Celebrating anything during COVID requires creativity and flexibility. Our anniversary this year evolved into not involving any trips, but it did take us outside our house, which is practically like a trip these days.
It was Jason’s turn to plan our anniversary activities. With so much uncertainty at present, I didn’t begrudge him the task. He made us a berries and cream cheese French toast casserole for breakfast, which we enjoyed on our patio. In the afternoon, we went on a hike along the Bonneville Shoreline Trail to the Bear Canyon Bridge and back, which was just over 3.5 miles. Jason picked this path because wildflowers were reported to be in bloom. They were. We encountered 16 or 17 different types of blossoms, some of them covering whole hillsides in sheaths of violet or blush.
The trail was empty until the bridge thanks to a shorter access point from the other side.The hillsides were brimming with blooming dots.
Afterward, we went to dinner at The Charleston Draper, which had recently reopened to guests. We sat in their courtyard under towering trees and twinkle lights at least 10 feet away from anyone; it was conscientiously charming. This normal outing was sprinkled with oddities like masked employees and used dishes being treated like radioactive waste, but it was enlivening to be able to celebrate in a practically standard way even in that alternate universe.
You can find anything online, including custom wrapping paper.
We spent the evening around a firepit in our backyard roasting marshmallows and spotting falling stars. It was basically a scene from a quirky but warming rom-com.
A cozy fire and a hot man? Sign me up!
Although not our usual celebration, we had a perfect day. After all, an anniversary is best spent with just two. Thanks, COVID for making togetherness inescapable.
COVID need not eradicate your own anniversary celebrations. Here are just a few ways you can commemorate your special day while maintaining social distance:
1. Lots of restaurants have created outdoor eating space. Make use of it.
2. Rent a cabin or condo in a remote location. You can get away from your house and still avoid people.
3. Enjoy al fresco dining in your own backyard.
4. Take in a drive-in movie. Many are playing old romantic favorites like Sleepless in Seattle and The Notebook.
5. Escape into nature on a hike or on a bike.
6. Take a hike and have a picnic on a deserted hillside.
7. Have a cookies and games night with homemade cookies and two-player games like Castles of Burgundy or Patchwork.
8. Prepare a delicious meal together using an online cooking class. Options include Gordon Ramsay’s Masterclass, America’s Test Kitchen, and cooking with the New York Times.
Being a social outcast has never been so cool… and isn’t likely to ever be again.
This spring, life quickly turned topsy-turvy in a way most of us didn’t realize was possible. Reflecting now on the last few months seems somewhat premature since the COVID situation is still in flux and the outcome is yet unknown. However, just going over the range of what has happened so far feels like a monumental task. Hence, I wanted to tackle this topic before a 25-page essay becomes necessary.
I’m still digesting this affair with the rest of the world. In another year, decade, or century perhaps we will fully understand the lasting legacy of this pandemic and what we should have done differently. Until then, here’s a bit of my limited perspective.
March
March is supposed to come in like a lion and go out like a lamb. Instead, it felt like one of those rollercoasters that starts out slow and then, next thing you know, the ground just ceases to be under you. It was a month of disruption and isolation where plans vaporized as if hit by a phaser on maximum. The roads and parks became silent and eerie while panic gripped communities. As the death count in the US rocketed and businesses suffered, many Americans fought over toilet paper and placing blame instead of coming together to hinder this microscopic foe.
Like most of you, Jason and I became lost in the pace of change. The month preceding the onset of social distancing was particularly busy for us, so much so that Jason determined we needed to cut out some of our routine activities. Be careful what you wish for my boy! From that eventfulness, we dropped off the quarantine cliff, and suddenly nothing was going on. At first, every day seemed exactly the same as we struggled to adjust.
After the initial shock of speedy isolation wore off, Jason and I started figuring out ways to make isolation less isolating. Within the first month of seclusion, we had 11 virtual board game nights with different sets of friends over Google Hangouts. In our peak week, we had four virtual game nights on consecutive evenings. That proved too much for my eyes. These games were made possible by the resourcefulness of Jason. He rigged some of my photography equipment to hold a cell phone over the game board for a board view. To date, we’ve successfully played Pandemic, King of Tokyo, Splendor, Pandemic Legacy, and Wits & Wagers this way.
I organized two virtual game tournaments for my family.
I initiated virtual King of Tokyo and Splendor tournaments with my family using the above-mentioned method. I was pronounced King of Tokyo, while my brother was declared the winner of Isolated Splendor. Later, an online Dominion tournament ensued, which was won by a nephew. The matches were more intense than expected, especially Splendor. Missing the competitive exhilaration provided by sporting events? Set up virtual game nights for all your cutthroat needs!
You can’t be a legitimate champion without a trophy.
Jason and I also introduced virtual movie nights to my family. We’d all watch a prearranged film at a specific time in our respective locations and get online to discuss the flick afterward. This was a weekly tradition for a couple months.
Beyond getting some screen time with real people to reassure us we weren’t the only ones left on the planet, Jason and I kept sane by taking walks almost every evening, often as soon as the workday was over. Sanity was also gained by nearly daily workouts. I’ve got strapping arm muscles (relatively speaking) thanks to my regular stints on the arm bike; I call these my COVID arms. It was easy to make time for exercise in the absence of everything else.
Having interesting projects helped break up the monotony too. Since I wasn’t taking new pictures, I was able to catch up on editing photos from a few years ago. I commenced some sewing projects for Regency accessories. Additionally, I started planting a forest of succulents, an undertaking I anticipated and bought supplies for before the shutdown. I also took advantage of internet learning opportunities. Online ukulele lessons, photography classes, and cosmetic chemistry courses all kept my brain engaged. Thank goodness for technology!
This was my first batch of succulents. I gave them all away.This was round two of my succulent mania/therapy. I’m about to plant round three.
Any day that was warm enough, I spent on my laptop in the backyard. This change of setting from the study to the patio mollified my mind considerably. On a few Saturdays, Jason and I legitimately got outdoors by snowshoeing up the slopes of Alta Ski Resort and then snowboarding down them.
Jason and I were disappointed the end of the boarding season dissolved due to COVID, but we made this happen.By the last time we went to Alta in mid-May, the snow had melted into countless crevasses.
And how was and is working from home working? Jason and I get along exceptionally well. Even after being compacted together 24-7 for months, we still adore each other. Transitioning to working from home was pretty easy for us. The hardest thing was Jason’s loud phone conversations and video chats. I’m pretty sure talking to people in meetings and out of meetings is 99% of what he does. I just escape to another floor, or better yet the backyard, when he’s being a chatty Cathy, and all remains good.
May
After two months of social distance, new routines seemed more normal. By the end of April, I had fallen into a productive pattern split between working inside in the morning and outside in the afternoon. The evenings mostly involved walks, cleaning, and exercise. A clear distinction emerged between weekdays and weekends as we grew more accustomed to our altered habits.
We also found a way to get “out” thanks to a local theater creatively transforming their parking lot into a drive-in, which started screening classics like The Goonies, The Bourne Identity, and Back to the Future Part II.
Jason and I launched “distant” lunches to allow for in-person contact. Basically, we realized we could meet up with friends at a park and easily maintain social distance. These lunches continue to be a source of unattached interaction for us. Everyone brings a chair and a meal, and we see each other with our eyeballs. We even did a distant picnic for a family Mother’s Day gathering.
As social obligations began to creep in again, in a limited fashion of course, I noticed they were a bit distracting. While I was ecstatic about seeing people on more than one occasion, the checkoffs on my to-do list declined as did my focus, which made me feel a little overwhelmed. After weeks with almost none of life’s normal interferences, it seemed unnatural to have them return. I missed feeling like there was plenty of time and reason to take long walks with Jason on nearly a daily basis.
Hiking has been another sanity booster for us. Horsetail Falls was one such trek.
June
I think I have acclimated to the new, new normal for now, which is a mix of nothing and something. The staggering lack of focus I felt a month ago has dissipated. I’m not sure where next month and the months after will take me and us as a country, but I hope we will navigate through them wisely.
With about 120,000 deaths in the United States from COVID-19 to date and a surge imminent in Utah, this virus continues to change and shape our attention and daily routines. Amidst the anxiety and turmoil, may we be safe. May we be sane. May we be considerate. May we be rational. May we be responsible. May we be compassionate. We are all in this together from the elderly lady living next door to the small business owner down the street, so let’s help each other and go easy on the judgement. That is my wish for all of you and for myself.
I can’t help but wonder if after all this is over, we as a nation and as a world will be a little depressed instead of elated. That may sound like nonsense. The thing is, when normalcy returns, we may remember that normal wasn’t perfect. The same problems we had before all of this will still be there. Needing to just get through the next few months is less intimidating than needing to get through the next 30 to 50 years. Plus, as engulfing as COVID feels at the moment, there will be other urgent crises. May our perseverance outlast this virus and make us more resilient to all that lies ahead. That is my final wish for this post and all those that read it.
The behavior of allergies varies considerably from one individual to the next. There is no exact formula for predicting how skin prick reactions or antibody levels will translate to allergy symptoms. This can make diagnosing allergies complicated and leave much room for uncertainty in the interpretation of test results. For my last post in this series on food allergies, I will discuss identification and therapy options currently available along with their limitations.
Before I proceed, the obvious should be noted; I am not a doctor. Your diagnosis and treatment plan should be reviewed with your medical provider. The purpose of this post is simply to supply information on some of the routes available.
Can’t I just diagnose my own allergy?
Many people take it upon themselves to diagnose their own allergies. While this may work in cases where severe reactions can be linked easily to certain foods, it’s generally not a reliable method and can lead to unnecessary dietary restrictions. Even for practitioners with years of experience, establishing an allergy can be tricky.
Sensitization gets mentioned a lot with allergy tests. Is it the same thing as an allergy?
Sensitization is not synonymous with allergy. Sensitization means the body has created defensive proteins (antibodies) to a particular substance it has deemed a potential threat. Sensitization may be asymptomatic, but symptoms must be present with an allergy. All allergies require sensitization; not all sensitizations become allergies.
How is an allergy diagnosed?
Diagnosing an allergy is a multi-step process. First, the clinical history of the patient should be assessed including family background and range of symptoms. The second step is typically a skin prick test. Additionally, an IgE serum analysis may be performed. After all that, a double-blind, placebo-controlled food challenge test may be conducted. The food challenge test is the gold standard for allergy identification and is the only way to conclusively determine the presence of an allergy and its level of reactivity.
What exactly does a skin prick test measure?
The skin prick test is often one of the first tools utilized to diagnose a food allergy. It is used to ascertain IgE sensitization to certain foods. For this test, the skin is lightly punctured in the presence of an allergen. This puncturing is done to allow mast cells in the skin to associate with the allergen. If IgE antibodies are present and cause mast cells to degranulate, histamine will be released, and a welt will form. This signifies a possible sensitization.
Why isn’t a skin prick test enough?
Skin prick tests are very accurate (90%) in proving someone is not allergic to a food, but they are much less successful in proving they are allergic. False positives are so common only 50% of reactions actually coincide with an allergy. Therefore, a skin prick test is not enough to verify an allergy to a given food. However, a history of reacting to a food and a positive skin prick test together are much more conclusive than a skin prick test alone. It should be noted, skin prick tests are only relevant for hypersensitivity reactions mediated by IgE. Delayed reactions like those facilitated by T cells cannot be detected via this method. As one final caution, you should pay no heed to the size of the welts created during this test. Although it may seem logical, bigger welts do not correlate with worse allergies.
If skin prick tests are regularly inaccurate, why are they performed so often?
The skin prick test does have many drawbacks, but it generally takes less than 15 minutes and only causes marginal irritation to the patient. Hence, its popularity.
What about IgE serum tests?
IgE serum assessments like fluorescent enzyme immunoassay and radioallergosorbent tests ascertain the presence of IgE antibodies in the blood to specific allergens. These tests only require a blood draw, which makes them particularly appealing. Unfortunately, they also have sizeable disadvantages.
Skin prick and IgE serum tests share some downsides. Both only detect sensitization, and they don’t detect it that well. Like a positive skin prick test, even if you have IgE antibodies to a particular food, it does not automatically follow that the food will cause allergy symptoms. Further, quantities of IgE do not correlate with severity of reactions. You could have a large amount of IgE in your blood for a specific allergen and tolerate it, or you could have a slightly positive test result for a food that elicits horrible reactions.
If skin prick and serum tests aren’t enough, what then?
Only those patients that have had a severe systemic reaction after ingesting a food and have a positive skin prick test need no further confirmation of their allergy. For everyone else, verification requires a double-blind, placebo-controlled food challenge.
A double-blind, placebo-controlled food challenge (DBPCFC), also called an oral challenge test, is the best way to diagnose a food allergy. Due to the chance of a severe reaction, this test is usually done at a hospital under medical supervision. The challenge starts with the patient consuming an amount of the suspected food so miniscule it’s not likely to cause a reaction or an identical amount of a placebo. The dose taken is doubled again and again until a normal amount of the food is being consumed. If a reaction occurs, the test is halted as needed.
Why the placebo control for the oral challenge test?
Patients may have anxiety about the possibility of having a reaction. This concern may lead them to believe they are having a reaction when they are not. The placebo control rules out these anxiety-driven false outcomes.
What about patch testing?
Patch testing involves the application of suspected allergens to the skin for two days. Each allergen solution is contained in a disc that is held in place with hypoallergenic tape. Often, a large panel of substances is screened at the same time, which can uncomfortably take up all the space on someone’s back. I think my doctor packed about 90 compounds on mine. Patch testing is performed to ascertain delayed-type reactions, such as those mediated by T cells instead of IgE. These include nickel and fragrance allergies. And yes, you can react to those substances in your food. Patch testing can also be useful when investigating possible causes for eosinophilic esophagitis, an allergic condition that triggers inflammation in the esophagus.
How does a food diary fit in?
A food diary can be helpful when investigating dietary issues of any sort whether they be allergies or other adverse reactions. It can be particularly valuable in uncovering routines of reaction and obscure problem ingredients. In a food diary, everything consumed is recorded from drinks to cough drops.
What about unconventional means of allergy diagnosis?
Those that suffer from allergies or have children that do can be taken advantage of by purveyors of diagnostic methods that lack scientific credibility. These unproven procedures include hair analysis, IgG testing, electroacupuncture, and muscle testing. While it is possible that some of these analyses will have enough research behind them to validate their use at some point, that is not the case today. Don’t be exploited in your eagerness for answers.
Since so many foods may contain allergens, many people ignore the warning statements.
Are there treatments for allergies beyond avoidance?
While avoidance is the only treatment for allergies that is completely successful, other approaches like immunotherapy have merit in many cases.
The goal of immunotherapy is to switch the body’s attitude to a food from allergy to tolerance. Immunotherapy involves eating daily doses of the allergen that slowly increase over time. This regular exposure in growing concentrations can lead to desensitization, which means reactions will be less acute and greater quantities of the allergen will be necessary to elicit them. Unfortunately, immunotherapy requires many doctor visits, often causes mild to moderate reactions throughout, and has the potential to cause severe reactions. Further, the most advantageous dosing amounts and periods are still being debated. Yet, this approach will likely become more common in the future since it has been shown to discontinue reactions in 50% of patients, which is called sustained unresponsiveness. Immunotherapy can be particularly helpful in removing some of the anxiety of inadvertent exposure. A doctor can talk you through the risks and benefits of this treatment and determine if it might be a good option in your particular situation.
But isn’t it better to just avoid everything I’m allergic to?
While avoidance does prevent symptoms, in some cases it may not be the best course of action as it can increase the severity of an allergy. Intake of an allergy-inducing food over time can lead to tolerance by increasing the formation of IgG antibodies, which block IgE. Therefore, regular consumption may protect against anaphylaxis. However, complete avoidance is still the best course of action in many acute cases. Your exact circumstances should be discussed with your doctor.
How exactly do IgG fit in?
IgG are our most prolific antibody defenders. They are found throughout the body and fight diligently against bacteria and viruses. In the intestines, they form for individual proteins when these proteins penetrate the intestinal lining. This most often happens when there is inflammation present, and the lining is compromised. Unlike IgE, significant amounts of IgG specific to food ingredients are normal in all individuals, and IgG antibodies are not associated with hypersensitivity reactions. In fact, they are essential to developing tolerance to food allergens. Since their presence is ordinary and not correlated with allergies, IgG tests should not be used to diagnose allergies. Interestingly, although IgG are largely beneficial, some studies have indicated surplus levels may be associated with chronic intestinal inflammation.
What is an elimination diet?
An elimination diet can be used to evaluate if a certain food or foods is causing or worsening a condition like atopic dermatitis. These diets may make getting nutrients difficult and are often only prescribed temporarily.
What about medications?
Drugs are available that may have an impact on food allergies. These include antihistamines, steroids, anti-IgE compounds, and antileukotrienes. From basic Benadryl to prescription medications like Omalizumab, which binds to IgE, you’ve got some options.
What will the future bring?
While the testing and treatment routes presently available for food allergies are perhaps less than ideal, the future may be more inspiring. More accurate testing methods are in their early stages. For instance, research has shown the basophil activation test (BAT) can differentiate between allergies and tolerances in sensitized foods. Additionally, allergy vaccines are being researched and developed. Vaccines work by inducing the creation of IgG antibodies specific to particular food allergens, which leads to tolerance. These could potentially be administered to pregnant women or at-risk infants. Scientists have also been undertaking the challenging task of designing processing and genetic manipulation to decrease the allergenicity of food. As an example, enzyme treatment has successfully been used to diminish the allergenicity of proteins such as gluten.
Like figuring out what triggers tantrums in two-year-olds, understanding more about what’s behind your body’s overblown reactions can help you manage them better. I wish you the greatest success in deciphering and dealing with the hypersensitive. May your IgE antibodies take up knitting or yoga instead of taking to drama.
References:
1. Anvari et al. (2018). The Nuts and Bolts of Food Immunotherapy: The Future of Food Allergy. Children, 5, 47.
2. Begin et al. (2013). Diagnosis of Food Allergy. Pediatric Annals, 1, 42(6), 102-109.
3. Gocki and Bartuzi. (2016). Role of Immunoglobulin G Antibodies in Diagnosis of Food Allergy. Advances in Dermatology and Allergology.
4. Manea et al. (2016). Overview of Food Allergy Diagnosis. Clujul Medical, 89(1), 5-10.
5. Masilamani et al. (2012). Determinants of Food Allergy. Immunology and Allergy Clinics of North America, 32(1), 11-33.
6. Mills and Shewry. (2004). Plant Food Allergens. Blackwell Publishing.
7. Thomsen. (2015). Epidemiology and Natural History of Atopic Diseases. European Clinical Respiratory Journal.
8. Valenta et al. (2015). Food Allergies: The Basics. Gastroenterology, 148(6), 1120-1131.
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