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Adults and Food Allergies

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Airborne Food Allergens—What’s the Risk?

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When we hear stories of serious allergic reactions to food, they often involve someone unknowingly ingesting a food that contains their allergen. Gut-wrenching stories like the grilled cheese that killed a NYC preschooler, the Indian takeout food fatality in England, the woman left paralyzed after ingesting peanuts while traveling in Budapest, and the sesame-related death of a teenage girl after eating a Prèt A Manger baguette at an airport. 

For many of us, these stories hit a bit too close to home.

In these cases, the food was ingested—but what happens when the allergen goes airborne?  

In January, a story about an 11-year-old New Jersey boy rocked headlines after he died from what authorities believe was an allergic reaction from breathing in the steam from fish cooking in the kitchen. 

While rare, allergic reactions to aerosolized allergens do occur. 

According to Dr. John Lee, Clinical Director of the Boston Children’s Food Allergy Program, most airborne reactions probably occur due to particles of protein that rise into the air when food is actively cooked, and then they’re inhaled. “I’ve had patients describe their throat itching while around peanuts, or reported mild reactions on airplanes, but most airborne reactions typically result from particles of protein rising off heated foods.” For example, he offers someone with a shellfish allergy walking into a seafood restaurant, or a wheat-allergic patient standing near boiling pasta.

According to the American Academy of Allergy, Asthma and Immunology, exposure to airborne food allergens does not typically result in anaphylaxis; however, these airborne particulates can cause symptoms such as itchy eyes, a runny nose, a cough, congestion, and difficulty breathing.

Airborne food particulates can also trigger two forms of occupational asthma: 1) baker’s asthma, following exposure to powdered allergen substances such as dried egg powder, soy flour, or wheat flour during baking; and 2) crab asthma, which is caused by dust and fume exposure from steaming, cooking, or scrubbing crab in processing plants. Both forms of asthma are considered allergic diseases because of the role allergenic proteins play in the respiratory response.

Notably, airborne allergic reactions aren’t limited to food. In at least one case, a chemical fragrance was the culprit. After a teenager named Brandon started developing headaches and hives at school, he connected his symptoms to Axe Body Spray. His allergy to the spray worsened, eventually leading to anaphylactic shock. Laws protecting manufacturers like Axe barred disclosure of the spray’s full ingredients list, preventing his family from discovering the allergenic trigger. Brandon had to leave school because of the exposure risks. 

Suffice it to say, airborne allergenic reactions extend beyond food. 

Most reported airborne reactions, however, continue to stem from common allergenic foods. Since peanut is the number one trigger of food-related anaphylaxis, the extent to which peanut particulates pose a risk is a common question in the food allergy community. 

In a 2003 study of 30 children with severe peanut allergies, researchers examined the extent to which inhalation and skin exposure elicited a reaction. For the skin test, one third of children experienced reddening or skin flares after peanut butter was pressed to their skin for one minute. Conversely, no child experienced respiratory symptoms after sitting in close proximity to three ounces of peanut butter for ten minutes.

The topic of aerosolized allergenic reactions has stirred enough controversy among food-allergic travelers that Southwest Airlines stopped serving peanuts on all flights starting in August 2018, and JetBlue does not serve peanuts on its aircrafts.

Food for thought? We think so. Have you experienced an airborne allergen causing an allergic reaction? Please share your experience if so! 

- Meg and the Allergy Amulet Team 

This piece was written by the Allergy Amulet team and reviewed by Allergy Amulet advisors Dr. John Lee and Dr. Jordan Scott. 

Dr. John Lee is the Clinical Director of the Food Allergy Program at Boston Children’s Hospital. Dr. Lee is widely recognized for his work in food allergy, and his commitment to patient health. 

Dr. Scott is an allergist/immunologist and operates several private allergy clinics throughout the Boston area. He is on the board of overseers at Boston Children’s Hospital, and the past President of the Massachusetts Allergy and Asthma Society. 

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Intuitive Eating + Food Allergy

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Proper nutrition, much like medicine, does not have a one-size-fits-all approach. In fact, what works for one person may not work for another. This is also why fad diets often don’t work. 

One of the more recent nutrition concepts that extends into counseling practices is Intuitive Eating, which encourages us to steer away from the diet mentality, and instead embrace positive lifestyle behaviors. The authors and dietitians behind Intuitive Eating, Evelyn Tribole and Elyse Resch, first wrote about the concept in 1995, publishing what is today the best-known book for helping rebuild healthy body images and restoring normal healthy eating behaviors. 

When I hear diet talk from friends, family, and clients, I’m often conflicted. On the one hand, I applaud the perceived need to change. On the other hand, I know scientifically that diets don’t often work; behavior and lifestyle changes are what stick. There is an overwhelming body of scientific literature that offers insight as to why our bodies fight diets. So if diets don’t work, then how do we make healthier, long lasting, and positive lifestyle changes? Here’s where Intuitive Eating comes into play. 

I like to compare Intuitive Eating to your best self-care day—it’s listening exactly to what your body needs, accepting it, nourishing it, and moving on. It’s giving your body the nutrients it needs while listening to your internal cues. 

The following are the 10 main ideas behind Intuitive Eating: 

1.   Reject the diet mentality. Get rid of the ideas and materials (books, magazines, etc.) that encourage and offer false hope of quick weight loss. 

2.   Honor your hunger. Physically and biologically feed your body the adequate energy it needs to function properly. Build trust in yourself that your body will tell you exactly what it needs. 

3.   Make peace with food. Give yourself permission to eat and abolish food rules. No foods are forbidden (unless you have a food allergy, that is). More on that later!

4.   Challenge the food police. Don’t applaud yourself for only eating x number of calories or feel guilty for eating that piece of birthday cake. 

5.   Respect your fullness. Really listen to the body signals that tell you you’re full. 

6.   Discover the satisfaction factor. Savor the foods that bring you joy and pleasure. You’ll typically find you end up eating less of that “forbidden” food because you took the time to savor it. 

7.   Honor your feelings without using food. Stress, anxiety, and boredom are some of the feelings that are often responsible for triggering emotional eating. Instead, pay attention to your emotional responses. 

8.   Respect your body. Accept your genes. You would never force your feet into the wrong shoes. Give your body the respect it deserves. 

9.   Exercise. Focus on how you feel while working out. If you hate it, try something new. Look at the true motivation behind your workout—is it to lose weight? Feel an endorphin high? Reduce stress?

10.  Honor your health. Make food choices that honor your health, but that also make you feel good. You don’t have to have a perfect diet. Remember, it’s progress over time that matters, not any one meal or one day that will make the difference. 

Over time, I’ve grown curious as to how food allergies, intolerances, and other medical conditions might apply to a philosophy like Intuitive Eating, which challenges us to actively listen to our bodies’ dietary needs. Initially it seemed counterintuitive to combine the two: one teaches us that we should intuitively feed our body what it needs/wants, while the other requires us to avoid certain foods for medical purposes. 

But what if Intuitive Eating could unlock greater freedom, patience, and kindness towards their bodies for those with food allergies?

Intrigued? Let’s dig into the details. 

Diets don’t work for a variety of reasons. Scientifically, when you restrict food or are on a diet, your brain produces something called neuropeptide Y, which triggers your brain to crave carbohydrates. Familiar with that feeling you get at 11am because you skipped breakfast? Pay a little thank you to your brain. It’s physically reminding you that you haven’t eaten and that you need to feed it carbohydrates because they are our body’s primary and preferred source of energy. When the body is in a deficit, we are physically depriving it of the calories and nutrients it needs to function. 

This isn’t to say all diets are bad. In particular, medically-prescribed diets are often extremely helpful and medically necessary for those suffering from food allergies, intolerances, and other medical conditions. However, many diets end up depriving your body of the vital nutrients it needs to function properly. The more you deny your hunger and fight your natural biology, the stronger and more intense these food cravings can become. 

If you’re reading this, there’s a good chance you either suffer from a food allergy or intolerance, or care for someone who does. Food allergies force us to eliminate foods or food groups to keep us safe. Intuitive Eating encourages us to ditch all food-related rules. How do you reconcile the two? What about challenging the idea that food allergies are a limitation, and instead, thinking of your food allergy as part of your body’s intuition? By reframing the way you think about your food allergy, you acknowledge your food cravings and indulge in the foods that your body CAN tolerate. Craving ice cream but have a dairy allergy? Search out dairy-free ice cream alternatives—there are a lot of comparable ones out there that are delicious and will do the trick. This way you honor your cravings, while respecting your body’s intuitive dietary boundaries. 

If you’re curious to learn more about Intuitive Eating, here are a few resources:

1.     https://www.intuitiveeating.org

2.     10 principles explained in depth: https://www.intuitiveeating.org/10-principles-of-intuitive-eating/

3.    Additional resources: https://www.intuitiveeating.org/resources/articles/

Rebecca Noren is on the Allergy Amulet health advisory board and works with chef Ming Tsai. Rebecca holds a master's degree in nutrition and is a registered dietitian. She is dedicated to bringing her expertise in public relations, marketing, and culinary production to the intersection of food, health, and food allergies. 

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Humans Are Pooping Plastic

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Got your attention? Thought so. 😉

If you’re thinking, What does poop have to do with food allergies? First, food allergies affect our health and diet, which implicates our digestive tract. Number two, research is increasingly looking to the gut for answers around the rise in food allergies. For these reasons, we thought the topic was a-poo-priate. 💩

This past summer, Austrian researchers reported that the deluge of plastic entering our environment is now entering our stool. That’s right—plastic has been discovered in 114 aquatic species90% of seabirds, and now, evidently, in us. 

As part of this first-of-its-kind study, researchers followed eight volunteers from a handful of European countries, tracked their consumption habits, and then sampled their stool. Small fibers of plastic—known as microplastics—were found in all participants’ feces to varying degrees, amounting to the first documentation of plastic in human feces to date. The findings confirmed what many scientists have long suspected: we’re eating plastic.

Scientists are now grappling with the health implications, which are largely unknown. Microplastics are capable of damaging the reproductive and gastrointestinal systems in sea life, but little is known about their impact on humans.

On average, 13 billion microplastic particles enter US waterways every day through the municipal water supply. An estimated 8 million tons of plastic enter the oceans each year. The latter bulk of plastic gets broken down into smaller bits, which are eaten by smaller organisms, and make their way up the food chain.

How does this relate to the food allergy and intolerance community? 

First, we know that immune health is closely tied to food allergies and intolerances. Experts have found that plastic in the gut can suppress the immune system and increase the likelihood of gastrointestinal diseases like inflammatory bowel disease. Second, research has shown that exposure to phthalates, which are found in many plastics, can increase childhood risk of allergies. According to the lead researcher of the study, Dr. Philipp Schwabi: “[my] primary concern is the human impact… especially [on] patients with gastrointestinal diseases.” He notes that “the smallest particles are capable of entering the bloodstream, the lymphatic system and may even reach the liver.”

While research on the human impact of plastic is still early, one thing is clear: plastic may be harming our immune systems, which could potentially implicate our body’s ability to tolerate and digest certain foods.

We’re eating our waste—that much is clear. Now the question is, what are we going to do about it? 

-      Abi and the Allergy Amulet Team 

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More Adults Have Food Allergies Than Previously Believed

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Last month, we shared the latest research on food allergy trends among children. The study found that approximately 7.6%—or 6 million—kids in the U.S. have a food allergy. Now we have more breaking food allergy news to share—this time concerning adults.

In early January, The Journal of the American Medical Association (JAMA) published a study on the prevalence of food allergies among U.S. adults. What did they discover? Approximately 1 in 10 American adults (~26 million) have a food allergy. 

This brings the total number of Americans with a food allergy to approximately 32 million, more than doubling the food allergy population! Previous estimates had the population at roughly 15 million Americans.

Below are a few more key findings:

  • Adult onset of food allergies is becoming more common; nearly half of food-allergic adults have at least one food allergy that began in adulthood.

  • The most common allergies among adults are shellfish (7.2 million), milk (4.7 million), peanuts (4.5 million), tree nuts (3 million), and fin fish (2.2 million).

  • Food allergies occur more often in non-white adults than in white adults.

  • Nearly 40% of adults with a food allergy reported at least one food allergy-related ER visit in their lifetime.

  • Adults ages 30-39 had higher rates of food allergy than younger adults. Adults over 60 had lower rates than other adult age groups.

Dr. Ruchi Gupta and her team at Northwestern University conducted both the adult and pediatric studies. Consistent with their research on children, Dr. Gupta’s team applied a stringent symptom methodology, which looked at the frequency, type, and severity of allergy symptoms as part of diagnosis to filter out those who more likely had a food intolerance. 

One thing is clear: food allergies are on the rise, and we need greater education, awareness, and research on this troubling health trend. 

A big thanks to Dr. Gupta and her team for their ongoing efforts to shine a light on the rising food allergy epidemic in our country.

- Susannah and the Allergy Amulet Team

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