We learned a lot from one egg. It was supposed to be lunch for our 11-month-old son, Tory, but the egg became the catalyst for an emergency drive to Children's Hospital and an extended lesson in dealing with the problems created by food allergies.
Although both of our children had an equal chance of inheriting my allergies, Jacqueline, our eldest, was allergy-free. And so, we thought, was our infant son.
One Sunday, we learned otherwise. Even casually informed parents know they should not feed eggs or orange juice (two of the most provocative food allergens) to a potentially allergic baby. In fact, pediatricians suggest avoiding these foods until the baby is older than six months, when its gastrointestinal system has matured. At 11 months, we should have been safe.
Unfortunately for some children, an allergic response to provocative foods (eggs, chocolate, citric acid, nuts, seafoods, grains and dairy products) can occur far beyond the half-year boundary many pediatricians consider a "safe zone."
In Tory's case, two teaspoons of egg produced a generalized allergic (or anaphylactic) reaction in something less than 90 seconds. His body swelled and turned bright red; he gasped for breath.
We knew enough not to waste time on the telephone, but instead raced to Children's Hospital emergency room.
We are lucky our son is alive and had no lasting ill effects from his egg reaction, although he did have a total body rash for 10 days after the incident despite thrice-daily doses of benadryl -- an antihistamine used to suppress allergic reactions.
Although this episode was scary, it really was only the begining of our ordeal. Now we had to adjust to having an allergic child in the house.
Treatment for a youngster with food allergies depends upon allergy evaluations -- which are difficult to perform and which vary in accuracy -- and on adherence to incredibly restrictive elimination diets that remove the offending foods.
Despite the widespread incidence of childhood food allergy -- one in three children has some symptoms of a food allergy -- there are fewer than a half-dozen pediatric allergists in private practice in the Washington area.
We returned to Children's Hospital for an initial evaluation by their chief of pediatric allergy, Dr. Michael Sly. These evaluations take a long time -- our first visit lasted four hours, depleting both child and parents of patience and energy.
It's important to prepare the child for ordeal, and it's helpful to bring juice, snacks, extra diapers and favorite toys.
Although studies show that skin tests for food allergies (the most common diagnostic method used on children) are only about 30 percent accurate, they are a critical phase in treatment planning. Once the allergy-causing foods are identified, the child has to avoid them.
Although skin testing is no more painful than any series of pin pricks, the process can be terrifying to a child. In most cases, babies and toddlers are physically bound to a "papoose board" while the skin tests are administered and remain there for another 10 to 20 minutes while the results are evaluated. With sufficient conditioning, some toddlers can take even this indignity in stride.
At the conclusion of our son's evaluations, we learned that he was indeed allergic to a multitude of foods, including milk, wheat, citric acid, tomatoes, squash, chicken and, of course, eggs.
Our pediatrician, Dr. Frederic Burke, supplied much guidance and counsel on how to eliminate these foods from our son's diet. He cautioned that prepared foods were all bound to be off-limits and reminded me to read labels carefully. Reading labels is essential if one is to avoid allergically provocative substances -- many of which are concealed in foods that seem safe at first glance. (Grocery-store oatmeal cookies, for instance, are made primarily with wheat rather than oat flour.) Citric acid is a common preservative, and egg byproducts are contained in almost all grocery baked goods.
My doctors sent us to the health food stores -- the only hope for a "ready to eat" food supply for an allergic child. We found, however, that even these stores were only partially useful and that cooking from scratch becomes a necessity if anyone is to remain true to an elimination diet.
Some foods can be easily obtained at health food stores: non-wheat flours, oriental noodles, wheat-free breads, jams without citric acid, honey cake, soy and goat milk, powered egg substitutes.
Sweets were almost impossible to find. And, for a teething child, there were no crackers or biscuits except for brittle rice cakes (the round, disc-like concoctions made from puffed rice). A good substitute turned out to be bagels, which in certain incarnations are wheat-free.
Pediatric allergists had suggested that goat's milk could be substituted for cow's milk, but our child rejected every attempt to feed him goat's milk. Eventually we relied on coffee "whiteners" to accompany cereal, but even whiteners can cause allergic reactions in some children.
Worried about calcium deficiency, we learned that one Tums tablet supplied the same amount of calcium as a day's milk consumption.
Wheat allergies restrict afflicted children to baked goods made from oat, rice or soy flour. These flours were available at the health food stores and several Safeways.
All of the items available from the health food stores or from the specialty departments of the grocery stores seem extraordinarily expensive -- reflecting yet another problem to be faced in meeting the needs of an allergy diet. A small package of oriental noodles was $2, and loaves of wheat-free bread were twice the cost of commercial wheat-containing counterparts.
For parents on a budget, cooking from basic ingredients may be the only acceptable way to beat health food store prices. About the only low-priced foods that can be purchased "ready-made" are oat- or rice-based cereals such as Cheerios or Rice Krispies, granola concoctions (check for the wheat-free variety), certain kinds of bagels, and honey cake.
It's not bad enough that I had to search for non-allergic food. Recipes for "allergy cuisine" from scratch are even harder to find.
The University of Texas publication called "The Egg Free, Milk Free, Wheat Free Cookbook," a paperback, contains a superb collection of recipes for allergic youngsters -- with meat, vegetable and cookie ideas galore for restricted diets. Other books are available from the Asthma and Allergy Foundation of America, 1302 18th St. NW, Washington, D.C. 20036.
The good news about restricted diets is that most are temporary. After several weeks of strict adherence, parents often are advised to reintroduce problem foods into the child's diet, one at a time, a week or so apart.
With luck, the abstinence period may alter an allergy pattern and, presto, your child may be able to tolerate wheat (or whatever) with no dire consequences.
We found that foods can be reintroduced by trial and error. If the child continues to react, we put the food back on the elimination list and tried again in another few weeks. Parents need to stay alert throughout and to remain optimistic.
Egg allergies are especially problematic. Many viral vaccines (measles, mumps and rubella vaccine, for instance) are grown on chicken egg embryos, so children with egg allergies can have potentially life-threatening reactions if injected with such vaccines. Children can be tested to determine whether it is safe to immunize them.
Our son, now 4 years old, continues to react to eggs. But he has safely outgrown allergies to milk, wheat and a number of other common foods. Although we have no fond memories of working to outlast these pesky allergies, the diet approach was undeniably effective for us.
Freed from food allergy symptoms, our child is happier, better-tempered and generally more robust than before. In addition, family meals are relaxed and enjoyable events.
As for the future, it is true that children with food allergies are prime candidates for respiratory allergies in later years. But, just as with the special diet, there is no reason to suppose that patience and medical progress won't come to the rescue -- hopefully with something prepackaged this time.
Not long ago, most people thought of illness as something that just happened to them. It was the result of germs in the air, bad genes or "something I ate." Getting sick was not a matter for praise or blame -- it was the luck of the draw.
Now people are not so sure. Many believe that they are personally responsible, to some extent, for their illness.
For example, a student describes a recent flu episode this way: "I knew that I was letting work pressure build up and staying up late when I needed rest, so my resistance was lowered. I felt in the back of my mind that I wanted to get sick so I could stop this cycle. I was a little disgusted with myself, and yet relieved, because I really wanted to take a rest."
This sort of statement is part of a general change in attitude about health. Stimulated by criticisms of modern "high-tech" specialized medicine, the burgeoning holistic health movement has emphasized taking personal responsiblity for one's own body, rather than relying exclusively on experts. At the same time recent medical research has suggested that emotion and life style can cause illness. Stress appears to interfere with the immune system, lowering resistance to infectious diseases. Habits such as smoking cigarettes or eating poorly can contribute to a variety of chronic illnesses including cancer and heart disease.
Such factors make it difficult not to take illness personally these days. The poor soul who has a heart attack may consider it retribution for life style sins. The time has finally come to throw out those cigars and pick up an exercise bicycle.
Taking illness personally can be good for your health. For example, Melvin and Teresa Seeman of the University of California conducted a year-long study comparing people who felt they had a large degree of personal control over their health with people who did not. Those who believed they controlled their health engaged in more disease-preventive measures, such as using alcohol in moderation and watching their diet. They tended to fall sick fewer times than the other group, and spend less time in bed with each illness.
Even among those who are already sick, there is evidence that the more active and personally involved patients recover faster. This is the opinion of Dr. Bernard Siegel, an assistant clinical professor of surgery at Yale University, who runs group sessions for patients with cancer and other serious diseases. He encourages them to become actively involved in fighting the illness through visualizing positive images and improving their life style, while also confronting ways in which they helped make themselves ill.
"Your life has to do with your illness," he says. "Cancer is a symptom that something has gone wrong in the patient's life. But feeling good helps you get better. The patients who say 'I had something to do with my illness' do not feel helpless and hopeless. They know that they can help themselves. It's the ones who feel like victims who do poorly."
But while taking personal responsibility for illness can be a positive step, it may have dangerous side effects. For one thing, always interpreting illness in personal terms can distract people from broader forces that cause disease.
"It shifts our attention away from social factors down to individual factors," says Peter Williams, a lawyer and a bioethicist at the State University of New York at Stony Brook. "With smoking, for example, this attitude ignores the support we give the tobacco industry. It ignores the synergistic effect of smoking and environmental pollution. If someone gets emphysema, you can blame it on the individual rather than the atmosphere of New York or Los Angeles."
Moreover, establishing personal blame can make the individual feel worse rather than better. After developing cancer, literary critic Susan Sontag wrote "Illness as Metaphor," a scathing attack on those who would interpret Cancer as the creation of one's emotions or personality type. "Psychological theories of illness are a powerful means of placing the blame on the ill," she wrote. "Patients who are instructed that they have, unwittingly, caused their disease are always being made to feel that they have deserved it."
Indeed, many of us immediately feel guilty when we get sick. Most everyone can point to something they did or didn't do that might have contributed to their predicament. But self berating rarely heals. And no one particularly wants to hear "I told you so." Being blamed for illness, perhaps unjustly, can add an emotional burden to the burden of the disease itself.
What, then, is the solution? Is it possible to take responsibility for health and illness in a productive way, while avoiding the pitfalls? While this is an issue for each person to resolve, I offer three guidelines:
* First, it seems clear that emotions and behavior do contribute to many illnesses. This does not mean they are the sole causes of disease. We can realistically acknowledge that there are factors out of our control, while still changing that which is in our power -- perhaps cutting down on smoking and boozing.
* Second, it is important to extend the notion of one's responsibility beyond just personal habits. If we felt the same responsiblity to address the social causes of disease -- environmental, occupational, economic -- we might all end up a little healthier.
* Finally, we should develop a sense of responsibility in health issues that is not confused with guilt or blame. Feeling accountable for one's illness can be relieving and empowering. The illness is no longer senseless. And if I have participated in getting sick, I can participate in getting well. There is a focus here on the future and on positive change. This is different from guilt, from blaming yourself for past failures that cannot be undone.
That sort of thinking usually makes one feel worse. And feeling worse never made anyone better.