May 23, 2011

Always be prepared even in familiar situations

We never leave home without the Epi-Pen, Jr. and antihistamine

With a growing number of food allergies (milk, peanuts, almonds, walnut, macadamia, halibut, kiwi) in our family, we don't eat out much.  The risk of cross contamination is just not worth it to me.  We do have a couple of restaurants that we've been to multiple times without incident.  One of them is a Thai restaurant where we've been able to chat with the chef/owner a few times so we feel better about trusting what's in the food.  Despite using crushed peanuts and peanut sauce in some of their most popular dishes, our favorite Thai food had never been a problem.  Until Mother's Day.

We ordered three dishes the kids had eaten before plus a new curry dish for my husband and myself.  (FYI We avoid all nut dishes and deep-fried foods since restaurants might reuse the same oil for allergy-safe and unsafe dishes alike.)  And like always, we spent time explaining to the server, not the owner this time, about our kids' allergies to peanuts, tree nuts, milk products such as milk, butter, and cream.  All the dishes were supposed to be clear of any of the kids' allergens.

Ryken's allergic reaction started a few minutes after we began our soup dish (tom kha gai).  He complained of abdominal pain and the skin around his mouth looked red and irritated.  We immediately recognized these as symptoms he has had in previous allergic reactions.  We asked him if it felt the same as when he needs to go to the bathroom and he told us no.  (Thank goodness he is almost 6 years old now and has developed an awareness of his body functions!)  We asked if his mouth or throat felt like it was getting thicker ("No") or if he felt like throwing up ("I don't know").  We waited a couple more minutes to see if it really wasn't a toilet issue and then decided to give him Benadryl which we carry around in a fanny pack or the car wherever we go.  The medicine seemed to calm Ryken shortly after -- to be honest, he got drowsy really quickly! -- although he still didn't feel completely himself.

In about 15 minutes we quickly chowed down the remaining three dishes since Ryken was half-uncomfortable from the soup, half-loopy from the meds.  All this time, we were checking in with Ryken to see if he felt close to vomiting.  Ryken had a horrific, Exorcist-style vomit incident a couple years back at our neighborhood Japanese restaurant that I never, never wish to happen again.  I took Ryken to the car as my husband waited for the check with Callan.  After another 5 minutes my husband emerged from the restaurant with concern on his face.  He opened the car door and immediately started talking but I wasn't listening.  I could already see that Callan was having an allergic reaction, too.  His left eye was swollen like a boxer and he couldn't keep his hands from rubbing at his eyes.  We gave him Benadryl immediately.  I asked Callan if his mouth felt itchy or it was getting thick and he said it was okay.  He had no other symptoms except for his swollen eyes and that alone took a full 24 hours plus another dose of medicine to subside.

Because the kids only share one allergen -- milk -- I'm thinking this is the likely culprit.  I haven't had time to go back to the restaurant yet but I definitely plan to let the owner know what happened so I can figure out if it was the server's error, if the chef changed her recipes (as the kids didn't eat any dishes new to them), or if it was likely a case of cross contamination.  In hindsight I probably should have asked to speak directly to the owner/chef to confirm the ingredients and to reemphasize the need for careful cleaning of shared equipment.

There is another possible explanation I had not even considered before: maybe my kids have a new food allergy.  Surfing online, I have read that people with existing peanut or tree nut allergies sometimes have a coconut allergy, too.  My kids have had flaked coconut and coconut milk on several occasions.  I don't remember there being a problem but were there some telltale signs of allergy I had missed?  We will be seeing the kids' allergist and pediatrician in the near future so I hope to get some more testing done then. 

As troubling as allergic reactions are, once the reactions have subsided I make note of what we can learn from them.  Besides being reminded of the dangers of eating out, the importance of speaking directly with a manager or chef about food allergies, and the necessity of taking our STAT Kids allergy pack (liquid antihistamine, measuring cup, and Epi-Pen, Jr.) wherever we go, we have been given another opportunity to see what kind of reactions Ryken and Callan are capable of having.  Callan, especially, has had a growing number of allergic reactions since December.  And all of his reactions have affected his left eye first and foremost.  Seeing this pattern emerge could help us (and his future teachers) identify an allergic reaction quickly.  His pediatrician had doubted that a previous swollen left eye had been caused by his moderate almond allergy.  She had thought swelling would at least affect both eyes and other parts of his face and body, which made a lot of sense to me.  But apparently not all allergic reactions hit his body so uniformly.
Callan's left eye is still puffy after two rounds of medication.

I am grateful that the kids have not ever had breathing difficulties but I am aware that their symptoms (swollen eyes, hives and rashes, abdominal cramps, vomiting) are indicators of a more serious allergic reaction.  And these reactions can quickly escalate into anaphylaxis.  We are becoming more familiar with their early signs of allergic reaction so, hopefully, we can deal with reactions as soon as possible and know best when to seek additional help.

Update:  I finally found out what caused the kids' reaction.  On a visit back, I explained the reaction to the same person, the owner's teenage daughter, who had served us that Mother's Day evening.  As suspected, the soup was the culprit.  The server was listing the ingredients and mentioned lactose-free milk.  "But that's okay for you, right?"  Um, no.  Not all!!  It was an innocent mistake but a near costly one.  After this instance I now always insist on having servers show our Select Wisely allergy alert cards to the chef and I make sure to emphasize no cow's milk of any kind. 

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