Food Allergies on a Budget September 9, 2022

It is no shock for those of us who live with this condition to learn that food allergies are expensive. The cost of medical care on top of prescription auto-injectors, grocery bills, time away from work to manage our condition, special child care (and sometimes schooling) can add up quickly. According to a 2013 study out of Northwestern University by Dr. Ruchi Gupta and others, food allergies cost over $4,100 per child in the U.S. That’s a total of over $20 billion dollars a year carried by patients and their families; $25 billion when other costs are factored in. To reduce the expense of food allergies on an individual or families budget, we need to look at a few key areas:

Prevention

From the Northwestern study, it is clear that prevention saves money. Hospitalizations accounted for the largest direct medical cost with emergency department visits coming in third. One way to manage your medical costs is to check in with your healthcare provider annually. Be sure to discuss any changes in your allergy, realistic risk and lifestyle management as well as treatment options available to you. Treatment can help protect you from accidental exposure by potentially lessening the symptoms of a reaction and keep you from needing emergency services.

Epinephrine Auto-Injectors

At that same yearly appointment, ask your healthcare provider which epinephrine auto-injector would be best for your lifestyle. Carrying a set of epinephrine auto-injectors is key to food allergy management and using it at the first signs of anaphylaxis can keep you out of the hospital and on the road to a quick recovery. There are many auto-injectors on the market to choose from, so finding one that fits your life should be easy. To make these more affordable:

• Check on manufacturers websites for coupons and other savings programs (for example, Viatris offers savings cards for EpiPen brand as well as their generic sets of auto-injectors and kaléo offers Auvi-Q for free to those who qualify).

• Call your insurance company to see which auto-injectors they cover and at what rate. Ask questions about how often you can renew prescriptions so that you can plan accordingly when you need a second (or third) set for work, school, or child care locations.

Food

Finding and buying allergy-friendly food can be a challenge. Dairy, egg, soy and wheat allergies – especially in combination – make purchasing safe food difficult and expensive. People with food allergies often need to shop at multiple supermarkets to find costly allergy-friendly products they can use. To save money on groceries, consider a few things:

1. Sign up for coupons on your favorite allergy-friendly manufacturers’ websites. While many stores don’t offer discounts on these “free-from” products directly, companies often offer. For example, if you scroll to the bottom of their homepages, Enjoy Life foods, Sunbutter, and others, offer coupons for both American and Canadian customers.
2. Use simple substitutions. Sure, you can bake with a speciality egg replacer at $6.50 a box. OR, you could use applesauce ($3.25 per jar).
3. Buy in bulk. We all know that bulk pricing is often lower per unit (ounce, pound, etc) than their smaller counterparts. Consider buying food that you use often in larger quantities. Also consider splitting the cost and contents of a bulk item (especially if it will spoil, like fruit, vegetables or meat) with a friend or member of your family – that way, you both get the best price!
4. Create a meal plan that utilizes leftovers from one meal to create another later in the week. You might have hamburgers one night and use the leftover ground meat to make tacos, meatballs, or chili another night.
5. Create a shopping list and stick with it. If you plan your meals, this is all you should need for the week or month.
6. Once you have your list, visit the website of the supermarkets near you to find the best prices. One store may be having a sale on just the item you need! And while you’re there, sign up for and take advantage of store loyalty cards. You can load coupons and discounts onto the card itself, so that all you need to do is enter your phone number at checkout to receive all the savings.
7. Save yourself a trip to a second or third store for those few allergy-friendly products they stock. Each stop means more time, more gas, and more temptation for impulse purchases. See if your item can be shipped to you via Amazon, Peapod, Walmart, Target, Costco, etc.

Food Assistance

Food assistance programs are a great way to get the food you need. Both the Supplemental Nutrition Assistance Program (SNAP) and Women, Infant, Children programs (WIC) are run by each state and offer a monthly stipend to be used on qualified products. Hint: your SNAP dollars go further at farmer’s markets!

Contact your local school to discuss availability of free breakfast and lunch programs. Some programs extend into the summer months, so be sure to inquire about how to access that benefit after school ends. These programs are available through the USDA and other non-profit organizations. While you’re there, also ask about weekend backpack programs run through food pantries and other non-profits.

If you need further assistance, contact a local food bank or food pantry. There are many tips for safely navigating the food pantry, so be sure to read through these suggestions. If possible, sign up to choose the items you need yourself (rather than having a box preprepared for you) – that way, you can pick food you like and read ingredient lists to make sure they are free from your allergen.

Medical Care

Contact your state to see if you qualify for Medicaid, an insurance program that provides medical coverage for individuals and families. If you do not, consider the Children’s Health Insurance Program (CHIP), also offered by each state. CHIP provides low-cost medical coverage to children (and sometimes to pregnant women) who earn too much to qualify for Medicaid. Like Medicaid, CHIP covers routine check ups, vaccinations, dental and vision care, emergency services and more.

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There’s no doubt that food allergies are expensive. But taking care of yourself, planning ahead, and reaching out for help when needed can go a long way in reducing cost AND stress.

Taking Care of Your Food Allergies AND Your Health May 10, 2022

There are a few simple things that everyone should be doing to protect their health. And while they benefit all, they are particularly important for people with food allergies. These activities aren’t just good for your well-being, they are also important to help prevent serious allergic reactions.

GET CONSISTENTLY GOOD SLEEP.

Yes, the elusive sleep recommendation… But studies show that sleep deprivation can lower a person’s threshold – meaning, the amount of allergen it takes to trigger a reaction. The lower a person’s threshold, the less allergen it takes to set off a reaction. Experts recommend getting a consistent amount of sleep every night by turning off devices an hour before bed; sleeping in a dark, cool room; and waking up at the same time every day ((sigh) yes, even on weekends…).

REDUCE EMOTIONAL STRESS.

Easier said than done, we know. Excess stress (and who doesn’t have that these days?!) also lowers your threshold and escalates potential reactions. Take care of your mental health by connecting with friends; getting out in nature; paying attention to your physical health (exercise, eat well, etc); engaging in yoga, meditation, or other relaxation techniques (like art, breathing and imagery exercises); taking breaks from social media and news when needed; and learning to say “no” to reduce feeling overwhelmed.

HYDRATE.

Water is critically important to the functioning of our bodies – and when they aren’t hydrated, it can wreak havoc. For someone with food allergies, dehydration can affect lung function, heart rate and core temperature – all of which are known factors in more serious reactions, known as anaphylaxis. You may be familiar with the “8×8 Rule”: every adult should drink eight cups of eight ounces of water a day. That amount might vary a bit based on where you live, your health, diet and what activities you do. One thing experts recommend is sipping on water even when you’re not thirsty to replenish all that you lose throughout the day.

LIMIT ALCOHOL USE.

Moderation is best. Alcohol dehydrates the drinker and can reduce threshold, triggering serious reactions faster. Alcohol can also decrease a person’s ability to make good decisions. People with food allergies have to be careful about what they eat and drink and they need to be able to evaluate their health in case of accidental exposure.

GET BETTER CONTROL OF YOUR ASTHMA.

It’s probably been on your to-do list anyway. Not being able to breathe clearly is no fun. It’s not only uncomfortable, it also dangerous for your health. Uncontrolled asthma can make allergic reactions worse by speeding up dangerous swelling in the lungs, making it difficult to breathe. Now is a great time to speak with your healthcare provider about lifestyle changes and other ways you can improve your asthma treatment.

ALWAYS CARRY TWO.

You can’t plan for accidental exposures, but you can be prepared for a reaction by always carrying two epinephrine auto-injectors. It is critical to carry a set with you (rather than leaving them in the car, a locker or at home) because occasionally a reaction may be persistent and require two doses of epinephrine before the patient reaches medical care. And rarely, devices are misused or misfire – so having a back-up is always a good idea.

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There’s no day like today to begin making positive lifestyle changes. Experts say it takes about three weeks to turn change into a new habit – so be patient and positive with yourself, making one good decision at a time. Talk to your doctor about these and other ways to improve both your health and your food allergy outcomes at your next visit.

Food Allergy Awareness Week May 9, 2022

AllergyStrong Food Allergy Awareness Month

Food Allergy Awareness Week (FAAW) brings attention to food allergies, a growing epidemic worldwide that affects up to 250 million people. But for those of us already living with this condition, FAAW is an excellent time to review important food allergy information, make changes to your food allergy routine and educate yourself on new information to improve your quality of life.

As the melodious Julie Andrews sings in The Sounds of Music, let’s start at the very beginning:

Food allergies are an immune system response to food. The immune system mistakes food for foreign substance and begins mounting an internal attack on it. For someone with a food allergy this results in a variety of symptoms that can range from mild to severe, to life-threatening.

To review symptoms of a reaction and anaphylaxis as well as how a young child might describe those symptoms, please see below.

The Language of a Food Allergic Reaction

There is no cure for food allergies. The most recommended treatment is food avoidance – that is strictly avoiding your allergens. While this sounds simple, food avoidance can be difficult to manage, time consuming, and costly.

For more information on US labeling laws and how to read food labels for allergies, please see below.

The Ins and Outs of Reading Food Labels

Some people with food allergies are pursuing a treatment called oral immunotherapy (or OIT). This is one of several treatments that offer “bite protection” for those with food allergies. This means, it would lessen or eliminate a reaction if someone with food allergies accidentally ingested their allergen. OIT and other similar therapies (like sublingual immunotherapy (SLIT), epicutaneous immunotherapy (EPIT), etc) offer protection but not a cure.

To learn all about OIT, please read the article below.

Food Allergy Treatment: OIT 101

Photo by cottonbro on Pexels.com

Food allergies are more common among adults than children. Studies show that 1 in 12 children have a food allergy whereas 1 in 10 adults do. Not only do food allergic kids grow to be adults, but adults are acquiring new food allergies in adulthood. These adults suddenly find themselves allergic to food they may have safely eaten their whole lives and navigating that change can be difficult.

To learn more about the impact of adults with food allergies, please see below.

The Impact of Adult On-Set Food Allergies

As we move through this week, we’ll explore several ways to make life a little better for you and the 32 million other Americans living with this chronic condition.

Food Allergies at School: Moving Beyond Food Bans December 10, 2021

For years, school administrators and parents alike have struggled with the question of how to keep students with food allergies safe while in their care. And in some cases, both schools and parents have supported school-wide bans on allergens in an effort to protect food allergic children. But for many, food bans just don’t work. So what do studies show? And what should schools be doing to safeguard children with food allergies?

School-Wide Food Bans

Food bans often prohibit all students from bringing in a specific allergen. Most often it is peanuts that are banned, followed closely by tree nuts (almonds, cashews, walnuts, pistachios, etc) or more generically “all nuts” (presumably peanuts and tree nuts). Limits like these can work on the classroom level, but are impractical when elevated to a school-wide policy.

1. Peanuts and tree nuts are only two of the nine most common allergens and there are over 160 documented foods to be allergic to.
2. Any allergen can cause a serious reaction. Banning nuts only protects those students and staff who have a peanut or tree nut allergy.
3. School-wide bans cannot be enforced.
4. Banning food school-wide often leads to the assumption that everything that comes through the school door is safe. We know that teachers and administrators cannot police every snack, special treat and lunch that each and every student and staff member brings. And the last thing you’d want to teach a food allergic child is to eat something (assuming it’s safe) without checking on the ingredients first.

Studies have also shown that food bans don’t protect students. In fact, a five-year study conducted by McMaster Children’s Hospital in Ontario, Canada notes that bans can actually stigmatize them by making them targets of frustration over food. Students with food allergies often cannot eat with their friends and become victims of bullying – a far too common, far too unmentioned experience of kids with food allergies.

When are Food Bans a Good Idea?

Preschool aged children are at a difficult developmental stage for food allergy management. They may not be able to understand the nuances and dangers of their food allergic classmates’ condition. In their effort to be a good friend, they may try to share food; and food allergic kids may be unable to distinguish safe from unsafe food at that age. And, of course, preschoolers have their hands on everything, setting the stage for cross-contact reactions.

Food bans are also a good idea within a classroom. The classroom is meant to be a safe and inclusive place for ALL students. It should be the protective home base for students with food allergies. Eliminating a student’s allergen from the classroom whenever possible is conducive to learning. If a student is worried that they may have a frightening reaction triggered by something in the classroom, they will be unable to focus on almost anything else as their minds and bodies go into fight or flight mode.

Food bans are also a good idea at group events such as the school dance, special group rewards involving food, team snacks, etc. Focusing on inclusiveness is critical – it’s a lesson in empathy and support for all involved.

What DOES Work? Better Management Ideas for Better Outcomes

Couple classroom and event-based food bans with these strategies for a protective and inclusive experience for students with food allergies:

1. Food Allergy Education: Kids are told to protect their friends with food allergies but are never taught the basics of the condition. Lessons on food allergy fit nicely into units about nutrition and health. Bonus: lessons about food allergy tend to be very interactive. They result in noticeably stronger sense of community and empathy for this and other invisible conditions in classrooms of all ages.
2. Food Allergy Training: Teachers, administrators and staff should also receive an education on food allergies. Theirs should include symptoms of an allergic reaction and the language a student might use to describe it, how to manage a reaction and what to do in case of emergency. They should also focus on the social/emotional impact of food allergies and related conditions so they can keep an eye on students who may be struggling.
3. Cafeteria: There are many ways to make the cafeteria a safer place for students with food allergies. First, make the ingredients transparent for diners by either posting the inclusion of the top 9 allergens on each item without an ingredient label or offering a point person to answer questions (or both). Second, offer allergen-friendly tables or seating. Peanut-free tables do not protect students with nut or other allergies. If there is flexibility, offer a broader allergen-friendly table where kids with food allergies can eat and feel understood. Also, reserve the ends of dining tables for kids with food allergies; this way, they can eat with their friends but not feel bound on either side by potential danger.
4. Enforce Hand Washing: Encourage or require children to wash their hands after eating and before entering their homeroom. Hand sanitizer (which is good at killing bacteria and viruses) does not remove the food protein that causes an allergic reaction. The only way to remove food protein is to wash with soap and water.
5. Stock Epinephrine: Finally, in addition to allowing students to keep an extra set of epinephrine auto-injectors at school, schools should take advantage of the Stock Epinephrine Act to keep extra, unassigned epinephrine auto-injectors at school for use by anyone who may experience a reaction. Anyone can develop an allergy to anything at any time in their lives, so having this life-saving medication available in an emergency is critical.

The ADA and Section 504: What it Means for Those with Food Allergies November 4, 2021

Equal Access and Protections Under the Law:

The Americans with Disabilities Act (commonly referred to as the ADA) is a law that prevents discrimination against people with disabilities. The ADA applies to workplaces, public schools, state and federal government institutions as well as spaces of public accommodation (private entities such as restaurants, museums, movie theaters, parks, etc). The ADA not only protects those with disabilities themselves, but also those associated with individuals with disabilities (such as caregivers).

Like the ADA, Section 504 of the Rehabilitation Act of 1973 is a national law that protects qualified individuals from discrimination due to their disability. This law applies to any center of education, employer or organization that receives financial assistance from the U.S. government. Examples of this include hospitals, public schools, nursing homes, human services programs, etc.

Section 504 centers around access and inclusion. Not only does this law require schools, employers and organizations who receive federal assistance to prevent discrimination based on disability, but it also requires them to provide equal access to program benefits and services to those with a qualified disability. It defines the rights of individuals with disabilities to participate in, benefit from and have access to programs and services.

Does Food Allergy Qualify as a Disability?

Under both the ADA and Section 504, qualified individuals are defined as those with a physical or mental impairment that substantially limits one or more major life functions. Food allergies puts a patient at risk of life-threatening anaphylaxis, limiting a patient’s ability to eat and interfering with their ability to breath – two major life activities.

Depending on the situation and your ability to protect yourself reasonably, food allergy may be considered a disability under the law. The key words are equal access and inclusion to programs and their benefits when assessing whether food allergy will qualify as a disability under the law.

What is a “504 Plan”?

504 Plans – named after the law – are roadmaps used to protect students in educational settings (most often K-12 public schools) and guarantee equal access to education.

These plans document what teachers, substitute teachers, administrators, and others should do in order to protect students with food allergies. 504 Plans are created by parents and representatives at the school for each individual student (often in conjunction with the school nurse and/or a doctor’s recommendations) based on the needs of their condition.

504 Plans outline reasonable accommodations that can be made to guarantee equal access to education and inclusion in the classroom and throughout the school.

What is Does a Reasonable Accommodation Look Like?

Reasonable accommodations are changes in either environment or process that public and private entities can take to ensure equal access and inclusion to patients with food allergies and/or offer protection to them. These requests should not place an undue burden on the entity to implement or maintain.

• In a school setting, a reasonable accommodation might be to request that students wash their hands after handling food at snack or lunchtime.
• At work, a reasonable accommodation might be requesting a shelf or space in the office kitchen to keep safe food.
• The ability to bring safe food into a restaurant or sport stadium might be a reasonable request in a space of public accommodation.

The right to equal access and inclusion in school, the workplace and spaces of public accommodation are guaranteed under the ADA and Section 504. Whether or not a patient with food allergies qualifies can vary – depending on both the situation and the patient’s individual allergies. That said, protecting those with food allergies and finding ways to include them in all places should be the goal of every institution public and private.

For more information, please visit The Allergy Law Project.

Can I Safely Get a Flu Vaccine with an Egg Allergy? October 15, 2021

Flu season is upon us and it’s poised to spread like wildfire once again. Patients who are allergic to eggs want to be protected from the affects of the flu, but worry about the risk of anaphylaxis from the ingredients in the vaccine. Those of us with an egg allergy face the same challenge each fall: Can we safely get a flu vaccine?

Myth Busting

Concern about egg allergy and the flu vaccine is one of the many myths that surround vaccines that we can easily dispel. YES, you can get your flu shot even if you have an egg allergy. The amount of egg protein that might be in the shot is too little to trigger a severe reaction according to allergists and the CDC. If you also have asthma, it becomes even more important to get vaccinated as asthma can lead to more discomfort and serious complications.

Another myth worth dispelling: You cannot get the flu from the flu vaccine. The vaccine does not contain a live virus; the live virus used to produce the vaccine is killed, broken up, and purified to make the vaccine. This means, the flu shot does not have any ingredient in it that can make you sick or spread the virus as was previously thought. The components of the vaccine allow your immune system to form antibodies that will be ready to attack should you be exposed to the real thing.

A Little History

Vaccines have been produced using egg for more than 70 years.

When the flu vaccine was first introduced in the early 2000s, it contained a small amount of egg protein. At that time, doctors were concerned that those with an egg allergy might have a reaction. They were particularly worried that the nasal spray delivery method might overwhelm the immune system and trigger a response. For that reason, they used to recommend the injectable flu vaccine followed by a 15-30 minute observation period for anyone with an egg allergy.

…the scientific community has noted that only 1.31 people in 1 million will react [to the flu shot]. That’s 0.000131% for perspective. You have better odds of being hit by lightning.

Where We Are Today

Things are different today. Although the flu vaccine still contains a very small amount of egg protein (ovalbumin), studies have examined the use of both nasal and injectable flu vaccine in allergic and non-allergic patients and have recorded almost no reaction for those with an egg allergy. In fact, the scientific community has noted that only 1.31 people in 1 million will react. That’s 0.000131% for perspective. You have better odds of being hit by lightning. That’s great news!

There are some who react to vaccines. In the last 10 years, there have been several studies that have shown that most of these reactions are caused by another component in the shots, not the trace amount of egg.

As such, the CDC encourages those with an egg allergy to get the flu vaccine and no longer recommends an observation period. Now, you can get your flu shot and be on your merry way!

Severe Reaction to Eggs in the Past?

No worries! The CDC still recommends patients with a history of severe reaction get a flu shot, but they suggest doing so in a medically supervised environment. That could be at a clinic, doctor’s office, hospital, outpatient facility or anywhere else where healthcare professionals can respond to an allergic reaction in the unlikely event one should occur.

The CDC defines a severe reaction as any symptom other than hives, particularly cardiovascular (fainting, lightheadedness, etc), respiratory (wheezing, coughing, etc) as well as any reaction requiring epinephrine.

In Short/Recommendations

• Doctors recommend that patients with an egg allergy get their flu shot.
• If you have an egg allergy, the chances of having a reaction to the flu vaccine are incredibly low.
• Both the flu shot and the nasal spray vaccine are safe for those with egg allergy.
• Most patients with egg allergy no longer need to be monitored following their vaccine unless instructed by their doctor.
• **If you have had a severe reaction to egg, be sure to get your flu shot in an inpatient or outpatient facility.**
• The flu vaccine protects patients from serious illness.
• If you have asthma, the flu shot is important to keep you from experiencing complications from the flu.
• **If you have reacted to the flu vaccine in the past, talk to your healthcare provider before getting your next shot.**

Questions?

For more information, please see the CDC’s page Flu Vaccine and People with Egg Allergies.

Symptoms of the Flu

Should you experience any of the following symptoms, please stay home and call your doctor.

Symptoms of the flu – which range from uncomfortable to dangerous – can vary:

• Fever/chills
• Cough
• Sore throat
• Runny or stuffy nose
• Muscle or body aches
• Headaches
• Tiredness
• Vomiting and diarrhea, *this is more common in children than adults

What the PFDD Meeting for Food Allergy Means for You September 23, 2021

Early this month, the Food Allergy Collaborative (of which AllergyStrong/AllergyShmallergy is a founding member) and its generous sponsors hosted the Externally-Led Patient Focused Drug Development (PFDD) meeting for Food Allergy. This impactful event was held for the benefit of the U.S. Food & Drug Administration (FDA) who governs therapies for this condition and sets labeling policy.

The purpose of a PFDD meeting is to present the patient’s experience and perspective to the FDA so that they consider the needs and priorities of our community as they approve new treatment and set regulations. The PFDD for Food Allergy meeting enlightened the FDA about the challenges and hardships faced by patients of all ages and backgrounds, the types of treatments and therapies we would like to see approved, as well as the risks we are willing to face vis-a-vis treatment options.

Watch the Externally-Led PFDD

We encourage you to watch and share the video using this link: https://foodallergycollaborative.org/pfdd/.

We heard from patients from all over the country who voiced their experiences with food allergy. Throughout the meeting, some themes echoed over and over again:

• The need for more accurate and informative diagnostics that are less invasive;

• The need for accessible, affordable food that is contains easy to evaluate, accurate labeling;

• The need for less invasive, easy to carry emergency medication; and

• The need for long-lasting therapies that treat allergies beyond the peanut.

Another topic that was mentioned again and again was a priority to find and approve treatments for the 26 million adults living with food allergy. As one participant stated, “…current treatment is oriented towards children. Those children DO grow up.” Another panelist described her adult on-set food allergies with chilling effect. “One day, I was eating this food without any issues. The next day… it nearly took my life.”

The Food Allergy Collaborative captured the broadest experience possible to represent the incredible diversity of patients and their individual journeys with food allergy. This included patients of different socioeconomic backgrounds as well as those who live in different communities across the country. We had representation from young and older patients, those with and without multiple food allergies, within and outside the Top 9 most common allergens, with and without related conditions (like eczema, asthma and EoE), those who have undergone treatment and those who have not.

The Food Allergy Collaborative is looking for more voices and additional perspectives using the link below. Comments will be accepted for up to 30 days (October 8, 2021) for inclusion in the Voice of the Patient report.  Patients impacted by food allergy are asked to think about:

• the burden of food allergies;
• their diagnosis journey and the challenges associated with diagnosis and oral food challenges;
• the challenges with avoidance and finding safe food;
• the challenges and experiences with epinephrine auto-injectors;
• their experience with treatment and clinical trials (how did it improve – or not – their lives? If they dropped out, why? What would they like to see in a treatment option?);
• Acceptable/unacceptable risks for food allergy treatment; and
• Desired goals for food allergy treatment/management.

We want to hear from you! Please submit your comments here: PFDD Patient Comments.

With this portion of the PFDD process behind us, the Food Allergy Collaborative is focused on the Voice of the Patient report. This report – to be published in Spring 2022 – will combine relevant research and survey data with the testimonies from the PFDD meeting and digital submissions.  This will offer the FDA the fullest picture of patient experiences possible, which will assist them as they review products which meet our communities’ needs.  The Food Allergy Collaborative has high hopes that our patients’ testimonies and the information that follows in our Voice of the Patient report will serve as an excellent resource for the FDA and other agencies as they evaluate treatments and consider policy for patients with food allergies.

Understanding the FASTER Act: Protecting Those with Sesame Allergy and Beyond April 27, 2021

The food allergy community has cause to celebrate! President Biden signed the Food Allergy Safety, Treatment and Education Research (FASTER) Act of 2021 into law, officially making sesame the 9th major food allergen. The FASTER Act will require manufacturers to label sesame by its common name in their ingredient labels and prioritize research and treatment for all food allergies.

Sesame joins dairy, eggs, peanuts, tree nuts, fin fish, shellfish, soy and wheat among the most common allergens. These “Top 9” allergens account for 90% of all allergic reactions – but allergies to over 170 different foods has been recorded. Although it was not originally included in the 2004 labeling law – the Food Allergy Labeling and Consumer Protection Act – which named the “top 8” allergens, recent studies show that sesame allergies are as common as some tree nuts which were included on that list.

Why is this important?

Sesame allergies are on the rise. While all food allergies have increased globally since the 1990s, sesame allergies are growing exponentially. It is currently estimated that more than 1.5 million Americans live with this life-threatening allergy. Sesame is known for producing serious reactions and is not typically outgrown. Food allergic visits to the emergency room have tripled in the last decade. Severe allergic reactions, called anaphylaxis, can be fatal.

To date, sesame was not required to be labeled by its common name on ingredient lists. Sesame was often listed under a number of different names including foreign terms such as “benne seed,” “gomasio,” or “tahini”. It could also be hidden in “lump sum” ingredients such as “spices” or “natural flavors,” making it difficult for consumers to determine whether a food might contain sesame or not.

By requiring sesame to be labeled by a common or recognizable name, consumers with food allergies will be able to easily tell if a food is safe for him/her to eat. The FASTER Act will protect patients from dangerous allergic reactions.

What is in the FASTER Act?

The FASTER Act requires manufacturers to include sesame seeds in plain language on ingredient lists on all packaged foods. Sesame seeds and any products made from sesame seeds (such as sesame oil, ground sesame flour, etc) will be listed simply as “sesame” or “sesame seeds.” This law will go into effect January 2023.

Importantly, this law also requires the Secretary of Health and Human Services (HHS) to prioritize a thorough review of food allergy prevention, treatment and research within the next 18 months. The FASTER Act also puts a regulatory process in place to review and declare other foods as “major food allergens” in the future. This allows the medical community to look ahead and open the door for additional food to be included on food labels.

In conclusion…?

The FASTER Act helps the US labeling laws better reflect the needs of the population. The inclusion of sesame begins to bring the United States in line with other industrialized nations. Currently, the United Kingdom, the European Union, Canada, Australia and others require clear labels for far more allergens in order to protect its citizens. And while sesame now joins the list of major allergens, many allergens remain unlabeled.

AllergyStrong – and the food allergy community at large – stand ready to help protect patients and ease the burden of this condition. The FASTER Act is a tremendous step in that direction!

The Myth of the “Mild” Food Allergy March 1, 2021

Patients and caregivers describe their food allergies in all sorts of ways, but there’s only one term that worries healthcare providers: mild.

Patients often list off their food allergies, distinguishing one from the other by stating, “I’m allergic to peanuts and have a MILD allergy to sesame.” or “I’m allergic to egg and have a life-threatening allergy to dairy.”

Statements like these are very concerning to healthcare professionals. They know something they wish EVERYONE did: there is no such thing as a “mild food allergy.” ALL food allergies have the potential to be life-threatening.

“Mild” and “severe” are words to describe allergic reactions. Reactions come in all forms and they CAN be mild. But it is impossible to know when a mild reaction will snowball into a severe, life-threatening one, called anaphylaxis.

When patients experience some of the less severe reactions to food – such as hives, swelling, itching or an upset stomach, for example – they believe that this will always be their reaction to that particular food. People often confuse their mild reaction for a mild food allergy. This mistake is certainly understandable, but it leaves patients, caregivers, teachers, chefs and waitstaff underprepared when a life-threatening reaction does occur.

Unfortunately, severity differs from one reaction to the next. And even doctors cannot predict how a patient will react to an allergen. Not only do reactions vary between different patients with the same food allergy, but reactions can differ from day to day in the same patient to the same allergen from one reaction to the next. This is why doctors recommend that patients strictly avoid their allergens and ALWAYS CARRY two epinephrine auto-injectors with them at all times.

There’s a saying in the food allergy world that sums it up:

“Past reactions do not predict future reactions.”

In short: each food allergy is as serious as the next – and every one can turn dangerous with the next bite. This is not to stoke fear, but rather a call to be vigilant about reading labels, take proper precautions, carry your epinephrine and follow your individualized emergency action plan should you have a reaction.

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As a reminder, here are the symptoms of an allergic reaction.

Mild SYMPTOMS include:

• Sneezing
• Runny nose
• Itching (often in the mouth, nose, and skin)
• A FEW hives
• Localized rash/redness
• Mild nausea/stomach discomfort

More severe symptoms include:

• Trouble swallowing/Throat tightening or closing
• Trouble breathing
• Wheezing/coughing/hoarse
• Feeling dizzy/faint
• Skin turning blue/low pulse rate
• Significant swelling of the mouth, tongue or lips
• Repetitive vomiting/diarrhea
• Widespread hives or rash
• Sudden anxiety/sense of danger

If you experience any severe symptoms or are in doubt, administer the epinephrine auto-injector and call 911 immediately.

Diagnosing a Food Allergy February 16, 2021

Anyone can develop a food allergy at any age to any food.

So when someone experience symptoms of an allergic reaction after eating, it is CRITICAL that they see a doctor to explore the possibility of a food allergy.

Symptoms of a food allergy vary not only from person to person, but from reaction to reaction. Some reactions are mild, while others (even to the same allergen) can be very severe.

When someone makes an appointment with a healthcare provider to discuss a reaction, there are several ways their doctor may go about diagnosing a food allergy. First, doctors will take a detailed medical history. It helps to bring a food journal of everything you have eaten prior to a reaction for the doctor to review. Only one test definitively determines a food allergy (the Oral Food Challenge). All others offer a picture of how the body is reacting to food and the likelihood it will experience severe symptoms after ingesting that food again.

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Oral Food Challenge

This test is considered the gold standard for diagnosing food allergies. This test measures how much of an allergen a patient can tolerate without reacting. If a patient can ingest a certain challenge level of allergen without reacting, they are considered not allergic to that allergen. During an oral food challenge, a patient is giving an increasing amount of an allergen beginning with the smallest dose. Oral food challenges are ONLY performed in a medically supervised setting where healthcare professionals monitor the patient for signs of an allergic reaction. These tests last several hours – so come prepared with books, devices, toys, etc.

Oral food challenges are also used to test whether a patient has outgrown a particular allergy. [See What is an Oral Food Challenge and How to Prepare for additional information.]

Blood Test

Blood tests measure a specific antibody in the blood called IgE. IgE, or immunoglobulin E, is the antibody that causes your immune system to react abnormally to certain food resulting in food allergy. A doctor will take a blood sample and test it against certain allergens. This gives the doctor a picture of how the body is responding to that food. There are also related blood tests called component tests. These helps narrow down true allergies (which can cause reactions) to false positives (or allergies to harmless protein in food). A patient can typically expect results in several days to weeks and will need to discuss the results with their doctor. The results of a blood test DO NOT PREDICT SEVERITY of a food allergy – they only predict the probability of a food allergy.

Skin Testing

Skin testing or skin prick tests are an in-office procedure that can provide results in 15-30 minutes. During this test, a small amount of allergen is applied to the skin (typically on a patients forearm or back). If a wheal (much like a bug bite) appears, the site is measured and considered positive. This relatively short test is not painful, but can be itchy or uncomfortable.

Blood and skin tests sometimes yield false positive results for a variety of reasons. Therefore, it is important you work with an allergist trained at interpreting the results and offering practical guidance for next steps.

Food Elimination Diet

Food elimination diets are just as their names suggest: a strict diet to be followed that does not contain a certain allergen (or several allergens), generally for up to four weeks. Following the elimination period of the diet, allergens are gradually added back in one by one to identify which one(s) a patient is reacting to. It helps to keep a food journal during this process to record what you eat and identify any other reactions you might have. This process can be tricky at first as most people are not well-practiced in reading ingredient lists and eliminating allergens when they hide in tricky places.

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It is CRITICAL to see a doctor when you suspect you have a food allergy. Studies show that the difference between a food allergy and a food intolerance isn’t well understood by most patients. That difference can be crucial: A patient does not want to take on the tremendous stress and burden of avoiding a food unnecessarily. Nor do patients want to be caught having a severe reaction without life-saving epinephrine and a plan of action.

Under the supervision of a trained medical professional, diagnosing (or ruling out!) a food allergy can be done simply and send you on your way to better health quickly.

Food Allergy Prevention Included in USDA and HHS 2020-2025 Dietary Guidelines January 28, 2021

Last month, the US Department of Agriculture (USDA) and the Department of Health and Human Services (HHS) issued the U.S. Dietary Guidelines for Americans. Updated every five years, this science-based advice helps Americans make decisions on what to eat and drink in order to promote short and long-term health, reduce the risk of chronic disease and meet nutritional needs.

The guideline, entitled, “Make Every Bite Count”, encourages all Americans to make healthy choices at each age and stage of their lives. One notable addition to this edition is the guidance surrounding when to introduce peanuts and eggs in infants and young children. Much like the 2017 U.S. National Institute of Allergy and Infectious Disease guidance, the latest dietary guidelines suggest giving infants and young children allergenic foods early and often. Early introduction of peanuts and eggs, between 4 and 6 months of age, helps reduce the risk of developing food allergies later. It further emphasizes that there is no evidence that delaying the introduction of these foods will help prevent food allergies. The guidelines note that infants and young children should be given peanuts, eggs, dairy, tree nuts, fish, shellfish, wheat and soy in an age and developmentally-appropriate way alongside complementary food.

The inclusion of guidance around food allergy prevention represents tremendous progress. The prevalence of food allergies has risen over the last several decades. Couple that with the fact that there is no cure as well as limited treatment options for those with food allergies, the need for strategies for prevention becomes critical. The inclusion of food allergy prevention guidelines will help pediatricians and parents work together to keep young children healthy as they develop and grow.

“Make Every Bite Count” doesn’t only focus on infant feeding guidelines. It also emphasizes:

• a reduction in added sugar consumption across all ages, avoiding added sugars altogether for infants ages 0-2 and then limiting it to 10% of total calories for ages 2 and older;
• limiting saturated fat to 10% of total calories for ages 2 and older;
• limiting sodium consumption to 2,300 mg per day (or less if under age 14);
• limiting daily alcohol consumption for adults to 2 drinks or less for men and 1 drink or less for women.

The FASTER Act: What It Is and Why it Matters December 9, 2020

Moments ago, the Senate unanimously passed the FASTER Act introduced by Senator Tim Scott (R-SC) and Senator Chris Murphy (D-CT). This is fantastic news for all patients with food allergies – and particularly exciting for the millions of Americans who are allergic to sesame seeds.

What is the FASTER Act?

The Food Allergy Safety, Treatment, Education, and Research (FASTER) Act is a bill aimed at increasing safety for those with food allergies and analyzing data and allocating resources for research and treatment.

Also known as S.3451/H.R. 2117, the FASTER Act proposes:

• An update to the food allergy labeling laws to include sesame.
  • Currently, sesame is not required to be labeled by its common name and can be hidden under general terms, making it both difficult and dangerous for the 1.5+ million Americans living with a sesame allergy.

• Requires the government to analyze promising opportunities for research so that they may diversify approved treatment options.
  • Currently, there is only one approved treatment option (oral immunotherapy – OIT) which can only benefit some patients with peanut allergy.

Photo by Pixabay on Pexels.com

Why is this important?

The FASTER Act increases transparency on ingredient labels for those with sesame seed allergies. This could set the stage for the labeling of other allergens that are hidden in ingredient labeling (such as corn). Allergy to sesame seeds are on the rise, the reactions to this allergen tend to be severe and this labeling change falls in line with how most other industrialized nations are approaching the allergen.

To learn more about sesame seed allergy, please read:

Sesame: the 9th Food Allergen?

Open Sesame: Prevalence of Sesame Seed Allergy & Progress in Labeling

FDA Issues Guidance Regarding Sesame Labeling

Food Allergy Advocacy – A Day on Capital Hill

The FASTER Act will also allocate funds so that the CDC can analyze data and encourage promising research for all food allergic patients. The most popular treatment for those with food allergies is “food avoidance” which is difficult, costly and filled with potentially costly mistakes. The only FDA- approved treatment to date is Palforzia, primarily aimed at children with peanut allergies. This bill could create opportunity for future treatments to emerge for other food allergies, increasing the number of people who can tolerate their allergen, reducing cost, worry and greatly improving quality of life.

What’s next?

This bill represents a compromise of H.R. 2117 and S.3451 – one that representatives from both the House and Senate have created together based on the original bills (House bill H.R. 2117 and Senate bill S.3451). Now that this new bill has passed the Senate, it will head back to the House for final approval. Following that, the FASTER Act will hopefully land on the President’s desk to be signed into law before this Congress comes to a close in January 2021.

Allergy Shmallergy/AllergyStrong will keep you posted on this exciting development!