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Teens and Food Allergies

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Navigating Food Allergies as a Teen

Most social gatherings as a teenager involve food. School dances involve going out to eat with your friends before the dance, and eating snacks during the dance. Going on a first date often involves going out to dinner or to a movie theater, where food is always present. Birthday parties almost always involve cake and ice cream during the celebration. We even have a holiday every year to celebrate being thankful for a plentiful harvest: Thanksgiving. All of these gatherings involve some sort of interaction with food. 

When you have food allergies, however, these common social gatherings are not just a matter of socialization. They are a matter of survival.           

I’m a teenager that’s just trying to fit in and be as “normal” as everyone else. This can make speaking up and asking for an alternative food option a scary task. What if they say no? What if they force me to leave? Worst of all, what if I have a reaction? All of these questions fly through my mind when I’m invited to hang out with friends, extended family, or to any other social gathering.    

I used to “make plans” or say I was busy just so I could avoid the awkward first communication of “oh sorry I can’t have that.” Though I’ve had some extremely positive social experiences that have made it easier to manage my food allergies! I remember one birthday party specifically. I was talking to my friend’s mother about my allergy and how I was going to avoid the birthday cake. Out of nowhere, she surprised me with a 100-piece bag of Starburst. She explained that my friend wanted to make sure that I could enjoy his birthday even though I couldn’t eat the cake. 

Dating can also bring about challenging situations. My freshman year of high school I took a date to watch a varsity high school soccer game. It was half time and she was hungry. I had eaten before the game, in order to prevent getting hungry at the game and being tempted to eat something there. We went up to the concession stand and she ordered a Snickers bar. Because I have a peanut allergy, this was a very awkward situation. Before we sat down, I reminded her of my allergy and she felt so bad—but I felt even worse. It was our first date and I didn’t want to do anything that would scare her. She quickly ate her Snickers bar and washed her hands.

Dating often involves food. Inevitably you will end up in situations like picking a restaurant or a snack at a movie theater, which is usually a good time to explain your allergy (and explain your choice of snack or restaurant). If your partner truly wants to be in a relationship with you, they’ll understand why you go to the same Mexican restaurant every week: it’s a safe choice for you. 

As a teenager, I’ve learned to advocate for myself and not be afraid to reject food that doesn’t have a label or is “so delicious it’s worth dying for” (yes, I’ve had people that didn’t know I had an allergy say that to me). While our parents advocate for us when we’re younger, as a teen they’re not with us as often, and we have to learn to be our own advocates. 

Every year I attend FARE’s National Conference and I hear a familiar discussion about the dialogue between food-allergic teens and their parents. Teens often talk about how their parents watch over them closely, and how they want to manage their allergies independently. Parents often ask me how their child can become more independent, and to that I say that they should give their teenager more of a chance to self advocate. I’ve always taken responsibility for keeping track of my auto-injectors, asking waiters about my allergies at restaurants, and speaking up in situations when I don’t feel comfortable. Teens don’t always do those things in front of their parents because their parents do it before the teen has the chance to.

This is a two-way street that involves cooperation and trust on both sides. As dangerous as the world can seem for a teen managing a food allergy, most food-allergic teens have looked that danger in the face for their entire lives. It isn’t going to stop them from living life to the fullest. Sure there will be times of difficulty, but that difficulty is only temporary. 

The one thing I want everyone to take away from this blog is this: speak up. 

Don’t be afraid of any challenge that comes your way, food allergies or not. Through my food allergy advocacy volunteer efforts I’ve met senators, mayors, CEO’s, entrepreneurs, and other amazing people with inspiring stories. Many have said that an issue becomes more impactful when a teen speaks up about it. If a teen is concerned, shouldn’t adults be as well? Every obstacle you face and every challenge that you meet can be overcome. Your voice is a powerful tool, so don’t be afraid to use it! 

 

Daytona Hodson is junior in high school and has a life-threatening food allergy to peanuts. He’s on his high school debate team and he’s a member of FARE’s Teen Advisory Group. Daytona has contributed to articles and spoken on panels for both FARE and Spokin. 

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Breaking Bread

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This past Christmas Eve, I listened to the soft sounds of Ave Maria and Silent Night waft through candlelit pews. My father has sung in a church choir ever since I was a child, like his father before him, so from a young age I was instilled with an appreciation for robed singers harmonizing centuries-old Latin hymns. I’m also a sucker for Christmas carols. 😉

As the communion bread was passed around among the pews, I thought about people who could not eat the bread—not because they weren’t baptized, but because they were allergic or intolerant.

Growing up, our family belonged to a small stone Episcopalian church on a grassy hill that could have been pulled out of the Scottish Highlands or a child’s storybook. At one point, we had a female priest, which was something of a rarity back then. Sermons routinely invoked global current affairs and the common values shared across religions, and everyone, regardless of creed, was welcome. We were a progressive church. The communion bread was also baked in the church kitchen and tasted heavenly. I’d walk up to the altar, cup my hands, and receive a hunk of doughy bread, which I’d dip into a chalice of wine. I can’t remember ever worrying about my food allergies during Sunday communion growing up. Plain bread as a kid was always considered safe. That has since changed. 

Today, 1 in 13 kids has a food allergy, and millions more have a gluten intolerance. We live in a different world from a couple decades back. The communion bread I ate growing up definitely contained wheat, although I never knew anyone that had a problem with gluten back then. These days, however, it seems as though at least one person at every dinner party is gluten-free. To accommodate, many churches now offer gluten-free bread with communion.

The rise of gluten-free products has been a double-edged sword for the nut-allergic like me: on the one hand, it has helped increase awareness and accommodations for those with food allergies and intolerances; on the other hand, nut substitutes (like almond flour) for wheat have become increasingly common. 

Years ago, I admittedly thought the spike in gluten-free products was more fad than the result of a growing severe medical condition. That all changed when I spoke to a woman at a food allergy conference years back who relayed the harrowing experience of her young son and how their family discovered his gluten intolerance. On Sundays, her son would develop debilitating migraines that would keep him bed ridden for days. As she described her experience, and his symptoms, I was horrified. Her family connected the dots back to the communion bread. “Gluten did that to your son!?” I thought. Unfortunately, their church wasn’t able to accommodate his gluten intolerance, and her family was forced to join another parish. 

At the Scottish storybook church, if you declined the bread or wine, you could fold your arms across your chest and receive a blessing from the priest. At the church I attended this Christmas Eve, communion bread was passed between parishioners in pews on trays, and wine (which turned out to be grape juice), was served in small plastic cups. Surprisingly, an individual blessing did not appear to be an alternative option. You’d think a simple blessing like this would be an option at all churches, allowing everyone to partake in communion and ensuring that the food allergic and intolerant aren’t left out.

Religion, like food, should bring people together. Breaking bread has long been a symbol of community and peace. That community piece is lost, however, if everyone isn’t afforded a seat at the table. 

- Abi & the Allergy Amulet Team

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Emerging Epidemic: Latest Research on Childhood Food Allergies Shows Troubling Trend

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We like to follow research in the food allergy world closely—after all, many of our team members are as personally vested as we are professionally in the advancement of food allergy research! Several of our senior team members either have food allergies or have children with food allergies. 

Last month at FABlogCon, we learned that Dr. Ruchi Gupta and her team at Northwestern University were soon releasing a new study in PediatricsThe Public Health Impact of Parent-Reported Childhood Food Allergies in the United States.

The study was published this month, and we wanted to share some key findings with you: 

  • Food allergies continue to affect a significant number of children in the United States—7.6 percent, or nearly 6 million kids, have a food allergy. Of those, 40 percent report having multiple food allergies.

  • Food allergies have a meaningful impact on families—42 percent reported a severe allergic reaction to their food allergen, and nearly 1 in 5 reported that their child had visited the emergency department for a food-allergic reaction in the past year!

  • Not everyone has emergency medicines at the ready—less than half of parents reported that their child has a current prescription for an epinephrine auto-injector, the only treatment for anaphylaxis. 

This study is a continuation of the work carried out by Dr. Gupta and her team in 2011. Their objective was to better assess the public health impact on childhood food allergies. They surveyed over 40,000 households using advanced statistical modeling to ensure they captured a representative sample of children in the United States. 

One noteworthy feature of this study was a “stringent symptom” methodology, which looked at the frequency, type, and severity of allergy symptoms as part of a diagnosis. This approach helped filter out those who did not likely have a food allergy, as several parents reported a food allergy when the symptoms were more characteristic of a food intolerance or oral allergy syndrome (OAS).

Even after applying the stricter criteria, food allergies are still a significant problem for American children. Today, 1 in 13 kids has a food allergy, which translates to 2 in every classroom. Peanut (2.2%) and milk (1.9%) are the most commonly reported food allergies, affecting 1.6 million and 1.4 million children, respectively. African American children are also more likely to have a food allergy than non-Hispanic white children and are more likely than other children to have multiple food allergies. 

Dr. Gupta (second from the left on the bottom row) and her SOAAR research team (Science and Outcomes of Allergy and Asthma Research) at Northwestern University.

Dr. Gupta (second from the left on the bottom row) and her SOAAR research team (Science and Outcomes of Allergy and Asthma Research) at Northwestern University.

We appreciate the work of Dr. Gupta and her team to increase awareness of the public health implications of food allergies. To quote from the study: “With the growing epidemic and life-threatening nature of food allergies, developing treatments and prevention strategies are critical.” 

We couldn’t agree more!

- Susannah & the Allergy Amulet Team 


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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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