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

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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.)

 

 

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!  

 

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

 

 

 

 

 

 

Food Allergy Resolutions January 7, 2020

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Happy New Year!

 

Each new year brings the hope of getting things right, of bettering ourselves.  When we set new year’s resolutions, we often seek self-improvement, time for personal passions, valuable social interaction, travel and adventure.

 

For those with food allergies, a key component to all of those resolutions is sticking to good food allergy management practices.  There’s nothing you can’t do with food allergies, but you need to make sure you’re safe and prepared when you do it!

 

Setting small achievable goals will help reset your habits and keep you safe as you pursue your dreams.  Here are some food allergy resolutions we ALL should keep this year:

 

1. Always carry 2 epinephrine auto-injectors.  There are many varieties on the market today in all shapes and sizes.  Find one that fits your lifestyle and carry it with you everywhere (yes, everywhere).  This may take some creativity, but it’s critical because early use of epinephrine is shown to save lives and reduce complication at the hospital.

 

2. Know the signs and symptoms of an allergic reaction.  A severe allergic reaction, called anaphylaxis (ANA-FIL-AXIS) can be VERY SERIOUS and even fatal.  That’s why it’s key to know the signs of a reaction and to know what to do in the first few minutes.  The Language of a Food Allergic Reaction outlines both the symptoms as well as how a young child might describe them.

 

 

photo credit: mia! via Flickr, creative commons (CC BY-SA 2.0)

3. Know the labeling laws. Food manufacturers are required to label for the Top 8 allergens – these are responsible for 90% of all allergic reactions.  But they are not required to label for cross-contamination or any allergen outside of the Top 8.  Are your allergens in that list?  What else should you know?  The Ins and Outs of Reading Food Labels is critical to help you make safe decisions for yourself and your family.

 

 

Photo by Luis Quintero on Pexels.com

4. Teach ONE person how (and when!) to use an epinephrine auto-injector.  Food allergies are a growing problem.  Statistically, 2 kids in every classroom have them. So do 1 in 10 adults.  We either know someone with a food allergy or we are allergic ourselves.  To protect patients and create food allergy allies, let’s teach one friend or family member (who doesn’t yet know) how to use an auto-injector.  Let them use a trainer if you have one – this will empower them should they need to use the real thing in an emergency.  Even elementary school kids can recognize symptoms of an allergic reaction and be taught to get an adult or nurse and call 911.  It’s easy!

 

 

Photo by Joshua Woroniecki on Pexels.com

Send us your new year’s resolutions!  We love to hear what kinds of wonderful and exciting things you have your sights set on!

 

 

Donate These Allergy-Friendly Foods This Holiday Season November 25, 2019

 

Happy Thanksgiving!

 

There is so much to be grateful for this holiday season – family, friends, and good health among so many other things to be thankful for.  But some families are struggling, worried about where they will get their next meal.  When you add food allergies to their list of concerns, their situation goes from difficult to dire.

 

Food banks and food pantries will be feeding families through the holiday season and throughout the year.  And, reflective of the prevalence across the United States, 1 in every 10 adults and 1 in every 13 kids that uses these services will have a food allergy.  Many will not list their food allergy, as food allergies often go undiagnosed.  But obtaining a ingredients to make a safe meal will not be easy.

 

If you donate to food banks or food pantries this season, please consider donating some of these much needed, shelf-stable items for clients with food allergies:

• Gluten-free bread (shelf-stable, unrefrigerated)
• Soy, Rice and Almond-Milk (shelf stable, unrefrigerated)
• Gluten and nut-free cereals
• Sunbutter, Soynut butter, and almond butter
• Nut-free granola bars (such as Enjoy Life, Made Good, etc)
• Gluten-free pasta and GF pasta meals
• Soy-free cooking oil (such as canola, olive, etc)

 

Antihistamines May Endanger Patients Experiencing Severe Allergic Reactions November 20, 2019

When to use antihistamines and epinephrine has always been a point of confusion for the food allergic patients and caregivers.  But a 2019 study out of New York helps to clarify the role of antihistamines in serious allergic reactions.

 

Severe allergic reactions, called anaphylaxis, are serious and can become life-threatening very quickly.

 

 

 

 

A recent study by Dr. Evan Wiley et al. suggests that administering antihistamines, such as Benadryl and Claritin, to patients who may be experiencing anaphylaxis can put them at risk for a more serious reaction.

 

 

The four year study which was just presented at the American Academy of Pediatrics national conference in October 2019, reveals that 72% of patients who use antihistamines at home to treat an allergic reaction delayed seeking medical care.

 

This puts patients at risk.  

 

Old, now outdated guidance, used to suggest that the first line of defense for an allergic reaction was Benadryl or another antihistamine.  No more.

 

 

We now know that delayed administration of epinephrine is associated with more severe reactions – reactions which require more medication and more frequent hospitalizations.  That means the longer a patient goes without epinephrine and the attention of emergency care, the worse their condition may be and the longer it will take to recover.

 

The author notes that epinephrine is the ONLY known lifesaving medication and a delay in receiving epinephrine can prove fatal.

 

IMPORTANT TAKEAWAY

At the first sign of a severe allergic reaction (anaphylaxis), patients and caregivers should use their epinephrine auto-injectors and seek emergency medical care IMMEDIATELY.

 

The new advice is “Epi first. Epi fast.”  And call 911.

 

 

Review the symptoms of anaphylaxis here.

Here’s how a child might describe an allergic reaction.

Needle-Free Epinephrine May Soon Be a Reality October 15, 2019

 

By now, we all know that epinephrine is the first – and best – line of defense against a severe food allergy reaction called anaphylaxis.  But when symptoms of anaphylaxis first appear, many patients and caregivers hesitate to give it.  Why?

 

Not only are patients unsure about the timing to deliver a dose of the life-saving medication, but they tend to pause at the idea of giving an injection.  Parents worry that it will be difficult to administer or that it will scare/hurt their children. And, patients are at risk for minor injuries associated with delivery such as lacerations and misfirings.  Doctors and clinicians say epinephrine auto-injectors are “underused” in an emergency.  Delays in administration of epinephrine during anaphylaxis put the patient at risk for a more severe reaction that could require more medication to stabilize.

 

To date, patients have had a single option for getting a dose of epinephrine: an injection given to the patient through the outer, muscular part of the thigh.  But the food allergy community has long wondered, is there another way?

 

Enter: intranasal epinephrine.  

Essentially: epinephrine delivered through a nasal spray.

 

Researchers have examined how well the body absorbs epinephrine when it is given intranasally as compared to intramuscular injection (the way epinephrine is currently administered through auto-injectors).  What they found surprised us all:  epinephrine can be absorbed and distributed throughout the body as a nasal spray just as well as it would an injection.

 

This is wonderful news for patients and caregivers that are afraid of needles.  But it’s also good news for those wanting to help in an emergency.  Because nasal sprays are a less invasive treatment, patients and caregivers may find themselves more likely to act quickly, administering much-needed epinephrine sooner and more frequently than they would otherwise.  Nasal sprays could make acting in those first critical minutes of anaphylaxis easier which could make follow-on emergency treatment less complicated and would ultimately save lives.

 

A few pharmaceutical companies have begun developing intranasal epinephrine products.  One such company is Bryn Pharma which developed a portable, easy-to-use spray (currently referred to as BRYN-NDS1C). BRYN-NDS1C was granted Fast Track Designation by the FDA and is currently undergoing human trials.  Bryn’s nasal delivery device has already been approved for use in other conditions by the FDA.

 

Another company, ARS Pharmaceuticals, whose product is called ARS-1, was also given Fast Track Designation to develop intranasal epinephrine.

 

Studies and trials continue, while questions remain about the efficacy of this delivery system when a patient experiences such factors as nasal/sinus swelling or moderate to severe congestion.

 

Although final approval by the FDA and ultimate delivery of this medication to customers is still unknown, we should all have high hopes for more and innovative epinephrine options to consider in the future.