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!

Celebrities with Food Allergies (4th Edition) November 17, 2020

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  Actress Gina Rodriguez at the 2014 Alma Awards

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Just another reminder that you are not the only one with a food allergy! 1 in every 10 adults has a food allergy and 1 in every 13 children do as well.

Bethany Frankel (reality star, Skinny Girl founder): fish

Jason Mantzoukas (actor, comedian):  egg

Tia Mowry (actress):  parent to a child with peanut allergy

Zhaire Smith (NBA 76ers player): peanuts, sesame

Patrice Evra (Juventus Soccer player): eggs

Alex Kerfoot (NHL Avalanche player):  peanuts

Ben Lovett (Mumford & Sons):  tree nuts

Jon Stewart (comedian): parent to child of celiac disease.

Sean McDermott (head coach, Buffalo Bills): food allergy parent

Alan Branch (Football Player, Patriots): food allergy parent

Elliott Sadler (NASCAR driver): parent of child with peanut allergy

Courtney Hope (Bold & The Beautiful, Actress):  dairy, gluten, corn yeast

Gina Rodriguez (actress):  blueberries

Jessica Vosk (Broadway actress): peanuts, tree nuts, sesame seeds, shellfish

Henri Laaksonen (tennis player):  salmon and possibly other fin fish

Daniel Robertson (baseball player, Tampa Bay Rays): pecans

Jameela Jamil (actress): gluten (celiac disease)

Justin Bieber (singer):  celery, gluten

Nina Dobrev (actress):  undisclosed food allergy

Heidi Collins (journalist):  gluten (celiac disease)

Britney Spears (singer and food allergy parent): son allergic to an ingredient in fried chicken.

Kylie Jenner (beauty mogul and food allergy parent): daughter allergic to peanuts, tree nuts

Holly Robinson Peete (actress and food allergy parent): four children allergic to multiple allergens

Jenna Fischer (actress):  sweet potatoes/yams

Mark Cuban (Maverick’s owner and Shark Tank investor): parent to a child with food allergies (tree nuts)

Lauren Conrad (reality TV star and designer): parent to a child with food allergies (dairy)

Blake Martinez (NFL player: NY Giants, former Green Bay Packer): dairy and egg allergy.

(All photos files are licensed under the Creative Commons Attribution-Share Alike 4.0 International license.)

FDA Issues Guidance Regarding Sesame Labeling November 13, 2020

FDA APAC Mtg Re: AR101

On November 10, 2020, the US Food and Drug Administration issued draft guidance to manufacturers regarding the labeling of sesame seeds and in food products. Allergy Shmallergy and AllergyStrong have tirelessly advocated for better labeling for sesame seeds alongside the Allergy & Asthma Network and others for years. We see this is a positive first step in achieving our goal of mandatory labeling.

Currently, sesame is the 9th most common allergen in the US and is not required to be clearly labeled on food ingredient labels. Unlike the requirement to label allergens in the “Top 8” (the eight most common food allergens) by their common, most recognizable name, sesame can be hidden under alternate, foreign names (like “tahini” or “bene seed”) or general terms such as “spices” or “natural flavors.” This means that patients who have a sesame seed allergy never truly know whether a food is safe for them by reading an ingredient label.

In the draft guidance, the FDA encourages (but does not require) food manufacturers to label for sesame. Susan Mayne, Director of the FDA’s Center for Food Safety and Applied Nutrition states, “Many Americans are allergic or sensitive to sesame, and they need the ability to quickly identify products that might contain sesame.” She notes that while most products that contain sesame are labeled properly, some ingredients are made from sesame seeds but are labeled otherwise. Consumers may not be familiar with these alternative names on a product label’s ingredient list.

Sesame seed allergies are on the rise in the United States. A 2019 study conducted by Dr. Ruchi Gupta and her team at Northwestern University shows that sesame allergy affects 0.23% of the U.S. population amounting to over 1.5 million patients nationwide – making it almost as common as soy or pistachio allergies which are required to be labeled as part of Food Allergen Labeling and Consumer Protection Act (FALCPA). And 4 out 5 patients with sesame allergy report having at least one additional allergy to manage.

1 in 3 patients with a sesame allergy have reported serious reactions. Given its rising prevalence combined with potentially dangerous reactions, it is surprising that updated guidance hasn’t been issued sooner. This move by the FDA is a positive first step towards mandatory labeling. Continued education about sesame seed allergy is needed so that lawmakers and food manufacturers can better protect their allergic consumers and bring the US labeling laws into better alignment with the other major Westernized nations. Currently, Canada, the United Kingdom, the European Union, Australia and New Zealand require sesame to be labeled in ingredient lists on all food products.

In the meantime, the Food Allergy Safety, Treatment, Education & Research (FASTER) Act, H.R. 2117, S. 3451 has been introduced in both the House and Senate with the hope of getting it signed into law before the end of the year. Among the items included in the the FASTER Act is the proposal to update the current labeling laws (under FALCPA) to include sesame seeds.

Another Pitch for Food Allergy Education October 28, 2020

Following my fascinating time teaching a senior writing seminar at a local high school (see What Does Food Mean to You?), I was struck by two things:

1. These high school seniors were impressively thoughtful, creative and bravely willing to share their rich and rewarding stories (and souls) with their peers. And,
2. They wanted to talk about food allergies more than any of that.

It’s FUN to talk about food – who doesn’t love to tell stories about their food adventures, a favorite meal, a holiday celebration, their dream dessert…?! As robust as our conversation was about writing and food, the conversation that followed was absolutely enlightening.

When I mentioned to the class that, in addition to my other writing, I often write about food allergies, hands went up immediately.

“How is a food allergy different than a food intolerance?”
“Can you outgrow a food allergy?”
“Do adults acquire new food allergies?”
“Are there treatments available?”
“What that medication people carry? How does it work?”
“How can I support my friend who has a food allergy?”

We spent 45 minutes – half of their class time – talking about food allergies that day. Forty-five minutes before we needed to cut them off and return to writing.

I spend a lot of time talking to school administrators about the value of food allergy education – especially for young children through early adolescence. This experience not only underscores the importance of food allergy education, but it highlights the continuing need to discuss it.

Two kids in every classroom have at least one food allergy. But as teenagers grow into young adults, they’ll soon find that EVEN MORE adults have food allergies than children. According to a study by Dr. Ruchi Gupta and her colleagues at Northwestern, 1 in 10 adults live with food allergies – 25% of whom acquired a new allergy AS an adult.

Administrators often see the value of a short unit about food allergies to health education, but don’t often add it to their curriculum. Why? Because, they say, these days kids grow up around food allergies. They know all they need to know from being around their peers.

But, based on my time in the classroom, it is clear this theory that students are absorbing food allergy lessons by osmosis doesn’t cover it. Young children don’t understand what a food allergy is and why some people have them. Pre-teens may lack understanding of the frequent obstacles and dangers their peers with food allergies face day-to-day. Teenagers are expected to help keep their friends safe but don’t know what it’s really like to have food allergies and don’t know how to help. And young adults may need to know how to recognize symptoms of food allergies and use an epinephrine auto-injector to save someone’s life.

Students hear the words “food allergy” and only have a vague sense of what it means. Even by age 18, students hadn’t learned what they felt they needed to know about the food allergies that they encounter. They were left with so many questions, I could have filled several sessions answering their questions.

If we expect our children and young adults to be empathetic to their peers who are physically, socially and emotionally affected by food allergies (and other medical conditions), we need to give them a proper introduction and equip them with the age-appropriate skills to become supportive friends and classmates.

At this time, most schools STILL don’t formally teach their students about food allergies despite the fact that there are nut-free classroom, peanut-free tables, and gluten-free options in the cafeteria. A short lesson would go a long way in fostering community, building empathy, empowering helpers and protecting students.

What Does Food Mean to You? September 23, 2020

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

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

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

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

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

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

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

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

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

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

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

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

 

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

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

 

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

 

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

 

 

How do you bring food into the classroom safely?

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

1. Enforce a “No Sharing” food policy.  

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

2.  Wash hands.  

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

3.  Cleaning shared surfaces.

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

4.  Review symptoms of an allergic reaction.

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

5.  Know how to respond to an emergency.

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

6.  Take advantage of the stock epinephrine program.

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

 

 

What can parents do to protect their children?

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

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

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

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

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

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

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

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

Important Update: FDA Temporary Labeling Policy June 22, 2020

 

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

 

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

 

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

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

 

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

 

 

 

 

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

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

 

 

Latest Information and Clarification:

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

 

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

 

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

 

 

 

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

 

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

 

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

 

The policy allows manufacturers to:

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

 

[Read FDA’s statement summary here.]

 

Image by Kevin Phillips from Pixabay

 

The specifics of the policy offer a few important details:

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

 

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

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

 

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

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

 

 

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

 

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

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

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

 

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

 

 

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

 

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

 

Resources for Food Pantries

 

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

 

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

 

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

 

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

 

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

 

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

 

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