Viewing entries tagged
tree nut allergy

Comment

More Adults Have Food Allergies Than Previously Believed

dan-gold-105699-unsplash.jpg

Last month, we shared the latest research on food allergy trends among children. The study found that approximately 7.6%—or 6 million—kids in the U.S. have a food allergy. Now we have more breaking food allergy news to share—this time concerning adults.

In early January, The Journal of the American Medical Association (JAMA) published a study on the prevalence of food allergies among U.S. adults. What did they discover? Approximately 1 in 10 American adults (~26 million) have a food allergy. 

This brings the total number of Americans with a food allergy to approximately 32 million, more than doubling the food allergy population! Previous estimates had the population at roughly 15 million Americans.

Below are a few more key findings:

  • Adult onset of food allergies is becoming more common; nearly half of food-allergic adults have at least one food allergy that began in adulthood.

  • The most common allergies among adults are shellfish (7.2 million), milk (4.7 million), peanuts (4.5 million), tree nuts (3 million), and fin fish (2.2 million).

  • Food allergies occur more often in non-white adults than in white adults.

  • Nearly 40% of adults with a food allergy reported at least one food allergy-related ER visit in their lifetime.

  • Adults ages 30-39 had higher rates of food allergy than younger adults. Adults over 60 had lower rates than other adult age groups.

Dr. Ruchi Gupta and her team at Northwestern University conducted both the adult and pediatric studies. Consistent with their research on children, Dr. Gupta’s team applied a stringent symptom methodology, which looked at the frequency, type, and severity of allergy symptoms as part of diagnosis to filter out those who more likely had a food intolerance. 

One thing is clear: food allergies are on the rise, and we need greater education, awareness, and research on this troubling health trend. 

A big thanks to Dr. Gupta and her team for their ongoing efforts to shine a light on the rising food allergy epidemic in our country.

- Susannah and the Allergy Amulet Team

Comment

Comment

The Nutty Nature of Nuts

vitchakorn-koonyosying-494184-unsplash.jpg

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. 

Comment

Comment

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

Comment

Comment

FOMO: Fear of Missing Out… On Nutrients

Part II: Wheat, Soy, Peanuts, and Tree Nuts

brooke-lark-229136-unsplash.jpg

Welcome to Part II of our FOMO series! Here we’re discussing how to replace nutrients lost from eliminating wheat, soy, peanuts, or tree nuts from your diet. You can find Part I here covering dairy, eggs, fish, and shellfish.

If you’re used to eating toast, cereal, pancakes, or other baked goods for breakfast, avoiding foods that contain wheat will likely be a hard adjustment. Or maybe you fed peanut butter and jelly sandwiches to your first child with no issue and your second child cannot eat peanut butter. It is an adjustment, to say the least! 

As a pediatric nutritionist, my work focuses on making sure kids with special dietary needs are getting the nutrients their growing bodies need. As you can imagine, many of my patients have multiple food allergies and have a fairly limited diet. The silver lining for these patients is that these children tend to have healthier diets because they’re avoiding lots of processed foods! 

I like to start by looking at each food that’s avoided and its corresponding nutrients side by side. As we discussed in Part I, this approach can make it less intimidating to identify other food sources for those lost nutrients.  

Screen Shot 2018-05-22 at 10.19.34 AM.png

Let’s take a closer look at a few of the nutrients needed when avoiding wheat, soy, peanuts, and tree nuts.

Wheat products in America are fortified with B vitamins, thiamin, riboflavin, and niacin. 

Thiamin is important for maintaining a healthy metabolism and key function of cells. The major thiamin food sources are whole grains, meat, and fish. In the US, breads, cereals, and infant formulas are enriched with thiamin as well as other B vitamins. If you’re avoiding wheat and most breads and cereals, you may want to ensure your wheat-free products are enriched with these key nutrients as well!

Niacin is another B vitamin—B3 to be specific. Niacin helps our bodies use fat, protein, and carbohydrates to create energy. This vitamin is also enriched in processed wheat products and can be found naturally in most meats as well as mushrooms, avocados, and sunflower seeds, to name a few. 

If you’re a meat eater and wheat-avoider, I’m not typically concerned that you’re missing out on B vitamins (thiamin, riboflavin, and niacin) or iron. However, you may want to think about how much fiber is in your diet. Many people substitute rice, potatoes, and corn-based products for wheat. However, these are mostly low in fiber.

Fiber is a carbohydrate that your body does not digest. There are two types of fiber: soluble fiber and insoluble fiber. Soluble fiber dissolves in water and helps to regulate blood cholesterol and glucose levels. Insoluble fiber does not dissolve in water and works to move food through the digestive tract. Many people experience symptoms like constipation after making a change in their diet. In these cases, I tell my patients to increase their fiber intake and add fruits, vegetables, legumes, brown rice, and other whole grains like oatmeal and quinoa. 

If you are not a meat eater, and you’ve eliminated wheat or soy, this next one is for you.

Iron is found in red meat, fish, and poultry, but there are many plant-based sources of iron outside of wheat and soy, including spinach, beans, lentils, nuts, seeds (e.g., pumpkin, chia, sunflower, and hemp), dried fruits, quinoa, and some fortified breakfast cereals. Iron is better absorbed with vitamin C, so I recommend adding an orange alongside your trail mix for your next snack. Calcium inhibits iron absorption, so whether you get your calcium from dairy or a dairy substitute, try to avoid eating them together. 

Avoiding soy is not easy because it is in so many foods. Both peanuts and soy belong to the legume family and contain many of the same nutrients such as B vitamins, protein, magnesium, and phosphorus. 

Magnesium helps normalize blood pressure and keeps our bones strong. Phosphorus also helps to keep our bones strong and helps our bodies make energy and move our muscles. Both of these minerals are found in abundance in beans, seeds, and tree nuts. Phosphorus is also found in dairy, eggs, in meat products, whole grains, potatoes, and dried fruit.

The goal for everyone should be to expand their diet and add more variety! A more diverse diet will lead to greater nutrient intake, and hopefully more delicious meals. If you feel like you’re in a food rut, take a chance and add something new to your routine. Your body (and likely your taste buds) will thank you!   

 

Tara McCarthy is a Registered Dietitian Nutritionist who has a passion for pediatrics. She has worked at Boston Children’s Hospital for over 15 years as well as a private practice and specializes in nutrition for children with special dietary needs such as food allergies, celiac disease, FPIES, EoE, allergic colitis, and sucrose isomaltose deficiency. 

Comment

Comment

Understanding More, Fearing Less

caroline-hernandez-219485.jpg

“Nothing in life is to be feared, it is only to be understood. Now is the time to understand more, so that we may fear less.”    – Marie Curie

Who better to listen to on the topic of fear than the first female scientist to win a Nobel Prize (twice!)? Curie had to overcome quite a few fears in the male-dominated science profession before winning those awards. She was also the daughter of a proud papa named Wladyslaw, a math and physics teacher (her mother died when she was ten), which is a nice segue to another proud papa: me. My name is David. I’m a 43-year-old corporate attorney, private equity and venture capital investor, and the father of three wonderful daughters. My daughter Caroline is not a scientist (yet), but like Curie, she confronts fear and hostile environments every day. She is severely allergic to peanuts and most tree nuts.  

As any parent of a child with a food allergy will attest, food outings are an exercise in fear. Even though my wife and I have no allergies, we experience this fear vicariously through Caroline daily. I can see the fear in Caroline’s eyes nearly every time we dine out. For a ten-year-old girl, this fear can be debilitating, frustrating, confusing, and embarrassing all at once. Caroline counts on us to always protect her, making us promise that she won’t get “hurt” when she eats out with our family. Caroline is good at math. Even at ten, she knows that getting it wrong even 0.1% of the time can be deadly. It is our very own David and Goliath story: my fragile young daughter against the fear of uncertainty. 

On a recent trip to our local ice cream parlor, we loudly (in keeping with custom) informed the teenage server of Caroline's peanut and tree nut allergies as we placed the orders for our three young daughters. The staff proceeded to assure us every precaution and make her ice cream cone in a separate, allergy-free area. These precautions always make me feel better, but the fear is constant, like white noise in the background.

First to receive her double-scoop cone was our eldest daughter, Ashley. Within seconds of handing her the cone I was startled to attention, "Dad, this tastes like peanut butter!" We didn't order a peanut butter cone for Ashley. Ashley has no food allergies, however, we never allow our other children to eat peanuts or tree nuts around Caroline. Family rule! I took a bite and sure enough, a strong flavor of peanut butter filled my mouth. Disappointed, we immediately informed one of the servers, who shrugged it off as if we had just informed her that she had forgotten to add green and red gummy bears to the cone. "Whoops, I guess we put the wrong thing in the order, sorry." I was stunned, but frankly, over the years I’ve grown accustomed to non-allergic parents, teachers, and servers acting like food allergies just aren’t a big deal. What if that server had accidentally given Caroline that cone? I clutched my daughter’s EpiPen case and shuddered to think what would have happened if she had been the one on the receiving end of that double-scoop chocolate cone. Uncertainty and fear gripped my insides. 

What’s a father to do? 

First, I make a point of frequenting stores and brands that promise nut-free facilities. The only “nut-free” bakery around is the next town over, but I think it’s worth the trip. I also support nut-free brands to ensure they stick around.

Second, I have spent the last five years of Caroline’s life trying to teach her to look out for herself. It’s a lesson I hope she will take with her when she is a teenager dining out with friends, and ultimately when she leaves our house and has to fend for herself. For my wife (Julie) and me, questions and doubts continually spin through our minds: Will she remember to carry her EpiPen at college? Will she know to diligently check food labels when we’re not around? Will she ever be too embarrassed to speak up about her food allergies when out with friends? To combat these concerns, we always try to make sure we’re helping her build the skills she needs to manage her food allergies solo.

One recent evening, while dining out at a local farm-to-table restaurant, I discovered half of a walnut in my nut-free pasta. While once again surprised and scared, it was a stark reminder of how easily cross-contact occurs. Enter Allergy Amulet, an early-stage technology company trying to create greater food transparency and help individuals with food allergies feel safer about the foods they eat. I believe that technology holds the key to helping her defeat her Goliath. That’s why Julie and I are proud investors in the company. 

Perhaps one day in the near future, my little wonder woman will not be brandishing a primitive sling-shot to slay the giant, but rather, an Amulet. Perhaps science will help her overcome her fears, and help her understand more, and fear less.

David would like to thank his wife Julie for her careful edits and contributions to this piece.  

Comment