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children with food allergies

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Best Practices for Kids + Epinephrine

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I’m not quite sure how summer passed by so quickly. Is it really back-to-school season already?! As families gear up for the school year ahead, we thought it would be a great time to review current best practices for kids and epinephrine—something every parent should know even if your child has no food allergies! 

Here are a few things to remember as you prepare for your child’s fun (and safe!) return to school.

Educating Your School Tribe

It’s a good idea to get your child’s food allergies on the radar of their school caretakers before the year begins—especially if your child is changing schools. Contact their school nurse and teacher to plan for where the epinephrine will be stored and how it will be used in case of an emergency. You may also want to discuss how snacks and treats are handled in the classroom. Many schools have food allergy policies in place, but some protocols are at the teacher’s discretion. 

It doesn’t hurt to schedule a face-to-face with your child, teachers, and caregivers before school starts to talk through your food allergy game plan. As a bonus, this gives your child an opportunity to meet their teacher before the year begins and help them tackle some of those first-day jitters! 

Epi Dosing Options

There are currently three different epinephrine dosages available. For adults and kids who weigh more than 30 kilograms (~66 pounds), the recommended dose is 0.3 milligrams. For smaller kids weighing between 15 and 30 kilograms (~33-66 pounds), the recommended dose is 0.15 milligrams. Several brands offer both dosing options, including EpiPen, Adrenaclick, and Auvi-Q.  

For infants and toddlers who weigh between 7.5 and 15 kilograms (~16.5-33 pounds), Auvi-Q makes an auto-injector with a lower dosage (0.1 milligrams), which also features a smaller needle. 

Make sure to check with your doctor to determine the best option for your child! 

Safe Storage

Remember that epinephrine is temperature sensitive. The medication should be stored at room temperature and never in extreme hot or cold climates (e.g., car glove compartments). Some brands also recommend that users periodically check to ensure the liquid has not changed color. If the solution assumes a pinkish or brownish hue, this can indicate decreased effectiveness. Epinephrine is light sensitive too—so store your auto-injectors in cases!  

Parents should work with their child’s school or daycare provider to map out a plan for both on-site and off-site storage (e.g., field trips), to ensure availability and maximum effectiveness. 

Using Your Epinephrine

As explained in one of our earlier blog posts, the outer thigh is the best place to administer the injection, even through clothing if necessary. Most manufacturers offer videos on their websites to demonstrate how to use their product. These can be a great resource for new caregivers and anyone that should be prepared for an allergic emergency. Like CPR, administering epinephrine is a good skill for any parent to have in their arsenal.

Replacing Your Supply

Currently, most auto-injectors expire within 12 to 18 months. Make sure to check your epinephrine expiration dates and mark them in your calendar. A good rule of thumb is to always have two auto-injectors in close proximity to any food-allergic child in case one is defunct (and in some cases, two injections may be required!). 

As you replace old auto-injectors, remember that some manufacturers offer coupons or other financial assistance, especially for lower income families.  

While we hope you never have to use an epinephrine auto-injector, we share these reminders to keep all of our children safe as we send them off to the classroom! 

- Susannah and the Allergy Amulet Team  

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What Food Allergies Can Teach Our Kids

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Every now and again, I like to write about my personal experience as a mom managing food allergies. Parenting is no easy feat, but it’s especially tough when you're raising a child that could stop breathing if accidentally exposed to certain foods.   

Although peanut and tree nut allergies are not something I would have chosen for my daughter, there has been an upside to her having food allergies. For one, our family has to look more carefully at the ingredients we put into our bodies, which has made us healthier eaters. The greatest gifts, however, have come in the form of life skills and values my daughter has learned at a young age.

Below are a few that immediately come to mind. 

Diligence. Now that my daughter is entering kindergarten, she’s starting to take charge of carrying emergency medicines to and from activities and storing them appropriately. Increasingly, she’s having to brave the world without me. Whether at school, summer camp, or a birthday party, she knows it’s her responsibility to ask if a food is safe when I’m not there to help her read the label. 

What has she learned? To be detail oriented and persistent—qualities that will help her in countless facets of life. 

Compassion. We talk to our daughter often about things that make her unique, like food allergies and wearing glasses. I find these talks help her relate to the differences between people both physically and situationally. Last year we saw a homeless family outside of a local store asking for money. After she asked me a few questions to better understand the situation, she decided we should give them the snacks we brought in the car so that they wouldn’t be hungry. Cue my proud mama heart swelling! 

Compassion is one of those life skills that will serve her well as a child AND as an adult. 

Time Management. It takes time managing food allergies! Label reading and meal planning take a lot longer when you have to think about a food allergy. Our daughter completed OIT for her nut allergies in 2017, and while it’s now been a year since we finished, she still has a daily maintenance dose of several nuts and a mandatory hour-long rest period afterward. It can be hard to find time to squeeze in her maintenance dose and rest time each day (today it was sandwiched between summer school and a T-ball game!).

Showing her how we map out each day and carve out time to manage her food allergies has been a great lesson in time management that will serve her well as she enters “big kid school” this fall. 

Bravery. It can be hard to stand up for yourself, let alone when you’re a small child! Food allergies have nudged her to become her own self-advocate (and a food allergy advocate!). I’d like to think we’ve led by example as her champion and guardians all these years and I’m proud to see her now standing up for herself (and her health). 

I hope her bravery goes beyond self-advocacy. I hope her newfound courage leads her to try new things, persevere through adversity, and stand up for others in need.

We all have moments when food allergies feel defeating, inconvenient, and stressful. But for all the woes allergies bring, they can also be a gift. It all boils down to perspective. Adversity breeds strength, and I see that strength in my daughter more and more each day.

-      Meg and the Allergy Amulet Team

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Spokin’s Susie Hultquist: A Fearless Food Allergy Mama!

Susie and her food-allergic daughter, Natalie.

Susie and her food-allergic daughter, Natalie.

If you’ve followed Allergy Amulet for a while, you know our team was founded by a female and that we love to support female entrepreneurs!

Unsurprisingly, we’re big fans of Susie Hultquist and the team she’s assembled at Spokin. This Chi-town team has built an app to help make managing food allergies easier! We recently sat down with Susie and asked her a few questions.

1. We understand you left your financial career on Wall Street to start Spokin. When did the “light bulb” moment happen?

It happened when my co-worker was selling girl scout cookies. I wanted to buy some, but in order to do that, I had to get ahold of a package to check the label and ensure they were safe for my family. I then went to their website to make sure the cookies were also available in our area. It took me 15 minutes to track down all the information I needed! That’s when I realized I was probably not the only person managing food allergies searching for this same information, and that there was a clear need to streamline and consolidate food safety information for the food allergy community.

At the time I was managing my company’s consumer internet portfolio and saw how different businesses were managing pain points. No one was solving this one, and I felt I was uniquely positioned to do so.

2. How long did it take to launch the app? 

It was two years in the making. I started by meeting with a lot of people who have food allergies. From there, we developed a content strategy and hired a graphic designer to work on app designs. We just celebrated the app’s first birthday!

3. What is your “why”?

My daughter Natalie. She’s allergic to peanuts and several tree nuts. I am determined to make her life easier and to help her live the fullest life possible. That’s what gets me up every day. 

A food allergy diagnosis often comes with a lot of no’s when it comes to food, and I want to be able to say yes as often as I can!

4. Spokin has a lot of new features and capabilities on the app. What are you most excited about?

Far and away is the map functionality! If you’re in the app and search within the “eateries” category you can choose any city in the US and see in seconds all the restaurants, bakeries, and ice cream shops others in the Spokin community have recommended. We now have 2.7 million reviews on the app and reviews span across 18 countries! 

To find in seconds all these yes’s after so many no’s is amazing. And it’s built by the food allergy community! This community is so generous. 

5. What does Spokin mean?

It’s a play on the word spoken. I had so many amazing interactions with people in the food allergy community that gave me advice verbally (where to eat in London, what chocolate chips to bake with, what to take with us on an airplane, etc.) but once spoken, that advice then vanished into thin air. All of this knowledge needed to be captured and shared with everyone. The idea was that if we built this platform, we could harness and share all of this great food wisdom with the food allergy community at large. 

6. When do you plan to release the Android version of the app?

We have started an Android waiting list and it’s on our product roadmap. We’re currently assessing demand, so please add your email to the Android list on our website, if interested! 

7. When you’re not focused on helping the food allergy community, what do you enjoy doing?

Spending time with my girls and my husband! We love to cook together, run together, and travel when we can. My girls all have very different interests so it’s fun to watch them pursue their passions. 

8. Since Spokin is based in Chicago, we have to know: do you cheer for the White Sox or the Cubs?

I love the Cubs, but I applaud the White Sox for offering peanut-free ballgames!

9. What’s your long-term vision for Spokin?

If everyone in the US with food allergies shared five recommendations we could build a database of 75 million data points that everyone can access! We’ve estimated that if it takes you 15 minutes a day to manage food allergies, then you can save a year of your life by having all of this information accessible to you. 

If you haven’t downloaded the Spokin app we recommend you check it out ASAP! Both Susie (Susie in the Spokin app) and Allergy Amulet’s founder, Abi Barnes, (allergy_amulet_abi in the Spokin app) have provided lots of recommendations!

-      Meg and the Allergy Amulet Team

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Everything’s Coming Up… Rotten

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Something in our world is changing. Our bodies are rejecting the food we eat. Even the experts don’t really know why.

In January, Netflix debuted an original six-part documentary series titled Rotten. The series travels deep into the heart of the food supply chain to reveal more than a few unsavory truths about what we eat. Of particular interest to the Allergy Amulet team was the second part of the series: The Peanut Problem.

This episode surveys experts across different fields to understand why the US has witnessed a surge in food allergies in recent decades—more specifically, to peanuts.

According to Dr. Ruchi Gupta of Lurie Children’s Hospital, one in four kids with a food allergy is allergic to peanuts, and more than half of those kids have experienced a life-threatening allergic reaction. 

The problem has become so widespread, in fact, that the peanut industry is beginning to take action. Peanut farmers have started pouring millions of dollars into food allergy research to help address the problem. To date, the National Peanut Board has donated approximately $22M to food allergy research. One company is even developing an allergy-free peanut, which could be on the market as early as next year. 

Peanuts are in trouble. In only a few years they have seen their reputation transform.

The Rotten series artfully underscores the risks that dining out presents. Responsible for nearly half of food allergy fatalities, restaurants have emerged as battlegrounds for those managing food allergies. Chefs must routinely navigate these food allergy minefields—and most kitchens are ill-equipped for the job.

We bend over backwards to make sure our food is safe. Bend over backwards because it’s life and death. – Ming Tsai, Head Chef, Blue Dragon

Surprisingly, no one really knows what’s going on. Doctors are still struggling with what seems to be a simple question: why the increase in food allergies? And why now?

According to Dr. Gupta, it’s likely a combination of genetics and our environment, with environmental factors triggering changes to the composition of our microbiome.

Getting your immune system to know this is ok, that in and of itself would be incredible. – Dr. Ruchi Gupta, Lurie Children’s Hospital

Some of the leading theories discussed in this segment, which we also discuss in an earlier post, include:

-       Microbiome changes: how antibiotic usage in infants and other environmental factors have affected our gut bacteria.

-       Clean state: the idea that the modern world is too clean and the lack of early exposure to dirt, bacteria, and animals weakens the immune system.

-       Early avoidance: for the past decade allergists have advised parents to avoid introducing allergenic foods early in life—it turns out early introduction may prevent the onset of food allergies.  

Much remains uncertain as to the reason for the rise in food allergies, and there is not yet a cure on the horizon. In the interim, management tools, standard precautionary measures (always carry epinephrine!), and treatment options like OIT can make living with food allergies a little easier.

We highly recommend carving out some time to watch this series—you won’t be disappointed.  Whether you have a food allergy, care for someone that does, or simply care about the food you eat—this series has something for everyone.

-       Meg and the Allergy Amulet Team

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Food Allergies Today: An Expert Q & A

There are many unknowns in the food allergy world today. Why are food allergies on the rise? What can I do to prevent my child from developing a food allergy? How do I find out if I have a food allergy or intolerance, or if my child has one? With the help of two of our medical advisors, Dr. Jordan Scott and Dr. John Lee, we have answered some of these common food allergy questions to help you dine with confidence! Let’s get started.

1) What is a food allergy and how does it differ from a food intolerance?

A food allergy is an immune system reaction. Your immune system is comprised of five different types of immunoglobulins/antibodies (IgA, IgD, IgE, IgG, and IgM). If you have a food allergy, IgE is the responsive antibody. When exposed to a food allergen, IgE attaches to the allergen, mistaking it as a foreign intruder. This IgE-allergen compound then binds to immune cells, triggering a release of histamine and other chemicals that produce an allergic reaction. Symptoms can affect the central nervous, respiratory, and gastrointestinal systems, and produce epidermal symptoms such as hives, rashes, or eczema. In the most extreme cases, a food-allergic reaction produces anaphylaxis, a life-threatening response that requires immediate medical treatment.

Food intolerances often affect gastrointestinal function, but they can also impact the central nervous system, respiratory health, and skin. The main difference between a food allergy and intolerance is that, although intolerance symptoms can be severe, they are not life threatening and will not produce anaphylaxis.

2) What are the leading theories for the significant increase in food allergies? 

Between 1997 and 2011, food allergies among children increased approximately 50 percent, according to the CDC. Unfortunately, there is no clear answer as to why. Below are some of the leading theories, in no particular order.

Theory One: Changes in our food system

Over the past few decades, our agricultural system has undergone a considerable transformation, including the introduction of GMOs (genetically modified organisms), increased pesticide application, and the addition of numerous chemicals to our foods. This theory suggests that these chemicals and modified foods are affecting our bodies and immune systems, particularly our gut health, thereby increasing our susceptibility to food allergies and intolerances.

Theory Two: Hygiene hypothesis

The second theory is the “hygiene hypothesis,” suggesting that our modern world is too clean, and our reduced exposure to bacteria is weakening our immune systems. Some research also suggests that the overuse of antibiotics in animals and the rise of prescription medication is killing the good bacteria in our gut alongside the bad.

Theory Three: Epigenetics

Some research indicates epigenetics are responsible for the rapid increase in food allergies—heritable changes in gene expression that don’t change the underlying DNA sequence. Epigenetic changes can be the product of environmental or other external factors, like diet or smoking, or the result of natural occurrence. Research is continuing to uncover the role of epigenetics in a variety of human disorders and fatal diseases.

Theory Four: Delayed allergen exposure

In the past few years, a growing body of research is suggesting that we may not be introducing children early enough to common allergens. In February 2015, the LEAP Study results came out, debunking the previously accepted practice of discouraging exposure to peanut among high-risk infants. This misguided approach may have contributed to the rise of peanut allergies and other food allergies.

3) What are the current methods for diagnosing a food allergy? How have they changed in the past several years? 

To diagnose a food allergy, an allergist performs one of two tests (or both): a blood test (such as an ImmunoCAP test) and/or a skin prick test. The blood test measures the level of allergen-specific IgE antibodies present in the blood. Skin prick tests are exactly as they sound: the allergists pricks the patient’s arm or back with a sterile small probe containing a tiny amount of the food allergen. A food allergy diagnosis is confirmed if a wheal (a raised white bump surrounded by a small circle of red irritated skin) develops around the contact area.

In some cases, an allergist may suggest a food elimination diet to pinpoint the offending food. They may also recommend an oral food challenge.

In an oral food challenge, an allergist administers tiny amounts of the potential allergen in gradually increasing doses over a set period of time (usually 1-3 hours). The patient is closely monitored in the event the food produces an allergic reaction, and epinephrine is always on hand in case of a reaction.

To date, oral food challenges are considered the gold standard for food allergy diagnosis. Skin prick and blood tests aid in diagnosis, but they are prone to error—false positives are not uncommon. For this reason, many allergists avoid blanket food allergy screening, and carefully choose which foods to test. Skin prick tests and blood tests have been standard practice for aiding in allergy diagnosis for the past two decades.

4) What are some common allergic reaction symptoms?

It’s first important to note that no two allergic reactions are the same, and just because you have a mild reaction to a small bit of sesame one day, doesn’t mean symptoms will present in the same way the next time you ingest that same small amount. Below are the most common symptoms to an allergic reaction.  

Mild symptoms include: itchy or runny nose, sneezing, itchy mouth, a few hives or mild itch, and mild nausea or discomfort.

Severe symptoms include: shortness of breath, wheezing, repetitive cough, pale or bluish skin, faintness, weak pulse, dizziness, tight or hoarse throat, trouble breathing or swallowing, significant swelling of the tongue or lips, hives or widespread redness, repetitive vomiting or severe diarrhea, anxiety or confusion, or some combination thereof.

It’s important that food-allergic individuals also be aware of biphasic anaphylaxis. A biphasic allergic reaction is a second episode of anaphylaxes that typically occurs within the first several hours after the initial anaphylactic event. The symptoms of biphasic anaphylaxis can be more severe than the initial reaction. Due to the risk of biphasic anaphylaxis, a doctor may require that you remain in the hospital for several hours after an anaphylactic event for monitoring.

5) What are the most common misconceptions about food allergies? 

There are several misconceptions about food allergies. Below are a few that we hear most frequently:

Food allergies aren’t real—False. Food allergies are real. They are a response to the body’s immune system upon exposure to an allergen. The immune system misinterprets the food as a harmful invader and releases histamine and other chemicals to protect the body from perceived harm.

Food allergies aren’t life threatening—False. If an allergic reaction becomes severe, it can lead to anaphylaxis—a potentially fatal allergic reaction that involves the rapid onset of swelling which can obstruct air passageways. Symptoms of an allergic reaction may be isolated to one major system in the body (e.g., wheezing or difficulty breathing), or can involve multiple systems (e.g., lungs, heart, throat, mouth, skin, or gut), and typically present within minutes after a person ingests the offending food.

Each allergic reaction becomes increasingly worse—Not necessarily. Allergic reactions can be unpredictable. The severity of a reaction is based on a number of factors, including: the amount of the allergenic food ingested, the person’s degree of sensitivity to that food, if exercise is involved, if they are sick, if alcohol is present in their body, and if certain medications are being used (for example, NSAIDS may increase the severity of a reaction). A person with food allergies might not always experience the same symptoms each time.

A food can be made less allergenic by cooking it—Partially true. Because a food allergy is an immune system response to a protein in a food, the protein remains in the food during heating, so it cannot be cooked out. The exception to this rule is sometimes seen in highly processed foods, and with milk and egg allergies—some people are able to consume these foods after heating, such as baked goods. Ask your allergist before trying this at home.

Adults don’t develop food allergies—False. Though most food allergies start in childhood, they can develop at any age.

Peanuts are the only food that cause severe reactions—False. While peanuts are the leading trigger of food-related anaphylaxis, any food can elicit a severe reaction—other common foods include seafood, milk, wheat, eggs, and sesame seeds.

One small bite is ok—If someone has a severe food allergy, and is highly sensitive to small amounts, even a tiny bite can trigger anaphylaxis. It is well documented that allergic individuals can experience severe reactions to trace amounts of an allergen in their food.

6) What are the three most important things a food-allergic individual can communicate to their friends, family, and co-workers?

First, alert your “tribe” (friends, family, work colleagues, caregivers) of your food allergies and their accompanying health risk. Also note the various ways you can be exposed (e.g., ingestion, touch, and inhalation).

Second, let them know what symptoms to watch for in case of a reaction.

Finally, tell them where you keep your emergency medications and teach them how to use an epinephrine auto-injector. Share your doctor-provided food allergy action plan, if you have one. Often parents with food-allergic children have one to serve as a guide for caregivers. The American Academy of Pediatrics recently published a customizable Allergy and Anaphylaxis Emergency Plan.

7) What role do you see technology playing in the lives of individuals with food allergies and how they manage them now, and in future? 

Food allergies have increased at an alarming rate over the past two decades. The silver lining is that we’re putting more research dollars and efforts into allergy education, management, and prevention. Numerous start-ups are spearheading this effort with cutting-edge technologies and innovation. This Spokin article published in January highlights several. Until we find a cure, technology is going to become a necessary part of how we manage food allergies.

8) What will be important for future food allergy diagnoses and treatment?

With food allergy diagnoses at an all-time high, it will become increasingly important to have improved diagnostic tools available to better understand who is at risk for severe reactions. New therapies to help people better manage their allergies are being developed every day. One example is oral immunotherapy, or OIT. OIT is a method of food desensitization that involves re-introducing the immune system to the allergenic food via oral ingestion in gradually increasing amounts over time, with the goal of eventual tolerance. Another example is the Viaskin® patch, otherwise known as the peanut patch. This approach uses epicutaneous immunotherapy. After applying the patch to your skin, the allergen is concentrated in the top layers of the skin, where it activates the immune system by targeting antigen-presenting cells without passage of the antigen into the bloodstream. The peanut patch recently entered Phase III clinical trials. Products are also currently being developed for milk and egg.

Is desensitization the future of food allergies? Or is a cure on the horizon? Only time will tell. Until then, innovation, research, heightened awareness, and education are paving the way for a brighter food allergy future.

If you have additional questions you’d like our experts to answer, please send them to Meg at mnohe@allergyamulet.com. We’d love to hear from you!

- The Allergy Amulet Team

 

These questions, and their corresponding responses, were written by the Allergy Amulet team and reviewed by Allergy Amulet advisors, Dr. Jordan Scott and Dr. John Lee.

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. Dr. Lee is widely recognized for his work in food allergy, and his commitment to patient health.

 

 

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