do. OFCs (oral food challenges) are the gold-standard for clinical diagnosis of food allergy and we had absolutely lost faith in the clinical diagnostic value of SPTs. 

Still, I had to wonder... what on earth was Dr. M talking about? Blood work for food allergies? How come we have never been offered this before? More on that in a different post. 

Dr. M provided me a muffin recipe and I was to bake 6 jumbo muffins that contained 2 eggs. 

The night that I baked those muffins was odd.  Eggs... in our house? After a year of strict avoidance and physical revulsion at even the mention of an egg.  Ok - I can pivot. Many countertop wipe-downs with Clorox and repetitive handwashing rituals ensued... 

The day of the baked egg allergy challenge arrived.  My husband took Penny, along with 2 of the 6 jumbo muffins, epi-pen in tow, and headed to Dr. M's office.

Penny ate an entire muffin over the course of 2-3 hours.  She was monitored routinely by a LPN.  Her cheeks did not flush.  She did not vomit.  She did not itch or cough or gag.She did not develop any symptom of allergic reaction or anaphylaxis. She was given the all-clear from Dr. M to eat1-3 servings of baked-in egg every day. She no longer has to avoid foods that may contain egg or are manufactured in a facility that processes egg.  

If anyone is nervous about an oral food challenge, my advice is to do it. If your allergist is in agreement that there is highly probable chance of success - do it.  There is no such thing as a failure, when it comes to OFC.  Might your child have an allergic reaction - yes; however, it is better to experience a reaction, even if it is anaphylaxis, in a controlled environment where epinephrine, oxygen, and professional help is available at the ready.  This way you know what anaphylaxis looks like, how effective epinephrine actually is, and what a reaction may look like in your child.  It is worth the risk, in my opinion, as long as a doctor you trust approves it.  

We hope to challenge Penny with scrambled eggs and undercooked egg, such as what is found in brownies and cookies, in the near future. When this was posited to Dr. M, she replied, "Time will tell."

We are thrilled that Penny is able incorporate this food into her diet.  It is liberating and an incredible relief. 

Penny passed this challenge two weeks after starting the AIP diet and supplements. Did this help her pass the oral food challenge for baked-in egg? Was it luck? Did it happen naturally without Dr. B's help? 

Time will tell.