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Teens and Food Allergies

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Sesame: More Than Just a Street

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Sesame allergy has been all over the news lately. Last year, a teenage girl tragically died at Heathrow Airport after eating a Pret a Manger baguette containing sesame—the ingredient was not listed on the packaging. This incident drew attention not only to the severity of sesame allergies, but also to deficiencies in food allergy labeling. 

A growing body of research indicates that sesame allergy is on the rise. A recent study published in Pediatrics estimates that 0.2% of the U.S. population has a sesame allergy, making it the ninth most common food allergy. 

The spike in sesame allergy has triggered a closer look at the way sesame is labeled on food packaging. This past October, the FDA released a statement indicating that it was considering sesame for mandatory allergen labeling on food packaging pursuant to the Food Allergen Labeling and Consumer Protection Act (FALCPA). Enacted January 1, 2006, FALCPA imposes special labeling requirements for the top eight most common food allergens: peanuts, tree nuts, fish, shellfish, wheat, eggs, milk, and soy. As you can see, the list does not currently include sesame. That could soon change. Notably, Canada, the European Union, Australia, and Israel currently require allergen labeling for sesame. 

For those out there managing a sesame allergy, know that you are amazing. Sesame is insidious, and because it does not fall within FALCPA labeling laws, it is infinitely harder to manage. 

If you’ve followed us for a while, you know that I have a daughter with serious food allergies to peanuts and tree nuts. She was diagnosed with these food allergies at one and is now six (and crushing Kindergarten!). What I haven’t mentioned is that from ages two through three we avoided sesame like the plague because of an anaphylactic reaction she’d had to hummus just before her second birthday.

She’d eaten hummus multiple times previously, but one day, while eating hummus at lunch, her lips began turning blue and she started coughing. One epinephrine auto-injector, several hours at our children’s hospital, and some IgE blood testing later, she was home safely with a new food allergy added to the list: sesame. 

Sesame often hides under the guise of “natural flavors” or “spices” on food labels. I used to keep a spreadsheet of every manufacturer I called knowing the ingredient could be lurking behind these vague categories. To make matters worse, some manufacturers won’t share this information, citing trade secret protection. I quickly learned that I had more success if I asked if sesame was included as an ingredient in any of these proprietary categories, as opposed to asking for the whole ingredient list. Sesame also lurks under different names like tahini, a paste made from sesame seeds. If you’re managing a sesame allergy, here’s a great list of food and non-food items that may contain sesame or any of its derivatives. 

It’s been over four years since my daughter’s anaphylactic reaction, and I can joyfully say that she’s outgrown her sesame allergy. But it was no walk in the park to manage, and I still vividly remember my sesame spreadsheet and the tears of frustration that went along with tracking all of the different food ingredients. 

For those managing a sesame allergy, the struggle is real, and FALCPA labeling for sesame would make things a LOT easier! Interestingly, the Pediatrics study we referenced earlier cited that the highest rates of epinephrine auto-injector prescriptions were found for children with peanut, tree nut, and SESAME allergies.

We’ll be following the regulatory deliberations closely, and will be sure to keep you all updated on social media as the discussion unfolds. Do you or does your child have a sesame allergy? What’s your experience been like?

 - Meg and the Allergy Amulet Team 

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Ming Tsai’s Food For Thought

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My journey with food allergies began when I opened my first restaurant, Blue Ginger, in 1998. I felt it was important that our kitchen be mindful of food allergies to ensure that all customers could safely dine with us. Little did I know that soon enough food allergies would become an enormous part of my everyday life. 

Just a few years after opening Blue Ginger, my oldest son was diagnosed with multiple food allergies; in fact, he was born severely allergic to soy, wheat, peanuts, tree nuts, dairy, shellfish, and eggs. At first, as a chef, I thought it was an unfunny joke from upstairs. But I soon realized it would be an invaluable lesson and opportunity. I quickly learned that trying to eat at restaurants with food allergies was a much larger task than I imagined. Even though I had established protocols in my restaurant for those with food allergies, most other restaurants didn’t take the same care. I can recall a few times where my family and I were turned away because the chef or restaurant did not want to accommodate us. There were a few occasions where my son was accidentally served a dish containing a small amount of one of his allergens, and within minutes he began exhibiting symptoms of an anaphylactic reaction. As a parent, it’s one the scariest experiences. Thankfully, my wife is a trained nurse, and we were able to spot the signs quickly and administer epinephrine right away. 

First implemented at Blue Ginger, and later at Blue Dragon (which is 100% peanut and tree nut free), we created a book that includes every dish on the menu and a comprehensive list of ingredients separated by dish components (i.e. proteins, starches, vegetables, sauces, and garnishes). This way, the patron and restaurant staff can easily determine which part of the dish has the allergen and omit the item from their order. For example, a customer with a peanut allergy would still be able to have the Chicken Satay with Peanut Sauce by opting for an alternate (and equally delicious) dipping sauce. 

Additionally, any ingredient processed and received from outside vendors is starred and the ingredients are indexed in our system (e.g., dried *egg* pasta). A highlighted ingredient indicates that it is one of the top eight food allergens: peanuts, tree nuts, wheat, soy, shellfish, fish, milk, or egg. Our protocols also ensure proper lines of communication between the front of house staff and the kitchen. Every manager, server, and bartender is trained to ensure all customers can safely dine with us. You can find an example of our documentation here.

My family’s experiences, and the knowledge that comes with being a restaurant owner and chef, inspired me to champion the first bill in Massachusetts to require all local restaurants to comply with food allergy awareness guidelines. It took four years working with the Massachusetts legislature to write Bill S. 2701, which was eventually signed into law in early 2009.  

I’m incredibly proud of the work that we’ve done in Massachusetts to help those with food allergies have a more positive restaurant experience. As a chef, restaurateur, and a food allergy parent, I’ve experienced this issue from multiple sides. From the customer perspective, it’s important to notify the restaurant when making the reservation, triple-check that the server understands the severity of the allergy, and do a final check when the food arrives at the table for any visible cross-contact with your allergen or mistakes. Food allergies are a two-way street. From the restaurant perspective, we need to have procedures in place to make sure customers can safely eat, but we also need to be made aware of any allergies and understand the severity so that we can accommodate. Over the years, I’ve developed a useful and effective way to better determine the severity of people’s food allergies. I ask, “Is using the same fryer okay?” The point we are getting at here is if shrimp is fried in a fryer, could the customer eat fries out of that same fryer? Depending on the answer we then have a better understanding as to the severity of the food allergy, which we use as a directive to the kitchen staff. 

Restaurants should care about food allergies not only because it keeps their patrons safe, but also because it’s smart business. The hospitality industry can be challenging, and meeting customer’s demands is always of the utmost importance. At the end of the day, we are all fighting for loyal customers. 

I guarantee you, if you serve a food allergy customer a delicious and safe meal, and they leave smiling, you’ll have a customer for life.

Peace and Good Eating, 

Chef Ming Tsai

 

Ming Tsai holds an equity stake in Allergy Amulet.

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Take Two: The Importance of Carrying Two Epinephrine Auto-injectors

With Halloween around the bend, we wanted to share a quick PSA on the importance of carrying two epinephrine auto-injectors in case of an allergic reaction. 

Why? Let’s look at the facts.

In cases of severe anaphylaxis, one dose of epinephrine is often not enough. Up to 20% of people who receive an initial dose of epinephrine for anaphylaxis require a second injection. This can happen even without further exposure to the allergenic trigger! A second allergic reaction called biphasic anaphylaxis can occur between 1 to 72 hours (typically eight hours) after the initial reaction.

Despite these harrowing stats, most individuals do not carry two auto-injectors.

In a study of roughly 1,000 US patients and caregivers with epinephrine prescriptions, 82% said they do not carry two auto-injectors. Meanwhile, 75% of respondents reported previously administering epinephrine. Of those that sought emergency care, 45% did so because a second dose of epinephrine was unavailable. 

Education and awareness is also lacking. Only a quarter of respondents reported that they were advised to carry two auto-injectors.

But epinephrine is expensive.

We hear you. Epinephrine auto-injectors are not cheap, which can make it difficult to have multiple epinephrine auto-injectors on your person at all times.  

Fortunately, that’s starting to change. Increased market competition and PR scandals like the one that rocked Mylan have helped drive down the price. 

Additionally, below are some cost-saving options worth checking out. 

-      Check for discount codes and savings plans on manufacturer websites. 

-      Purchase generic epinephrine alternatives.

-      Explore mail-order pharmacy options (you may be able to receive a larger supply of medication at a lower co-pay amount if these benefits apply).

-      Price shop between local pharmacies—prices vary, especially between large chains and small pharmacies.

-      Ask your doctor about patient assistance programs. 

-      Switch to your insurance carrier’s “preferred” auto-injector (if applicable).

-      Double check that your pharmacy has applied all possible coupons at check out.

-      Ask your company’s HR department if they offer financial assistance to employees to cover prescriptions.

We hope you all have a SWEET and SAFE Halloween! And don’t forget to TAKE TWO!

-      Meg and the Allergy Amulet Team

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Food Allergies + Natural Disasters… A Different Kind of Storm

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As torrential floods from Hurricane Florence ripped through the Carolinas earlier this month, Madison, Wisconsin—home of the Allergy Amulet headquarters—was still reeling from record rainfall levels and flash floods. 

These events got us thinking: How should the food allergy community prepare for a natural disaster? 

First, there are great emergency kit checklists available through the American Red Cross and FEMA websites, which advise on supplies to have at the ready in case of an emergency. If you or your loved one has a food allergy, however, you have a few extra things to consider.

Tell me more.

At a minimum you should plan to have several days’ worth of allergy-friendly foods on hand that don’t require refrigeration, heating, and that don’t spoil easily. This might include canned vegetables, granola, or dried fruits and meats. Don’t forget several days’ worth of water, too! 

The American Red Cross recommends having a seven-day supply of any necessary medications. For food allergy families this could include your antihistamines as well as epinephrine, or any other doctor-recommended medications (e.g., inhaler). Depending on where you live, and what type of emergencies are most common, you may want to have these items already packed and stored in a convenient location. For example, if you live in an area prone to tornadoes, it’s likely that you have a basement, so you may want to store your emergency supplies down there.  

What if I need to evacuate?

Evacuating in the wake of a natural disaster can present unique challenges for those with food allergies. Shelters may not serve allergy-friendly meals, and even if they do, families may need to manage for cross-contact. Having allergy-friendly foods on hand and disinfectant wipes for hands and surfaces can help mitigate exposure risk. Make sure to also pack emergency action plans for children if you have them, insurance cards, and an emergency contact list with your medical providers!

Check expiration dates!

Don’t forget to review and update your emergency preparedness kit at least once a year, and make sure to check the expiration dates on your epinephrine and antihistamines. Spokin recently offered a feature on its app that helps you to manage epinephrine expiration dates.

We all hope that you never need your emergency supplies, but it’s a good idea to be prepared! 

- Susannah 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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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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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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