Questions:

Differential diagnosis list given the multiple episodes of vomiting between 10/3 and 10/8 following a variety of different foods and the blood work/labs/skin prick results from testing at DHMC on 10/9/25:

  • Possibly EoE. Follow up with gastroenterologist on 12/16

  • Possibly FPIES. We will have to re-introduce each possible trigger foods individually/incrementally. Most likely suspect based on what she was eating between 10/4-10/8 would be wheat because she had pasta at multiple meals, and other than the 1/64 teaspoon of cottage cheese on the afternoon of 10/4, we avoided feeding her egg or other dairy that week, but she was offered pasta multiple times.

1) How unusual is this pattern that Julia is demonstrating of food tolerance for a time (walnut-1 month, lentil and dairy-6 months—very frequently) turning into allergy? It is our understanding that most allergies will show themselves much faster (ie: after a few exposures to the food). If this pattern is rare, should we be concerned that something else beyond the allergy is going on (a broader immune disorder or genetic disorder or something else) that we should be concerned about?

2) Is there any known factor happening in a child’s immune system development around the one year mark that can help explain the loss of lentil and dairy to allergy around this time? Could this loss be connected to her strarting the spoon sheet in September in addition to the heavy feeding of the other allergens we believed she tolerated?

3) You referenced having a soft handshake with the spoon sheet/allergens—that slow and gentle is the best approach. I am worried we have way over-indexed on the regular feeding of Julia’s tolerated allergens because we’ve been so hopeful that this approach of “early/often” will mitigate the development of more allergies. Have we perhaps unintentionally harmed/overburdened her immune system by such heavy focus on her eating an allergen filled diet (of any we believed she tolerated)? She has been eating dairy nearly daily, wheat most days, eggs 3x a week, peanut 3x a week, almond 3x a week, hazelnut 3x a week, and sesame 3x a week, and then in the last month (September) she was also doing her first spoon sheet. Additionally she very regularly eating black beans and kitchari (the dish that is lentil based with green peas and mustard seeds). Her skin prick test in May showed sensitivity to peanut (w/f: 4/10), but she was tolerating it. Still with a legume sensitivity and a tree nut allergy (cashew/pistachio) when she was 7 months old—followed by the diet we’ve fed her for the last 5 months, have we maybe been too aggressive with feeding allergens?

A: Dr. Shaker’s response to this was that he didn’t think we had been too aggressive with allergen introduction and that developing EOE in response to the black microdosing spoon sheet would be highly, highly unusual.

4) Should I continue to keep all egg out of my “lactation diet” while I breastfeed? Or can I incorporate baked egg?

5) Can we offer baked egg at home, or do a food challenge for baked egg?