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Scientists Find Link Between Antacid & Antibiotic Exposure and Food Allergies & Asthma

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As someone who remembers (with disgust) that pink goo as a child (also known as the antibiotic amoxicillin), I read this headline in shock. Did that chalky bubble gum syrup make me more susceptible to developing food allergies and asthma?

Here’s what the scientists found. 

In a recent study published in JAMA Pediatrics, researchers looked at approximately 800,000 infants that had ingested antibiotics or antacids in their first six months of life. They found that those exposed were more likely to develop food allergies or asthma. 

Babies are routinely prescribed antacids for regurgitating food or experiencing acid reflux after a feeding. This is very common in infants, so you can appreciate why this study is sending shockwaves throughout the parenting community!

The research hones in on how antacids and antibiotics affect an infant’s microbiome—that place where trillions of bacteria help aid in digestion, fight infection, and regulate the immune system. We know that antibiotics kill the bad bacteria that make us sick, but they also wipe out the good stuff that keeps us healthy. Antacids similarly can help ease digestion, but a less acidic stomach can alter the bacterial composition of the intestine and reduce protein digestion

The microbiome has been a hotbed of research lately—especially in the food allergy field. As we’ve discussed in a previous post, one of the leading theories behind the rise in food allergies is the impact that chemicals and medications are having on our microbiome and gut health—especially at a young age. We’ve also previously written on gut health and the important role the microbiome plays in healthy immune function.  

“This does not mean that infants should never get antacids or antibiotics,” Dr. Claire McCarthy notes in response to the study. “Antibiotics can be lifesaving for infants with bacterial infections, and there are situations when antacids can be extremely useful.” She adds though that both medications are often overprescribed and encourages doctors to “ask if it is truly necessary [to prescribe these medications]—and whether there are any alternative treatments that might be tried.” The lead author of the study, Dr. Edward Mitre, also recommended in light of the findings that “antibiotics and acid-suppressive medications should only be used in situations of clear clinical benefit.”

The recent surge in research surrounding gut health and the microbiome is a welcome trend, and one that will hopefully lead us to more concrete answers surrounding the origin of food allergies and how to mitigate or eliminate them altogether. 

- Abi and the Allergy Amulet Team

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The 411 on the 504: School Allergy Plans Decoded

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Last month we covered the basics of kids and epinephrine. This month we’re bringing you the skinny on school management plans for your child’s food allergies.

Are you wondering about a 504? An IEP? Have we lost you? 

Don’t worry, we’ve got you covered. 

Setting Up the Plan

Most school districts have district-wide plans for food allergy management, treatment, and reaction prevention. Many states also offer suggestions for school districts on managing food allergies based on guidelines from the Centers for Disease Control and Prevention. To date, there is no federal regulation that standardizes these policies and procedures, so these policies vary between states (and often between school districts within each state). 

The first step in setting up an allergy management plan for your child is to reach out to your child’s school. Many schools will ask you and your child’s doctor to fill out an allergy and anaphylaxis emergency plan form, although this form can go by different names. This form covers what steps school staff should take in case the child is exposed to an allergen or if he/she exhibits symptoms of a reaction. The American Academy of Pediatrics published this template form for reference. Once submitted, the school nurse typically prepares an Individualized Healthcare Plan (IHP): an internal document that outlines the processes the school should follow in the event the child experiences an allergic reaction. 

Some parents go one step further and request a 504 plan. Section 504 is part of a federal civil rights law that protects individuals with disabilities and health conditions, including life-threatening food allergies. The law applies to all schools and programs that receive financial assistance from the U.S. Department of Education (so all public schools and some private schools). A 504 plan lays out how the school should prevent and respond to allergic events. If a 504 plan protocol is not followed, there are several dispute resolution options available for parents. 

To secure a 504 plan, a parent must contact the school district’s 504 coordinator, who works with school officials to determine if the child qualifies. This determination is based in part on medical history, so your doctor may need to provide the school with this information. If the child qualifies, the team will work together to determine what special accommodations and protocols must be followed. 

Notably, if your child has a disability and qualifies for an Individualized Education Plan (IEP), a separate 504 plan is not necessary. The child’s food allergy accommodations may be joined under their IEP. Also of note, in some non-religious private schools where 504 plans do not apply, parents may rely on the Americans with Disabilities Act (ADA) to ensure that the school implements a food allergy management plan for the child. 

School Policy Options

Since there are no national standards for food allergy protocols, policies vary widely between schools. 

According to a recent study surveying school nurses across the country, the most frequently reported policies include: training school staff to respond to allergic reactions and anaphylaxis, using epinephrine autoinjectors, and managing for cross-contact in cafeterias. Other policies commonly implemented include: community food allergy awareness events, designated lunch areas for children with food allergies, and food guidelines for classroom celebrations.

The least frequently reported policies were: allergen labeling information in cafeterias, food management policies for after-school activities, and school-provided stock epinephrine for field trips and off-campus outings. In light of the differences between school policies, parents should understand their school’s protocols before developing their child’s plan.

Words of Wisdom

Finally, we talked with a few food allergy parents in different school districts and asked them to share a few words of wisdom on these management plans:

- “Plans may be different within the same school system—as your child goes from elementary to middle to high school, you will want to revisit your plan. For example, once a child moves to a different school building, new protocols may be appropriate. Older children may also be allowed to self-carry epinephrine or antihistamines.”

- “Make sure your plan or school policies cover transportation to and from school if your child rides the school bus.”

- “Think about after-school plans for your older child, as middle and high school students often have plans with friends after school. For example: can they store their medicine in a school locker during the day–even if the school doesn’t allow self-carry–so that they are prepared to go to a friend’s house or activity directly after?”

We hope this rundown of plan options, food allergy management policies, and parenting wisdom helps you to better advocate for your child’s food allergy needs!

-      Susannah and the Allergy Amulet Team 

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The Nutty Nature of Nuts

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For years, patients diagnosed with a tree nut or peanut allergy have been told to avoid all nuts. But what if I told you that being allergic to one nut doesn’t necessarily mean you’re allergic to another? What if I also told you that avoiding nuts altogether could result in a higher risk of BECOMING allergic to nuts?

Nuts, right?

To make things even more confusing, it’s possible to be allergic to some tree nuts and not others (e.g., a patient could be allergic to all tree nuts except hazelnut and almond). Walnuts and pecans are almost 100% cross-reactive, so if you’re allergic to one, you’re almost certainly allergic to the other. The same is true of cashews and pistachios. But that’s pretty much where the similarities end. 

Often, if a patient has an allergic reaction to a peanut or a tree nut, their allergist will advise the patient to avoid all nuts. Why? The rationale is three-fold: 1) some tree nuts are cross-reactive with others; 2) nuts are often packaged and handled in a shared facility, making cross-contact more likely; and 3) it is often easier for a doctor to advise patients to avoid all nuts (including peanuts, which are technically a legume). 

Doctors have also generally recommended strict avoidance of all nuts after a peanut or tree nut allergy diagnosis because of the challenges in distinguishing between nuts. Otherwise, the patient would be expected to know the difference between all of the different types of nuts: almonds, brazil nuts, cashews, hazelnuts, macadamia nuts, pecans, pine nuts, pistachios, and walnuts—both shelled and unshelled. Studies have also shown that allergy patients are only slightly worse at identifying tree nuts than their allergists. 

Patients would also have to trust that kitchen and waitstaff at restaurants could distinguish between the nuts (spoiler alert: many can’t). Additionally, it’s hard to find bags of tree nuts that don’t list warnings of possible cross-contact with other tree nuts or peanuts due to manufacturing practices. In order to determine which nuts a patient is allergic to and which ones are safe, one or more oral food challenges may be necessary. 

Because of this, recommending that a patient avoid all nuts has historically been deemed the more practical—and safer—approach to food allergy management. 

Then came the LEAP (Learning Early About Peanut) study.

The LEAP study suggested that kids who were at risk for developing a peanut allergy were significantly less likely to become allergic if they ate peanuts early and often. The study also showed that if a patient was unnecessarily avoiding peanuts they were more likely to become allergic to peanuts over time. This suggested that unnecessarily eliminating certain allergenic foods could increase a child’s risk of becoming allergic.

This study led to a seismic shift in the food allergy community’s understanding of food allergies and allergy management practices. Suddenly, blanket avoidance of all tree nuts and peanuts came with the potential risk of increasing an at-risk child’s chances of developing a food allergy. For this reason, it is important that allergists talk with their patients and/or the patient’s families after a peanut or tree nut diagnosis about the different approaches to managing food allergies and decide together what is in their best interest. 

The first option is the oldest approach: strict avoidance of all peanuts and tree nuts. Many patients and families feel safe with this approach. Total avoidance may lessen the fear of a reaction due to cross-contact. Accordingly, for many patients and/or families, avoidance is the right choice. Another option is to have the patient continue to avoid the foods they are allergic to (in this example certain tree nuts) and teach families how to safely eat the foods they are not allergic to. This process may involve a food challenge. Deciding to eat certain nuts when allergic to others does involve learning how to read labels to check for potential cross-contact, learning what the different nuts look like shelled and unshelled, and understanding that eating those nuts is something that should be done at home and not in restaurants. 

We still have a lot to learn about food allergies, but hopefully in time we’ll get better at managing, diagnosing, and treating them. In the meantime, for newly diagnosed food allergy patients, candid conversations are a good start. 

 

Brian Schroer, MD is on staff at Cleveland Clinic Children’s Hospital where he sees patients of all ages with allergic and food-related diseases. 

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Best Practices for Kids + Epinephrine

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I’m not quite sure how summer passed by so quickly. Is it really back-to-school season already?! As families gear up for the school year ahead, we thought it would be a great time to review current best practices for kids and epinephrine—something every parent should know even if your child has no food allergies! 

Here are a few things to remember as you prepare for your child’s fun (and safe!) return to school.

Educating Your School Tribe

It’s a good idea to get your child’s food allergies on the radar of their school caretakers before the year begins—especially if your child is changing schools. Contact their school nurse and teacher to plan for where the epinephrine will be stored and how it will be used in case of an emergency. You may also want to discuss how snacks and treats are handled in the classroom. Many schools have food allergy policies in place, but some protocols are at the teacher’s discretion. 

It doesn’t hurt to schedule a face-to-face with your child, teachers, and caregivers before school starts to talk through your food allergy game plan. As a bonus, this gives your child an opportunity to meet their teacher before the year begins and help them tackle some of those first-day jitters! 

Epi Dosing Options

There are currently three different epinephrine dosages available. For adults and kids who weigh more than 30 kilograms (~66 pounds), the recommended dose is 0.3 milligrams. For smaller kids weighing between 15 and 30 kilograms (~33-66 pounds), the recommended dose is 0.15 milligrams. Several brands offer both dosing options, including EpiPen, Adrenaclick, and Auvi-Q.  

For infants and toddlers who weigh between 7.5 and 15 kilograms (~16.5-33 pounds), Auvi-Q makes an auto-injector with a lower dosage (0.1 milligrams), which also features a smaller needle. 

Make sure to check with your doctor to determine the best option for your child! 

Safe Storage

Remember that epinephrine is temperature sensitive. The medication should be stored at room temperature and never in extreme hot or cold climates (e.g., car glove compartments). Some brands also recommend that users periodically check to ensure the liquid has not changed color. If the solution assumes a pinkish or brownish hue, this can indicate decreased effectiveness. Epinephrine is light sensitive too—so store your auto-injectors in cases!  

Parents should work with their child’s school or daycare provider to map out a plan for both on-site and off-site storage (e.g., field trips), to ensure availability and maximum effectiveness. 

Using Your Epinephrine

As explained in one of our earlier blog posts, the outer thigh is the best place to administer the injection, even through clothing if necessary. Most manufacturers offer videos on their websites to demonstrate how to use their product. These can be a great resource for new caregivers and anyone that should be prepared for an allergic emergency. Like CPR, administering epinephrine is a good skill for any parent to have in their arsenal.

Replacing Your Supply

Currently, most auto-injectors expire within 12 to 18 months. Make sure to check your epinephrine expiration dates and mark them in your calendar. A good rule of thumb is to always have two auto-injectors in close proximity to any food-allergic child in case one is defunct (and in some cases, two injections may be required!). 

As you replace old auto-injectors, remember that some manufacturers offer coupons or other financial assistance, especially for lower income families.  

While we hope you never have to use an epinephrine auto-injector, we share these reminders to keep all of our children safe as we send them off to the classroom! 

- Susannah and the Allergy Amulet Team  

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What Food Allergies Can Teach Our Kids

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Every now and again, I like to write about my personal experience as a mom managing food allergies. Parenting is no easy feat, but it’s especially tough when you're raising a child that could stop breathing if accidentally exposed to certain foods.   

Although peanut and tree nut allergies are not something I would have chosen for my daughter, there has been an upside to her having food allergies. For one, our family has to look more carefully at the ingredients we put into our bodies, which has made us healthier eaters. The greatest gifts, however, have come in the form of life skills and values my daughter has learned at a young age.

Below are a few that immediately come to mind. 

Diligence. Now that my daughter is entering kindergarten, she’s starting to take charge of carrying emergency medicines to and from activities and storing them appropriately. Increasingly, she’s having to brave the world without me. Whether at school, summer camp, or a birthday party, she knows it’s her responsibility to ask if a food is safe when I’m not there to help her read the label. 

What has she learned? To be detail oriented and persistent—qualities that will help her in countless facets of life. 

Compassion. We talk to our daughter often about things that make her unique, like food allergies and wearing glasses. I find these talks help her relate to the differences between people both physically and situationally. Last year we saw a homeless family outside of a local store asking for money. After she asked me a few questions to better understand the situation, she decided we should give them the snacks we brought in the car so that they wouldn’t be hungry. Cue my proud mama heart swelling! 

Compassion is one of those life skills that will serve her well as a child AND as an adult. 

Time Management. It takes time managing food allergies! Label reading and meal planning take a lot longer when you have to think about a food allergy. Our daughter completed OIT for her nut allergies in 2017, and while it’s now been a year since we finished, she still has a daily maintenance dose of several nuts and a mandatory hour-long rest period afterward. It can be hard to find time to squeeze in her maintenance dose and rest time each day (today it was sandwiched between summer school and a T-ball game!).

Showing her how we map out each day and carve out time to manage her food allergies has been a great lesson in time management that will serve her well as she enters “big kid school” this fall. 

Bravery. It can be hard to stand up for yourself, let alone when you’re a small child! Food allergies have nudged her to become her own self-advocate (and a food allergy advocate!). I’d like to think we’ve led by example as her champion and guardians all these years and I’m proud to see her now standing up for herself (and her health). 

I hope her bravery goes beyond self-advocacy. I hope her newfound courage leads her to try new things, persevere through adversity, and stand up for others in need.

We all have moments when food allergies feel defeating, inconvenient, and stressful. But for all the woes allergies bring, they can also be a gift. It all boils down to perspective. Adversity breeds strength, and I see that strength in my daughter more and more each day.

-      Meg and the Allergy Amulet Team

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FPIES: Not As Delicious As It Sounds

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From time to time, we like to write about the rarer forms of food allergy. We’ve covered  Eosinophilic EsophagitisOral Allergy Syndrome, and allergies to red meat and water! Today’s blog topic will cover another lesser-known, but very serious food allergy: Food Protein-Induced Enterocolitis Syndrome (FPIES for short). 

What is it?

FPIES is a non-IgE immune system reaction to food that affects the gastrointestinal (GI) tract. IgE stands for the antibody immunoglobulin E, and most allergic reactions (think top eight most common food allergies) involve this antibody. FPIES is cell-mediated, which results in a delayed allergic reaction.

Notably, unlike typical food allergies, FPIES does not show up on standard allergy tests.

Who does it affect?

FPIES reactions often show up in the first weeks or months of a child’s life. Sometimes the child may be a little bit older if they’ve been exclusively breastfed. First reactions often occur when introducing solid foods, such as infant formulas or cereals, which are typically made with dairy or soy.

What are the common trigger foods?

For infants that experience FPIES from solid foods, rice and oats are the most common triggers. Other reported triggers include, but are not limited to: milk, soy, barley, sweet potato, squash, green beans, peas, and poultry. 

Any food protein can be a trigger and some infants may be sensitive to other foods as well. As with any food allergy, some children may only react to 1-2 foods, while others may react to several. 

What are the symptoms?

FPIES can cause severe symptoms following ingestion of a trigger food. Classic FPIES symptoms include diarrhea, severe vomiting, and dehydration. These can lead to changes in body temperature, blood pressure, and lethargy. Upon ingestion of a trigger food, there is a characteristic delay of 2-3 hours before the onset of symptoms. 

Symptoms can range from mild (such as an increase in reflux and several days of runny stools) to life-threatening (shock). In several cases, after repeated vomiting, children often begin to vomit bile. Diarrhea typically follows and can last up to several days. It’s important to note that each child is unique and may experience their own range and severity of symptoms. 

Importantly, many infants who are eventually diagnosed with FPIES are initially suspected to have a severe infection or sepsis based on their symptoms. 

How is it diagnosed?

FPIES cannot be detected with traditional allergy testing methods, such as skin prick or blood tests that measures IgE antibodies. It is accordingly tough to diagnose.

Researchers are currently looking to atopy patch testing (APT) for its effectiveness in diagnosing FPIES. APT involves placing the trigger food in a metal cap, which is left on the skin for around 48 hours. The skin is then observed for symptoms in the days following removal.

Additionally, the outcome of APT may determine if the child is a potential candidate for an oral food challenge: the gold standard for food allergy diagnosis. A medical doctor, often an allergist and/or gastroenterologist, should be involved in the diagnosis of FPIES.

Is there a silver lining?

The good news is that FPIES usually resolves with time! Many children outgrow FPIES by age 3, allowing kids to introduce the offending foods back into their diet over time. With proper medical attention and a personalized dietary plan, children with FPIES can grow and thrive! 

- Meg and the Allergy Amulet Team

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A Brief History of Molecularly Imprinted Polymers: The Heart of Allergy Amulet’s Technology

 Dr. Joseph BelBruno, Scientific Advisor at Allergy Amulet.

Dr. Joseph BelBruno, Scientific Advisor at Allergy Amulet.

If you’ve been following our blog for a while, you’ve probably heard us talk about our scientific approach to detecting food allergens: molecularly imprinted polymer (MIP) films. These films lie at the technological heart of the Allergy Amulet. 

In a previous post, we covered the basics of how the technology works. Quick review: an MIP is a polymer (plastic) formed in the presence of target template molecules to create molecular molds. Once the templates are removed from our films, they leave behind trillions upon trillions of plastic molded “locks” that bind when in the presence of our molecular “keys.” In our films, these keys represent allergenic ingredients.

Today’s post looks at the history of MIP technology. While our science team has made considerable breakthroughs in the MIP field, we didn’t pull the foundation technology out of thin air. In fact, the body of work on MIPs dates back almost 100 years!

The first scientific mention of MIPs was back in 1931: a scientist named M. V. Polyakov discovered that when he made polymers out of silica in the presence of another molecule, the polymers would selectively absorb that molecule.

Some say the origins of MIP technology started with Jean Dickey at Cal Tech. He tried imprinting silica with organics back in 1949. The modern approach to imprinting began in Europe in the seventies and eighties with Klaus Mosbach in Sweden, Günter Wulff in Germany, Borje Sellegren in Amsterdam, and Karsten Haupt in France. These and other scientists developed many of the classic methods for creating imprinted polymers. Importantly, some studies found that in select circumstances, MIPs could imitate the functions of receptors, enzymes, and other biological molecules. 

After these initial discoveries, scientists identified new applications throughout the 20th century—mostly in drug separation—and you can currently buy MIP resins from leading science manufacturers like Sigma Aldrich. Yet, as with any nascent technology, development progressed slowly. Only in the past ten years have MIPs finally hit their stride: nearly half of all MIP papers were written in the past decade. Over time, researchers have optimized the conditions and techniques for developing MIPs, which has expanded the types of molecules MIPs are capable of imprinting. This has dovetailed with advancements in nanotechnology and communications technology. For example, the nanomaterials we use in our sensors were prohibitively expensive ten years ago. With these advancements, diverse commercial applications of MIP technology are finally becoming a reality.

For a detection device, successfully imprinting an allergenic ingredient (or any other target) is only half the battle.

Why is that? Well, even if an MIP can selectively bind the target molecule, it does so on a nanoscopic scale—we would have no way of knowing that binding occurred. Creating an MIP sensor accordingly requires a system that can translate that imprinting into something comprehensible (what scientists would call a transducer). While there has been significant research into different types of transducers for MIPs, a common approach has been electrical conductivity: an easily measured property that is already widely used in sensor technology.

There are several methods that convert successful imprinting to an electrical response. Two of the most popular methods involve using either conductive polymers or combining the MIPs with conductive nanomaterials.

Some of the first successes in creating conductive MIPs originated with Dr. Joseph BelBruno: a world-renowned chemist, Dartmouth chemistry professor, and Scientific Advisor at Allergy Amulet. Dr. BelBruno’s research laid the foundation for developing conductive MIP sensors. His work spawned the first commercial application of MIP sensors.

Allergy Amulet is positioned to become the second company to commercialize MIP sensors, and the first to create MIP sensors for detecting allergenic ingredients. Our sensors combine MIPs with an electrical response to create sensors for detecting molecular tracers of allergenic ingredients in food.

As with any novel application of an existing technology, it is important to recognize and pay tribute to the work of those before us. Learning and studying from the successes and failures of our predecessors is how we will advance as a scientific community, and advance as a society.    

-      Nazir and the Allergy Amulet Team

 

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Spokin’s Susie Hultquist: A Fearless Food Allergy Mama!

 Susie and her food-allergic daughter, Natalie.

Susie and her food-allergic daughter, Natalie.

If you’ve followed Allergy Amulet for a while, you know our team was founded by a female and that we love to support female entrepreneurs!

Unsurprisingly, we’re big fans of Susie Hultquist and the team she’s assembled at Spokin. This Chi-town team has built an app to help make managing food allergies easier! We recently sat down with Susie and asked her a few questions.

1. We understand you left your financial career on Wall Street to start Spokin. When did the “light bulb” moment happen?

It happened when my co-worker was selling girl scout cookies. I wanted to buy some, but in order to do that, I had to get ahold of a package to check the label and ensure they were safe for my family. I then went to their website to make sure the cookies were also available in our area. It took me 15 minutes to track down all the information I needed! That’s when I realized I was probably not the only person managing food allergies searching for this same information, and that there was a clear need to streamline and consolidate food safety information for the food allergy community.

At the time I was managing my company’s consumer internet portfolio and saw how different businesses were managing pain points. No one was solving this one, and I felt I was uniquely positioned to do so.

2. How long did it take to launch the app? 

It was two years in the making. I started by meeting with a lot of people who have food allergies. From there, we developed a content strategy and hired a graphic designer to work on app designs. We just celebrated the app’s first birthday!

3. What is your “why”?

My daughter Natalie. She’s allergic to peanuts and several tree nuts. I am determined to make her life easier and to help her live the fullest life possible. That’s what gets me up every day. 

A food allergy diagnosis often comes with a lot of no’s when it comes to food, and I want to be able to say yes as often as I can!

4. Spokin has a lot of new features and capabilities on the app. What are you most excited about?

Far and away is the map functionality! If you’re in the app and search within the “eateries” category you can choose any city in the US and see in seconds all the restaurants, bakeries, and ice cream shops others in the Spokin community have recommended. We now have 2.7 million reviews on the app and reviews span across 18 countries! 

To find in seconds all these yes’s after so many no’s is amazing. And it’s built by the food allergy community! This community is so generous. 

5. What does Spokin mean?

It’s a play on the word spoken. I had so many amazing interactions with people in the food allergy community that gave me advice verbally (where to eat in London, what chocolate chips to bake with, what to take with us on an airplane, etc.) but once spoken, that advice then vanished into thin air. All of this knowledge needed to be captured and shared with everyone. The idea was that if we built this platform, we could harness and share all of this great food wisdom with the food allergy community at large. 

6. When do you plan to release the Android version of the app?

We have started an Android waiting list and it’s on our product roadmap. We’re currently assessing demand, so please add your email to the Android list on our website, if interested! 

7. When you’re not focused on helping the food allergy community, what do you enjoy doing?

Spending time with my girls and my husband! We love to cook together, run together, and travel when we can. My girls all have very different interests so it’s fun to watch them pursue their passions. 

8. Since Spokin is based in Chicago, we have to know: do you cheer for the White Sox or the Cubs?

I love the Cubs, but I applaud the White Sox for offering peanut-free ballgames!

9. What’s your long-term vision for Spokin?

If everyone in the US with food allergies shared five recommendations we could build a database of 75 million data points that everyone can access! We’ve estimated that if it takes you 15 minutes a day to manage food allergies, then you can save a year of your life by having all of this information accessible to you. 

If you haven’t downloaded the Spokin app we recommend you check it out ASAP! Both Susie (Susie in the Spokin app) and Allergy Amulet’s founder, Abi Barnes, (allergy_amulet_abi in the Spokin app) have provided lots of recommendations!

-      Meg and the Allergy Amulet Team

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FOMO: Fear of Missing Out… On Nutrients

Part II: Wheat, Soy, Peanuts, and Tree Nuts

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Welcome to Part II of our FOMO series! Here we’re discussing how to replace nutrients lost from eliminating wheat, soy, peanuts, or tree nuts from your diet. You can find Part I here covering dairy, eggs, fish, and shellfish.

If you’re used to eating toast, cereal, pancakes, or other baked goods for breakfast, avoiding foods that contain wheat will likely be a hard adjustment. Or maybe you fed peanut butter and jelly sandwiches to your first child with no issue and your second child cannot eat peanut butter. It is an adjustment, to say the least! 

As a pediatric nutritionist, my work focuses on making sure kids with special dietary needs are getting the nutrients their growing bodies need. As you can imagine, many of my patients have multiple food allergies and have a fairly limited diet. The silver lining for these patients is that these children tend to have healthier diets because they’re avoiding lots of processed foods! 

I like to start by looking at each food that’s avoided and its corresponding nutrients side by side. As we discussed in Part I, this approach can make it less intimidating to identify other food sources for those lost nutrients.  

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Let’s take a closer look at a few of the nutrients needed when avoiding wheat, soy, peanuts, and tree nuts.

Wheat products in America are fortified with B vitamins, thiamin, riboflavin, and niacin. 

Thiamin is important for maintaining a healthy metabolism and key function of cells. The major thiamin food sources are whole grains, meat, and fish. In the US, breads, cereals, and infant formulas are enriched with thiamin as well as other B vitamins. If you’re avoiding wheat and most breads and cereals, you may want to ensure your wheat-free products are enriched with these key nutrients as well!

Niacin is another B vitamin—B3 to be specific. Niacin helps our bodies use fat, protein, and carbohydrates to create energy. This vitamin is also enriched in processed wheat products and can be found naturally in most meats as well as mushrooms, avocados, and sunflower seeds, to name a few. 

If you’re a meat eater and wheat-avoider, I’m not typically concerned that you’re missing out on B vitamins (thiamin, riboflavin, and niacin) or iron. However, you may want to think about how much fiber is in your diet. Many people substitute rice, potatoes, and corn-based products for wheat. However, these are mostly low in fiber.

Fiber is a carbohydrate that your body does not digest. There are two types of fiber: soluble fiber and insoluble fiber. Soluble fiber dissolves in water and helps to regulate blood cholesterol and glucose levels. Insoluble fiber does not dissolve in water and works to move food through the digestive tract. Many people experience symptoms like constipation after making a change in their diet. In these cases, I tell my patients to increase their fiber intake and add fruits, vegetables, legumes, brown rice, and other whole grains like oatmeal and quinoa. 

If you are not a meat eater, and you’ve eliminated wheat or soy, this next one is for you.

Iron is found in red meat, fish, and poultry, but there are many plant-based sources of iron outside of wheat and soy, including spinach, beans, lentils, nuts, seeds (e.g., pumpkin, chia, sunflower, and hemp), dried fruits, quinoa, and some fortified breakfast cereals. Iron is better absorbed with vitamin C, so I recommend adding an orange alongside your trail mix for your next snack. Calcium inhibits iron absorption, so whether you get your calcium from dairy or a dairy substitute, try to avoid eating them together. 

Avoiding soy is not easy because it is in so many foods. Both peanuts and soy belong to the legume family and contain many of the same nutrients such as B vitamins, protein, magnesium, and phosphorus. 

Magnesium helps normalize blood pressure and keeps our bones strong. Phosphorus also helps to keep our bones strong and helps our bodies make energy and move our muscles. Both of these minerals are found in abundance in beans, seeds, and tree nuts. Phosphorus is also found in dairy, eggs, in meat products, whole grains, potatoes, and dried fruit.

The goal for everyone should be to expand their diet and add more variety! A more diverse diet will lead to greater nutrient intake, and hopefully more delicious meals. If you feel like you’re in a food rut, take a chance and add something new to your routine. Your body (and likely your taste buds) will thank you!   

 

Tara McCarthy is a Registered Dietitian Nutritionist who has a passion for pediatrics. She has worked at Boston Children’s Hospital for over 15 years as well as a private practice and specializes in nutrition for children with special dietary needs such as food allergies, celiac disease, FPIES, EoE, allergic colitis, and sucrose isomaltose deficiency. 

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Food Allergy Awareness Week! Things I’d Like People to Know… And a Little Dr. Seuss

Teal Empire State Building.png

It’s almost here, food allergy awareness week 2018! The official dates for this year are May 13-19.

I’m currently sitting in my office looking at a recent picture of my daughter and me at our state capitol with the governor to advocate for food allergy awareness. If you’ve followed Allergy Amulet for a while, you know I’m a passionate food allergy mom!

One of the greatest things about food allergy awareness week is that it’s a conversation starter. I LOVE that statistics are being shared left and right to paint the picture of how many people are affected! Heck, even buildings around the country are “turning teal” in recognition!

However, it’s important that the conversation not just be about how MANY people are affected, but HOW they are affected. So in the spirit of awareness and conversation, I wanted to share 10 things I’d like other parents to understand about food allergies!

1.    Food allergies are not a choice. We don’t know why our family has food allergies, and we have to manage them diligently every day. Please don’t feel sorry for us, help advocate for us!

2.    Food allergies can be life threatening and they’re a serious health issue, not simply an inconvenience—trace amounts of a food allergy protein can be deadly.

3.   Food allergies require planning. We can’t often join spur-of-the-moment outings, so please make sure to give us a heads up so we can plan ahead!

4.    If we ask questions about your food multiple times, it’s not because we don’t trust you, it’s because there’s no room for error. It’s not personal, it’s precautionary.

5.   Food allergies can be draining—mentally, emotionally, and financially. We can’t let our guard down and our vigilance level is always in “on” mode. We want to experience the same events and activities as everyone else, but it’s not always easy.

6.   We’re not germ freaks if we ask you to wash your hands after eating, or if you see us wiping down an airplane seat with disinfectant wipes. It’s simply that we are trying to keep the risk of allergen exposure to a minimum.

7.    Activities don’t have to involve food to be fun! If you know that someone with food allergies will be joining an activity or celebration that you’re organizing, try to be mindful of the foods they avoid (and give them a heads up if their allergen will be present so they can plan accordingly)!  

8.    Always feel free to ask questions. We will never get annoyed if you ask us a million questions about our allergies. Education is the first step to understanding!

9.   We’re just parents doing what we have to do to keep our kids safe. Please realize we’re not trying to inconvenience you, and that we’d do the same for your child!

10.  It helps to have a village of support so you don’t feel like you’re isolated on an island—if you are part of someone’s village, THANK YOU. It’s not an easy task!

Lastly, I leave you with some brilliant words from Dr. Seuss’s Horton Hears a Who. It seems appropriate for food allergy awareness week. ☺️

Don’t give up! I believe in you all!

A person’s a person, no matter how small!

And you very small persons will not have to die

If you make yourselves heard! So come on, now, and TRY!

 

The Mayor grabbed a tom-tom. He started to smack it.

And, all over Who-ville, they whooped up a racket.

They rattled tin kettles! They beat on brass pans,

On garbage pail tops and old cranberry cans!

They blew on bazookas and blasted great toots

On clarinets, oom-pahs and boom-pahs and flutes!

Great gusts of loud racket rang high through the air.

They rattled and shook the whole sky!

 

When they got to the top,

The lad cleared his throat and he shouted out, “Yopp!”

And that Yopp...

That one small, extra Yopp put it over!

Finally, at last! From that speck on that clover

Their voices were heard! They rang out clear and clean.

 

And the elephant smiled. “Do you see what I mean?”...

They’ve proved they ARE persons, no matter how small.

And their whole world was saved by the Smallest of ALL!

 

- Meg and the Allergy Amulet Team 

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