San Diego Erin Bushie had no idea that her one-year-old daughter, Aubrey, had a severe food allergy until the call came from day care. "At the day care, they all had a spoonful of peanut butter at lunch. She had trouble breathing and her eyes swelled up, and they called me right away. My boss let me go, and I took her to the doctor immediately. But when I got there to pick her up about ten minutes after the call, her eyes were so swollen that they were almost shut. It was scary."
Erin and her husband David now live with the reality that Aubrey must not have certain foods. Now almost three years old, Aubrey doesn't seem to care that some foods are off-limits for her. She is bright, energetic, and outgoing, blurting out, "I can't have eggs!" Her mom corrects her, "Not anymore. Now you can." Aubrey adds, "I can't eat peanuts!" then rushes off to the living room of their Talmadge home. Erin lists her allergies: "It used to be eggs, peanuts, cats, and dogs, but she's outgrown the allergy to eggs already. She used to be fatally allergic to peanuts, but her scores have gone down -- lower than most kids who have allergies to peanuts, but they said to still not give her any. She might outgrow that too, but they don't expect her to. We worked with Dr. Michael Mellon at Kaiser and he was just great."
"What made it so scary was that I didn't know. One time, probably the third or fourth trip to the hospital, the respiratory therapist said, 'She probably has asthma.' I didn't know allergies were related to asthma at all. That was in September of 1999. By January 2000, we had her tested. They skin-tested her by making some pricks in her back."
Kaiser put Aubrey in a study, since she was too young for the regular therapy of inhalers. "They were starting this new medication, called Pulmicort, that was supposed to be like an inhaler. They provided us with everything, including the nebulizer [which reduces medicine to a fine spray], and did the study with several different babies. She responded well to it, and at the time she was around cats and dogs, and she could do that with the Pulmicort, even though she was allergic to them. In fact, ever since we've started it, she has not been back to the hospital once."
Pulmicort is the generic name for Budesonide, a popular anti-inflammatory steroid used in treating asthma. A corticosteroid, Pulmicort inhibits the body's ability to react to allergens or cause inflammation.
Erin brings out a machine about the size of a school lunch box with an electrical cord. It is a compressor nebulizer. The dosage of medicine is placed in the machine, and it produces a "fog" of medication for Aubrey to breathe through a mask connected by a hose. A new, smaller, battery-operated machine is still unopened. The new machine will allow Aubrey more flexibility, as it can be used anywhere. Erin calls this process "fogging."
While wearing a mask to inhale vapor is easy for an adult, getting a one-year-old to do it is not easy. "At the hospital, they used a Barney character with a mask, and they let the kids put it on Barney, then themselves. She didn't like it the first time, but after that she was okay. I think it's because she started so young."
Like other allergy patients, Aubrey needs an emergency dose of adrenaline on hand in case of anaphylactic shock, but she was too small at first for a standard "Epi-pen" kit. "We had to carry around a syringe and fill it ourselves with the proper dosage in case she ate the wrong foods. Whenever we went to the hospital, we went because she was having trouble breathing. Her passages were shutting on her, though she never broke out in hives or anything like that. Now that she's older, she can handle a bigger dosage, so we have the 'Epi-pen Junior' kit."
David is aware that, like most parents of allergic children, they have to go out of their way to inform anyone who comes in contact with Aubrey of the dangers. "All of Erin's awareness and reactions of what she has to do -- every situation we have to go into -- we're pretty informative to all the people involved. It takes an effort, but Erin, being a former teacher, she's really attentive to detail. She lets people know, not in an offending way, but just so everyone becomes aware of it. Everybody contributes, and there hasn't been any issue as far as her ingesting any foods that give her reactions." David produces an elaborate instruction sheet printed for babysitters, parents of friends, and teachers. It lists Aubrey's allergies and offers instructions on medications to use and dosage. "Erin has a gift for enrolling people into the idea of taking care of our kid!"
Erin doesn't think any of this has been embarrassing, nor has anyone treated them as oddballs because of their concern. "Everyone's been great about it. I think, too, when I say that she's fatally allergic to peanuts, they hear the word 'fatal,' and they understand that this isn't something that she's just going to be coughing at. After going to the hospital three or four times and seeing what a struggle it was for her to breathe -- and sometimes it was an hour before the respiratory therapist was able to see her -- after seeing your child struggle like that, you're not going to be timid about letting people know.
"If she has to go to a friend's house or day care, you have to let them know she's allergic to peanuts so they don't give it to her. Dr. Mellon said this is common with babies, that she seems to instinctively know what she's allergic to, and she won't eat it. When she was allergic to eggs, she wouldn't eat them, when she would eat everything else under the sun. At the home day care I used to send her to, she'd say, 'I can't have peanuts' and 'I can't have eggs,' and a lot of the kids were older, so they'd all look out for her."