Allergy Shmallergy

Simplifying life for families with food allergies.

Yes, You Can Get a Food Allergy at Any Age October 1, 2018

Food allergies aren’t always something you’re born with.  Many believe that once they reach preschool age without a food allergic reaction, both they and their children are out of the woods.  Not so, says allergists.

 

Unfortunately, food allergies can begin at any age.  In fact, you can get a food allergy to any food at any age.  We can all agree; that’s a bummer!

 

Unfamiliar with symptoms and without epinephrine, many adults discover their allergy through a reaction.   My own father-in-law had enjoyed seafood for decades before having a severe allergic reaction (called anaphylaxis) on an airplane when he was in his forties.  Thirty thousand feet over the Atlantic Ocean, he was served shrimp – something he had eaten many times before.  No sooner had he finished his meal than his symptoms begin: swollen eyes and esophagus, itchy mouth and skin.  Thankfully, he made it to their destination with the help of an overwhelming amount of Benadryl.  But I think we can all agree, that’s no place to discover a food allergy.

Shrimp salad chongdog pixabay

It can be confusing to adults (as well as to their families and friends), when someone can tolerate a food one day and react to it the next.  As with all families adjusting to food allergies, there is a huge learning curve that accompanies diagnosis.  Adult food allergy patients need to relearn how to shop, cook, order food and – importantly – they must learn to recognize symptoms of allergic reactions including anaphylaxis.

 

Just as with pediatric food allergies, symptoms range from mild to severe to include:

  • Itching or tingling mouth, lips and/or tongue
  • Hives, itching skin, eczema
  • Swelling of the tongue, throat, lips, eyes, face, or other parts of the body
  • Wheezing, nasal congestion or other trouble breathing
  • Abdominal pain, diarrhea, vomiting
  • Dizziness, lightheadedness, fainting

 

Symptoms of a severe reaction (called anaphylaxis) include:

  • Constriction of the throat or tightening of the airway
  • A swelling or lump in the throat that makes it feel hard to breath
  • Shock, a severe drop in blood pressure
  • Rapid pulse
  • Sense of impending doom
  • Dizziness, lightheadedness, loss of consciousness

*Emergency medical care is needed if experiencing any symptoms of anaphylaxis.  Even after administering an epinephrine auto-injector, seek immediate medical attention.

 

Busy adults sometimes miss symptoms of food allergies.  On occasion, adults experience vomiting without itching, swelling or hives – a symptom which imitates a virus or the flu.  After a suspected reaction, adults should meet with an allergist.  At their first appointment, patients should also discuss their other medical conditions as well as bring a list of prescription medication they take.  Specialists can help decipher between symptoms of one condition and food allergic reactions as well as give advice about any issues with administering epinephrine or taking antihistamines.

 

Too little is known about why adults develop food allergies.  Fifty-one percent of people with food allergies developed at least one as an adult.  Approximately 5% of adults live with food allergies in the United States.  The most common among them is shellfish (present in 54% of adults with food allergies), followed by tree nuts (43%).  But adults suffer reactions to all kinds of food allergens.  Although you can truly get a food allergy at any age, most adult reactions occur between ages 30 and 40 and affect women more often than men.

 

There is an initial emotional burden of being diagnosed with food allergies.  This is common. Food allergies can be especially stressful as patients are adjusting to their condition and retraining their behaviors or overcoming a severe reaction.  Experiencing anxiety is normal to some degree [please read Managing Food Allergy Anxiety]; however, if the stress and anxiety of food allergies becomes overwhelming, it is recommended that patients reach out to a mental health professional and mention it to their allergist.  Both can work to give you practical and easy-to-implement strategies to reduce fears.

 

 

FDA Approves First Generic EpiPen September 6, 2018

The U.S. Food and Drug Administration (FDA) has recently approved the first generic EpiPen to be made by Teva Pharmaceuticals.  There are currently several brands of epinephrine auto-injectors available to patients:  Mylan makes EpiPen, EpiPen Jr. and its own brand-sponsored generic; kaléo offers Auvi-Q; and Impax Laboratories markets Adrenaclick.  However, this generic EpiPen by Teva Pharmaceuticals will be the first time a non-brand alternative is available.

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Obtaining approval from the FDA for a generic was complicated by the fact that both the medication (epinephrine) as well as the device itself had to be reviewed.  There is no firm estimate on when to expect this new generic on the market or the cost of the product once it gets there.

 

The competition generated by a generic should help the epinephrine auto-injector market. To date, Mylan’s EpiPen has nearly monopolized the market but its exorbitant cost has gained unwanted attention.  Mylan’s EpiPen price has risen over 400% in the last 10 years to over $600 a set.  To counter the negative press, Mylan created their own generic EpiPen which still average $300 per set.  Patients and families are hoping the introduction of a true generic device will drive down the cost of the absolutely necessary, life-saving devices as well as help to prevent epinephrine auto-injector shortages like the one we’re experiencing presently.  They’re also hopeful this generic will help expand options covered by their insurance plans.  Doctors, emergency workers and advocates are also optimistic that this may help get epinephrine in the hands of patients who may otherwise be unable to afford it.

 

 

 

Alpha-Gal Allergy and the Lone Star Tick August 6, 2018

Lone-star-tick-map-cdc

An unusual food allergy is on the rise across the United States.  And it could strike anyone – with or without a previous history of allergies.

 

Caused by a tick bite, this once-rare condition can cause a person to develop an allergy to red meat and, in some cases, to dairy products.

 

Interestingly, this allergy is triggered by a carbohydrate (known as the alpha-gal molecule) and not a protein like most allergic reactions.  Just as fascinating, Alpha-gal allergy is characterized by a delayed on-set of symptoms.  Unlike a traditional food allergy which usually causes a reaction very soon after eating, Alpha-gal allergic symptoms typically show themselves between 3 and 8 hours after red meat consumption.

 

Alpha-gal allergy is spread through a bite from the Lone Star tick.  The Lone Star tick can be found in wooded areas and grassy areas in the southeast, east coast and midwest of the United States as well as parts of Canada and the northern portion of South America.  It can also be caused by the European Caster Bean tick and the Paralysis tick in Australia.

 

The best way to prevent a tick bite is by using tick repellant when exploring in the woods and areas of high grass. Wear long sleeves, long pants, and high socks whenever possible on such excursions.  Check your skin and hair following an outing.  Here’s the CDC’s advice on how to properly remove a tick.

Lone-star-tick-stages-cdc

 

The symptoms of alpha-gal allergic reaction vary from a runny nose, nausea and diarrhea, to hives and anaphylaxis, the most severe form of allergic reaction (review the symptoms and language of an allergic reaction).  Just as with a traditional food allergy, those with alpha-gal allergies should treat their symptoms immediately with epinephrine.

 

To review the symptoms of anaphylaxis as well as how those symptoms may be described by a child, please read The Language of a Food Allergy.

 


Comment below!

I would love to hear from those who have an alpha-gal allergy!

What has your experience been like?

What are some of the trickiest foods to avoid?

What is the most difficult part of managing this allergy?

How has this changed your perspective?

 

 

 

Your Must-Read Allergy and Asthma Resource April 26, 2018

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Check out The Allergy & Asthma Network’s fantastic and informative publication Allergy & Asthma Today.  You can find it in your doctor’s office or online.  Not only does it contain information about food allergies, but it also covers asthma and other allergies as well.  I learn something new in every issue.

 

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The latest issue features two of my articles.  The first covers lupin allergies. (Have you heard of them?  You’ll want to learn more…).  And, the second article covers the backlash Sony Pictures faces following their decision to include an allergic reaction in the children’s movie “Peter Rabbit.”

 

Be sure to check these articles and all the others out today!

 

 

Do You Have Oral Allergy Syndrome? April 13, 2018

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When I first met my husband, he was such a carnivore he used to joke that the only way he’d eat a vegetable was via pizza.  He also told me that he was allergic to raw fruits and vegetables. All raw fruits and vegetables.  Needless to say, I was skeptical.

 

When I joked to our allergist that my husband was peddling his “allergy story” as an excuse to eat more steak, the doctor and nurses just stared.  Instead of laughter, they gently whispered that what he was experiencing was a real thing called oral allergy syndrome.  The joke was definitely on me.

 

Oral Allergy Syndrome (OAS) is experienced by so many people – as many as 1 in 3 people with seasonal allergies – that it is likely the most common form of food allergy in adults.  Those with OAS react to certain (usually fresh) fruits, vegetables, and nuts usually at the same time they have hay fever and environmental allergies. In other words, if you suffer and sneeze when the spring pollen comes blowing in, you may experience itchy ears and lips when you eat almonds, peaches or carrots.  This is not considered a separate food allergy but rather a cross-reaction from the weed and tree pollen found in fruits and other plant-based foods in a distant form.

 

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Sufferers of oral allergy syndrome may notice that they experience symptoms more frequently during spring pollen season.  Some sufferers may ONLY experience symptoms during peak periods of pollen and some experience them year-round.

 

OAS symptoms tend to occur within moments of eating a trigger food.  Symptoms of oral allergy syndrome include:

  • Itching or burning of lips, mouth, ear canal, or throat;
  • Swelling of lips, tongue or uvula;
  • Eye, skin and nose reactions are common;
  • Tightness of the throat;
  • If the allergen is not digested fully, it may delay releasing histamine resulting in vomiting, diarrhea, indigestion, and/or cramping;
  • Rarely, wheezing, vomiting, hives and/or low blood pressure.

Oral allergy syndrome rarely results in anaphylaxis – the most severe form of food allergic reaction.

 

An allergy to certain pollens can correspond to oral allergy syndrome to certain foods.  See the chart below to explore which pollen (and their variants) are found in which foods.

Oral Allergy Syndrome

 

If you believe you experience OAS, you should make an appointment with an allergist to confirm your suspicions and rule out a true food or latex allergy.  As you lead up to your doctor’s visit, it’s a great idea to begin a food journal to chart and track symptoms which may relate to this condition.  Once at the allergist’s office, you can expect them to go over your food diary, symptoms, your personal medical history and – if necessary – give a skin prick, blood test or set up an oral food challenge.  As with a regular food allergy, an oral food challenge is the gold standard for diagnosis.

 

Treatment options are similar to those for environmental allergies since they are interrelated.  Allergists may suggest that you avoid your trigger foods or eat them only when they are cooked for a certain length of time at a certain heat (since this alters the protein that sets off an allergic reaction).  In some cases, a doctor may treat the environmental allergy with antihistamines or steroids and occasionally will prescribe an epinephrine auto-injector in case of severe reaction.  Be sure to ask your allergist about immunotherapy.  Allergy immunotherapy had been reported to help both the environmental as well as oral allergy syndrome symptoms.

 

 

 

 

What is an Oral Food Challenge and How to Prepare February 5, 2018

Let’s start right from the beginning:

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What is a food challenge?

 

Sometimes a skin prick test and/or a blood test does not give a doctor enough information to know if a patient is truly allergic to a particular food.  A food challenge, sometimes known as an Oral Food Challenge (OFC) or just oral challenge, is the best way for an allergist to evaluate a patient’s allergic response.

 

Food challenges are sometimes used to diagnose a food allergy.  While skin prick tests and blood tests are great indicators of a food allergy, they cannot help a doctor or patient understand their individual risk of a reaction.  Only the Oral Food Challenge can demonstrate a person’s true sensitivity to a given food.

 

Oral challenges are also helpful in determining whether a patient has outgrown a food allergy.  Doctors will suggest an oral food challenge when they believe an individual may successfully tolerate a food they previously tested allergic to.

 

How does it work?

For a variety of reasons, doctors may want to test a patient against his/her food allergy.  In a doctor’s office or hospital setting, food is given to that patient every 15 to 30 minutes – beginning with a very small amount and increasing with each “dose”.  The patient is observed and medically evaluated at each interval to check for symptoms of a reaction.  Feeding typically continues until a full portion of that food is consumed safely.

 

If the doctor sees symptoms of a reaction, he/she will stop the test.   If, on the other hand, there are NO symptoms, your doctor may rule out a food allergy and discuss ways to manage that food going forward.

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Where do you go for a food challenge?  Can I do it myself at home?

OFCs are ONLY conducted in a doctor’s office or hospital setting and should only be done under a doctor’s supervision.  It is critical that the patient be checked by a doctor or nurse at each stage in the process for a reaction.  And, should such a reaction occur, the medical staff are on-site ready to respond immediately.

 

You SHOULD NEVER conduct an oral food challenge at home.

 

How safe are OFCs?

 

Food challenges have an excellent safety record because allergists and trained professionals follow medical standards and procedures for the test and they are prepared to handle any emergency that arises.  Thousands of OFCs have been performed worldwide safely.

 

Be aware, there is a risk for an allergic reaction with this test which is why it MUST be performed by a doctor in a medical setting.  The most common reactions in an oral challenge are mild skin and stomach reactions which are typically treated with antihistamines.  Allergists are prepared to use epinephrine and other medications in the unlikely event that a more severe reaction occurs.

 

That said, most doctors recommend an oral challenge when they believe the patient will pass this test.  They try to set their patients up for success.

 

How do I prepare for a food challenge?

 

1.  Remind yourself and/or your child that there is no “passing” or “failing” an oral challenge – there are only results.  In this way, you can keep anticipation and disappointment in check.  [But feel free to go crazy celebrating if you’re able to add another food to your diet later!]

 

2. Have a conversation with your allergist’s office about what to bring and how to prepare it.  Allergists typically recommend how to prepare the food you are testing for.  For example, when my son tested for soy, we brought soy milk; for wheat, we brought toast; for milk and egg, we were instructed to make muffins and French Toast using a particular recipe.  Depending on your child’s age and particular tastes, the allergist may be able to alter the recommended food to make it more palatable.

 

3. You will need to stop taking antihistamines as well as some other medications for at least one week prior to your appointment.  Discuss this with your doctor’s office for further instructions.  ALWAYS take emergency medication (such as a rescue inhaler or epinephrine) should you need it leading up to the oral challenge. Oral challenges can be postponed if need be.

 

4. Prepare for the day.  Oral Food Challenges often take several hours.  Think about what will amuse you and your child for that period of time.  Consider coloring books, small lego sets, matchbox cars, books, a portable DVD player or iPad.  And, yes, that means you might arrive with a giant “tote bag of fun,” looking like you’re ready to move into the doctor’s office like I did.

 

5. Write down questions about the possible results of the test as you go along,  You should have a chance to discuss the results after the challenge has finished.  Some questions you may wish to ask if you can add a new food:

  • What do the results tell us about my allergy?
  • Are there any limits to the quantity/variations of this new food we can add?
  • Can we add this food in its baked AND unbaked forms?
  • What symptoms should I look for over the next few hours and days?
  • Does this alter my Emergency Action Plan?  Can you fill out a new plan so that I can copy this information for the school nurse, after care, babysitter, etc?

 

 

For those of you who have experienced an oral challenge: what advice would you add?

 

The Dangers of a Dairy Allergy November 17, 2017

cereal and milk pixabay StockSnap

 

Three year old, Elijah Silvera, was attending a regular day of preschool in New York City recently, when preschool workers fed him a grilled cheese sandwich despite school papers which formally documented his severe dairy allergy.  Elijah had a severe allergic reaction and went into anaphylaxis.  Standard procedure for anaphylaxis is to administer epinephrine and call 911 immediately.  Instead, the school called Elijah’s mother, who picked up her child and drove him to the hospital herself.  Doctors in the emergency room tried but were unable to save him.

 

Dairy allergy is the most common food allergy among young children.  And, although the peanut can produce some of the most severe allergic reactions (as well as some of the most tragic headlines), an allergy to milk products can be life-threatening.  The myth that a dairy allergy is not serious and doesn’t require as much vigilance causes great frustration to many who are allergic to milk, as does the idea that a food is “allergy free” if it does not contain nuts. To those who live with it, a dairy allergy requires an enormous amount of preparation and education since milk is an ingredient in so many products.

 

Dairy is cow’s milk and found in all cow’s milk products, such as cream, butter, cheese, and yogurt.  Doctors sometimes advise patients with a dairy allergy to avoid other animals’ milk (such as goat) because the protein it contains may be similar to cow and could cause a reaction.  Reactions to dairy vary from hives and itching to swelling and vomiting, to more severe symptoms such as wheezing, difficulty breathing, and anaphylaxis.  Strictly avoiding products containing milk is the best way to prevent a reaction.  The only way to help stop a severe food allergy reaction is with epinephrine; patients should always carry two epinephrine auto-injectors with them at all times.

 

Just like other allergens, cross contamination is a concern for those with a dairy allergy. Even a small amount of milk protein could be enough to cause a reaction. For example, butter and powdered cheese (like the kind you might find on potato chips) are easily spreadable in a pan, within a classroom or on a playground.  And, as with other allergens, hand sanitizer does NOT remove the proteins that cause allergic reactions.  Doctors recommend hand washing with good old soap and water – but wipes work in a pinch.

 

Those allergic to dairy must not only avoid food; they often have to look out for health and beauty products too.  Dairy can be found in vitamins, shampoo, and lotions.  It is critical to read the ingredient labels of every product you buy each time you buy it as ingredients and manufacturing procedures may change.

 

In the United States, any food product containing milk or a milk derivative must be listed as DAIRY or MILK under the current labeling laws (see The Ins and Outs of Reading Food Labels, Aug. 2016).  If you are living or traveling elsewhere, this list of some alternative names for dairy may be useful:

 

milk (in all forms: goat, whole, skim, 1%, 2%, evaporated, dry, condensed, etc)
butter (including artificial butter and margarine)
cream
buttermilk
sour cream
half and half
yogurt
cheese
ice cream
custard
sherbet
pudding
chocolate
ghee
whey (all forms)
casein
caseinates (all forms)
casein hydrolysate
lactose
lactulose
lactoferrin
lactalbumin (all forms)
diacetyl
rennet casein

 

Let’s spread the facts about dairy allergy so that our schools and teachers better understand how to accommodate and care for students with food allergies.   Any allergen can produce severe, life-threatening allergic reactions and all food allergies should be taken seriously and managed with attention.  I sincerely  hope that by informing others we can prevent another tragedy like the one the Silvera family was forced to experience.