Comment

Whole Foods for Thought: The Debate Over Quality Versus Quantity

AdobeStock_93118442.jpeg

You’ve probably heard by now that Amazon bought Whole Foods. The latter’s shareholders recently approved the transaction, and assuming regulators sign off on the deal, the creators of Man in the High Castle and the sellers of the Squatty Potty will now be joining you at the dinner table. Bon appetite :)

On the one hand, the deal is expected to make shopping at Whole Foods more affordable. Awesome! Consumers are already seeing markdowns on several food items including butter, bananas, and eggs. But there’s one nagging question out there that looms large: where would that money otherwise have gone? To the farmers? To its employees? And how will Amazon’s takeover impact the quality of food and the values that Whole Foods has stood by all these years?

At Allergy Amulet, we care about food quality and a healthy work environment. We also care about high-quality food being accessible and affordable to everyone! So naturally, we’ve been following this deal closely. 

According to Jeff Wilke, CEO of Amazon’s worldwide consumer business, “[e]verybody should be able to eat Whole Foods Market quality—we will lower prices without compromising Whole Foods Market’s long-held commitment to the highest standards.” That’s all well and good, but there’s one problem with that statement: the inverse relationship between quality and quantity.

California’s first organic strawberry farmer, Jim Cochran, confronted this dilemma at his farm. To satisfy increasing demand for his strawberries at Whole Foods, Jim expanded his farm from four to 24 aces. Recognizing the problem between increased yield and berry quality, he scaled back to 12 acres to focus on quality over quantity.

Is it possible to produce high-quality strawberries on a massive scale?

Here’s an interesting fact: Americans spend less on food than people in any other country in the world. Indeed, most countries spend over 10 percent of their incomes on food, whereas Americans spend closer to 6%. Why is our food so cheap?

As Michael Pollan points out in Omnivores Dilemma, food is cheap because the true costs have been externalized—we still pay them, but instead of paying at the register, we pay in the form of rising obesity rates, cheap labor, and lax environmental and safety regulations. Consider too that between 1995 and 2010, the American taxpayers gave the agriculture industry roughly $262 billion in subsidies. This begs the question: is our food really that cheap?

Let’s say Amazon decides not to compromise on quality: who then is getting the short end of the stick with the lower price tag? There is some concern that the Whole Foods culture and workplace environment will soon change with Amazon in charge. After all, Whole Foods salaries average around $18 an hour, whereas Amazon pays on average $12 an hour (a figure below the national average). Amazon also has a reputation for grueling work conditions at its warehouses, and reports of intense surveillance and monitoring of its employees—another cause for concern.

At Allergy Amulet, our work lies at the intersection of food and health. We care about food quality and safety; we also appreciate that good food often costs more, and is not accessible to many Americans. For this reason, the conversation around food quality is an important one. Everyone deserves high-quality, nutritious food, but the question stands: how do we make that food affordable to everyone without compromising on quality or forfeiting the values underpinning good food like well-paid farmers, safe working conditions, humane animal treatment, and sustainable farming practices?

Hopefully, Amazon has the answer.

- Abi and the Allergy Amulet Team

Comment

Comment

You Down with EoE? No Thanks, Not Me.

AdobeStock_132975320.jpeg

Every now and again our team at Allergy Amulet likes to post blogs about lesser-known conditions that affect the food allergy population (our people)! One such blog, I’ll Take My Allergies Medium Rare, covers some uncommon (but very real) forms of allergy. Today’s installment is no different! Have you ever heard of a condition called Eosinophilic Esophagitis (E-o-sin-o-fill-ik Uh-sof-uh-jie-tis), or EoE for short?

What is it?

If you have EoE, a large number of white blood cells (eosinophils) build up in the lining of the esophagus (the tube that connects your mouth to your stomach). This buildup is a reaction to food, airborne allergens, or acid reflux, and can inflame and injure esophageal tissue. EoE is a recognized chronic allergic/immune condition, and is not typically outgrown (but it can be managed)! EoE is a relatively new disease, as it has only been identified in the past two decades. Accordingly, there is still much to learn about this complex condition.

Who does it affect?

EoE affects approximately 1 out of every 2,000 people in the United States. In recent years, allergists and gastroenterologists are seeing an increasing number of patients with EoE—this is presumably due in large part to greater physician awareness about the condition. Most patients with EoE are considered atopic, meaning they have a family history of allergies, asthma, or symptoms of one or more allergic disorders. These can include food allergies, eczema, seasonal allergies, and asthma. For patients with environmental allergies, their EoE may be worse during pollen season. Allergic reactions to food are the main cause of EoE in many patients, and foods such as dairy, soy, wheat, and eggs are often the main culprits. Interestingly, according to Dr. Jordan Scott of Boston Children’s Hospital, the development of EoE has occurred as a side effect of oral immunotherapy for food allergies in up to 3% of cases.

What are the symptoms?

EoE symptoms vary depending on age. Infants and toddlers may refuse food or fail to gain weight. School-age children often experience difficulty swallowing, vomiting, or have recurrent abdominal pain. Teens and adults generally have trouble swallowing, especially dry or dense solid foods. In some cases food can get trapped in the esophagus, which can lead to choking.   

How is it diagnosed?

There are certain criteria for diagnosing EoE that most allergists, gastroenterologists, and pathologists agree on: symptoms consistent with EoE, an upper endoscopy procedure (lets the doctor see what’s happening in your esophagus), and an esophageal biopsy (tissue samples of the esophagus are taken and analyzed). A specialist may also recommend further evaluation (e.g., a gastroenterologist may refer a patient to an allergist for food allergy testing and vice versa).

Is there a silver lining? 

The rise in EoE cases has led to greater physician awareness and further research around the condition. Additionally, a wide variety of treatments have been identified for those managing EoE, such as:

1.    Empiric elimination diet—removing major food allergens (e.g., dairy or wheat) from your diet and gradually adding them back in one at a time under close physician watch and guidance. This diet is often most successful with the help of a dietitian, as it can be tough to manage.

2.    Elemental diet—all sources of protein are removed from the diet and replaced by an amino acid formula, oils, and simple sugars. This treatment is often reserved for children with several food allergies who have not responded to other treatments.

3.    Medical therapy—swallowing small doses of oral corticosteroids has proven effective for managing inflammation. Proton pump inhibitors are also used to control acid production. 

Each of these treatments has its advantages and disadvantages, so it’s helpful to first discuss them with your physician before trying any one approach. One challenge with treatment, according to Dr. Scott, is that patients must typically undergo multiple endoscopy procedures to ensure that esophageal inflammation is improving with meds, dietary avoidance, or both.

The good news is that you don’t have to go it alone! There are numerous support groups and organizations out there that can help, such as APFED and CURED. When it comes to understanding and managing immune conditions, having a trusted support network is key!

- Meg and the Allergy Amulet Team 

Comment

Comment

How to Save a Life

Abi and Sakura at Middlebury College in 2007.

Abi and Sakura at Middlebury College in 2007.

Have you ever stabbed anyone? I have.

I stabbed my friend and Allergy Amulet Co-Founder Abi Barnes with an EpiPen in the summer of 2007.  

Abi and I spent that summer at Middlebury College, where I had just wrapped up my sophomore year. Alongside roughly 100 others, we immersed ourselves in an intensive Mandarin language program, pledging not to speak English for the program’s nine-week duration. Abi’s dorm was across the hall from mine, and we soon became good friends. We watched movies, went on runs, gossiped and joked, but always in this foreign tongue that consumed every part of our daily lives. We couldn’t even read in English, forcing several of us to secretly pass around an English version of the last Harry Potter book, which had just been released—no one wanted to attempt reading that in Chinese.

One particular summer day, we finished up our morning classes and walked over to the dining hall. We were now several weeks into the program, so I was used to seeing Abi meticulously look for nuts on the ingredients list of every item on the self-service buffet menu. She and I chatted away while she seemingly nonchalantly searched for ingredients that could kill her.

Among the various menu items was a grilled, flaky white fish with a brown sauce that we both opted for that day. Shortly after we sat down and started eating, Abi suddenly froze. “Oh my god,” she said; I was alarmed. Not because she turned pale, or had a look of panic in her eyes, but because she spoke English within earshot of other students and teachers.

《什么?》What?” I said.

“Oh my god.”

Worried about Abi getting in trouble I asked,《你为什么说英文?》“Why are you speaking in English?”

“No seriously, I can feel it. It was the fish sauce. I didn’t check it. I know it. I can feel it. I need my EpiPen,” she said in a panicked manner.

《在哪里?》Where?

“We have to go. It’s in my room.”

Abi grabbed my hand and we ran across campus to our dorm. Once in her room, she tossed me the EpiPen in its original cardboard packaging and said, “Read the instructions.” I learned later that it’s always better to let someone else administer the epinephrine­ needle. I also learned that it’s good to have someone with you—which makes sense, considering that someone having an allergic reaction could pass out.

At this point, we were speaking only in English. I remember my hands shaking while I held the instructions and found myself reading them over and over again. Meanwhile, Abi was popping Benadryl tablets like pink Tic Tacs. She extended her paper-white thigh to me and said, “You’ll need to do it with full force.”

So I took a generous upward swing and stabbed her. Bright red blood trickled down her upper thigh. We then rushed to the hospital.

Many hours later, when the hospital determined she was safe to leave, our friend drove over to pick us up. We got into the car and The Fray’s “How to Save a Life” came on the radio. We laughed and heaved a collective sigh of relief.  

It wasn’t until days later when we went swimming in a nearby lake that I realized the force of stabbing her had left a black and blue bruise bigger than my hand on her thigh. I knew that food allergies were dangerous, but this incident with the fish sauce was a terrifying reminder of that fact. I remember Abi was completely wiped out after the ordeal, and to think that she has to constantly look out for dangers lurking in foods must be exhausting.

Fast forward a decade and I’m currently the Chief Operating Officer of a family-owned Japanese restaurant group in New York City. At each of our 15 locations, our staff is trained to manage food allergies. I’d like to think that we’ve educated our staff about food allergies since opening our first location in 1984, but the reality is that dining out is always a potential minefield for individuals like Abi. It makes sense that she came up with the idea for Allergy Amulet.

Stabbing Abi in the summer of 2007 will forever stay with me as a reminder of the importance of food allergy awareness and education. I also hope that incident will remain my first and last stabbing.

 

Abi’s longtime friend, Sakura Yagi, wrote this post. For additional information on the proper use of epinephrine, please read here

Comment

Comment

More Tools, More Problems? Food Allergies Since 1960

This guest post was written by Theresa MacPhail—assistant professor in the Science, Technology, and Society Program at Stevens Institute of Technology. 

Last December, I wrote a blog post about the early history of food allergies from the 1800s through the 1960-70s. In this installment, we’ll examine more recent food allergy chronicles, current treatments, and diagnosis debates. Despite advances in our understanding of the immune system, and promising developments in allergy-related technologies (like the Allergy Amulet), the lack of a cure or effective treatments for food allergies persists.

The Discovery of IgE

Immunotherapy treatments were first tested in animals, and then cautiously applied in clinical settings to treat both respiratory allergies and food allergies beginning in 1911. The risk of an accidental anaphylactic response was, and is, ever present. Much of the early allergy testing and treatment remained unchanged until the mid-1960s, when two separate research teams discovered immunoglobulin E, or IgE—a molecule that naturally forms in human blood.

IgE’s discovery led to a greater understanding of the inflammatory response that follows allergen exposure, sparking more research around the cause of allergic reactions. By 1975, the first commercially available and reliable blood test for IgE became available for clinical use. IgE testing quickly became a significant aid in allergy diagnosis, since an elevated presence of IgE levels in the blood often indicates a food allergy.

IgE has played an enormous role in subsequent allergy research, diagnosis, and treatment. However, while IgE tests provide information as to the likelihood of having a food allergy, 50-60% of IgE blood tests yield a “false positive” result, creating a great deal of uncertainty in diagnosis. IgE as an allergy biomarker is accordingly far from perfect.

Food Allergies - A Rising Prevalence?

If you follow the news or social media, or have a young child in the school system, it certainly seems that food allergies are on the rise. Although food allergy awareness has increased over the last decade and has become a more popular topic of conversation, the food allergy prevalence rate has been difficult to measure with confidence.

Figures on the national and global food allergy population are unsettled. This is largely because the numbers rely on multiple data sets collected across different methods and research groups. Official estimates place the figure at around 15 million. Adding to this confusion is the difficulty in confirming the presence of an allergy with current diagnostic tools (often IgE testing, discussed above). The majority of food allergy and food intolerance cases depend on self-reporting and sometimes self-diagnosis—and those numbers fluctuate greatly. A recent paper looking at multiple different allergy studies found that “[s]elf-reported prevalence of food allergy varied from 1.2% to 17% for milk, 0.2% to 7% for egg, 0% to 2% for peanuts and fish, 0% to 10% for shellfish, and 3% to 35% for [other foods].” A 2013 paper further suggested that “at least 1%–2% and up to 10% of the US population suffers from food allergies," which based its findings on "self-report, skin prick test (SPT), serum-specific IgE (sIgE), and oral food challenges (OFC).” These reports show that food allergy populations vary based on allergy type, reported severity, geographic region, study design, and testing method.

In short, with no easy and standardized way to diagnose food allergy cases, it is difficult to confirm and measure the perceived rise in the food allergy population.

The LEAP Study and the Future of Oral Immunotherapy

Perhaps the most significant study on food allergy in the last 50 years is the Learning Early About Peanut Allergy (LEAP) study by the Immune Tolerance Network. In this study, infants at a higher risk of developing a severe allergy to peanuts were randomly assigned to one of two groups: one that would avoid ingesting peanut-containing foods until age 5, and one that would consume a peanut-containing snack (~6 grams of peanut protein) with three or more meals per week until age 5. Of the children who avoided peanut, 17% developed a peanut allergy, compared to only 3% of the children in the control group. In a press release for the study, one of the researchers noted how for decades allergists have recommended that infants avoid consuming allergenic foods, and this study "suggests that this advice was incorrect and may have contributed to the rise in [] peanut and other food allergies.” Indeed, the LEAP study overturned decades of prior advice and shook the allergy research community. The study also gave credence to one of the oldest forms of allergy treatment: immunotherapy. 

After a decade of research, oral immunotherapy is becoming more widely accepted as effective for the most common food allergies (e.g., peanut), but little is known about its long-term effectiveness. If you’re not familiar, oral immunotherapy (OIT) is a method of food desensitization that involves re-introducing the immune system to the allergenic food in gradually increasing amounts over time, with the goal of eventual tolerance. Although researchers are optimistic about its potential, it is not without its drawbacks. You can learn more about OIT in Allergy Amulet’s blog post here.

The Promise and Peril of Epinephrine

Epinephrine (the hormone adrenaline) was first discovered in 1900 and marketed to treat asthma attacks and surgical shock. By 1906, with the development of a synthetic version, the drug was in common use by clinicians to treat severe asthma attacks. Immunologists and allergists experimented with dosages in the decades following, standardizing treatment protocols.

In 1975, a biomechanical engineer developed the first auto-injector syringe for the military, which was then adapted for use with epinephrine. It wasn’t until 1987, however, that the FDA approved the first epinephrine auto-injector for the general public. Epinephrine auto-injectors proved so effective—and the dosage delivered was so consistent—that it became the standard prescription for anyone suffering from a severe allergy. By the 1990s, food allergy patients were advised to carry one at all times for their safety.

In 2016, the mother of a child with a severe food allergy began a campaign against the dramatic rise in price of one of the most popular epinephrine auto-injector brands: EpiPen. The price of EpiPen surged between 2004 and 2016 – increasing from $100 to over $600. With few competitors on the market, Mylan Pharmaceuticals, the manufacturer of the EpiPen, felt no need to lower its prices. The story went viral and sparked debate about pharmaceutical industry pricing policies and access to affordable healthcare. Since the scandal broke, there has been a call to develop alternative and less expensive epinephrine auto-injectors.

The Epi-Pen story—and this post—highlight the urgent need for greater investment in allergy research and innovation. Let’s hope that with new advancements in the coming years, food allergy itself will be history. 

Comment

Comment

Smoothie Bars & Ice Cream Parlors: A Potential Allergy Nightmare

Standing in line at Trader Joe’s last week, I noticed a sign alerting shoppers of a recent recall of their Matcha Green Tea Ice Cream due to “the potential presence of small metal pieces in the product.” If you’re thinking, “That’s nuts!” You’re right—although in my case, either would probably be just as harmful (I’m fatally allergic to nuts). 

The idea that some small dangerous object could be hiding in your food is not a far-flung concept for the food-allergic. If you’ve never lived with a food allergy, or cared for someone with a food allergy, it’s hard to appreciate the dangers that lurk behind seemingly innocent foods. And they often hide in the most unsuspecting places. Two such places are ice cream parlors and smoothie bars—or what UCLA pediatric allergist Dr. Maria Garcia-Lloret refers to as “allergy minefields.”

If you’ve ever been to an ice cream parlor with a food allergy, you know that the only thing separating a scoop of almond praline swirl and plain vanilla is typically a bucket of water—and for someone with a severe food allergy, that’s not going to cut it. Trace amounts of a food allergen, as low as parts-per-million levels, can be fatal for those with a severe food allergy.

These days, many popular smoothie bars offer “protein boost” health supplements, which often include tree nut and peanut powders (or other popular plant-based powders like chia seed, brown rice, hemp seed, green pea, sunflower seed, or pumpkin). These powders can have incredibly high allergen concentrations, which is to say, the slightest trace of one of these powders can trigger a severe reaction.

Dr. Garcia-Lloret, a professor of pediatric allergy at the Mattel Children's Hospital at UCLA and a pioneer in the food allergy community, has been treating food-allergic patients for nearly 20 years. Needless to say, she’s seen countless allergic reactions and anaphylactic episodes over the years. When we spoke, she offered a cautionary tale when it came to these cold summer treats. "Based on my experience, those with food allergies should be wary of ice cream parlors and smoothie bars, as they don't usually think of these types of establishments as hazardous, and they lower their guard." She also mentioned that teenagers are particularly vulnerable in these settings, noting how carefree summer outings with friends too often lead to the emergency room. 

That said, if you have a food allergy but still need your cold smoothie or ice cream fix (like me!), the most important thing you can do is know all of the ingredients present at the facility, and make sure you’re comfortable with the measures the facility takes to prevent cross-contact. Additionally, here are a few other tips:

1.     Ask the smoothie bar to use a freshly washed blender. Double-check their sanitizing process to ensure the blender has been thoroughly cleaned and there is no lingering allergen residue.

2.     Make sure the ice cream scoop has been thoroughly washed since its last use.

3.     If the person behind the counter wears gloves, ask them if they’d kindly change their gloves (or wash their hands if they’re not wearing gloves, as appropriate). Many of these establishments offer other foods as well, so this is a good way to ensure you’re avoiding cross-contact.

On the upside, many ice cream parlors and smoothie bars are becoming increasingly allergy-conscious, and are implementing more stringent protocols to accommodate those with severe food allergies. Let’s be honest, what kid (or adult) doesn’t want to participate in this classic summer pastime? If you’re now wondering, Where do I find hidden these allergy-friendly gems?! Spokin recently compiled this short list of some the nation’s most allergy-friendly ice cream parlors! Or, if you’d prefer to purchase a pint instead, check out this list of top allergy-friendly ice creams!

Wishing you all a SWEET summer!

- Abi and the Allergy Amulet Team

Comment