Child with a LTFA to egg developing an allergy to chicken?

[emcsmom]

Hi there. I used to post quite a bit as eggallergymom (couldn't get that sign-on to work!), but my daughter's LTFA has taken a backseat to some medical issues with my son the last few years. Fortunately, things have been quiet on the food allergy front, for the most part (aside from some school silliness). But she now appears to have developed a sensitivity to chicken, at least if a consistently rising RAST result to chicken is to be believed. Her allergist is now recommending we feed her chicken at least twice a week to try to keep that sensitivity in check, and keep it from blooming into a true allergy. But that's a hard sell for my daughter, who's been a vegetarian for the past four years (she's now almost 12). Have any of you experienced this, or been given this advice?

[maeve]

Is the sensitivity just showing up in allergy testing or is she showing other symptoms like hives or GI issues? My daughter was first diagnosed with egg allergy at 9 months of age and has eaten chicken without issue.

[emcsmom]

She had some tongue tingling, cramping and diarrhea several years ago (before she became a vegetarian) after eating a rice dish that I'd prepared with chicken broth (that I'd made myself at home). I knew there was no egg in the food and the reaction didn't progress to anaphylaxis. That's when the allergist started testing for a RAST response to chicken, though he said a true chicken allergy is uncommon, apparently. Her first number was 1.23, which was pretty negligible (particularly compared to her egg white/yolk RASTs, which have climbed steadily since a biphasic anaphylaxis episode in 2010, and are now 85/70).
But her chicken RAST has been rising steadily since then; her most recent RAST for chicken was 4.0, which is a pretty respectable number, right? Again--her egg numbers are really high, but I think a 4.0 is not a number to ignore, given her history. That seems to be the allergist's perspective as well. Because she's a vegetarian, she doesn't eat chicken and I don't prepare any food for her that involves chicken broth or chicken protein anymore. I would hate to see her develop another significant allergy, though. But the idea of eating chicken is a really hard sell.

[Macabre]

I've experienced much of this!

My son became a vegetarian at 7 (DH and I are not but are functional vegetarians most of the time--don't cook meat in the house but once or twice a year when DS is gone).

He was only allergic to peanuts (and celery), having outgrown tree nut allergies. Until shrimp was included on a blood test panel. Our allergist does SLIT (sublingual immunotherapy) and for some resin included it in the semi-annual testing.  We thought nothing of it. First of all, he won't blatantly consume it, and I am allergic to shellfish and avoid cross contact in restaurants--so he knows how to avoid it.

He decided at first not to include shrimp in his daily sublingual drops.  He did not want to ingest shrimp protein.  We were fine with that decision, though we really don't want him to have a reaction from XC. But we respected his decision to be vegetarian at whatever level he was comfortable with.

Every six months his blood work showed a shrimp allergy.

A year or two passed, and he said at one appointment that he did want shrimp in his drops. That was HUGE. So he has a little shrimp every day.

I was proud he made the decision, but it was HIS DECISION.


I'd let your DD guide you --her conscience is worth something.

It's great to see you!



PS  DS is now 17. He decided a year ago to do the shrimp drops.

[emcsmom]

Thanks, Macabre! That does sound like a very similar scenario!
At this point, DD is vetoing the chicken. While I respect her right to do so and will certainly not force her to eat meat, I do wonder about the long-term consequences of developing a full-blown allergy to chicken. We've got few restaurants that we trust as it is (other than the one vegan place where we live). A chicken allergy would certainly take Chipotle out of the mix, and that's our go-to fast food place. I'd have to think a chicken allergy would up the ante in terms of cross-contamination, too. It's challenging enough to find foods that are produced in egg-free places; adding in chicken-free will be interesting.
But we can give this some time and see what happens!

[maeve]

Is egg your child's only allergy? I ask because with broth I would suspect nuts as cross contamination with my daughter or egg (though since her baked egg challenge we don't have to worry about cross contamination as much).

McC, was your DS challenged to see if it was an allergy or something just showing up on tests? I say that because DD tested positive for dairy on a SPT as part of the screening for a clinical trial. She eats dairy daily without issue (not even flare in eczema). Also, she's tested positive for soy on RAST testing but is not allergic to it (it's a cross reactivity in the testing because of her peanut allergy).

I guess what I'm getting at is that a challenge is the only definitive way to determine if she's truly allergic. She's young enough that you can put your foot down as a parent and have her do the challenge (if the doctor will do so) because it's a safety issue as you pointed out even if she eats vegetarian.

[Macabre]

Oh of course not. He would not have challenged it. He would never knowingly consume animal protein---until he decided a year ago to add the shrimp SLIT, knowing if was allergic it would be better to lose it. He's seen what a pain of a time I've had with a shellfish allergy--no reason to have to deal with that once peanut is "gone," yk?

[Macabre]

Also Maeve, our allergist doesn't do SPT for food. This was several ImmunoCAP tests running--every six months for a couple of years. Though there can be false positives, it's not nearly like the rate with SPTs. I tend to out quite a bit more stock in ImmunoCAP results--but especially if I see a trend. There was also no reaction history, because he had not blatantly consumed shellfish in years.

[emcsmom]

Hi Maeve--the broth was homemade and we have an egg-free house, so there wasn't any egg in it. I am reluctant to force my nearly-12 year old to do a food challenge, particularly one that involves meat when she's a vegetarian. As a practical matter, I'm not even sure how I'd do that. It wasn't a cavalier decision for her to give up meat several years ago, and attempting to "force" an older child into a food challenge seems like a bad idea on a lot of levels to me.

So ultimately--I guess that's my own answer. We stay where we are, and keep re-evaluating as she gets older.

[CMdeux]

I agree-- never that great an idea to force a child-- must less trick one-- into a food challenge against their will.

What I wonder is if you've approached the conversation as one of being lower-impact on those around her.  This is something that factors heavily into my DD16's approach to life with food allergies.  For example, she would probably never have done an open egg challenge without that facet of things.  It was a matter of being old enough to want to give dating partners more freedom in their own diets, to give friends/family more freedom in their own kitchens, etc. 

She could care less about eating eggs-- EVER.  But her poor fellow college students certainly do care, and it makes life far easier in other ways if she knows that she simply doesn't need to worry about X at all, ever.

Does that make sense?  Because at it's root, the reluctance to evaluate the severity of the allergy is a food preference (albeit a serious one, which I understand is NOT the same thing as "I'm picky/I don't like that") and not a matter of safety. 

For my own family (and I am not for one instant judging what others do or do not here) we evaluate our "footprint" with others and our justifications for making such requests of them on the basis of what is NECESSARY, not what is convenient, philosophically consistent, etc. for ourselves.  If I have to ask for no shellfish at the local potluck in order to be able to eat anything (or just to attend) then I'm only going to be comfortable doing that if I know that my safety is on the line.

I'm not sure if this makes complete sense or not.  I just don't ask OTHERS for accommodations that I don't know that I need.  That is, I do every thing in my own power first, and only then ask others.  It's a philosophical position on allergy management, I suppose.  Which is why I-- truly-- don't judge others for doing things differently-- I just offer that as another facet to the multiple things under consideration.

Not all 12yo may be ready to see things through that lens, either.  Mine was, and Mac's DS as well, but neither of them are typical teens, nor were they typical as tweens.

Good luck, and I'm that you won't ever have to deal with it as an allergen, either way.

Tissue culture derived vaccinations and drugs might be a concern to someone with a chicken allergy, by the way.  Not a big one, and probably most people wouldn't need to worry about the ultra-trace amounts in question even with an allergy in play-- but it's worth investigating if you happen to be someone highly sensitive to an avian allergen.

[emcsmom]

That's an interesting point. I do see some value in limiting the difficulty that a food allergy creates for others, though I think that can be a slippery slope, of course, particularly with a tween who's very, very quiet and very much a people-pleaser, as my daughter is. Getting her to a place where she's comfortable advocating for herself and vocal enough to ask about labels and ingredients, etc., has taken years. She's a very bright, articulate kid, just fundamentally really reserved ("shy" is not my favorite word so we use "reserved") so drawing attention to her LTFA in any capacity is not a comfortable position for her. We've worked hard to normalize that experience for her, and she has a good group of friends who are as supportive as they can be (without actually living in that world themselves), but it's been a growth process. At any rate--I think what will be a more compelling argument for her right now, anyway, is that a chicken allergy will limit her choices to eat in restaurants or eat in friends' homes. It's already challenge enough to avoid eggy places, but a chicken allergy would eliminate two of our three safe options, likely (leaving just the vegan place she likes).

[spacecanada]

I have been silently reading this thread as it unfolded.  As a vegan with food allergies, I can see every one of the mentioned sides to this.  I also see the side where people try to or unknowingly slip vegetarians some meaty items because it's easier or because they think it doesn't matter (because it's a choice) -- and chicken broth or items with chicken would be the most common items in my experience.  So knowing whether or not there's an allergy would be very important. 

From the vegetarian/vegan perspective though, it would be very difficult to convince myself to eat meat for any reason.  Though, my reasoning would make me do it if I had to for life-critical health -- and that would probably be the only reason.  Allergies trump lifestyle food choices in my opinion.  (I will admit to eating things that aren't vegan because they were SAFE.  For instance, we were on vacation and the noodles they made contained egg but safe for all of my allergies - I'm not actually allergic to egg. Or the safe bakery near my house uses lard, but they are SAFE, so when people buy their cookies for me in lieu of their non-safe goodies, I may eat them if I'm hungry enough.)

Another thing to consider: chicken isn't a priority allergen and doesn't have to be declared on the label, so buying food items, even seemingly vegetarian or vegan ones, could become extremely difficult.  Many vegetarian items are made in shared facilities with meaty ones.  'Natural Flavour' could become your nemesis (as it is mine.)  If you could prevent that, quality of life could be much higher for the long run.  (I'm currently trying to prevent more food allergies for just that reason - one non-priority allergen is difficult enough.)

If the allergist thinks a food challenge is due, I would have an open discussion with your daughter to let her decide what to do.  She seems old enough to make those decisions.  I always like to quote the UN Rights of the Child that children have the right to be involved in decisions that affect them.  Give her all the details, from all angles, and all consequences, and see what she thinks.  It doesn't have to be all at once, and don't expect an immediate answer, just a discussion for now with follow-up later. 

Just a few more things to consider. A tough one, for sure.

[emcsmom]

That's a great point about chicken ingredients and labeling, spacecanada. That would make it a lot trickier.
I will talk to my daughter about all of this, and see if the allergist would be willing to do a chicken challenge, if I can get my daughter on board willingly. I do think it's important that it be her decision, but she's a bright kid and she may get there if she has all of the information in terms of the potential consequences of adding another serious allergy to the mix.

Thanks, everyone, for your great advice and perspectives!

[Linden]

I also see the side where people try to or unknowingly slip vegetarians some meaty items because it's easier or because they think it doesn't matter (because it's a choice) -- and chicken broth or items with chicken would be the most common items in my experience.  So knowing whether or not there's an allergy would be very important. 

Yes, Yes, 100X yes.  I've had people slip me chicken on many occasions and some of them were aggressive and insistent that something had "no meat" in it or was "vegetarian".  And these weren't even items I was asking about; folks were actually going out of their way to make sure I ate a particular item.

One more point, if I may, and this is not to sway your daughter one way or another.  After being vegetarian for some time, I found chicken (and meat and fish) gave me quite the stomach ache.  Just thinking this might be a confounding factor if your daughter ever does decide to go the chicken route.     
 

[Macabre]

Oh good point. Yeah, I told DS that if he ever decides to eat meat to take it slowly. After a period in college when I didn't eat meat, when I did (because I don't hurt to hurt my dad's feelings), I got sick.