The Impact of Adult On-Set Food Allergies March 25, 2019

People often think of food allergies as a childhood disease, where 1 in every 13 kids have a food allergy.  And, much attention DOES need to be paid to the developmental years to keep young food allergies patients safe.

 

But recently, Dr. Ruchi Gupta and her research team reported that 1 in 10 adults have a food allergy in the United States – that’s 26 million adults.  This more than doubles previous estimates putting the total number of patients with food allergies over 32 million people in the US.

 

Beyond the fascinating information presented in her study.  This has tremendous implications outside of the medical field.  This number changes the discussion in a variety of industries who should now be taking food allergies into account in a way they may not have before.

 

 

To put it in all in context, food allergies affect:

• 1,500 passengers that fly Delta daily
• 260,000 passengers that the FAA serves daily in and out of U.S. airports
• 520,000 visitors to Disney World annually
• 15,000,000 guests at Hilton Hotels annually
• 10,000,000 diners at fast food establishments annually
• Almost 2,900 ticket holders at each and every Major League Baseball game
• 72,000 fans annually at AT&T Stadium watching the Dallas Cowboys play
• 400,000 teachers in primary and secondary schools
• Nearly 95,000 people working as chefs, cooks and other food preparation employees

 

 

But, these numbers aren’t exactly representative of all those who are affected by food allergies.  Parents, siblings, co-workers and friends all make decisions based on their companion with food allergies.  And, when handled well, those experiences flying, visiting amusement parks, staying at hotels, eating in restaurants, attending events, etc, leave a lasting impression that breeds customer loyalty.  Companies need to carefully consider food allergies and implement best practices to gain and retain this kind of loyalty.  If 32 million Americans suffer from food allergies directly, it may be safe to assume that as many as 120 million Americans are affected by them indirectly by enjoying time with allergic friends, family and co-workers.

 

Mistakes with food allergy do not only lead to uncomfortableness (such as hives), as many who do not have food allergies sometimes believe.  They can lead to serious emergencies as reactions vary from simple hives to fainting, throat closing, respiratory distress and cardiac issues and need to be taken very seriously in order to be managed properly.  This requires education across the board and thoughtful policies that offer patients a safe experience.

 

What can companies do to offer safe options to those with food allergies?  Where can they be more transparent?  What can they do educate their employees?  How will they prepare for a food allergic emergency?

 

It will be interesting to see which companies embrace these statistics and what they do to do be sensitive to this epidemic.

 

 

 

The Right Diagnosis for Food Allergies: IgE vs IgG Tests March 8, 2019

When you suspect that you or a loved one has a food allergy, you’ll want to get an official diagnosis.  More and more, patients are seeing offerings and advertisements for IgG test kits that claim to identify food allergies and sensitivities.  But what are they?  And, is that the correct test for diagnosing a food allergy?

 

What is an IgG test?

IgG tests  – known as food sensitivity tests – measure your immune-antibody response to foods.  Specifically, it measures something in your immune system called immunoglobulin G – the body’s most abundant antibody that protects against bacterial and viral infections. These kits require a blood sample (sometimes through a fingertip) that gets mailed back to a laboratory to evaluate.  Kits test against around 100 food products and food additives, sending you back results and recommendations.

 

How does IgG fit in with food allergies?

It doesn’t.

 

According to Dr. Dave Stukus of Nationwide Children’s Hospital, IgG cells are more of a memory antibody – they don’t predict food allergy or food intolerance.  Instead, IgG cells are a response of the immune system after the body has been exposed to a food.  It’s no wonder some people get results many items long – it indicates they have a varied diet, but does not suggest food allergy nor food intolerance.

 

According to the American Academy for Allergy, Asthma and Immunology (AAAAI):  “IgG and IgG subclass antibody tests for food allergy do not have clinical relevance, are not validated, lack sufficient quality control, and should not be performed.”  

 

The European Academy of Allergy and Clinical Immunology says the presence of IgG4 antibodies “should not be considered as a factor which induces hypersensitivity, but rather as an indicator for immunological tolerance… In conclusion, food-specific IgG4 does not indicate (imminent) food allergy or intolerance, but rather a physiological response of the immune system after exposition to food components. Therefore, testing of IgG4 to foods is considered as irrelevant for the laboratory work-up of food allergy or intolerance and should not be performed in case of food-related complaints.“

 

In other words, they don’t recommend it as a diagnostic tool for food allergy or intolerance because it may result in unnecessarily avoiding healthy foods and cause undue stress and anxiety.

 

What is an IgE test and how does it differ from IgG?

Not to be confused with IgG tests, IgE tests are associated with food allergy and allergic responses.  An IgE test measures immunoglobulin E, the antibody responsible for initiating and perpetuating an allergic reaction.  It is measured through a blood test and the results are given as a number to indicate your likelihood of being allergic.

 

Are there other diagnostic tests?

Yes.  Skin prick test are also often used.  The skin is lightly irritated with a liquid form of various allergens.  If allergic, the skin will develop a hive at each allergic location.  The size of that hive will remeasured and recorded.

 

The gold standard of testing for food allergy remains the oral food challenge.  Under medical supervision, a patient is given small, then increasingly bigger amounts of an allergen, and monitored for signs of reaction. If they show no signs, it means their body tolerates that food and they are usually not considered allergic.  If they react, it means their body does not tolerate the food, they are considered allergic and that food should be avoided.    [To learn more about Oral Challenges, read What is an Oral Food Challenge and How to Prepare]

 

 

If you suspect you or someone you know has a food allergy, be sure to talk to a doctor and get the right test so that you can make healthy decisions about how to stay safe and feel great.

 

Food Allergy Family in Need January 31, 2019

A FAMILY NEEDS OUR ASSISTANCE!

 

Please review the Amazon Wish List (below) to help.

 

Many at-risk and food insecure families across the country (and around the world) struggle with the cost of allergy-friendly food. Families in crisis – that are already struggling with major obstacles – are forced to make difficult decisions about how to feed and care for their food allergic children. They are sometimes forced to decide between feeding a child safely or at all.

 

To face this terrible situation breaks my heart.

 

I’m consulting with a case worker who has a family struggling with these very issues.  Their child has multiple food allergies and they are struggling to afford the free-from food they require.  They are in crisis.  Let’s make things easier for them.  We can help this family feed their young child as they weather this difficult transition. Please visit AllergyStrong or Allergy Shmallergy‘s Facebook page for more information.

 

AllergyStrong Amazon Wish List

 

Thank you in advance!

 

Food Allergy or Food Intolerance? January 14, 2019

 

Following an illuminating study conducted by Ruchi S. Gupta and her colleagues Christopher M. Warren, et al, it is clear that most Americans don’t understand the difference between a food allergy and a food intolerance.  The study found that in the U.S.  20% of adults claim to have a food allergy, but when evaluated by a medical doctor only 10% have symptoms consistent with a true allergy.

 

What is a food allergy? What makes it unique?

Food allergies are an immune system response to food.  When the body mistakes a food as harmful, it produces a defense system (in the form of antibodies) to fight against it.  These antibodies in the immune system – called immunoglobulin E (IgE), found in the lungs, skin and mucous membranes – release a chemical that sets off a chain reaction of the vascular, respiratory, and cardiac systems.

 

Food allergic reactions can vary from hives, swelling of the mouth, lips and face, and vomiting to respiratory issues (such as wheezing), drop in blood pressure, fainting, and cardiac arrest.  Anaphylaxis is a very serious and potentially fatal condition that is characterized by a sudden drop in blood pressure, loss of consciousness and body system failure.  Epinephrine (administered by an auto-injector) is the only medication that can slow or stop anaphylaxis.

The most common foods that cause a food allergic reaction are:  peanuts, tree nuts (such as walnuts, pistachios, pecans, etc), dairy, eggs, wheat, soy, fin fish (salmon, tuna, etc), and shellfish.  But almost any food can cause an allergic reaction.

 

 

What is a food intolerance?  How does it differ from a food allergy?

Food intolerances also make people feel discomfort.  However, this discomfort is not life-threatening.  Food intolerances are a digestive response that occur when food irritates the digestive system or makes it difficult for a person to break down the food.

 

Symptoms of a food intolerance can include bloating, gas, nausea, stomach discomfort/pain, vomiting, diarrhea, heartburn, headaches, and irritability.  Dairy, or lactose intolerance, is the most common trigger.

 

What are some other differences?

 

Food allergic reactions can occur with even the smallest amount of food ingested.  In addition to the range of major symptoms when ingested, it can also cause a skin reaction just upon contact.  A food allergy is a reaction to the protein contained in a food (such as gluten with a wheat allergy).

 

With food intolerances, amount of food consumed matters.   The more food consumed, the worse the digestive reaction.  Food intolerances occur because the body cannot break down the sugar in a given food (like lactose in milk).

 

Food allergies are diagnosed in several ways.  The golden standard is an oral food challenge – where a patient eats their suspected allergen under medical supervision to note the reaction.  Patients may take an IgE blood test or be asked to take a skin prick test to diagnose and monitor food allergy.

 

When a food intolerance is suspected, patients are often asked to keep a food journal or diary in which they note the foods they ate as well as the symptoms they experience.  Patients may also be asked to eliminate a particular food from their diet and note symptoms for a period of time.

 

In both cases, a doctor will help give an official diagnosis and guide the patient through any changes that need to be made to their lifestyle.   Those with food allergies will also discuss issues like cross-contamination, emergency action plans, and epinephrine.  Those with food intolerances may talk about medications that can help to ease symptoms. Avoidance of problem foods will be suggested for food allergies as well as food intolerances.

 

Knowing the difference between a life-threatening food allergy and an uncomfortable food intolerance will help keep you safe, make appropriate lifestyle changes and get you the relief you need sooner.  

 

 

We Need YOU! Call to Action for Sesame Labeling December 20, 2018

 

Photo by Pixabay on Pexels.com

Living with a sesame seed allergy (and any allergy outside of the Top 8) is challenging.  To get a sense of it, read Sesame: The 9th Food Allergen? originally published in Allergy & Asthma Today magazine.

 

With claims that sesame-derived products are healthier and our taste for international cuisine is on the rise, it’s no surprise that the prevalence of sesame allergies is increasing. And, like the peanut, allergic reactions to sesame can be severe.  The allergy is misunderstood by others who often incorrectly assume that if you can’t see sesame seeds on top of a food, that they aren’t inside either.  Sesame labeling is also a large part of the problem.  Sesame can be labeled in a number of challenging ways.  In addition to the long list of alternative names, sesame can be listed as “seasoning,” “spices,” or “natural flavoring.”  This makes it nearly impossible to know whether a product actually contains this allergen or not without calling manufacturers.  Additionally, manufacturers are not required to disclose the presence of sesame often citing proprietary reasons.

 

The FDA is finally considering a request to add sesame to the Food Allergen Labeling and Consumer Protection Act (FALCPA) requiring manufacturers to label for sesame as they currently do for the Top 8 allergens (peanut, milk, egg, tree nuts, wheat, fish, shellfish, and soy).   All of the national food allergy non-profits are weighing in to give supporting documentation and research, but the FDA needs to hear from you!

Please take a minute to report your experience and challenges to the FDA using this form below:

FDA Regulations – Sesame as Allergen in Foods

 

It only takes a minute or two, so please submit your comments today!  The FDA is welcoming comments only through Dec. 30, 2018.

 

**If you have emails from manufacturers or photos of labels where sesame is hidden under an alternative name or not listed at all, please submit these as attachments as they will be powerful examples of what consumers are facing.**

 

Keeping our fingers crossed…  Thank you for your support!

 

FDA Issues New EpiPen Warning – November 2018 November 19, 2018

Before you head out of town for Thanksgiving, please be sure to check your EpiPens!

 

A new advisory issued by the FDA warns that some EpiPen Auto-Injectors may not slide of out the plastic carriers case easily.  The labels attached to some of the EpiPen 0.3mg and 0.15mg auto-injectors as well as the authorized generic versions of the same strengths may prevent the devices from easily slipping out of the protective carriers, making access to the auto-injectors difficult or impossible.

 

In a letter of explanation, Pfizer (the makers of Mylan’s EpiPens) notes that the labels may have been improperly applied during manufacturing.  In an emergency, this may make it hard for patients to get their auto-injectors out of the carrier tube, delaying administration of epinephrine.

 

*It is important to note that neither the medication (epinephrine) nor the auto-injector itself is affected by this warning.  Both the medication and the auto-injector will work properly once removed from the protective carrier case.*

 

If a patient has a device that does not slide out easily from the tube or a label that is not affixed properly, please contact Mylan Customer Relations at 800-796-9526.

 

For more information, please read the joint statement from Mylan and Pfizer here.

Carrying Epinephrine: Stunning Stats and Easy Solutions October 16, 2018

We all know that the best treatment for anaphylaxis, a severe life-threatening allergic reaction, is an immediate dose of epinephrine.  So, why then do patients not carry it?

 

Some patients do not have access to epinephrine.  Although the drug epinephrine itself is not expensive, the devices used to administer it can be very costly.  Sometimes prohibitively so.  Many are working to reduce the price families must pay at the pharmacy.  The makers of Auvi-Q, for example, are offering their product for free to those with commercial insurance (including those with high deductibles and for whom it is not covered) in an effort to get epinephrine in the hands of patients who need it [read more here].  A generic EpiPen has just been approved by the FDA to be introduced in the coming year.

 

Teens are a group known for their non-compliance in carrying epinephrine.  Teenagers, wired to take risks and extra concerned about fitting in with peers, are often found without epinephrine when they critically need it.  In an effort to be like everyone else,  they some times purposely leave their auto-injectors when socializing with friends.  Adolescents will also mentally minimize the perils of leaving their auto-injectors at home and/or not reading ingredient labels while basking in the potential benefits of acting and operating like their friends and not drawing attention to themselves – a dangerous combination.

 

An Alarming Study

 

Dr. Dave Stukus and his colleagues from Nationwide Children’s Hospital conducted a study  four years ago of patients and their caregivers being seen by an allergist at their clinic.  Among their patients at high risk, only 40% carried auto-injectors even though 60% knew that epinephrine should be carried with them at all times.  Nearly 50% of patients carried expired devices and of the 60% diagnosed with asthma (which could make an anaphylactic reaction even more serious) only 38% carried had epinephrine with them at their clinic visit.

 

But Adults Surely Know Better…

 

Nope.

 

Adults with food allergies fared no better.  A survey was conducted earlier this year (March – June 2018) of 597 people representing themselves and their children (a total of 917 patients).   While the majority of those questioned filled their prescriptions for epinephrine, almost half (45%) didn’t have their auto-injectors with them at the time of their most severe reaction.  Shockingly, 21% didn’t know how to use their epinephrine auto-injectors (EAIs).

 

#AlwaysCarryTwo

 

In the same 2018 study, fewer than 25% of patients or caregivers routinely carried multiple auto-injectors despite the advice that all patients carry at least two self-administering epinephrine auto-injectors.  Carrying two EAIs is critical in case one fails or a second dose is needed before emergency services arrives.

 

To Sum It Up

 

According to Dr. Stukus, there are several reasons for not carrying epinephrine:

• inconvenience
• cost
• forgetfulness
• complacency if a long time has passed between reactions
• expiration of previous EAIs
• lack of understanding that patients should carry two EAIs at all times

and, I would add

• denial of severity of conditions and the reality of a reaction

 

Solutions

 

First, all patients need access to epinephrine.  Financial assistance is available!  If you need help affording an auto-injector, please consider savings programs offered by the various pharmaceutical companies.  The non-profit Kids with Food Allergies has an excellent article to help make EAIs more affordable,  What to Do if You Can’t Afford Epinephrine Auto Injectors.

 

Second, education about the difficulties and dangers of managing a severe allergic reaction without epinephrine is needed.  This begins in the doctor’s office.  Physicians should ask about how and how often patients carry their auto-injectors and discuss best practices to make carrying two EAIs a habit.  In between visits, patients can learn how to properly use an epinephrine auto-injector and why there’s no need to be afraid of using it.

 

Smart placement of epinephrine will help you remember to take it with you.  It is important to note that you cannot store auto-injectors in your car (temperature fluctuations can affect whether the device will fire properly and how well the medication will work once injected).  Instead, consider leaving it on a hook by the door you exit out of, next to your phone or keys, or set a reminder on your phone to alert you 10 minutes before you’re due to leave the house.

 

There are always many ways to carry epinephrine.  A purse makes it easy.  But a drawstring cinch bag, gym bag or a backpack will work for men.  Some auto-injectors fit right into a pant pocket!  There are specialty products that help you carry your auto-injectors in inventive ways, such as running belts, wristlets, arm bands, leg holsters, clip-on bags, etc.

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Lastly, make it a habit.  You know that feeling when you forget your phone?  Or your lunch?  With regular practice, remembering your epinephrine will become second nature.

 

As Dr. Stukus sagely points out, emergencies are never planned.  They are not predicted.  Epinephrine auto-injectors are meant to be kept in arm’s reach.  Carrying your epinephrine is certainly a lot less hassle than going to the emergency room for the night.