Compliance

I would recommend taking 30 pills per day for 6 months as prescribed and see how that works before saying someone was slacking off #AAAAI15

— Nathan Hare M.D. (@AllergyTalk) February 23, 2015

One of my favorite tweets that came out of the American Academy of Allergy, Asthma, and Immunology conference this year. It arose as a reaction to an abstract  with a negative result. That is, the placebo group improved more than the treatment group. People often don't publish their results when they are negative, so this took a certain amount of courage (and is how science should proceed). The conclusion form the study is: "FAHF-2 is a safe herbal medication for food allergic individuals and shows favorable in vitro immunomodulatory effects; however, efficacy for improving tolerance to food allergens is not demonstrated at the dose and duration used." Emphasis is mine.

A theme in "curing" food allergies is that researchers are skilled at curing mice. It's the (murine to human) jump that can be a hurdle. But why?

Mice are controllable

Everyday, the mice in these studies all eat the same food. They don't go out with friends and get sick. They never miss a dose. Their stress level is controlled. As is their exposures allergens, both food and environmental. But, we are dosing a person with all the unpredictability that implies.

James's Record

As a person goes, James is compliant. He hardly ever misses a dose. He complains vehemently about the cream, but still applies it twice a day. But, other factors still come into play.

Stress

James is a perfectionist and puts himself under a vast amount of stress. In theory, I could lower his stress exposure, but the cost would be his maturing as a person.

Diet

Almost all of our meals are local and organic, but James loves snacks and pretty much snacks as a normal teenager (chips, candy, etc). 

Life

We have one. There are times when pills get forgotten, when he gets home late and puts on his cream without a shower, or has to be somewhere early and misses his bath.

Keeping up enthusiasm

Reviewing his progress

One of the benefits of going to NYC this summer was reviewing his improvements since he has started treatment. We were moving day to day and not taking time to reflect.

Not having hives anymore has also been a huge boost. He has a daily reminder, physically, that the treatment is working.

Sharing others progress

When people share their results in the CHA FB group, I share with him. I did this prior to him starting treatment as well. His own blood work won't be for another month, so hearing about others improving boosts his morale.

Not making a big deal

At fist, it seemed huge, insurmountable really as the number of pills he was taking kept going up. But now, it is routine. I tell him if he's had a change in protocol, but don't focus on it being hard or too much. It just is.

Whatever your treatment, have you had compliance issues? And how did (or do you) deal with them?

Under Pressure for the Fourth

On the CHA FB Group,there have been multiple conversations about the benefits of pressure cookers and their benefits. Dr. Li has recommended them to some patients. To be clear, she has never discussed them with me, or any particular diet at all, except for asking James to stop eating cheese and amending that to less cheese at the dismay on his face.

The benefit of pressure cookers, for those with allergies, is that the pressure makes the proteins easier to digest than other forms of cooking. This post from The Food Renegade has a nice collection of abstracts outlining the research (scroll down to "But, Doesn't Pressure Cooking Still Denature Proteins in the Food?"). Here is another example, comparing the nutritional quality of microwaved and pressure cooked legumes.

The benefit of pressure cooking for legumes with it's fast cooking is pretty obvious, but we don't eat legumes. I still use the pressure cooker multiple times a week and recently got a question as to how I used it. It turned out that our July 4th meal was a great example, although we don't usually use it so much for a single meal.

Please note that the times listed are for the cooking times, not for the time it takes to come to pressure. I haven't timed that, but I think add approximately 10 minutes to come to pressure.

Also, I have an electric pressure cooker, which will affect times. If you have a manual, please adjust accordingly.

The Night Before

Potato Salad

I have included the recipe I used below, but you can use any recipe.

Peel and cube the potatoes.

The potatoes and the eggs can both be added to the pressure cooker, the eggs nestled on top of the potatoes, on top of or in whatever steamer basket/trivet your pressure cooker came with. Add 1/2 cup of water. Cook on high for 4 minutes. Release the pressure and put the potatoes and eggs in a waiting ice bath. Allow to cool, peel your eggs and proceed.

I have found that eggs are easier to peel out of the pressure cooker. No promises.

The recipe I used was adapted from Hellman's Original Mayonnaise Potato Salad Recipe :

4 lbs potatoes

4 eggs

1 cup sliced celery

1 cup sliced green onion

1 c mayonnaise

2 T prepared mustard

Salt and pepper to taste

To make the dressing, combine the cooked egg yolks, mayonnaise, and mustard until smooth. Mix together the potatoes, cooked egg whites, celery, and green onion. Add salt and pepper to taste.

The Day Of

Ribs

I like falling off the bone ribs, whereas my husband and James likes ones with a little more pull to them. The pressure cooker makes the ribs fall off the bone tender like I like. Since we had a crowd coming over, I made some in the pressure cooker and my husband smoked some outside and everyone was happy.

For the record, the score at the party was nearly split, with the smoked ribs coming out slightly ahead of the pressure cooked ones.

I hope that he will adapt some Chinese style steamed rib recipes to the pressure cooker at some point, because the texture at the end is perfect.

That said, for BBQ style ribs, here is how we cook them:

1. Cut the ribs into 3-4 ribs sections. Our pressure cooker is 6 quarts and can hold about 2 lbs of ribs at a time.

2. Season the ribs with whatever spices you like.

3. Place the ribs in the pressure cooker and just cover with water.

4. Cook at high pressure for 18-22 min (I split the difference and use 20 min).

5. Release the pressure and allow to sit for 10 min.

6. Pull the ribs out of the water and let sit for 5-10 min.

7. Use a BBQ sauce of your preference on the rib and grill for 5 min per side.

I was doing 2 racks of ribs. The pressure cooker needs time to sit and cook in between uses, so I let both the ribs and the pressure cooker sit for 5-10 min. Then, I repeated the steps.

Corn on the Cob

For the party, I cut the corn in half, but you can leave it whole. The directions don't change. Put in the steaming basket or trivet. Add water. Amounts depend on how much corn. I used ten 1/2 ears and 1 1/2 cups of water. The timing won't change - 2 minutes at high pressure and then release the pressure.

Final thoughts

I love the pressure cooker, the way some people love their slow cooker. James would never eat any food out of a slow cooker because of the texture, but there's never any complaints about the pressure cooker.

Things I love:

1. It uses little energy.

2. It doesn't heat up the house.

3. It's fast.

4. It's easy.

On a usual basis, I use it at least a couple times a week. It has replaced our rice cooker. In the "not quite so hot months," (some places refer to them as winter), I make stock and soup. James will eat pretty much any vegetable in a soup, but the soups he loves are canned soups, with their ultra-soft vegetables. Pressure cooking soups gives you ultra soft vegetables. When I have stock, it is simple to make soup at lunch in 6 minutes for a healthier lunch than he otherwise would have.

I have this 6 qt Cuisnart Pressure Cooker   (affiliate link) 

If you are not as much of a wimp as I am, stove top pressure cookers can be very inexpensive. I understand they are very safe but I like the easy button.