What Does Food Mean to You? September 23, 2020

Although I’m not a teacher, I often find myself in the classroom with students. I’m called upon to teach a wide variety of subjects to students of all ages. Last year, I was a guest lecturer for a senior writing seminar class titled, “Food, Travel and Adventure.” As a current writer, food enthusiast and former diplomat, this class was right up my alley.

There are many different types of writing: narrative, journalistic, scientific… You could use any of these styles to write about food. However, sometimes when you’re writing about food, you’re not writing about food at all.

For example, in the book Julie & Julia, author Julie Powell dedicates page after page to descriptions of ingredients, recipes and preparations. But what she’s really writing about in this autobiography is self-discovery:

“Julia taught me what it takes to find your way in the world. It’s not what I thought it was. I thought it was all about-I don’t know, confidence or will or luck. Those are all some good things to have, no question. But there’s something else, somethng that these things grow out of. It’s joy.” 

In his book, Yes, Chef, Chef Marcus Samuelsson verbally fans the aroma of each ingredient from his kitchen through the pages to the reader to vividly envision and inhale. But Samuelsson isn’t writing about food either, he’s writing about culture and communication.

“Food and flavors have become my first language. Not English, not Swedish, not Amharic…”

Food critics, who write exhaustively about taste, texture and flavors are not ONLY writing about food. They are also writing about creativity, artistry and talent.

“Magical dishes, magical words: a great cook is, when all is said and done, a great poet. . . . For was it not a visit from the Muses that inspired the person who first had the idea of marrying rice and chicken… Parmesan and pasta, aubergine (eggplant) and tomato…?”
‘Cinquante Ans a Table’ (1953) 
Marcel Étiennegrancher (1897-1976)

When I write about food, it is born out of my own experience. When you have food allergies, food may mean something different to you. When food can both sustain you and do you harm, your relationship to food may be complicated – or not!

When I write about food and food allergies, I am writing about inclusion, respect, and trust. I am writing to express my appreciation, a pot boiling over with gratitude. I am illuminating my belief that access to safe and healthy food is a right and a necessity – one that creates opportunity for learning, growth and a better future. Finding safe food can be a creative challenge that offers hope, pleasure and a platform for fun times spent with friends and family.

Most of all, as a person who adores someone with food allergies: food – and its sometimes endless hours of preparation and worry – represent love. Pure (and hopefully delicious) love.

COVID Life: Food (Allergies) in the Classroom this Fall? July 2, 2020

 

U.S. Department of Agriculture – Fruit-bar-pic—Web, Public Domain, https://commons.wikimedia.org/w/index.php?curid=17799829

The American Academy of Pediatrics (AAP) came out with a statement in favor of in-person schooling for children wherever schools can do so safely.  In it, they cite the importance of school on child and adolescent mental health and academic engagement as well as the lower rate of transmission and contraction of the coronavirus. [Read the AAP’s full statement here.]. The AAP’s statement also offers guidance to schools about how they might resume in-person education while protecting students as much as possible.

 

In May 2020, the Center for Disease Control (CDC) also published guidance about schooling during the COVID-19 pandemic.  At that time, AllergyStrong co-signed a letter urging the CDC to balance their guidance with the concerns of life-threatening health conditions facing students including food allergies – which they did.  [Read the CDC’s updated guidance here.}

 

Both the AAP and CDC recommended that students eat meals in the classroom rather than the cafeteria in order to promote social distancing and limit contact between classes (cohorts) and grades.  And, both AAP and CDC mention the need to be cognizant of food allergies in that scenario.

 

 

How do you bring food into the classroom safely?

The AAP and CDC guidance leaves many parents wondering how can teachers, staff and administrators help protect their students from food allergic reactions while following this guidance?

1. Enforce a “No Sharing” food policy.  

This must be strict and plainly stated to protect classmates from food allergic reaction which can be serious.

2.  Wash hands.  

This is doubly important in the age of COVID.  But unlike a virus, food allergens are not eliminated by hand sanitizer.  Hand washing with good-old soap and water is what is recommended to prevent cross-contamination and cross-contact with food protein that can cause a severe reaction.

3.  Cleaning shared surfaces.

It is critical to clean common surfaces (again doubly so with the coronavirus at play) to prevent accidental cross-contact and protect students with food allergies.  Cleaning with soap and water is best.

4.  Review symptoms of an allergic reaction.

It is imperative for teachers and classroom staff to re-familiarize themselves with the signs and symptoms of an allergic reaction as well as how a child might describe those symptoms [Read, The Language of a Food Allergic Reaction for more information.].

5.  Know how to respond to an emergency.

Minutes matter during a food allergic reaction.  Severe reactions, called anaphylaxis send patients to the hospital and can be fatal.  Review a student’s 504 plan and any Emergency Action Plans available.  Know where epinephrine auto-injectors are stored, how to use them and WHEN to use them.

6.  Take advantage of the stock epinephrine program.

Under the School Access to Epinephrine Emergency Act, also referred to as the Stock or Unassigned Epinephrine Act, schools are allowed to keep on-hand epinephrine auto-injectors that are not prescribed to a particular patient for use in emergencies.  This program is available in 49 states and is used to save the life of any student, teacher or staff member having an allergic reaction regardless of whether they have epinephrine on file.  Up to 25% of stock epinephrine use in schools is with people who have no history of diagnosed food allergies.

 

 

What can parents do to protect their children?

1. Establish/Review the student’s 504 plan.

Section 504 of the Americans with Disabilities Act protects a student’s access to equal education and academic success while preserving safety.  Provisions in a 504 plan for a student with food allergies might include class-wide hand washing, a voluntary refrain from bringing allergens into the classroom, communication with parents about allergens, or approval for a student to carry his/her own epinephrine auto-injectors. Now is the perfect time to work with your school to establish a written 504 plan for your food allergic child should you feel they need it.  [Read Kids With Food Allergies Sample Section 504 Plans for Managing Food Allergies for more information.]

2. Practice how to respond to situations with food with your child.

Because eating may be done in the classroom, a child’s peers may have questions or comments about his/her food allergy.  Practice answering these questions with your child so they feel comfortable and confident to handle anything that comes their way. [Read Armed with Words:  Teens and Food Allergies to get your conversation started.]

3. Review symptoms of an allergic reactions with your child.

It is critical that everyone with food allergies know the signs and symptoms of an allergic reaction.  Teach these symptoms in an age-appropriate way so as not to scare younger children.  Let kids know that these symptoms typically appear soon after eating and tell them to speak up (even interrupting a teacher) if they are concerned they are having an allergic response.  [Read: React? Act! to help teach this important lesson.]

4. When age-appropriate, demonstrate how to carry/use epinephrine auto-injector.

Carrying an auto-injector is a big responsibility and a big relief to some children.  Teaching kids how to carry their epinephrine auto-injector (always have it with you, don’t let your friends play with it, etc) and how to use it is key.  In fact, invite one or two close friends over and demonstrate how to use the auto-injector with the trainer or firing off an old one on an orange or grapefruit will also help protect your child should an emergency arise.  We’ve adapted an old medical school mantra from my father-in-law for food allergies, “If you think you need to use the auto-injector, you DO need to use it!” Remember, administer epinephrine and go to the hospital immediately for further treatment and monitoring.

Important Update: FDA Temporary Labeling Policy June 22, 2020

 

AllergyStrong has participated in several discussions with the US Food & Drug Administration in partnership with several passionate food allergy advocacy organizations to ensure protections for food allergy consumers.

 

Our most recent meeting offered an opportunity for the food allergy community to voice its concerns based on our daily challenges with food purchasing.  Additionally, we were able to learn more about the policy itself as well as manufacturers initial reactions.

 

The food allergy community should feel reassured that the FDA understands our concerns and is working with advocates to keep patients safe.  They underscored their commitment to transparency in our meeting and demonstrated their willingness to respond to our concerns.

Background:  The FDA relaxed it requirements for food labeling on May 22, 2020 in order to preserve the food supply chain during the COVID-19 pandemic.  In short, this temporary policy allows manufacturers to substitute minor ingredients without issuing a label change. [Read FDA Issues Temporary Policy Allowing Some Substitutions in Food for details of this policy.]

 

The FDA is trying to balance food safety with food security during the COVID-19 pandemic.  They believe this guidance provides the flexibility needed by manufacturers with guardrails to ward against adverse health effects.

 

 

 

 

FDA’s Stance on Food Allergies in Relation to this Policy:

• Although the FDA gives limited flexibility to manufacturers to substitute minor ingredients, it does not compromise on food allergens because they represent a health and safety risk.
• The Top 8 allergens (peanut, tree nuts, milk, egg, soy, wheat, fish and shellfish) cannot be substituted in for another ingredient without an appropriate label change.
• Additionally, gluten, sulfites, glutamates and other ingredients known to cause sensitivity in people cannot be substituted in for another ingredient.
• Finally, manufacturers are warned against substituting in priority allergens (such as sesame, celery, lupin, buckwheat, molluscan shellfish, and mustard) that are common in other parts of the world without a label change.

 

 

Latest Information and Clarification:

• We urged the FDA to require more transparency from manufacturers when they need to substitute an ingredient.  Advocates and the FDA agreed that a sticker that sits on top of the ingredient label on packaging to indicate the most current ingredients would be best.
• The FDA is also recommending that substitution information to be listed on manufacturers websites and signage be placed at the point of sale.
• Following conversations with the food industry, the FDA stated that manufacturers do not want to make changes to their products unless forced to by circumstance.  They expect to see this policy employed rarely and to see omissions rather than substitutions.

 

In response to our conversation, the FDA issues an FAQ page on this policy with further clarifications.

 

AllergyStrong will continue to track this policy and keep you informed.  We will continue our conversations with the FDA to best support food allergic consumers and ensure food safety and transparency for all.

 

 

 

IMPORTANT: FDA Issues Temporary Policy Allowing Some Substitutions in Food May 26, 2020

 

The FDA just released a temporary relaxation of its food labeling policy.  This temporary change comes into effect to prevent shortages and manage delays in the food chain supply during the COVID-19 crisis.  This policy will remain in effect through the end of the public health crisis.  Although the policy takes food allergies into consideration, it may have an affect on the safety of food particularly for those who allergies fall outside of the Top 8 (peanut, tree nut, dairy, egg, wheat, soy, fin fish, and shellfish).

 

“The food industry has requested flexibility when manufacturers need to make such minor formulation changes… that may cause the finished food label to be incorrect, but that do not pose a health or safety issue and do not cause significant changes in the finished food due to the temporary formulation modifications.”

 

The policy allows manufacturers to:

• Make minor formula changes consistent with the product’s taste, texture and integrity; and
• Continue labeling their original ingredient list without noting changes made.

 

[Read FDA’s statement summary here.]

 

Image by Kevin Phillips from Pixabay

 

The specifics of the policy offer a few important details:

1. On page 6, FDA encourages manufacturers to make label changes whenever possible noting that consumers rely on those labels to make informed choices. They are not, however, required to alter their labels during this time.  If labeling cannot be changed on the package, the FDA recommends companies use alternative means of informing consumers for transparency, such as posting information on their website or applying stickers to packaging.
2. As always, flexibility remains in place for formulations of generically grouped ingredients, such as “spices”, “flavoring” or “color,” and can be changed without relabeling.
3. The FDA is authorizing this flexibility for minor ingredient changes.  When considering these “minor” ingredients, the FDA highlights:
   • Safety: does the ingredient substitution cause an adverse health effect (such as food allergens)?;
   • Quantity: the substitution must generally be for ingredients that comprise 2% or less of the finished food/final product;
   • Prominence: the substitution should not conflict with a major component of the product (for example, wheat in a muffin);
   • Characterizing Ingredient: the substitution/omission should not represent the ingredient that defines the product (such as raisins in a raisin bagel); and
   • Nutritional/Other Claims: the substitution should not misrepresent nutritional or other claims made about the product.

 

Faced with supply issues of their own, manufacturers can now reduce the amount of ingredient they use or choose to omit it altogether.  Additionally, they may temporarily substitute an ingredient that is less than 2% of its finished product.  The FDA encourages manufacturers to consider allergens (the Top 8 allergens as well as many common allergens beyond) before making a change and suggest labeling should such a change be necessary [page 8].  

The FDA policy outlines several areas where it will not object to substitutions [page 10].  One area of possible note for those with food allergies is Fats and Oils.  The FDA will not object to a swap of fats and oils as long as they do not pose an obvious allergenic risk (say using peanut oil instead of vegetable oil) and is derived from the same source (plant, animal, etc) and are highly refined.  They specifically mention a hypothetical scenario where a manufacturer might substitute canola oil for sunflower oil.  Speak to your allergist about your personal risk with refined oils and these possible substitutions.

 

As we strive to understand how this policy will impact our community, we recommend that those with food allergies:

• Read ingredient labels carefully, looking for stickers or other notifications of ingredient substitutions;
• Call manufacturers and/or check on their websites frequently to understand which products may be affected by substitutions; and
• Speak with your allergist about these changes and how they may affect your specific allergies.

 

 

[Read the FDA’s full policy here:  Temporary Policy Regarding Certain Food Labeling Requirements During the COVID-19 Public Health Emergency: Minor Formulation Changes and Vending Machines]

 

The FDA has issued this guidance without public comment due to the emergency circumstances.  However, their policy notes, “This guidance document is being implemented immediately, but it remains subject to comment in accordance with FDA’s good guidance practices.

Comments may be submitted at any time for FDA consideration. Submit written comments to the Dockets Management Staff (HFA-305), Food and Drug Administration, 5630 Fishers Lane, Rm. 1061, Rockville, MD 20852. Submit electronic comments to https://www.regulations.gov. All comments should be identified with the docket number FDA-2020-D-1139 and complete title of the guidance in the request.”

Food Allergies at the Food Pantry – Information and Resources for Food Pantries May 18, 2020

 

According to a study conducted by Dr. Ruchi Gupta and her colleagues in 2013, having a food allergy in the house costs an additional $4,000 per year.  Among the many factors that go into that figure is the cost of food allergy-friendly food.  Safe food can cost two to five times as much as their regular counterparts.  For example, a jar of peanut butter currently costs $1.19 and a jar of peanut-free sunbutter costs $6.29. It’s the same story with dairy-free milk and gluten-free pasta. These differences are enough to blow almost any budget.

 

 

Food banks and food pantries should be aware that about 10% of all of their clients and client families have a food allergy.  This doesn’t even include those with celiac disease which also requires a restrictive diet. When one family member has a food allergy, the food is often excluded from the home out of an abundance of caution. While food allergies directly affect 10% of the population, they indirectly affect the entire family by impacting their food selection.  This leaves food allergy families with few viable options when seeking out assistance.

 

As you can imagine, the inability to afford safe food disintegrates an already delicate situation quickly making mealtimes even more dangerous or sparse.

 

Resources for Food Pantries

 

• Ask clients directly if they or a member of their household has a food allergy.  Some patients volunteer their food allergy diagnosis, but many do not.

 

• If you hear a client describing their experience with food with any of the following symptoms, they will likely need to avoid that food and should seek advice from a doctor.

 

• Symptoms of food allergy vary from reaction to reaction.  They include: hives, swelling, wheezing/trouble breathing, nausea/vomiting, fainting/dizziness, and tightness in the throat among others.  [Please see Anaphylaxis 101: Familiarize Yourself With the Symptoms for a full list of symptoms and what to do if they occur.]. These symptoms usually occur soon after eating.

 

• A food allergy is different than a food intolerance in several ways – the most important distinction of which is that food allergies are life-threatening whereas food intolerances are not. But, they BOTH require a patient to avoid certain foods. Strict avoidance is necessary for food allergies.

 

• U.S. food manufacturers are required to label for certain allergens by their common name. And “Made in a facility with…” or “May contain…” statements are completely voluntary.  Read about food labeling laws here [The Ins and Outs of Reading Food Labels] and offer this information to your clients who may have a food allergy.

 

• If food is being prepared on site, please familiarize yourself with “cross contact” also referred to as “cross contamination.”  This occurs when an allergen touches another food directly or indirectly by touching a shared surface.  For example, this can happen on counters, cutting boards, in pots, on pans, cooking and serving utensils, plates, etc.  And although you may not be able to see the allergen with the naked eye, there may be enough protein present to trigger a life-threatening reaction.  It’s important to clean work surfaces, pots/pans, and cooking/serving utensils when preparing safe food for clients with food allergies.

 

• When trying to remove an allergen, always use soap and water.  Hand sanitizer (which is effective in killing bacteria, viruses and germs) does not remove allergens  (which are made up of proteins) from hands or surfaces.  Always wash your hands before preparing a safe meal for clients with food allergies.

 

Food Allergies at the Food Pantry – Need Assistance? May 12, 2020

 

Photo by Monirb CC BY-SA 4.0

Affording safe food is on the minds of many right now.  With layoffs, furloughs and unemployment, more people are turning to food pantries than ever.  But if you have a food allergy, you may be concerned about facing challenges to obtaining safe food.

 

If you have food allergies and need food assistance, here are some things to keep in mind.

 

Tips for Those Who Need Assistance

 

• If you’re lucky to live near one, there are a few food allergy-specific food pantries operating in the United States.  Note: some have suspended operations due to COVID-19. They may, however, still be a resource for information during the lockdown.  Check out each organization’s page for eligibility requirements.
  • Food Equality Initiative – operating in and around Kansas City, MO
  • Mend Hunger – operating in and around Chicago, IL
  • S.A.F.E. – serving people in and around Howard County, MD
  • Garden of Health – serving people in and around Montgomery County, PA
  • The Rachel Way – operating in and around Plymouth, PA
  • The Gluten-Free Food Bank – operating in Massachusetts

 

• There are many local food pantries kindly serving the public right now and some are willing or already stocking safe supplies.

 

• If you’re looking for specific allergy-friendly (or “free-from”) staples, those goods may be harder to find.  Sometimes, food pantries will shop for/hold items for those with medically necessary diets.  Call your local food pantry and explain your family’s needs.

 

• Rather than relying on staff, check the food choices for you/your family personally, taking time to read labels.

 

• Many of us are relying on brands we haven’t used before.  Read the ingredient labels of all food carefully.  Remember that allergens outside of the top 8 (dairy, eggs, wheat, soy, peanuts, tree nuts, fish, and shellfish) are not required to be labeled by their common name.  And manufacturers are not required to label for possible cross-contamination.  Call the manufacturer directly for more information.

• If there are prepared meals on site, ask a supervisor about whether the staff receives food allergy training and/or take measures to prevent cross-contact and always have your epinephrine auto-injector with you as usual.

 

• Many schools are offering free lunches to their students.  Some are naturally free of certain allergens (often peanuts and tree nuts).  Call your local school district and speak with the food services manager to get details on how your district handles food allergies in these packaged meals.

 

• The Supplemental Nutrition Assistance Program (SNAP) and Women Infant Children (WIC) supplemental program are governed by each state.  Each have their limitations when it comes to food allergy-friendly food, but both SNAP and WIC may help in getting you staples as well as fresh produce and meat for your pantry.

 

• It was just announced that SNAP recipients can buy groceries through Amazon. Shoppers get free delivery when they spend over $25.  Visit amazon.com/snap-ebt for more information.

 

• The SNAP program goes a long way at farmers markets.  If there is one open near you, find out how you can take advantage of this promotion safely.

 

• Make your resources go further!  Use fresh food first, followed by frozen foods and pantry items.  Planning meal ahead of time with a thought towards how to incorporate leftovers into future meals helps eliminate waste and makes the best use of your food.

 

• Food substitutions may be more practical than expensive free-from products.  For example, using applesauce ($2.75/jar) when baking may cheaper than buying specialty egg-replacer ($6.99/box). There are many great places to find these substitutions, like this one from Kids with Food Allergies.

 

 

Free-From Manufacturers Who SHIP TO YOU! April 18, 2020

Photo by Wonderland via Flickr, Attribution 2.0 Generic (CC BY 2.0)

 

It’s rough getting groceries these days!  You never know what you’ll see or miss at the supermarket.  One day it’s bread, the next it’s chicken!  And, those empty shelves can be a little disheartening.  It is even worse when you rely on a specific product to keep you safe and out of the hospital.

 

While most consumers can get by with a different brand here and there, families with food allergies can’t.  They depend heavily on specific brands and products to keep them fed and safe from experiencing a severe allergic reaction called, anaphylaxis.  “Free-from foods” are often in smaller supply than their  regular counterparts without a global pandemic. Because many consumers are buying in bulk (or sometimes panic buying) as they shelter-in-place, it often means food allergy-friendly essentials are unavailable to those whose health depends on them.

 

Let’s take a look at how to get the food you or your family needs as they STAY HOME and shelter-in-place:

Good tip:  Some companies are running a little behind on shipment (only a week) so order BEFORE you need something urgently.

 

We’ve noticed that some big box stores are selling certain free-from items online and are willing to ship things like gluten-free pastas (whereas boxes of regular pasta are often “in-store only” products). It’s worth taking a quick peek at these sites if you need a product more urgently since they tend to ship food fairly quickly.

 

Cold products (those that need to be refrigerated or frozen) are best purchased directly at the store or through a local delivery service (such as Instacart, PeaPod, etc).

 

Some items that are hard to find in person, are easy to find online.  Some free-from/allergy-friendly brands are shipping directly to their customers.  Look at all the manufacturers who are working overtime to ensure you get the products you need!

 

If you’re looking for a big or little treat, why not try a food allergy-friendly bakery?  Some are local (for pick up) and others you can order online.  Here’s Allergy Shmallergy’s list of Allergy Friendly Bakeries.

 

Allergic Living also compiled an excellent list of how manufacturers are handling the increased need for their products during the coronavirus – read here.

 

(Do you have a free-from product you’ve been purchasing directly?  Leave us a comment and we’ll add it to the list for other families!)

 

Schar  – offers gluten-free products including breads, snacks and pasta

Enjoy Life – offers products free from the Top 14 allergens!  Enjoy Life makes snack foods as well as baking supplies (chocolate chips, flour, pizza flour, etc).

Vermont Nut Free Chocolate – this feels critical to me!  I’ve already had enough chocolate to become a living, breathing chocolate Easter bunny.

Namaste – recommended by a baker, this is a great resource for gluten-free and allergy-friendly baking and waffle mixes, soups and pasta mixes.

Made Good – known for their granola bars and cookies, Made Good is currently offering 35% off plus free shipping!

Ener-G – Known widely for its egg-free egg replacer and gluten-free products.

WowButter – a tree nut and peanut-free sunflower butter now ships directly!

The Gluten and Grain-Free Gourmet – offers gluten, dairy and soy-free products.  Paleo friendly.

Safely Delicious – snacks that are free from gluten, peanuts, tree nuts, dairy, soy, and egg PLUS they are donating a portion of their proceeds to SpokinCares and Food Equality Initiative.

Eleni’s New York – the delicious, safe nut-free cookies can be delivered right to your door!!

The Gluten-Free Bar – selling gluten-free granola bars and bites!  On sale now…. stock up!

Cherrybrook Kitchen – their gluten, dairy, peanut, nut-free baking and breakfast mixes have been a staple of many pantries.

No Whey Chocolates – Chocaholics rejoice.  These are dairy, peanut, tree nut and soy-free.

ZEGO Foods – These healthy bars and mix-ins are full of the good stuff with none of the allergens.  For real – they are free of the Top 14 (check out their allergen statement!)

OWYN – selling plant-based protein drinks as well as dairy-free milk!

Kate’s Safe and Sweet – free from peanuts, tree nuts, soy, wheat, fish, shellfish, dairy and eggs (as well as pea, legume, sesame, chickpea and coconut-free!), Kate’s cake mixes, frosting, food coloring and accessories ship quickly straight to you!

Senza Gluten – This 100% gluten-free restaurant and bakery in NYC is closed through May 1st, but lucky for us they ship!

Kips – Who doesn’t love Top 8 free granola bark?!  Free from peanuts, tree nuts, dairy, eggs, wheat, soy, fish and shellfish.

Baked Cravings – Too many amazing tree nut and peanut free treats to name!  Ships nationally!

Simple Kneads – Small batch baked goods in a dedicated gluten-free facility.  I can smell the bread from here!

Partake Foods – Makers of delicious gluten-free, vegan (dairy and egg-free) cookies.

 

But wait, there’s more!

Should you need an epinephrine auto-injector refill and wish to avoid the pharmacy, remember that many pharmacies are delivering prescriptions free of charge.  And, Auvi-Q continues to serve patients through its excellent home delivery program that ships straight to your door!

Food Allergies, Eczema, Asthma and the Coronavirus (COVID-19) March 26, 2020

 

What strange times we’re living through!

 

Because we’re dealing with a novel virus (that means “brand new!” – lucky us…), everyone has LOTS of questions.  Many food allergy, asthma and eczema patients are concerned how COVID-19 interacts with their condition(s).  This information is best guidance from experts given what we currently know about the coronavirus, COVID-19. As always, speak to your own doctor about your personal health and follow best guidance issued by the Center for Disease Control (CDC).

 

We will keep updating this page as questions and answers arise.

 

Are patients with food allergies more susceptible to the coronavirus?  

No, having a food allergy does not put you at increased risk for COVID-19.  Even if a patient has experienced anaphylaxis, they are not considered immunocompromised or at a higher risk of catching the coronavirus.

Sources: Allergic Living

 

What about patients with asthma?

Patients with asthma are at the same risk of acquiring the coronavirus as the general public.  However,  because COVID-19 is a respiratory virus, outcomes for patients with asthma are unknown.  In addition to best prevention practices (social distancing, washing hands, not touching your face, etc), asthma patients are urged to continue maintaining their asthma – keeping it well-controlled is key.

 

For more clarification and more detailed information, please see AAFA’s coronavirus guidance here and speak to your personal doctor.

 

If I’m experiencing a severe allergic reaction, should I avoid the emergency room?

No.  We urge patients to continue being cautious (read labels, stick with brands you trust and ALWAYS carry epinephrine).  However, if you are experiencing severe symptoms of an allergic reaction (called anaphylaxis, learn to recognize the symptoms here), use your epinephrine auto-injector immediately, call 911 and get to the emergency room for additional care and monitoring.

 

Should I be aware of any food allergens in COVID-19 treatments?

It appears that there isn’t a universal medicine that doctors can prescribe to combat the coronavirus at this time.  The current treatments are all experimental and vary from hospital to hospital and patient to patient.  Wear a medical bracelet if you have one detailing your food allergies and mention your allergies should you need to see a doctor or be prescribed medication.

 

For more on this topic, please read the detailed answers from FARE’s Chief Medical Advisor, Dr. Tom Casale.

 

I hear there are spot shortages of inhaled albuterol.  Is it still safe to use a nebulizer for my asthma?

Nebulizers are believed to spread coronavirus by aerosolizing contagious virus particles, so hospitals are turning to inhaled albuterol to help COVID-19 patients (thus the shortage). However, using your nebulizer at home as prescribed is still safe. (Albuterol itself is still being produced at a normal pace.)

 

IF YOU SUSPECT YOU HAVE COVID-19, know that virus particles can remain in the air for several hours.  Be sure to use your nebulizer in an area away from other household members so as to minimize their risk of infection.

 

For more information, please see the American College of Asthma, Allergy and Immunology (ACAAI) site.

 

Is there an epinephrine shortage?

No, epinephrine auto-injectors are not experiencing a shortage.  Check the expiration date on your auto-injectors.  Should you need a new one, contact your doctor or local pharmacy.  Many pharmacies are delivering prescriptions as well as other supplies with no minimum and Auvi-Q operates on a direct delivery system.

 

I have eczema, is there anything I should do to prevent infection?

Eczema is a break in the skin’s natural barrier, so it’s critical to take extra care of your hands and face during the coronavirus outbreak to prevent discomfort and unnecessary touching of the face.  Currently experts do not believe having eczema poses an increased risk of contracting the coronavirus which is typically transmitted through the mouth, nose, and eyes to the respiratory system.

According to the National Eczema Association, there is no need to wash with harsh antibacterial soap.  If the skin on your hands are already cracked or prone to stinging, try soap formulated for sensitive skin, making sure to wash for 20 seconds as recommended.  Additionally, use lotions as usual to continue to heal the affected areas and use anti-inflammatory creams as needed.

 

I’m in the middle of oral immunotherapy (OIT).  How do I proceed?  Do I go to my regular visit?

This is a discussion best had with your doctor.  Many practices are delaying updosing during this time.  But food allergies vary from patient to patient as does oral immunotherapy treatment protocols.  Contact your doctor for detailed guidance.

 

Here are some additional places to reference with expert medical guidance and vetted facts:

Allergy and Asthma Network (AAN, The Network)

Asthma and Allergy Foundation of America(AAFA)

Food Allergy Research Education (FARE)

American Academy of Allergy, Asthma and Immunology (AAAAI)

American College of Allergy, Asthma and Immunology (ACAAI)

Center for Disease Control (CDC)

 

Be a Food Allergy Friend – Kid Edition March 3, 2020

You’ve probably heard of food allergies.  Someone in your class might have one.  Maybe your friend has one.  But what are they?

What is a food allergy?
Food is safe for most people, but a person with a food allergy cannot eat the foods they are allergic to or they will get sick and may need to go to the hospital.  The most common food people are allergic to are peanuts, tree nuts (such as almonds, walnuts, and pecans), milk, eggs, fish, shellfish (like shrimp and lobster), soy and wheat (bread, pasta, cake, and cookies for example) – but you can be allergic to almost any food!  Food allergies are a medical condition – that means they are not a choice.  They can be serious, so it’s important to know how to be a Food Allergy Friend.

 

 

Don’t Share Food 

People with food allergies have to be very careful about what they eat.  Even though it’s nice to share and be generous with your friends in general, it’s best not to share food with someone who has a food allergy.  They know how to read ingredients to find food that is safe for them.

 

Wash Your Hands!

Washing your hands before and after eating is a great habit!  It cleans your hands of dirt and germs before you eat so you don’t get sick.  After you eat, washing your hands wipes away food that your friends might be allergic to and keeps them safe and healthy, too!

 

Know What to Do

If your friend begins to feel sick or has trouble breathing after they eat, get an adult right away.  If no adult is around, call 9-1-1 and tell them about your friend’s food allergy and how they are feeling.

 

Speak Up!

Some times other people – even adults! – don’t understand what a food allergy is. YOU can help others understand how serious food allergies are.  And, if you see something that might not be safe for your friend with a food allergy, speak up and let someone know.

 

Have FUN Without Food

Food isn’t the special ingredient in having fun – your friends are!  So plan activities with your friends without the food.  There’s LOTS to do!  Build a fort, climb a tree, play ball, paint, jump rope…  you name it! What do you like to do with YOUR friends?

 

Is it Safe? Chocolate vs. Food Allergies February 7, 2020

Photo by Pixabay on Pexels.com

Chocolate might just be the key to the heart.  But if you have food allergies, proceed with caution – Chocolate can contain a number of common allergens.  Although people can be allergic to the proteins in chocolate itself (often times to cocoa), patients typically react to one of the many other common ingredients in chocolate products.  These are dairy, eggs, peanuts, tree nuts, soy, and corn among others.

 

Under the U.S. Food Allergy Labeling and Consumer Protection Act, food manufacturers must label for the top 8 allergens (milk, eggs, peanuts, tree nuts, soy, wheat, fish and shellfish).  Sometimes, however, allergens are present in a food but not named on the ingredient list.  Undeclared milk is the most frequently cited reason for FDA product recalls and chocolate is one of the most common products that causes consumer reactions.

 

What about dark chocolate? That’s safe, right?

Dark chocolate can contain milk even when it isn’t listed as an ingredient.  In fact, in 2017 the Food & Drug Administration conducted a study, testing nearly 100 different chocolate bars.  Only 6 listed dairy as an ingredient.  Of the remaining bars, 61% contained milk.  Why is this?  Dark chocolate is often produced on the same equipment as milk chocolate which cross-contaminates it making it unsafe for those with dairy allergies.

 

The FDA also found that milk was present in 3 out of every 4 dark chocolate products with advisory statements, such as “may contain” or “made on equipment with.”  These advisory statements are voluntary, so be sure to call the manufacturer if you don’t see one present.

 

What if I’m not allergic to milk? How do other food allergies fair?

Although dairy is one of the most common causes of allergic reactions when consumers eat chocolate, it’s not the only allergen to be concerned about.  Candy, treats and dessert products are often processed on shared lines with other ingredients and cross-contamination is a problem.

 

If you’re allergic to peanuts, tree nuts, soy, corn, eggs and wheat you should also be careful – as should patients with celiac disease.

 

White Chocolate?  Please tell me I can have that…!

White chocolate is made from cocoa butter, milk, sugar and vanilla.  Manufacturers also often add soy.  Just as with milk or dark chocolate, it can contain other common allergens such as wheat, corn, peanut or tree nuts that could cause a reaction.  If you are allergic to one of those allergens, you may wish to steer clear of white chocolate as well.

 

What IS Safe?  A lot actually!

If your mouth is watering just looking at square of chocolate, don’t despair!  Here are some allergy-friendly options to satisfy that sweet tooth:

 

Disclaimer: Manufacturers change their practices often and without warning. Always check the ingredient label and call the manufacturer should you have further questions.

 

[This is not a sponsored post.]

 

Andes Candies

These refreshing chocolate and mint treats are peanut, tree nut, and gluten-free and produced in a peanut, tree nut, gluten and egg-free facility.

 

Dove

SOME of Dove’s product line (Silky Smooth) are made free of peanuts and tree nuts in a peanut/tree nut-free facility (see link).  However, be sure to read labels carefully because Dove makes other products that contain nuts or could be cross-contaminated with them.

 

Enjoy Life

Enjoy Life’s products are always free from peanuts, tree nut, dairy, eggs, soy, wheat/gluten, fish, shellfish, sesame, sulfites, mustard, lupin, and crustaceans.  And you can sometimes find it in your local grocery store!

 

Free2B Sun Cups

For those with peanut, tree nut, and/or dairy allergies, these sunbutter filled chocolate cups are just as good as their peanut butter counterparts but SAFE!  All of their products are free of the top 12 allergens (dairy, egg, peanuts, tree nuts, soy, wheat, fish, shellfish, sesame, corn, mustard, and coconut).

 

Hershey’s

Contact Hershey’s to get the latest allergen information.  They have a fair number of gluten-free products.  Milk-chocolate Hershey’s kisses were processed in a peanut and tree nut-free facility on peanut and tree nut-free lines as of summer 2019.  Plus, Hershey’s utilizes good labeling practices, offering thorough ingredient and advisory labels.

 

No Whey Chocolate

No Whey Chocolate products are always free from peanuts, tree nut, dairy, gluten, egg, soy, and artificial colors and flavors. (Plus, they’re vegan and kosher!)

 

PASCHA chocolates

PASCHA products are free from peanuts, tree nuts, dairy, eggs, wheat/gluten, soy, sesame, fish, shellfish.  Check out their website where they clearly label their (lack of – *except soy*) cross-contamination list.

 

Safe Sweets

This family owned company makes treats that are peanut, tree nut, dairy, and gluten-free in a free-from facility. Many of their products are also soy-free – be sure to check their FAQ section to identify which ones.  (They are also kosher pareve and some products are vegan!)

 

Vermont Nut Free Chocolate

It’s in the name: nut-free chocolate that’s delicious and easy to order.  They are very allergy-aware and will label if a product is processed alongside anything in the top 8 allergens.  You can find these in stores or order online.

AllergyStrong Presents at the Food Allergy Fund Summit January 28, 2020

 

 

(My apologies! I am well overdue in posting about this excellent and always informative event.  Please be sure to see the full list of presenters and agenda on the Food Allergy Fund’s site.)

 

 

[Click here to watch the Agents Of Change panel video – Food Allergy Fund Summit DC.  AllergyStrong begins around 33:00/34:00 minutes in.  But be sure to watch the entire video – every advocate and their efforts are highly impressive and so vital to our community.]

 

In November, I had the good fortune to attend and participate in the always-fascinating Food Allergy Fund Summit held at the Newseum in Washington, DC.

 

With the Capitol in the background, CNN’s Chris Cilizza moderated a day that brought together a diverse group of speakers.  Researchers, legislators, doctors, advocates, innovators, journalists and celebrities treated attendees on the current state of food allergies.  Themes of the day included:

• The role of the FDA and state of federal funding
• The psychology behind food allergy management during adolescence
• The intricacy and mystery surrounding immune cell response
• The latest immunotherapeutic innovations
• The gut and microbiome’s role in immunology
• Advocacy efforts

A major theme of the day was the underserved community.  Dr. Hemant Sharma, Director of the Food Allergy Program at Children’s National Medical Center and Chief of the Division of Allergy and Immunology, spoke at length about health and racial disparities in food allergy.  Dr. Sharma outlined the unmet needs to the underserved community and how Children’s National Medical Center has set out to address them.

 

The subject of the underserved community is near and dear to my own heart.  I began AllergyStrong to address the needs of the underserved community.

 

As such, AllergyStrong was proudly featured on the Agents of Change advocacy panel alongside passionate and driven advocates like Mary Vargas, Lianne Mandelbaum, and JJ Volupas, moderated by Allergic Living Editor, Gwen Smith.

 

The word “underserved” is an industry term that refers to patients who lack access to critical resources – in this case, access to food, healthcare and education.  The underserved community encompasses low income patients as well as food insecure families, minority populations – especially those who lack adequate language skills to navigate the healthcare system, rural communities where resources are not easily accessed as well as at-risk patients such as those who find themselves using public assistance due to extreme weather, fire, or other natural disasters.

 

AllergyStrong exists to help bridge the gap in health education and awareness.  Several disparities we try to address:

 

1. Access to medical care and resources.
   We work to promote and provide food allergy education to communities through community health clinics and school nurses.
2. Lack of education and awareness.
   To promote education and awareness, we filmed a public service announcement this summer in partnership with some outstanding organizations.  Our PSA, Spell It Out aims to clear up misconceptions about food allergies and inform students and caregivers about the basic facts of living with the condition.  AllergyStrong works with organizations such as schools and food pantries to bolster support and protection for patients with food allergies.
3. Access to affordable safe food.
   We also work with social services and case workers who serve clients with food allergies to help usher families through a difficult time.

 

To stay in-the-know about AllergyStrong’s activities and how you can help or participate, please subscribe to our newsletter here.

 

What a day!  And, the perfect quote!

 

Click here to watch the Agents Of Change panel video – Food Allergy Fund Summit DC.  AllergyStrong begins around 33:00/34:00 minutes in.  But be sure to watch the entire video – every advocate and their efforts are highly impressive and so vital to our community.

Food Allergy Treatment: OIT 101 January 21, 2020

[DISCLAIMER: Oral Immunotherapy is always conducted under the direction and supervision of a medical doctor.  It is an individualized plan.  Please talk to your doctor if you’re interested in learning more about OIT.  This is not an endorsement of OIT and is for informational purposes only.]

 

While the U.S. Food and Drug Administration considers whether to approve Aimmune’s  Palforzia – possibly the first drug to be approved for peanut allergy, let’s get an overview of OIT.

 

Oral immunotherapy isn’t a new concept.  In fact, it has been discussed in medical journals for over a century and used for decades to help patients desensitize to environmental and drug allergies as well as build a tolerance to venom.  OIT has been studied in food allergy (mostly for peanut allergy) for the last 20 years and been in medical trials for just over 10 years.

 

Following a successful presentation to the U.S. FDA in September 2019, we stand on the cusp of seeing the first oral immunotherapy drug (Palforzia) approved.  Until now, food allergic patients have had no other option but to avoid their allergen for the life of their allergy.  FDA-approved drugs, like Palforzia, and other therapies would offer some patients progress, giving them much-needed treatment options to increase tolerance and protect them from life-threatening reactions for the very first time.

 

What is OIT?

Oral immunotherapy – or OIT – is a treatment option for some with food allergies that is managed and is strictly monitored by a patient’s allergist.  [NOTE: OIT and desensitization should ONLY be done under medical supervision and with guidance from your personal doctor.]

 

Oral immunotherapy is a safeguard.  It is a therapy intended to protect patients should they accidentally be exposed to their allergen.  It can also bolster a patient and caregiver’s mental health by reducing anxiety and stress caused by the heavy burden of food allergy management and unexpected, potentially life-threatening reactions.

 

Immunotherapy (whether oral, epicutaneous, sublingual or otherwise) is a treatment option to help patients tolerate a higher level of allergenic protein and is NOT a cure for food allergies.

 

Photo by cottonbro on Pexels.com

 

How does it work?

 

OIT is a form of desensitization – that is, the process of retraining a patient’s body to tolerate a larger amount of the allergen to which they are allergic without causing a reaction.

 

For example, if a patient is allergic to peanuts, a doctor would give a patient an amount of peanut protein (beginning with a tiny dose of 1/100th of a peanut or three milligrams). That dose is gradually increased until that patient can safely eat a level of protein that would otherwise cause a reaction.  The goal of many OIT programs is to get the patient to tolerate at least 600 mg of peanut protein (or the equivalent of 2 peanuts), although these goals vary from practice to practice and patient to patient.

 

Dairy OIT solution – photo by OakleyOriginals via Flickr (CC BY 2.0)

 

Is OIT only for those with a peanut allergy?

 

Although the FDA is currently only reviewing a drug aimed at peanut allergy, oral immunotherapy trials are available for those who suffer from other food allergies as well.

 

How effective is oral immunotherapy?  Does it work?

 

Peanut, egg and milk OIT has been studied most closely and shown to desensitize 60-80% of participants.  Studies related to peanut oral immunotherapy specifically have between 85-90% success rates.  Other food allergens have not been studied as thoroughly and initial results show they may not be as effective at increasing a patient’s tolerance.  These  numbers are the result of oral challenges and not real-world accidental exposure.

 

Can anyone pursue oral immunotherapy?

 

If you’re interested in OIT, it’s best to speak with your doctor.  The process of going through OIT can be demanding and does not fit every lifestyle.  And, there are certain food allergy-related conditions (such as eosinophilic esophagitis – EOE – and others) that might make immunotherapy more difficult.

 

Photo by Negative Space on Pexels.com

 

Consider this…

 

There are a few side effects that are possible while undergoing OIT.  The most common issue patient’s experience is gastrointestinal (reflux, cramping and vomiting), followed by oral itching, hives, and wheezing.  The risk for anaphylaxis is higher for those going through immunotherapy due to a patient’s regular exposure to their allergen.   Patients also risk  developing/inciting EOE – which often goes away when therapy discontinues.

 

The process of oral immunotherapy can be rigorous.  It requires an oral challenge, frequent doctor’s visits, and a comfort with using an epinephrine auto-injector.  Therapy also puts some restrictions on the life of patients as a precaution. For example, after dosing patients are required to rest to keep their body temperatures steady for 2 to 4 hours. And, daily monitoring is required.

 

Patients often need to take a daily or weekly maintenance dose indefinitely to keep up their tolerance.

 

Finally…

 

Oral immunotherapy is a much-needed treatment options for those seeking some protection and relief from the demands of living with food allergies.  Safeguarding patients against cross-contamination and accidental exposure is important for a patient’s physical as well as mental well-being.  But OIT is not for everyone.  If you’re interested, talk to your doctor about OIT and see if it’s a good fit for your lifestyle.

 

For more information, please read:

The Current State of Oral Immunotherapy from AAAAI