I can tell you exactly where I was when the field of allergy and immunology first stole my heart. I was in my first year of medical school sitting in an overly cool classroom taking notes as fast as any human hand could. My pathology lecture was just ending and immunology was up next. I rubbed my sore fingers and prepared to write down, verbatim, the next lecture.

But shortly after my professor started to speak, I realized that I had completely stopped taking notes. I had allowed myself to be drawn into the story that she was weaving, a story of T cells and B cells and their physical and chemical conversations with each other. It was amazing.

Little did I know that she was introducing me to a cast of cellular characters that would soon become not only important for me to pass my next immunology test, but also to complete my subsequent fellowship training and to my understanding of the mechanism of food allergy, an immunological disease that would affect three of my four children.

In 2005, after completing a pediatric residency, I started my fellowship in the field of allergy and immunology at the Children’s Memorial Hospital in Chicago. I had a 7-week-old baby boy at home so I was knee-deep in motherhood, but I was ready. I was excited to finally be seeing patients with the allergic and immunological disorders that I had been so interested in during medical school.

These diseases, including chronic sinusitis, seasonal allergies, and immune deficiencies, were all challenging and interesting, but what drew me in the most was food allergy. There was something so cruel and senseless about a disease that denies a child a bakery cookie – it made me want to break its code.

Patient Emotions
As fellows, we were taught to take a detailed history of the allergic reaction from the patient and the parent, paying exquisite attention to what food was ingested, the timing of the ingestion in relationship to the symptoms and what symptoms occurred.

Patient histories would often become complicated, a fusion of facts and feelings. We would then perform skin-prick testing with the suspected food protein and draw blood for the same allergen. Combining the history and the results of the testing, a diagnosis was made.

We would review an allergen avoidance sheet with the family, explaining the importance of reading food labels, and discuss an emergency health-care plan, teaching the families how to recognize and treat an allergic reaction. We provided them with a short list of support services and asked them to follow up in one year. It was a good system, at least as far as I knew.

By the end of my first year of fellowship, we had twin boys (yes, we had three boys in 13 months!) and one of them, Gino, literally had hives on his skin only a few days after he was born. He would soon be covered in itchy, bleeding eczema and more often than not, vomit, so I made an appointment with an allergist.

Next page: The diagnosis: a powerful blow

“Extreme Adventures” appeared at the top of the page, followed by a list of activities on the tour. I held my breath as I read the descriptions, to the effect of: “Travel through river canyons at 100 kilometers per hour in a jet boat!” “Bring your courage along as we bungee jump over Queenstown!” “Fall out of a plane from 14,000 feet over magnificent scenery.”

I stopped there. “Are you crazy?” I e-mailed back. “I hope these activities cost extra, and you can’t afford them.”

“Everything is included except for skydiving,” she replied, inserting a smiley emoticon.

Not only did I think she was nuts for considering jumping off a mountaintop attached to a rubber band or parachuting from a plane, but also for sharing this information with me. Having grown up watching me deal with her severe milk allergy, she knew I was wired to worry.

When dining out, I’d interrupt while she was ordering, urging the waiter to check the dish’s ingredients before she had a chance to ask herself. Once the meal arrived, I’d lean over her plate to inspect the food for any trace of butter or cheese.

But that anxiety was nothing compared to what I felt after Arielle, at age 16, had an anaphylactic reaction requiring three doses of epinephrine and hours of monitoring in the emergency room.

From that day on, whenever she was headed out to meet friends, I’d stop her at the door and ask where she’d be eating and if she had her medications with her.

She’d glare back at me. “You can’t keep me in a bubble for the rest of my life.”

***

She was right. Ultimately, I wanted what she wanted – for her to enjoy the same activities and freedoms as any teen. I worked on backing off, and reminded myself that she had always been careful: checking labels, alerting servers and managers to her allergy and passing up a food when she couldn’t be certain whether it contained dairy.

With planning and proper precautions, she spent two weeks without incident in Provence through a high school exchange program. (Full disclosure: my husband and I followed her to France. We stayed approximately 30 miles from her home base and never saw her, but felt reassured that we were only a car ride away in case of an emergency.)

Next page: The trip of a lifetime