Allergy Shmallergy

Simplifying life for families with food allergies.

Prep Your Meds for School: Refill Options July 28, 2017

Time to get your emergency medications ready for school.  Don’t worry:  there’s still lots of summer fun to be had!  But to maximize summer fun over back-to-school frenzy, there are a few things you can do.

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  1. Check the Date:  Check the expiration dates on your epinephrine auto-injectors.  If they are due to expire between now and December, it may be a good time to consider refilling your prescription.
  2. Know Your Options:
    • There are several choices of epinephrine auto-injectors these days and they all efficiently deliver the same life-saving drug (epinephrine) in different ways.  I’ll outline those different auto-injectors below.
    • Talk to your doctor and consider your lifestyle when choosing your auto-injector.
    • Be sure you, your school nurse, caretaker, and child are all familiar with how to operate the auto-injector(s) you choose to stock at home, school and elsewhere.
  3. Update Your Emergency Action Plan:  Your doctor may have provided you with one or you can take Allergy Shmallergy’s Emergency Action Plan to your doctor on your next appointment.  Make a copy for home, your car, on-the-go, and school.
  4. Ask Directly:  You may need to ask your doctor specifically for the auto-injector you wish to use.  Some doctors prescribe only one without discussion, but are certainly willing to write a prescription for the auto-injector that works best for you.

 

What ARE the options for epinephrine auto-injector:

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Auvi-Q:

Yes, it’s back on the market and better than ever.  Auvi-Q delivers epinephrine via a compact package that speaks to you.  You heard that right: it talks you through an injection, even counting down the length of time you are supposed to hold the device in place.  Plus, the needle automatically retracts, reducing the possibility of post-injection injury.  Each Auvi-Q is about the size of a deck of playing cards, easy to carry for everyone (especially teens, young adults and fathers – who can fit them in their pockets).

 

*Auvi-Q automatically ships and delivers their auto-injectors directly to you.  Initiate this process with your doctor.  To read more about their direct delivery service as well as their cost-coverage programs, refer to the Affordability program page.

 

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Adrenaclick:

Adrenaclick has a slimmer profile than the well-know EpiPen, but is about the same length. Adrenaclick is a no frills epinephrine auto-injector, often used as a generic for EpiPen.  In fact, responding to the rising costs of brand name epinephrine auto-injectors, CVS pharmacies (among others) replaced its stock of auto-injectors with Adrenaclick. In their words, “Patients can now purchase the authorized generic for Adrenaclick®… This authorized generic is a Food and Drug Administration (FDA)-approved device with the same active ingredient as other epinephrine auto-injector devices.”

 

*IMPORTANT, Adrenaclick operates differently than EpiPens and they DO NOT come with a trainer.  If you choose to use this useful auto-injector, be sure to also place an order for an Andrenaclick trainer.  And, do your research for best pricing locally.

 

EpiPen:

EpiPens are the most widely used and most familiar of the epinephrine auto-injectors.  In fact, its familiarity is what keeps many customers coming back.  School nurses and even non-allergic individuals may be more accustomed to its look and how to use it.  In addition, EpiPens are substantial – making them easy to find in a backpack or purse.  In 2016 Mylan, the manufacturers of EpiPen, released a generic of its own product in response to public pressure over its pricing.  Both products contain the same medication and use the same or similar injector mechanisms.  EpiPen’s price has not been reduced in any way and is the most expensive auto-injector on the market.  The generic version is less expensive, but still a price worth considering for many.

*Mylan does offer coupons which can be found on their website.

 

An Allergy Update from Krispy Kreme July 25, 2017

A Dozen Doughnuts from Krispy Kreme sameold2010 flickr

Dozen Doughnuts from Krispy Kreme – unedited by sameold2010 via Flickr Shared thanks to Creative Commons Sharealike license

 

Krispy Kreme contacted me last week to alert the allergy community of an ingredient change.  In December 2016, they introduced a Nutella doughnut.  And starting today, Krispy Kreme will begin to offer a peanut-flavored doughnut.  [Cue the chorus of groans…]

 

So, while Krispy Kreme will no longer be safe for those with peanut or tree nut allergies, do not despair!  If you check Allergy Shmallergy’s ever-growing list of Food Allergy Friendly Bakeries, you’ll notice a number of doughnut shops that are both safe AND delicious.

 

From Krispy Kreme:

“On July 24, Krispy Kreme Doughnuts will introduce a doughnut with peanuts and peanut ingredients in our shops and other locations where Krispy Kreme doughnuts are sold. Because the safety of our customers is our top priority, I wanted you and your community to be among the first in the U.S. to know about the introduction of this ingredient to our menu.

The introduction of this specific peanut menu item at Krispy Kreme Doughnuts is new, but Krispy Kreme shops have never been allergy-free and specifically nut-free. Our shops have ingredients that can contain known allergens, including nuts. We receive ingredients from suppliers who produce products with allergens, including nuts, tree nuts, fish and shellfish. While some shops do not sell products made with nuts on the menu, because of how our products are manufactured, none of our shops are ‘nut-free.’ Following national safety guidelines, we take many steps to clean machines and surfaces in our shops, but there is the possibility that trace allergens might be found in our products. As a result, we post and label known allergens and ask guests to make sure they check the post before entering our shops and the labels before consuming.

 

For more information about Krispy Kreme’s ingredients, please visit http://krispykreme.com/Nutritionals.”

 

What is Lupin Allergy and Why You Should Care June 26, 2017

Lupin allergy is on the rise.  But most people haven’t even heard of lupin in the first place.    Travelers to Europe, Australia, Canada, the Mediterranean and even the U.S. should become familiar with it.  So should those who are gluten-free as well as those who have a peanut or soy allergy.

 

Read the article I recently wrote for the Allergy & Asthma Network, entitled “Why Is Lupin Allergy Becoming More Common?” to find out what lupin is, where it is found and who is most at risk for a reaction.

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Why Is Lupin Allergy Becoming More Common?
from the Allergy & Asthma Network dated June 14, 2017

 

Have you heard of lupin? Don’t feel bad; most Americans haven’t heard of it either. But that’s likely to change.

 

What is lupin?

Lupin (or lupine) beans are legumes – putting them in the same plant family as the peanut. Lupin beans are high in antioxidants, dietary fiber and protein and low in starch. And like all legumes, they are gluten-free.

Lupin beans are commonly used in Mediterranean cuisine. Sometimes ground into flour and blended into regular wheat flour, lupin is also widely used in Europe and Australia. There, lupin is frequently found in baked goods and pastas as well as breads, sauces, beverages (such as beer) and meat-based products like sausage and hamburgers.

Lupin is showing up in the United States as well. It appears most often as a substitute for gluten or soy in free-from products as well as replacement for genetically modified ingredients and animal proteins (primarily dairy and egg).

 

Can you be allergic to lupin?

Although not one of the “Top 8” allergens, lupin is beginning to make headlines in the food allergy world. For many, eating products containing lupin is completely safe. However, for a few, lupin can trigger an allergic reaction. The odds of having a reaction are higher if you already have a peanut allergy. This is called cross-sensitivity.

There is no evidence that lupin allergy is more severe than other allergens. Like all allergic reactions, symptoms vary. Those who are allergic to lupin have reported reactions ranging from hives, swelling of the lips and face, to gastrointestinal and respiratory distress, and cardiovascular issues.

 

Do manufacturers label for lupin?

Due to the frequent use of lupin in European and Australian packaged goods, coupled with reports of allergic reaction, manufacturers in the European Union are required to label for lupin. But this requirement is voluntary in places like the United States, Canada, Australia and other parts of the world where you may find lupin listed among other ingredients without special emphasis. U.S. laws and regulations only require labeling to highlight the Top 8 allergens.

Those allergic to lupin or unsure should be careful of unlabeled, over-the-counter baked goods like pastries sold at a bakery, bread rolls served at a restaurant or beer at a local pub.

 

Other names for lupin are:

  • Lupin Bean/Flour
  • Lupine Bean/Flour
  • Lupin Seed
  • Lupini
  • Termes
  • Altramuz
  • Tarwi
  • Termos

While lupin is currently popular in Europe, its presence is increasing in the United States and elsewhere. As the demand for gluten-free and other free-from goods grows, so may the use of lupin.

If you are concerned you may be allergic to lupin, speak to your board-certified allergist to discuss level of risk, testing and prevention strategies. Avoiding the allergen is the only way to prevent an allergic reaction.

 

 

 

 

Best (and Worst) Practices of Some of Our Favorite Restaurants June 12, 2017

Restaurants need to pay attention to food allergies.  Aside from the obvious risk of health complications, misunderstanding of such common and serious conditions comes off as uninformed, unsympathetic, and negligent.  Sometimes even the best restaurants aren’t well-informed or trained about handling food allergy requests.  But when a restaurant gets it right, it earns a customer’s loyalty forever.  Below are some of the best and worst practices among our experiences.  I’d love to hear some examples of BEST practices from YOUR dining experiences by commenting below.

 

To understand what’s happening behind the kitchen doors, read Allergic Living’s Special Report, What Restaurants Are Getting Right and Wrong on Food Allergies.  And if you work at a restaurant, please read Simple Strategies for Restaurants to Manage Food Allergies for easy ways to improve food allergy service.

 

 

Hops (Greensboro, NC)

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The reputation of this burger joint was impossible to ignore.  And, we knew from our first year eating here that it was well-deserved.  In fact, I had been impressed that they offered gluten-free beer and buns, despite the fact that we do not eat gluten-free.

However, one night, arriving with a large group of friends, we noticed that a vegetarian burger containing nuts was added to the menu.  This greatly increased the possibility of cross-contamination for our peanut and tree nut allergic son.  We asked the server if the restaurant could clean a small portion of the grill before making my son’s hamburger. No. Could they grill his burger in a pan?  No.  Would they consider grilling his burger on a piece of clean tin foil?  No.

 

So, we walked across the street and ate there instead.  Rather than thinking flexibly, the restaurant has lost our business – not just our family’s business, but that of our entire group.

 

Miyagi (McLean, VA)

This Japanese restaurant is always crowded.  Its sushi is consistently fresh and delicious.

 

When we explained that my son had a sesame seed allergy and could not have any sesame on his order, they seemed to understand.   But it was a different story when the plate arrived with sesame seeds covering the side dish.  And the replacement was sent back on the same plate with the side dish scraped off.

 

Firebirds Wood Fired Grill (Moorsetown, NJ)

Driving down the New Jersey Turnpike, we all grew hungry and needed a break from the car.  We decided to stop at Firebirds off exit 4 on a whim.  And, what a great choice!  The food was great and the servers were extra careful with our food allergy requests.  The chef himself came over to our table to answer each question we had.

“I like to visit each table with food allergies personally,” he said, “so that you know I understand your concerns and we can discuss a plan so you know you’re eating safely.”

The chef watched his best friend deal with celiac disease and food allergies at restaurants and wanted to change that experience for his own customers.  The effort was enormously appreciated!

 

Clare and Don’s Beach Shack (Falls Church, VA)

This local restaurant is an experience unto itself.  In addition to its fun and friendly indoor ambiance, it has generous outdoor seating with a fire pit for the cool months and live music for the warmer ones.  The owners always make everyone feel warm and welcome.  Their quick response to our questions (even when that requires contacting suppliers or figuring out how to make something safe on the fly) is part of their natural, good-natured customer service.  And, it’s something we’re incredibly grateful for.

In fact, they’ve become so accommodating with and accustomed to my son’s orders that when the ticket comes into the kitchen, his meals often return to the table with a greeting from one of the owners herself.

 

Burton’s Grill (Charlottesville, VA and elsewhere)

This restaurant gets kids’ menus right.  Rather than ordering and substituting everything as food allergy families usually do, this menu allows kids (and their parents) to customize each piece.  And for those of us with dietary restrictions, that means more options, less hassle.  We still had a few questions for our server (safety of hamburger buns and fry oil) and were pleased to see the seriousness with which they sought the answers.  Such a great experience, we made a repeat visit within the same weekend.

 

Harvey Cedar’s Shellfish Co (Long Beach Island, NJ)

This is a perennial favorite for our family and friends.  A down-to-earth seafood restaurant with friendly staff is a no-brainer.  But nothing with food allergies is completely straight-forward.  As my son became more and more adventurous and we posed more and more questions about their menu, one server in particular took it upon himself to create an allergen menu with the help of the owner and chefs.  We were hugely impressed with this simple and easy to navigate menu.  It has encouraged my son to try even MORE menu items which has resulted in his love of swordfish, mussels, and lobster!

 

La Tela (Kiawah Island, SC)

We waited for 45 minutes to sit down at this popular wood-fired pizza and Italian restaurant just off Kiawah Island.  By the time we had been seated, it was late and the kids were STARVING.  We had a great time eating here a couple of years prior and were looking forward to a good meal.

When we told the waiter my son was allergic to peanuts, tree nuts, sesame seeds and sensitive to dairy (because of his EOE), a manager returned to discuss the menu with us.  She had thorough knowledge of kitchen preparations and ingredients.  As it turns out, because they use pine nuts in their pesto pizza (which contaminates the oven) only salad and plain pasta were safe for him – a HUGE disappointment.  But they were willing to prepare pasta for my son in a dedicated pot to ensure it was safe.  He was not thrilled, but we appreciated the extra step.

Unfortunately, the pasta arrived covered in sauce – something my son doesn’t like and specifically ordered against.  When we pointed this out to our server, he was clearly put out.  Annoyed and not hiding it, he said that although the kitchen could prepare another batch of pasta, it would take a very long time.  He suggested that my son just eat the meal in front of him.

The last thing you want to do is tell a food allergic child (or anyone with a medical condition) to just suck it up.  We left frustrated with our mixed experience.  While the restaurant itself was great, this visit emphasizes how much of your experience lies with the individual you are working with.  In our case: the server.

 

Sandbox (Long Beach Island, NJ)

Breakfast is tricky for those with dairy allergies.  So much of what kids want to order in the morning (pancakes, waffles, even scrambled eggs) is made with milk.  My son has become used to having fruit and bacon when we’re out at breakfast.  But on this one morning, he really wanted French Toast.  There were a lot of hurdles to overcome before we could safely order this: safety of the bread and preparation surface, can they coat it only in egg…?    Yes on all accounts.  This specially prepared French Toast – made in a separate pan – makes my son SO happy.  Sandbox’s flexible thinking makes him feel great and relaxed.

 

But, when we spoke with the owner, we experienced a funny lack of awareness.  While we complimented her restaurant at being so good at handling food allergies, she made a few insensitive comments.  We told her about my son’s many food allergies. Having been a former teacher, she said, “Oh!  I would have HATED to have you in my class!”  Later, my son asked, “What’s wrong?  Why wouldn’t she have wanted to teach me?”  Not the message you want your customers leaving with.  Also, you wouldn’t say that to someone in a wheelchair or with a serious illness.  Why say that to a child who similarly didn’t choose to have food allergies?

 

Rocco’s Tacos (throughout Florida)

Rocco’s Tacos is our Florida obsession.  My whole family loves eating at this festive and delicious restaurant.  It’s made even easier to love because across locations, Rocco’s takes food allergies seriously.  They seek out ingredients and are creative at work-arounds when necessary.  At our most recent visit in Boca Raton, the server approached us to let me know that his brother had food allergies, conveying that he understood our questions and concerns whole-heartedly.  That kind of information is so helpful when explaining what you (as the food allergy family) are looking for.

And, look!  They flag food allergy orders from the kitchen to table so that mistakes are avoided.  Love that system!

 

Sakura (Vienna, VA)

Japanese hibachi restaurants, as it turns out, can be a fantastic place to eat with food allergies.  Many do not use any dairy.  And their prep surface is diligently cleaned right in front of customers.

 

Sakura’s menu clearly states that they don’t use peanuts or peanut oil in any of its menu items.  They take time to understand the food allergies at our table and craft a careful plan to cook each meal in the proper order to ensure its safety.  When we eat with our extended family, as we often do, we need to avoid my son’s food allergies as well as my in-law’s – that means, no peanuts, tree nuts, sesame seeds, dairy, or shrimp.  They prepare everything with ease (and great skill!) right in front of us.

 

Panzone’s Pizza (Long Beach Island, NJ)

Panzone’s boasts some of the best pizza on the Jersey Shore.  But it was when we began ordering their other menu items that we realized how easy they made things for food allergic families like ours.  The owner pulled out a binder filled with ingredient lists for all menu items, including those from her suppliers.  Stock from suppliers is typically our biggest roadblock for information.  Restaurants often have no idea what is in a supplied item and cannot take the time to call to inquire.

 

Perusing Panzone’s ingredient binder allowed us to partake in items that are usually not safe elsewhere: like (cheeseless) cheesesteaks, amazing breaded wings, and fish tacos.

 

Simple Strategies for Restaurants to Manage Food Allergies June 6, 2017

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Dining out is stressful for those with food allergies.  Very stressful.  We carefully put our lives in the hands of wait staff, cooks and chefs in order to participate in the social aspects that surround food.  A well-educated waiter, manager or chef can create life-long patrons of a food allergic customer.  Negligent or ignorant staff could send that same customer to the hospital (or worse) and impugn their business’s reputation.

 

When dining out goes well, it’s the backdrop of a happy memory (and stomach!).  But when restaurants get it wrong, they don’t just lose a food allergic customer; they lose that person’s entire family and friends.

 

So many pitfalls surrounding food allergies at eating establishments could be easily avoided.

 

Food Allergy Training

It all starts with thorough training.

 

Food allergies and food preferences are NOT the same thing.  Understanding the consequences of ingestion in both cases is important.  Wait and kitchen staff also need to understand what each food allergy means.  I can’t tell you how many times we announce my son’s dairy allergy only to have the waiter return and assure us the meal we inquired about is, in fact,  “gluten-free” or doesn’t have any eggs in it.  This is both unhelpful and makes a customer feel as if the staff doesn’t understand food very well – not to mention food allergies.

 

 

In addition to reviewing how to handle a food allergy request in the kitchen, it’s important to relay some of these solutions to the waitstaff.  They should be able to help the customer think creatively and to reassure them that your restaurant understands their concerns and can prepare a safe meal for them.

 

At one restaurant with a large group of friends, we noticed that a vegetarian burger containing nuts was added to the menu.  This greatly increased the possibility of cross-contamination.  We asked if the restaurant could clean a small portion of the grill before making my son’s hamburger.  No. Could they grill his burger in a pan?  No.  Would they consider grilling his burger on a piece of clean tin foil?  No.  So, we walked across the street and ate there instead.  Instead of thinking flexibly, the restaurant has lost our business – our entire group will not eat there any longer.

 

Conversely, we’ve found a breakfast place that will make my son’s french toast both without milk and cook it in a separate pan to ensure it’s safe.  All done with a smile.

 

 

Prep Waitstaff to Handle Common Questions

In addition to giving waitstaff information about what can and cannot be accommodated in your restaurant’s kitchen, arm them with information about your dishes.

 

If there are only 3 dishes with tree nuts, highlight those items.  Perhaps the kitchen stocks (but does not advertise) gluten-free pasta.  Sorbet does not contain dairy – be sure to point that out!

 

Practice Answering the Customer/Understand their Perspective

 

Give waitstaff, cooks, chefs and managers time to practice responding to customer concerns.  Those with food allergies often feel as if they are imposing on others by asking a lot of questions and getting reassurances that they can eat safely.  In short, they sometimes feel as if their food allergy is an imposition.

 

Restaurants can and should respond with patience and kindness – reducing the stress of dining out and increasing a customer’s positive experience.  But sometimes, they don’t:

 

At one Italian restaurant, there was only ONE item on the menu that would up being safe for my son.  When we mentioned to the waiter that we had asked for it without sauce, he responded poorly.  After making it seem like a huge hassle to redo, he basically suggested my son just suck it up.  Wrong message.

 

You’ll read many more examples in Shmallergy’s upcoming post, Best (and Worst) Practices of Some of Our Favorite Restaurants.

 

Supplier Lists/Binder of Ingredients

Keep a binder (be in digital or paper form) that contains the ingredients of each item used in the kitchen as well as supplier information.  Remember to keep it up-to-date as suppliers and dishes often change.  This makes both checking ingredients as well as seeking answers to food safety questions much simpler.  We’ve flipped through many a supplier/ingredient book which has added a great amount of reassurance to our dining.

 

Another option is to create an allergen menu which allows waitstaff and/or diners to easily reference to allergens.  One restaurant we eat at regularly created one after my son began asking his own food allergy questions.  It doesn’t have to be fancy; just reliable.

 

 

These simple strategies to understand and accommodate food allergies will forge lasting relationships with customers and will enhance your restaurant’s reputation for service.

 

Food Allergy Retrospective: How Far Have We Come? May 17, 2017

When the term “food allergies” was first mentioned in our lives in 2005, my son was only a few months old.  Already suffering from severe, body-encompassing eczema and a family history of food allergies, my pediatrician mentioned that we’d have to approach first foods very carefully with him.  I thought she was being WAY overcautious.  Like a ridiculous amount.  I was told to avoid feeding him anything with peanuts, tree nuts, milk, egg, wheat, soy, shellfish, fish, strawberries, pork, and corn in it.  I remember thinking, who had ever heard of anyone allergic to corn?!  And, so much for Cheerios as a finger food!

 

Now twelve years later, I think about what a genius that same pediatrician was and what a long way we’ve come since that first discussion about food allergies.

 

In 2005, there were approximately 11 million Americans living with food allergies.  Today, there are 15 million. And that number is growing.  Back in 2005 there may have been 1 child with food allergies per class; now there are at least 2 in every classroom.

 

In 2005, there were no food allergen labeling laws.  Manufacturers could “disguise” ingredients under a variety of names.  If you were allergic to dairy, for example, you had to memorize over 45 different names of ingredients that contained milk protein (whey, cream, casein, lactose, curd, rennet, ghee, flavoring… read the complete list here).  There were no suggestions to include voluntary “may contain” statements.  And, manufacturers were not well informed about how to respond to customer service questions about the safety of their products.

 

In 2005, consumers had less choice of emergency medication but it was far more affordable.  A pair of EpiPens cost only about $50. Other epinephrine auto-injectors were hard to come by and Auvi-Q wasn’t even invented yet.

 

In 2005, I felt alone with my son’s condition.  I started writing about food allergies, in part, to reach out to other like-minded parents experiencing the same daily struggles and triumphs that I was.  There was no research about the psychological impact of growing up with food allergies.  I was figuring out how to parent a confident, competent kid AND how to safely navigate the world with food allergies all at once.

 

I am so thankful to you all today for being part of the Allergy Shmallergy community – for giving me feedback, reminding me that we’re not alone running into and overcoming food allergy-obstacles, and for supporting each other, helping to make each other’s lives simpler and happier.

thank-you-362164_1920 pixabay ryan mcguire

 

 

 

 

Best Allergy Blogs of 2017 May 8, 2017

allergyBANNER

 

Healthline compiles a list of each year’s best allergy blogs each of whom serves as a valuable resource to its readers.

 

Allergy Shmallergy is once again thrilled to be on this list and amongst such fantastic company.  I’m an avid reader of many of my co-honorees!

 

Thank you to those at Healthline for being an excellent resource to us all.  And congrats to all those on the list!

 

Click here to check out all the wonderful and motivated writers, advocates and innovators who are trying to make life better and easier for those with food allergies.