The Food Challenge: Controlling Allergies With Tiny Bites

Blake Ringstrom had a feeding tube for two years due to severe food allergies.

April 1, 2009, 4:55 PM

April 2, 2009— -- Five-year-old Blake Ringstrom's life has been an extraordinary and excruciating journey through a medical minefield.

Blake is allergic to so many foods that, until recently, he was fed only through a tube implanted in his stomach. Now, after undergoing an emerging medical technique, Blake can enjoy a normal, sit-down meal with his family.

For his mother, Becky Ringstrom, seeing her son eat normal food is "pretty overwhelming. We still like to sit here and watch him eat."

This enormous and welcome milestone was all made possible by an improved diagnosis method for food allergies in children, called the Food Challenge.

Thanks to this method, Blake was recently able to take his very first bites of real food in nearly two years. Using the Food Challenge, children who test positive to allergens, using blood and skin tests, are fed -- in a highly controlled setting -- incremental amounts of the very foods to which they appear to be allergic.

Even though an estimated 12 million Americans suffer from food allergies, diagnosis and treatment can be all over the map.

The standard methods of blood and skin testing revealed that Blake's allergic reactions, first diagnosed when he was 6 months old, are dangerously off the charts. His intake of solid foods was restricted to pork and white navy beans.

"We felt like we were grasping at straws," said Blake's mother. "He wasn't getting better, he wasn't growing, he was still kind of sick all the time. ... The itching was constant. We had to put socks over his hands so he wouldn't make himself bleed."

The Ringstroms, who live in a small town in Minnesota, took Blake to the Mayo Clinic, where doctors decided a draconian move was the safest course: Take him off solid foods altogether. He was fed by a tube for two years.

"We just changed our mindset," Becky Ringstrom said. "We felt like this is helping him. ... This is his food; some people eat with a fork, but for him ... he eats with his tube."

But it was difficult for Blake to see other children eating normally.

"Birthdays are really hard," his mother said.

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'He Didn't Know How to Eat'

Desperate for a more normal life, Blake's parents found their way to Denver's National Jewish Hospital, known for its pioneering work on food allergies. There, Blake's allergies were rediagnosed by a series of food challenges, meaning he was fed small amounts of the foods he and his family believed would make him sick.

"We decided that if we are here, we need to try this," Becky Ringstrom said. "If he really is determined not to eat forever, we just wanted to know for sure."

"He didn't know how to eat again," said Dr. Jonathan Malka, a pediatrician at the hospital. "So I had to start over from the beginning; how to feed a child who has not eaten for the last two years."

The very first food challenge was tiny portions of pureed sweet potatoes.

"Unfortunately, he ended [up] vomiting the sweet potatoes violently all over," Ringstrom said. "At first, we thought, 'Oh no, this is terrible.'"

But they kept at it. Soon, a few bites of a banana rocked Blake's world.

"We sat at a table and he ate a banana like any other 5-year-old kid would do," Ringstrom said. "[It was] very, very exciting."

"The Food Challenge is what we call the gold standard for diagnosing food allergy," said Dr. David Fleischer, an assistant professor of pediatrics at National Jewish Hospital. "It is the best test for determining whether someone has a food allergy."

Fleischer and his colleagues discovered, in a new landmark study, that more than half the foods triggering positive blood tests could, in fact, be added safely back to the diets of patients based on food challenges.

The study seems to indicate there may be thousands of Americans, perhaps more, who aren't eating food that they probably could eat safely.

"The problem is that a lot of people think they have food allergies; there are a lot of people that have reactions to food out there, but not every reaction is a food allergy," Fleischer said.

It was that type of reaction that brought 5-year-old Ashley Garcia to the emergency room after eating an ice cream cone with nuts. The suspicion: a potentially life-threatening allergy to peanuts.

"By the time we got there, her eyes were bloodshot red and it seemed like there was a whole other layer of skin," said her father, Sergio Garcia. "She broke out in a rash."

Time, Accuracy, and Cost Questions

Ashley's parents decided to allow her to undergo a food challenge, even though the risk was another dangerous allergic reaction.

"It hit me last night, that if it's going to happen, this is probably the best place for it to happen," Garcia said.

Their goal is modest.

"Ashley's goal is that she can eat Reese's peanut butter cups," Garcia said.

The food was introduced gradually, beginning with only a half gram of peanut butter. The portion was increased, and a nurse checked for allergic reactions after each serving. Finally she got the peanut butter cup.

"It's good," she said.

"[This] tells me she should be able to go and have peanut butter," said Sandy White, a registered nurse at the National Jewish Hospital. "She should be able to be around peanuts and not have a reaction."

Food challenges may be the emerging standard, but they can cost thousands of dollars; less accurate blood tests typically run about $300.

"It is a burden to do on a daily basis," Malka said. "It takes time, it takes staff, and there's always a risk associated with any food challenges ... because of an allergic reaction. But if it's done in the right setting, with the right testing behind it, it's a very safe test to do."

Now, Becky Ringstrom's kitchen is loaded with foods she calls, "Blake-safe." Currently, Blake is allowed to eat about 15 foods. Last fall, he sat down to his very first Thanksgiving meal.

"So many of the foods that he was able to gain, the sweet potatoes, the corn and the mashed potatoes, the turkey, they were all passes for him," Ringstrom said. "So to know that we can ... just sit down as a family and eat it, it was just overwhelming."


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