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Food Allergy Emergencies

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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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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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Managing Food Allergies at the Gym and Yoga Studio

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Food allergy management is not reserved for the kitchen, dining room, cafeteria, and restaurants. Food allergies follow you everywhere, from airplanes to offices, to places you would least expect—like yoga studios.

My favorite yoga teacher, who has a peanut-allergic son and maintains a peanut-free house, uses the yoga studio as her place to eat all the peanuts she can’t at home. I only learned about her son’s allergy because I spotted her spooning peanut butter right out of the jar and directly into her mouth before class one day. As a regular, there’s a good chance of her assisting me, and it is not unusual for her to lie right on top of students during a seated forward fold. 

Since we may be getting “intimate,” I knew I would have to tell her about my allergy. I explained that I was allergic to peanuts and would appreciate it if she either washed her hands or not assist me that day. Since she’s an allergy mom and understands the struggle, she was embarrassed that she had never thought of this as an issue when teaching. 

Yoga studios aren't the only place I’ve encountered my food allergies. They have shown up in locker rooms, the swimming pool, and on a marathon race course. I bet I’m not the only one who has spotted an allergen during a workout! 

As someone with many food allergies (peanuts, tree nuts, sesame, soy, and sunflower seeds, to name a few), I’ve gotten pretty good at managing them in public workout spaces. Below are my top tips! 

Your auto-injector is your number one workout buddy.

Having your epinephrine auto-injector with you at all times is a best practice no matter where you are or what you are doing. This is especially true for the gym. The last thing you want is someone scrambling to your locker—perhaps not knowing or forgetting the lock combo—and then rummaging through your things to find your auto-injector. Keeping it in a small bag with you is a convenient way to carry it from machine to machine. Activities in extreme temperatures, like hot yoga, may require an exception to this rule.

Have a water bottle that stands out.

Just like the yoga studio was my teacher’s go-to place for snacking on peanut butter, the swimming pool is where my husband eats peanut M&Ms. Besides not kissing, we do not share water bottles when he eats peanuts! 

While unlikely, you might share the same water bottle as someone else at the gym, and you don’t want to accidentally sip from the wrong spout! When it comes to your water bottle, make sure it stands out and that you always know where it is. If you bring along a bag for your epinephrine auto-injector, you can pop your water bottle in there! Or add stickers, a name label, or tie a ribbon around your bottle to ensure it’s unique. 

Clean what you can.

Wiping down surfaces at the gym is always a good practice—food allergies or not. 

Sometimes this isn’t always an option—take bouldering, for instance. I recall one time watching people shell pistachios and then going right back to the climbing wall. In these cases, you just have to use your best judgment.

Specialty equipment at a yoga or boxing studio can also have questionable cleanliness. In these cases, it is best to bring your own mat, props, and gloves. If you’re there for the first time, or can't bring your equipment, it’s a good idea to ask how they clean their equipment or request a newly-cleaned item. You may want to wipe it down yourself just in case 😁.

Let someone know about your allergy.

When working out alone, it helps if someone knows about your food allergies. Before any yoga class, I always say something to the instructor because I’ve experienced teachers lathering students with essential oils. 

Don't be embarrassed by saying something. I used to be, but really who is it harming? Nobody! 

Managing food allergies means you have to be a little more diligent when engaging in extracurricular activities, even ones that aren't food related. Taking simple precautions to mitigate risk is all part of life with food allergies and shouldn't stop you from hitting the gym!

What tricks do you use when navigating public workout spaces? I’d love to know! 

 

Kortney Kwong Hing is the allergy girl behind the blog Allergy Girl Eats. She has multiple food allergies (peanuts, tree nuts, sesame, soy, sunflower seeds and more), but does not let them stand in the way of enjoying food and exploring the globe. On the blog Kortney shares stories of life as an allergic adult, tips on managing everyday life with food allergies, and a few favorite allergy-friendly recipes. 

Kortney is also one of the co-founders of Allergy Travels, a website and online community that shares travel insights and inspiration for those managing allergies. 

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Killer Beauty Regimens

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When we think about managing food allergies, we don’t tend to consider lipstick or lotion. But we should.

Walking down the aisle of my local co-op recently, I grabbed a tub of moisturizer labeled “tester” and applied a dab to my hand. I tried placing the scent, and when I couldn’t, turned the jar around and saw almond oil listed as the first ingredient. My stomach clenched, and a variant of “shoot” slipped from my mouth. I’m deathly allergic to tree nuts. I washed my hands immediately, and fortunately, I was fine. Historically, my worst skin exposure outcome is hives. However, given the unpredictability of allergic reactions, it’s still hard not to panic. 

You’d think after all these years and several close calls I’d be more careful; but when it comes to skincare and beauty products, I routinely let down my guard. I shouldn’t.

Did I sufficiently give you a fright? 

Good. Sometimes a little fear is a good thing. Especially when you’re talking about something as serious as an allergic reaction! 

For the food allergic, even moderate skin exposure can be serious. Creams, soaps, oils, make-up, lipstick, and balms can also lead to small amounts of ingestion, so it’s important for those with food allergies and their loved ones to vet these items with the same diligence they do foods. Don’t forget vitamins, teas, and herbal supplements, too! 

Beware the two S’s: spas and salons. 

Planning a massage, manicure, or haircut? Make sure you tell your massage therapist or stylist to avoid products containing your allergen. This is especially true if you’re allergic to nuts—you’d be surprised how many spas and salons use nut oils. Just last month while getting my haircut I was surrounded by advertisements for the salon’s newest cherry almond shampoos and conditioners. Suffice it to say, I steered clear of this product line. 😉 

FDA labeling laws and cosmetics.

Skincare and beauty products are not regulated in the same way that foods are for allergens—even if they contain a common allergenic ingredient! 

The Food Allergen Labeling and Consumer Protection Act (FALCPA), which we explore in an earlier blog, applies to FDA-regulated food products, not cosmetics and beauty products. Accordingly, these products do not need to adhere to FALCPA labeling requirements, although many brands list these ingredients anyway. Regardless, it’s worth taking note.

We hope this information hasn’t spooked you, although it is Halloween season! Rather, we hope this knowledge helps you stay informed and safe when managing your food allergies. So before you slather on some blood-red lipstick this All Hallow’s Eve, check that label!

Wishing you all a BOO-tiful Halloween! 👻🎃

- Abi and the Allergy Amulet Team 

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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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