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

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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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A Look Behind the Label: How Food Manufacturers Prevent Allergen Cross-Contact

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In an earlier post, we explored food allergy labeling laws and why many food products include “may contain” statements. To better understand the extent to which these foods may in fact contain allergens, we’re going closer to the source: food manufacturers.

On nearly all matters concerning food safety, including allergen control, FDA-regulated food manufacturers follow the Food Safety Modernization Act (FSMA).

Signed into law in 2011, FSMA introduced significant reforms to the nation’s food safety laws. For the first time, food manufacturers were required to develop and maintain a written “food safety plan.” FSMA also gave the FDA discretionary authority to approve or reject these food safety plans, giving auditors considerable interpretive power over which food safety plans would pass muster.

In 2015, the FDA published a final rule on Preventive Controls for Human Foods. This regulation is one of the key parts of FSMA and mandates that companies perform a Hazard Analysis and develop Risk-Based Preventive Controls (often referred to as “HARPC”).  The regulation requires manufacturers to identify and implement controls for any “reasonably foreseeable” food safety hazard–which includes the top eight most common allergens (tree nuts, peanuts, shellfish, finfish, soy, milk, egg, and wheat). Accordingly, if any of these allergens could end up in the final food product, manufacturers must implement preventive controls, defined as “written procedures the facility must have and implement to control allergen cross-contact.” Notably, allergen testing is currently discretionary, not required.

So how tough are these food safety plans on food allergens?

According to food safety expert Dr. Scott Brooks, pretty tough. “While FSMA is not prescriptive, food safety plans must stand up to scrutiny from FDA inspectors. The FDA has published industry guidance to help ensure FSMA compliance, and those in the industry know that it’s important to follow the FDA’s guidance documents.” While not finalized, the FDA draft guidance document on HARPC advises implementing controls to prevent cross-contact, and other measures including product sequencing and sanitation controls.

Most larger companies invest considerable resources into food allergen management, according to food safety expert Dr. Bert Popping. Indeed, “large manufacturers often test foods for trace allergens and have allergen management controls in place.” Dr. Popping notes however that “a number of typically small and medium-sized companies have no allergen management in place, and accordingly will often issue precautionary statements like ‘may contain’ for legal reasons, without performing any risk assessment.”

Further guidance on HARPC will be important for advancing safety measures around allergen control at food manufacturers. Until then, we may have to settle for “may.”

- Abi and the Allergy Amulet Team

 

This piece was written by the Allergy Amulet team and reviewed by Dr. Bert Popping and Dr. Scott Brooks for accuracy. 

Dr. Bert Popping is the managing director of FOCOS, a food consulting group based in Germany. Dr. Popping has over 20 years of experience in the food industry, and has authored over 50 publications on topics including food authenticity, food analysis, validation, and regulatory assessments.

Dr. Scott Brooks is a food safety consultant and founder of River Run Consulting. He is the former Senior VP of Quality & Food Safety, Scientific and Regulatory Affairs at Kraft Foods, and prior to that was the VP of Global Food Safety, Scientific & Regulatory Affairs, and Quality Policy at PepsiCo.

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I'll Take My Allergies Medium Rare

If you’ve followed Allergy Amulet lately, you know we LOVE to talk about food allergies. Recently, we discussed the phenomenon of Oral Allergy Syndrome: a typically mild allergic reaction that can occur after eating a raw fruit or vegetable. This got us thinking: What other unusual allergy phenomena are out there?

We attempt to answer just that question in this post, because allergies aren’t always as common as peanut, pollen, and pet dander. They can also include red meat, metal, and even WATER!

While rare, these allergies are just as real. Here, we break them down for you.  

1.    Red Meat

If you’re a Radiolab fan like we are, you are definitely going to want to tune in to this podcast. The podcast follows the story of a woman who developed a meat allergy from a tick bite! One bite from a Lone Star tick can cause people to develop an allergy to red meat, including beef and pork. This type of allergy has been attributed to a sugar in meat called “alpha-gal.” Individuals bitten by the tick develop antibodies against this sugar. Symptoms include congestion, rash, nausea, swelling, and even anaphylaxis. Symptoms usually manifest within 4 to 6 hours after eating red meat. That said, be sure to check for ticks if you’re hiking in THIS region of the US! Additionally, a letter recently published by researchers in the Journal of Allergy and Clinical Immunology warns that the Zoster (shingles) and MMR (measles, mumps, and rubella) vaccines have been linked to anaphylactic reactions to meat.

2.    Exercise

This type of allergy has been reported only about 1,000 times since the 1970s. Exercise-induced allergic reactions typically occur during or after exercise, and generally follow from eating certain foods beforehand. Symptoms range from a mild rash and hives to anaphylaxis. The most commonly-reported incidents of exercise-induced anaphylaxis involve wheat, shellfish, tomatoes, peanuts, and corn.

3.    Gelatin

Gelatin—a protein derived from collagen—forms when connective animal tissue or skin is boiled. Allergic reactions to gelatin are often linked to vaccines, as many contain porcine gelatin as a stabilizer. Gelatin is also found in most gummy candies, as well as in products like marshmallows and some ice creams, dips, and yogurts. If you thought you were allergic to gummy bears, it may actually be gelatin!

4.    Leather

Have you ever experienced a foot rash after wearing leather shoes? Leather probably isn’t the culprit—you’re more likely allergic to the chrome used in the tanning process. Leather allergies are generally restricted to skin rashes. Several well-known car companies actually avoid using chromium on their leather seats because of this known allergy. So if the anti-fungal powders aren’t working, and you wear leather shoes, it may be because you have a chrome allergy!

5.    Water

Water-you talking about?! Yes, there is such a thing as a water allergy. An allergy to water, or aquagenic urticaria, is very rare. There are less than 100 cases reported in medical literature. Affected individuals typically develop hives when their skin comes in contact with water, regardless of the temperature. This condition appears more commonly in women, and most often during puberty. The hives and itchiness most often appear on the neck, upper trunk, and arms, and usually go away in 15-30 minutes. Antihistamines generally help relieve symptoms.

6.    Latex

Latex allergy is most commonly diagnosed in individuals frequently exposed to latex, such as healthcare professionals. It’s estimated that less than 1% of the US population has an allergy to latex, but for those in the healthcare sector, it’s closer to 8-17%! Interestingly, a latex allergy can also produce an allergic reaction to certain foods because of cross-reactivity (check out our blog post on Oral Allergy Syndrome to learn more about this phenomenon)! Individuals with a latex allergy need to stay alert, as latex can hide in unexpected places like mattresses, root canal sealant, utensils, and spandex. 

7.    Spice

It is estimated that 2-3% of individuals live with a spice allergy. Allergies to spices such as garlic or coriander are rare and usually mild, although severe reactions have been reported. Reactions can occur from inhalation, ingestion, or touch. A spice allergy can be difficult to manage as spices are commonly used in foods, cosmetics, and dental products. For example, dentists often apply cloves to extracted wisdom teeth cavities after the operation. A good reminder to alert your dentist of all of your allergies—especially rare ones!

8.    Nickel

Nickel allergy is a common cause of contact dermatitis—an itchy rash that pops up when your skin touches a normally harmless substance. Nickel is a silvery metal that is regularly mixed with other metals to form alloys. It is most often associated with earrings and other jewelry, but can also be found in many everyday items like cell phones, chairs, zippers, coins, and eyeglass frames. It may take repeat or prolonged exposure to items containing nickel to develop an allergy. Treatment may reduce the symptoms, but once you develop a nickel allergy, you’ll always be sensitive and will need to avoid exposure.

9.    Touch

Dermographism urticaria, or “skin writing,” is a type of allergy where you can write on your skin with the pressure from your fingernail. Firm pressure on the skin creates red wheals, which may accompany itching. Dermographism affects approximately 4% of the population. It can manifest at any age, but is most common in young adults. Symptomatic dermographism is usually idiopathic (of an unknown cause), though it may have an immunologic basis in some patients. Trauma to the body may play a role as well. This type of rash typically goes away after about 15-30 minutes, and can be controlled with antihistamines. 

10. Cold

Last but not least is an allergy to cold temperatures. Yes, you read that correctly. Cold urticaria is a skin condition that manifests when the skin is exposed to low temperatures. It is most common in young adults. Symptoms are generally limited to hives; however, the severity of cold urticaria varies widely. A whole body (systemic) reaction—the more severe form—typically occurs after swimming in cold water. This can lead to low blood pressure, shock, and even death. The cause for this allergy is poorly understood. The good news is that this type of allergy generally only lasts a few years.

So, have we sufficiently scared you? Or are you now more fascinated by the human immune system than ever before? We hope it’s the latter!

-       Meg and the Allergy Amulet Team

 

Allergy Amulet advisors Dr. Jordan Scott and Dr. John Lee have reviewed this piece for accuracy. 

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. Dr. Scott is an allergy/immunology instructor at the University of Massachusetts.

Dr. Lee is the clinical director of the food allergy program at Boston Children’s Hospital and an Instructor in Medicine at Harvard Medical School. He is also the co-creator of AllergyHome.org, a website that offers online resources to help educate and promote awareness about food allergies in schools, camps, and other settings. Dr. Lee is widely recognized for his work in the food allergy space, and his commitment to patient health.

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