Allergy Shmallergy

Simplifying life for families with food allergies.

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

Screenshot 2018-04-26 10.22.49

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.

 

Screenshot 2018-04-26 10.16.32

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:

glass milk pezibear-1379822_1920

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.

 

The Language of a Food Allergic Reaction September 11, 2017

A food allergic reaction can vary from mild to severe and typically takes place shortly after eating or exposure.  All reactions require immediate attention.  But with severe allergic reactions, called anaphylaxis, minutes matter.

 

As kids head back to school and begin new activities, it’s important for EVERYONE to become familiar with the symptoms of anaphylaxis and what it language a young child might use to describe it.

 

Symptoms of Severe reaction

Some of the symptoms of a severe reaction are obvious: hives, vomiting, coughing.  But for others, we need to rely on verbal clues.  Young children may describe an allergic reaction a little differently than adults would.

 

Language of Food Allergic Reaction

 

Should you suspect that your child, or one in your care, is experiencing anaphylaxis, act immediately:

  1. Administer epinephrine, holding pen for 5-10 seconds in meaty part of outer thigh.
  2. Call 911.
  3. Contact parents.

 

Minutes matter when it comes to treating anaphylaxis.  Knowing the symptoms and the different ways it might be described will help you save a life.

 

 

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

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

 

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

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

 

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

 

What is lupin?

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

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

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

 

Can you be allergic to lupin?

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

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

 

Do manufacturers label for lupin?

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

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

 

Other names for lupin are:

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

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

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