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top 8 food allergies

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Sesame: More Than Just a Street

Sesame Blog Image.JPG

Sesame allergy has been all over the news lately. Last year, a teenage girl tragically died at Heathrow Airport after eating a Pret a Manger baguette containing sesame—the ingredient was not listed on the packaging. This incident drew attention not only to the severity of sesame allergies, but also to deficiencies in food allergy labeling. 

A growing body of research indicates that sesame allergy is on the rise. A recent study published in Pediatrics estimates that 0.2% of the U.S. population has a sesame allergy, making it the ninth most common food allergy. 

The spike in sesame allergy has triggered a closer look at the way sesame is labeled on food packaging. This past October, the FDA released a statement indicating that it was considering sesame for mandatory allergen labeling on food packaging pursuant to the Food Allergen Labeling and Consumer Protection Act (FALCPA). Enacted January 1, 2006, FALCPA imposes special labeling requirements for the top eight most common food allergens: peanuts, tree nuts, fish, shellfish, wheat, eggs, milk, and soy. As you can see, the list does not currently include sesame. That could soon change. Notably, Canada, the European Union, Australia, and Israel currently require allergen labeling for sesame. 

For those out there managing a sesame allergy, know that you are amazing. Sesame is insidious, and because it does not fall within FALCPA labeling laws, it is infinitely harder to manage. 

If you’ve followed us for a while, you know that I have a daughter with serious food allergies to peanuts and tree nuts. She was diagnosed with these food allergies at one and is now six (and crushing Kindergarten!). What I haven’t mentioned is that from ages two through three we avoided sesame like the plague because of an anaphylactic reaction she’d had to hummus just before her second birthday.

She’d eaten hummus multiple times previously, but one day, while eating hummus at lunch, her lips began turning blue and she started coughing. One epinephrine auto-injector, several hours at our children’s hospital, and some IgE blood testing later, she was home safely with a new food allergy added to the list: sesame. 

Sesame often hides under the guise of “natural flavors” or “spices” on food labels. I used to keep a spreadsheet of every manufacturer I called knowing the ingredient could be lurking behind these vague categories. To make matters worse, some manufacturers won’t share this information, citing trade secret protection. I quickly learned that I had more success if I asked if sesame was included as an ingredient in any of these proprietary categories, as opposed to asking for the whole ingredient list. Sesame also lurks under different names like tahini, a paste made from sesame seeds. If you’re managing a sesame allergy, here’s a great list of food and non-food items that may contain sesame or any of its derivatives. 

It’s been over four years since my daughter’s anaphylactic reaction, and I can joyfully say that she’s outgrown her sesame allergy. But it was no walk in the park to manage, and I still vividly remember my sesame spreadsheet and the tears of frustration that went along with tracking all of the different food ingredients. 

For those managing a sesame allergy, the struggle is real, and FALCPA labeling for sesame would make things a LOT easier! Interestingly, the Pediatrics study we referenced earlier cited that the highest rates of epinephrine auto-injector prescriptions were found for children with peanut, tree nut, and SESAME allergies.

We’ll be following the regulatory deliberations closely, and will be sure to keep you all updated on social media as the discussion unfolds. Do you or does your child have a sesame allergy? What’s your experience been like?

 - Meg and the Allergy Amulet Team 

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OIT—Is It For Me?

Feeding your peanut-allergic child peanuts is not easy as a mother—I would know, I do it every day. Your instincts as a parent are to keep your child as far out of harm’s way as possible. But in today’s world, peanuts may be the best management tool we have for my peanut-allergic child.

Let me explain.

My daughter was born with a severe allergy to peanuts and tree nuts. For the first three years of her life, we strictly avoided these foods. She’s now four. Last April, we agreed to undergo an oral food challenge at her allergist’s office to find out if she was still allergic. Her peanut blood test numbers had dropped considerably—this blood test measures levels of Immunoglobulin E (IgE) to individual allergens in the body. IgE is the antibody that triggers food allergy symptoms. Plus, she hadn’t been exposed to peanut since she was a baby. Unfortunately, the oral food challenge outcome wasn’t as we hoped: after ingesting ¼ of a peanut, split into three gradually increasing doses over a 45-minute period, she experienced an anaphylactic event and we had to administer epinephrine. It was an emotional day, to say the least.

After discovering that she was still severely allergic to peanuts, we decided to explore oral immunotherapy: a method of food desensitization that involves re-introducing the immune system to the allergenic food in gradually increasing amounts over time, with the goal of eventual tolerance.

For our family, the results have been life changing. The same little girl that reacted to ¼ of a peanut now eats 12 peanuts daily with zero symptoms. But OIT is not necessarily for everyone, so I’d like to share our family’s journey and offer some insights into the process so that you can determine whether it’s a good fit for you or your child.

If your allergist doesn’t have a clear picture of your allergy severity, treatment may start with an oral food challenge. Once the individual has been identified as an OIT candidate, they are typically provided a juice-like beverage containing tiny amounts of the allergen. This beverage is consumed during the same two-hour period every day. Depending on how quickly a patient builds up a tolerance, your allergist may recommend coming in every week or two for an “updose”—an increase in the amount of allergen consumed. As the immune system grows more tolerant, the patient eventually moves to a powder form (which is typically sprinkled onto food), and finally to solids (e.g., whole nuts).

Importantly, OIT requires a considerable time commitment. Although updosing typically occurs every week or two, the allergen must be consumed every day to build and maintain tolerance. OIT also places constraints on physical activity. During OIT, the patient can only engage in calm, quiet activity half an hour before dosing, and at least two hours afterwards (during their observation period). This ensures that the immune system doesn’t get “revved up” unnecessarily and trigger an allergic reaction.

Is OIT perfect? Not quite. For the foreseeable future, my daughter must eat 12 peanuts with a two-hour observation period everyday. However, we can now choose the time frame each day, and expect the observation period to shorten over time. There’s also a measure of unpredictability. On two occasions, our daughter developed a couple hives after her prescribed dose, and we had to give her antihistamines. Other times, we had to lower her dose because she was sick, which can compromise the immune system. It is these situations, and the risk of producing a more serious adverse outcome, that discourages many allergists from taking up the practice. Indeed, OIT is still relatively controversial. Additionally, OIT treatments are still in their nascent stages and are not widely practiced, so there is less data and information available.

Importantly, not every food-allergic child or adult is a good candidate for OIT. For example, if a patient has severe environmental allergies, acute asthma, or eosinophilic esophagitis, they will not likely qualify for OIT. Additionally, OIT treatment is not available for all allergens—desensitization to peanuts, for example, is far more common practice than, say, shellfish.

If you think OIT may be of interest to your family, I’d encourage you to talk to your allergist and seek out additional information and guidance. You can also reach out to me at mnohe@allergyamulet.com for more on the parent perspective—I’m always up for a good food allergy chat!

- Meg, Director of Strategic Development

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