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food allergy education

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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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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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Scientists Find Link Between Antacid & Antibiotic Exposure and Food Allergies & Asthma

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As someone who remembers (with disgust) that pink goo as a child (also known as the antibiotic amoxicillin), I read this headline in shock. Did that chalky bubble gum syrup make me more susceptible to developing food allergies and asthma?

Here’s what the scientists found. 

In a recent study published in JAMA Pediatrics, researchers looked at approximately 800,000 infants that had ingested antibiotics or antacids in their first six months of life. They found that those exposed were more likely to develop food allergies or asthma. 

Babies are routinely prescribed antacids for regurgitating food or experiencing acid reflux after a feeding. This is very common in infants, so you can appreciate why this study is sending shockwaves throughout the parenting community!

The research hones in on how antacids and antibiotics affect an infant’s microbiome—that place where trillions of bacteria help aid in digestion, fight infection, and regulate the immune system. We know that antibiotics kill the bad bacteria that make us sick, but they also wipe out the good stuff that keeps us healthy. Antacids similarly can help ease digestion, but a less acidic stomach can alter the bacterial composition of the intestine and reduce protein digestion

The microbiome has been a hotbed of research lately—especially in the food allergy field. As we’ve discussed in a previous post, one of the leading theories behind the rise in food allergies is the impact that chemicals and medications are having on our microbiome and gut health—especially at a young age. We’ve also previously written on gut health and the important role the microbiome plays in healthy immune function.  

“This does not mean that infants should never get antacids or antibiotics,” Dr. Claire McCarthy notes in response to the study. “Antibiotics can be lifesaving for infants with bacterial infections, and there are situations when antacids can be extremely useful.” She adds though that both medications are often overprescribed and encourages doctors to “ask if it is truly necessary [to prescribe these medications]—and whether there are any alternative treatments that might be tried.” The lead author of the study, Dr. Edward Mitre, also recommended in light of the findings that “antibiotics and acid-suppressive medications should only be used in situations of clear clinical benefit.”

The recent surge in research surrounding gut health and the microbiome is a welcome trend, and one that will hopefully lead us to more concrete answers surrounding the origin of food allergies and how to mitigate or eliminate them altogether. 

- Abi 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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My Child Doesn’t Have a Food Allergy... But Her Friends Do

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When my family moved to a new neighborhood five years ago, we quickly learned that our new neighbors’ oldest son had a severe peanut allergy. Our children became fast friends, and the kids went back and forth between the two houses all the time. None of our three children have food allergies, so this was very new to us. To ensure that he was safe while under our care, we knew we had to get up to speed on how to keep him out of harm’s way (and well fed!).

Here are the top 10 tips we’ve learned, in case you find yourself in a similar situation:

1)    Ask the Question. Inviting a new friend over for a play date or sharing snacks at the park? Always ask the other parent or caregiver if their child has any food allergies. Allergy parents are often grateful if you bring it up!

2)    Read Labels. Get to know the ingredients of the snack foods you regularly buy. Which granola bars contain tree nuts? Which crackers are made in a facility that processes peanuts? At a minimum, know where to look on the packaging to find allergen info. I’m often surprised when a food I would have considered to be nut-free actually isn’t. We’ve created a cheat sheet for you to learn the rules of label reading!

3)    Keep the Original Packaging. It’s so much easier to check the ingredient list on a box of crackers if it is still in the original packaging. Often, similar products made by different companies have different allergy warnings and ingredients. 

4)    Have Allergen-Free Snacks on Hand. Consider offering fresh fruits, veggies, or cheese for kids who can eat dairy. We’ve found that parents of kids with allergies are happy to make suggestions for healthy and safe snacks that everyone can enjoy. As an added bonus, minimally processed foods are healthier anyway!

5)    Think About Cross-Contact. When you make a PB&J for your child, does the knife go in both jars? If so, that jam may contain peanuts. I try to use two different knives, but if we have a friend over with a peanut allergy, I open a new jar of jam rather than risk an allergic reaction.

6)    Keep Up the Hand Washing. We all know we should have kids wash hands before eating, but what about afterwards? If your kids eat a peanut butter sandwich, be mindful that their hands may have peanut residue on them, which could pose a risk to those with peanut allergies! Post-meal hand washing also helps keep those toys clean! 🙌  

7)    Think Outside the House. When we carpool with the neighbor that has a peanut allergy, I wipe down the car handles and other surfaces that our kids touch, especially since our family often eats in the car! Let’s be honest, don’t we all? 😉

8)    Make Birthday Parties Inclusive. Ask about food allergies on the invitation. For an electronic invite, you can list what you are planning to serve. We have a child in one of my kids’ friend groups with an egg allergy. His mom is always willing to bring alternative snacks and treats, so a heads up is appreciated in case she needs to plan ahead! 

9)    Know and Support Your School’s Rules. Our elementary school has some classrooms that are nut free, so we always pack nut-free snacks. The lunchrooms are generally nut friendly, with designated nut-free tables. If my child wants to eat with a friend who sits at the nut-free table, he also needs a nut-free lunch. It’s important to avoid undermining the school’s allergen policies. There are plenty of delicious food options for your child that will also keep their friends safe!

10)   Make it Easy on Older Kids. Older kids don’t want you hyper-managing their food choices, especially when they aren’t your children. Make it easy for teens and tweens to self-manage their food allergies by offering plenty of safe options and letting them choose. 

With these guidelines in place, we have been able to successfully navigate the food allergy terrain while keeping our children’s friends safe (and bellies full!).

- Susannah 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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Do Waitstaff Create a False Sense of Security?

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I’m often asked whether a consumer device that tests for unwanted ingredients in foods will give those with food allergies a false sense of security when dining out. My response is usually the same: do waitstaff give the food allergic a false sense of security when assuring customers their food is safe?

From personal experience as a waitress, and as someone with food allergies, I can assure you, it happens.

Roughly a decade ago, I waitressed at a restaurant in Midtown Manhattan. It was a fast-paced work environment that demanded recall of dozens of orders and seating positions at any given time. The restaurant was located a few blocks north of Madison Square Garden, so we’d routinely get flooded with hungry patrons before and after performances. During my tenure waiting tables, I grew accustomed to the frequency with which waitstaff made mistakes—and it’s often. A few times a week I would mix up orders, fail to put in special requests, and was once lambasted for accidentally serving a woman regular coke instead of diet. I never made that mistake again.

But there’s a difference between mixing up soft drink orders and forgetting to inform the kitchen of a food allergy. Despite their best efforts and intentions, waitstaff don’t always get it right—even when it comes to food allergies. Many waiters don’t know that pesto usually contains pine nuts, that marzipan is almond paste, or that peanuts and nutmeg are not tree nuts. According to a recent CDC report, restaurants were found responsible for nearly half of all food allergy fatalities over a thirteen-year period. That same report found that less than half of all restaurant managers, and only one third of servers, receive any formal training on food allergies. Legislation is also lagging. Today, only six states (Illinois, Massachusetts, Maryland, Michigan, Rhode Island, and Virginia) and two cities (NYC and St. Paul, MN) have passed laws to increase food allergy safety and awareness in restaurants. We’ve clearly got a long way to go.

I’ve also had my fair share of personal experiences with misinformed waitstaff. This past year alone, waitresses at two different restaurants assured me that my dish was allergen-free when, in fact, it was not. One of the more memorable incidents occurred when I was ten. Our family went to a fancy restaurant near our home for my mom’s 40th birthday. I typically wasn’t allowed desserts at restaurants, but my parents decided to make an exception. We informed the waitress of my food allergies, who then confirmed with the chef that the dessert was safe. After sheepishly taking a small bite, the waitress came barreling out of the kitchen towards the table: there was marzipan in the icing (they hadn’t checked with the pastry chef until after it was delivered to our table). Fortunately, I spit the cake out and the reaction did not rise to the level of anaphylaxis.

Dining out has and will always present challenges for the food allergic, and living in a bubble isn’t a realistic option: I don’t know one adult with food allergies that doesn’t dine out at restaurants or eat foods prepared by others. Right now, the food allergy community relies on the word of the kitchen and waitstaff—the first and only line of defense to prevent a reaction; then there’s epinephrine if things go wrong. Little progress has been made in the way of management tools for preventing allergic reactions in past decades, but fortunately, that’s starting to change. We’re finally seeing a surge of start-up activity in the food allergy space, with different products and apps designed to help the food allergic population better manage their allergies. After all, dining out shouldn’t feel like a game of Russian roulette!

Consumer devices that test foods for unwanted ingredients are intended as a supplement, not a substitute, to the standard precautionary measures those with food allergies would otherwise take when dining out or eating foods prepared by others. For example, I’m still going to tell the waitstaff I have food allergies; I’m still going to take a small bite before diving into my dish; I’m still going to avoid Thai restaurants, desserts, and pesto; and I’ll continue to have my epinephrine on hand. But an additional layer of assurance would be a vast improvement on the status quo.

Having been on both sides of the table, I know this much is true: waitstaff make mistakes, and it only takes one to trigger anaphylaxis. We food allergic folks need all the tools and reassurances we can get.

- Abi and the Allergy Amulet Team

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What To Expect When You’re Expecting…An Oral Food Challenge

My daughter, moments after finishing her first oral food challenge.

My daughter, moments after finishing her first oral food challenge.

This topic is pretty fresh in my mind as my daughter underwent an oral food challenge to macadamia nuts last week. In case you’re not familiar with an oral food challenge (OFC), or haven’t experienced one yet, let us fill you in.

Today, oral food challenges are considered the gold standard for food allergy diagnosis in children and adults alike. Skin prick and blood tests aid in diagnosis, but they are prone to error—false positives are not uncommon. You can read more about food allergy diagnosis methods in our blog Food Allergies Today: An Expert Q & A.

There are typically three reasons why you might do an oral food challenge:

1. You or your child tested positively for a food allergy but have never actually eaten the food.

2. You or your child tested positively for a food allergy and have eaten the food before with no symptoms.

3. To see if you or your child has outgrown a known food allergy.

An oral food challenge is usually held at your allergist’s office over a few-hour period. The allergist administers tiny amounts of the potential allergen in gradually increasing doses over a set period of time (usually 3-6 hours). In my experience, the whole challenge start to finish lasts around 4 hours. Once the full serving is administered, the doctor will typically observe the patient for a couple hours to monitor for signs or symptoms of an allergic reaction. If symptoms occur at any point during an OFC, the challenge stops and symptoms are treated immediately.

Importantly, not everyone is a good candidate for an OFC. According to allergist Dr. Jordan Scott, “when asthma is flaring or when patients are ill, we don’t challenge.”

Let’s talk about what to expect. First, block off the day, because even if the OFC is expected to last only a few hours, the experience can be emotionally draining and stressful. Being prepared and understanding the purpose and procedure is incredibly important! Below you’ll find a list of things to prepare ahead of time so you can tackle the challenge head on. 

Ask your allergist what he/she needs you to bring. He may ask you to provide the food for the challenge, or his office may provide the food (we’ve done both). If you’re providing the food, make sure you’ve done your homework to ensure it’s not processed in a shared facility or processed on a shared line with something else you’re allergic to. For example, when we challenged sesame a couple years ago, we ensured the hummus we brought wasn’t processed in a shared facility with nuts: my daughter’s other allergen. We didn’t want cross-contact playing a factor.

Ask your allergist what you should stop doing. Ask your allergist what medicines you need to stop taking before the challenge. Our allergist requires that we stop giving our daughter her daily antihistamines for seasonal allergies a few days before the challenge, as that could mask reaction symptoms during the OFC. Additionally, she cannot take any asthma medicine that day. However, if asthma symptoms start flaring, there’s a chance they’ll want to play it safe and reschedule your challenge anyway—clear communication with your allergist is key!

Bring lots of activities for entertainment. If the trial is for a child, I’ve found that new activities, games, and library books always help to hold their attention longer. Having a favorite stuffed “friend” or something that the child associates with comfort is helpful too. If you’re an adult, a good book and your favorite digital gadgets will probably suffice!

Pack safe snacks. If the challenge goes well, you may be at the allergist’s office for several hours. However, the tiny doses of food your allergist administers aren’t likely to fill you up ☺. We like to bring some of our daughter’s favorite tried and true snacks that we know are safe (another way to avoid bringing cross-contact into the equation!). Since the challenge is at an allergist’s office, and there will likely be patients in the near vicinity with food allergies, it’s an added bonus if you can bring foods that are free from the most common allergens: peanuts, tree nuts, fish, shellfish, wheat, egg, milk, and soy. I also bring disinfectant wipes in case the food spills so that I can clean it up properly for the next allergic patient. Good food allergy etiquette is important!

Bring your emergency medications. While this may seem unnecessary (hello, you’re at the allergist’s office ☺), it’s important. There’s always a small chance of a delayed reaction, and if that happens on the way home, you’ll want to have your epinephrine and antihistamines at the ready.

Stay calm. If you’re a parent accompanying a child to an OFC, it helps to remain calm if your child experiences an allergic reaction. “If a reaction occurs, it is important for parents to remain calm because children can pick up on the anxiety and feed on that,” allergist Dr. John Lee advises. If your child experiences a reaction, Dr. Lee also suggests that parents avoid calling it a “failed challenge” in front of their child, noting that “this can make a child feel as if they’ve somehow failed, or done something wrong.”

Leave the siblings at home. If the food challenge is for your child, it’s smart to leave any siblings at home so you can stay focused—especially in the event of an allergic reaction. Best-case scenario, your child doesn’t have a reaction and it ends up being quality time with your babe. If you’re an adult, you’ll still want to bring someone with you for support and to make sure you get home safely.

Set a course of action/next steps. Once the challenge is complete, talk to your allergist about next steps. If the challenge went well, make sure you know how to proceed with exposure to the food moving forward. If it didn’t, they may recommend future testing/follow up, and possibly strict avoidance of the food.

I hope you find these tips helpful! After experiencing my daughter’s first oral food challenge, I felt far better equipped to take on the second. In case you’re wondering, she passed her OFC to macadamia nuts! This is one nutritious food we can add back into her diet. Hooray!

If you’re interested in discussing oral food challenges further, let me know. We’ve been through several, so I know the ropes pretty well!

- Meg and the Allergy Amulet Team 

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