Allergy Shmallergy

Simplifying life for families with food allergies.

kaléo Introduces First Ever Epinephrine Auto-Injector for Infants and Toddlers April 30, 2018

Filed under: Preparedness — malawer @ 8:30 am

A food allergy diagnosis is jarring at any age.  But it is particularly unsettling when your baby or toddler is diagnosed.  Parents worry that they may not be able to recognize the symptoms of a severe allergic reaction called anaphylaxis.  Large-sized auto-injectors seems especially intimidating and parents often worry that the dose of epinephrine will overwhelm their infants’ small, little bodies.

 

Until recently, the 0.15mg dosed auto-injectors – typically used for children weighing between 33 and 66 lbs (15 – 30 kilograms) – were the only option for infants and toddlers.  However, kaléo Pharma, the makers of Auvi-Q, just announced that the FDA has approved Auvi-q 0.1mg  – a strength intended for infants and toddlers.

 

At a time when the rate of food allergies is still increasing and pediatricians are recommending the early introduction of peanuts and other allergens to prevent the development of food allergies, this device is arriving in the nick of time for food allergy parents.  It is everyone’s hope that Auvi-q’s correctly-dosed auto-injector will embolden parents to confidently administer epinephrine to their young children without hesitation.

 

Image result for Auvi-q 0.1

The FDA-approved Auvi-q 0.1mg will have several features that are better suited for little ones.

  • It is dosed properly for infants and toddler weighing between 16.5 and 33 lbs (7.5 to 15 kilograms)
  • It contains a needle length appropriate for smaller bodies, reducing incidents of injury.

 

If you’re not familiar with the Auvi-Q epinpehrine auto-injector, it’s a compact auto-injector about the size of a deck of cards.  Auvi-Q features voice prompts to guide you through injection step-by-step and contains a needle that automatically retracts for safety.

 

 

If you have a baby or toddler and would like more information, here is a link to Auvi-q’s 0.1 page and, as always, speak with your doctor.

 

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#MinutesMatter: Be Prepared for Severe Allergic Reactions March 2, 2018

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I hope that no one finds themselves in the situation of experiencing a severe allergic reaction.  But it pays to be prepared.  Studies have shown that delayed use of epinephrine is the leading cause of negative outcomes during anaphylaxis.  That’s why #MinutesMatter in the event of an emergency.

 

What can you do to prepare for an unexpected allergic reaction?

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1. Have a current Emergency Action Plan (EAP) and review it.  Emergency Action Plans are forms filled out by your doctor or allergist which outline actions to take in the event of an allergic reaction.  They are arranged into If/Then actions based on symptoms making it easy to determine what you should do. And, EAPs should always note the presence of asthma in a patient, as asthma can complicate a reaction.  To learn more, please read Allergy Shmallergy’s Emergency Action Plan or obtain a copy like the one created by the American Academy of Pediatrics.

2.  Lay patient down.  If the patient is vomiting, lay them on their side. Elevate the legs if possible.  This position helps with blood flow.

3.  Administer epinephrine.  The sooner, the better.  Should you need to administer epinephrine, do not wait.  Early administration of epinephrine is associated with the most positive results, including less medication needed at the hospital.

4.  In the case of severe allergic reaction (anaphylaxis) first administer epinephrine, then call 911.  You will need to go directly to a hospital after experiencing anaphylaxis even if symptoms subside.  This is because patients require additional monitoring and because secondary reactions can occur – even hours after contact with a suspected allergen.

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Other keys to success:

Always carry two epinephrine auto-injectors with you wherever you go. Most allergic reactions occur between seconds to 60 minutes after coming into contact with an allergen.  However, in rare cases, allergic reactions can be delayed.  Epinephrine is the only medication that will stop an anaphylactic reaction.  

Train your tween, teen and friends about the symptoms of anaphylaxis, how and when to use an epinephrine auto-injector.  Make sure they understand that there’s no major downside to using an epinephrine auto-injector.  Remind them to inject first, then call 911.

Carry Benadryl liquid or Zyrtec syrup for minor allergic reactions.  In the case of anaphylaxis, patients will still need epinephrine to stop this type of severe allergic reaction.  However, if someone is experiencing minor reactions (for example: hives, itchy mouth) products containing active ingredient Diphenhydramine will help make things more comfortable.

 

 

Most importantly, follow this Emergency Room mantra:  If you THINK you need to use epinephrine, you DO need to use it.  

 

In a severe allergic reaction #MinutesMatter.

 

 

 

 

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.

 

Important Story: FDA Warning to Mylan, Maker of the EpiPen, on Device Defects and Review November 6, 2017

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Earlier this fall, the FDA issued a warning to Mylan, the makers of EpiPens.  In a scathing letter, the FDA highlighted manufacturing defects as well as Mylan’s failure to conduct adequate internal reviews after receiving many complaints about the life-saving device, EpiPen’s malfunctions.  To date, there have been 7 deaths, 35 hospitalizations and 228 complaints about EpiPen and EpiPen Jr. devices this year.  [See F.D.A Accuses EpiPen Maker of Failing to Investigate Malfunctions, New York Times, Sept. 7, 2017]

 

Following an FDA inspection of the manufacturing plant, FDA’s letter to Mylan describes EpiPens that were leaking epinephrine and others that malfunctioned.  In March of this year, Mylan issued a recall of a small batch of EpiPen and EpiPen Jr devices.

 

While it is difficult to connect these defects to the deaths reported, as anaphylaxis itself can be deadly even with properly receiving epinephrine, these reports are not encouraging.

 

In February of this year, we had a frightening experience. [Please read the full story,  The Fire Drill- 5 Key Lessons from an Intensely Scary Night.]  Not long after eating at a restaurant, my 12 year old, food allergic son was rushed home, wheezing severely and coughing.  He was so weak and nauseous that he could barely stumble to the bathroom.  As I asked him questions, trying to evaluate the situation, it was becoming increasingly impossible for him to speak at all.  I wheeled around to grab my EpiPens just steps from where my son sat.  When I turned back around, he was blue.

 

This is every parent’s worst nightmare.  It was certainly mine.  Amidst the chaos of an increasingly critical and deteriorating situation, my only saving grace was that I held in my hand an EpiPen that would contain the correct amount of the life-saving drug, epinephrine and deliver it safely.

 

I can’t imagine being in that same moment now, knowing that the EpiPen in my hand may or may not save my son’s life.  That it may or may not have the right dose of medicine.  That the needle may or may not misfire.  Would the knowledge of EpiPen defects cause you to hesitate?  Would you instead call an ambulance that would take even more time to arrive?  When minutes matter, these short hesitations in action, improper delivery of medication, and any other complications that arise during anaphylaxis could be costly…. even deadly.

 

Bear in mind, Mylan has also increased the cost of EpiPen from $50 in 2008 to over $600 currently.  And, while the high cost of EpiPens are prohibitive, parents are still buying them, and they’re paying for one thing:  reassurance.  They pay for the firm knowledge that this product administers the correct amount of medicine properly every time.  If that can’t be demonstrated, there are plenty of other auto-injectors on the market with a proven track record of reliability to consider.

 

Despite these less-than-comforting reports, please continue to carry and use your EpiPens and other auto-injectors.  According to the FDA in a recent Bloomberg article, “We are not aware of defective EpiPens currently on the market and recommend that consumers use their prescribed epinephrine auto injector. We have seen circumstances in which adverse events reports increase once a safety issue is publicized, like a recall. We continue to monitor and investigate the adverse event reports we receive.”

 

I plan to keep you all informed as we continue to follow this story.

 

To read more on this story, please see EpiPen Failures Cited in Seven Deaths This Year, FDA Files Show posted on Bloomberg, Nov. 2, 2017.

 

Armed with Words: Teens and Food Allergies October 25, 2017

Ah… the teenage years!  Although my son is only 12 now, I can feel them coming on and am seeing a preview of the food allergy challenges we’ll be facing for the foreseeable future.

 

Teens and young adults with food allergies are at the greatest risk of having a reaction.  Risk taking behavior is all part of the teenage brain.  And when hormone changes, the desire to fit in and peer pressure are combined with food allergies, innocent situations can turn deadly.

 

Studies show that preadolescents and teens – who typically do not want to draw attention to themselves – shy away from mentioning their food allergies and often intentionally leave their emergency medication at home.

 

What can parents do?  Continue talking to your teen about his or her food allergies and the new situations they face.  Play out various scenarios and involve them in the problem solving.  Importantly, arm them with the language to use to avoid putting themselves at risk.  If we can give them some ways to deal with their food allergies in a smooth, off-handed manner, they may be more likely to self-advocate, speaking up when it matters.

 

Share your child’s go-to lines and we’ll include them below.

 

Practice these.  Make them your own: deliver the lines with humor, sarcasm, be nonchalant or matter-of-fact.  However you decide,  just speak up!

 

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Situation:  (Friends are at a restaurant/cafeteria/movie theater hanging out)  Mmm… Try some.  It’s so good and I think it’s nut-free.  Here have some!

Straightforward Reply:  That does look good.  But, I’m allergic to nuts.  I’d love to try it if it’s safe- is there an ingredient list?

Alternative Reply:  That’s a great looking [brownie, cookie, dumpling…etc].  I think I’m going to pass.  But, thanks for offering!
These approaches work because they alert your friends that you have an allergy and simply can’t eat things that aren’t safe.  But if they are persistent:

Situation Progresses:  Come on!  Have one little bite!!!

Reply: (Distract)  No chance.  But have you tried the donuts [or insert food – either at the location or elsewhere]?  They’re insane!

Reply:  A little bite can make me really sick.  I’d rather hang at this party/football game/movie than head to the hospital.  I’m good!

 

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Situation:  Your teen is worried about bringing his/her epinephrine auto-injectors out with their friends.

Reply:  Hey guys, I have my auto-injectors in this bag just in case anything happens.  Do you want to drop your phone or sweatshirt in here too?  Might as well fill it up!

Solution:  Carry two Auvi-Qs!  Each Auvi-Q is about the size of a deck of cards and can fit in most pockets.  You DO need to carry two – if necessary, place them in a jacket pocket.  And, let a trusted friend know they are there.

 

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Situation:  You’re at a restaurant/food court/concession stand with your friends. You need to ask several food allergy-related questions, but you’re embarrassed.

Reply: (to friends) I have to ask the manager a few questions.  I’ll be right back.
In this scenario, you can ask questions about ingredients without drawing attention to yourself.  Don’t miss the chance to eat safely and without worry or you’ll miss having fun with your friends!

Reply:  (Before you order… to your friends)  Hey, guys.  I’m going to need to ask a bunch of food allergy questions.  Do you want to order first?

OR:

Reply: (Before you order… to your friends)   Hey, guys.  I’m going to need to ask a bunch of food allergy questions.  Just keep talking so I don’t get nervous.  (Jokingly) You know I have stage fright!

 

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Situation:  You’re at your friend’s house.  Your friend’s mom offers to get you “something to eat.”  “I’ll grab you guys a snack!” she says, with no further description.

Reply:  I have a food allergy.  Do you have a piece of fruit I could eat?

OR:

Reply:  I have food allergies.  If you don’t mind, can I read some ingredient labels to see what’s safe for me?

OR:

Reply:  Thank you for offering, but I have a food allergy.   I’m okay for now.
OR:
I brought my own snack – all I need is a bowl/spoon/fork!

Parents love kids who take charge of themselves and are forthcoming with important information.  Telling an adult on-site that you have a food allergy gives you another layer of protection – a second set of eyes and someone to help if you feel you’re having a reaction.

Situation: A boy/girl you’ve been eyeing just asked you to go out for ice cream – but you have concerns about your food allergies at ice cream shops.  

Solution:  Find a coffee shop or restaurant with a similar fun feel that you know is safe and suggest you go there to hang out.

Solution:  Try an activity-based date.  Bowling, mini-golf, watching your school’s football game, seeing a band play, etc are sure to bring the fun without too much worry about food.

Reply:  I’m actually allergic to dairy/nuts/peanuts.  Would you mind if we tried this new frozen yogurt shop?  I’ve been dying to try their sorbet flavors!
Mentioning your allergies right away isn’t a deal breaker; it’s a way to ensure that you’ll feel relaxed on your date.  And when you’re more relaxed, you’re more likely to have fun!

 

Food Allergy Help for Hurricane Harvey Families August 30, 2017

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Families just like ours need help.  They find themselves in the path of Hurricane Harvey and many are without resources.  Not only are many thousands of people evacuated from their homes, but those who remain will likely not have access to supermarkets or deliveries as roads and commercial buildings will be effected for days or weeks.

 

The folks at the San Antonio Food Allergy Support Team posted an update today about how to donate food allergy-friendly food to those in southeast Texas.  Monetary donations are the best way to make an immediate impact.  And, food allergy-friendly donations, particularly those that make feeding children easier, are greatly appreciated.

 

Here is Allergy Shmallergy’s link to Emergency Food Allergy Donations on Amazon.  I will continue to update this list throughout the upcoming days.  This is just to get us all started and is, by no means, an exhaustive list of needs.  Feel free to send your families’ favorite allergy-friendly foods, but remember that it should be shelf-stable and not require refrigeration.

Emergency Food Allergy Donations
Link: http://a.co/129iX7e

 

Please read below for details.  And, remember: there are MANY excellent organizations that need assistance now.

 

Thank you in advance: Your help is appreciated beyond words!

 


From the San Antonio Food Allergy Support Team:

[Post updated Wed. 8/30 at NOON CST]

Texas was hit very hard by Hurricane Harvey.

Many of the people who have been evacuated from the Corpus Christi area are already here in San Antonio. We have some evacuees from Houston, but are expecting thousands more.

If you’d like to help food allergy families, here’s how…

The San Antonio Food Bank is coordinating food efforts to help ALL of Texas hurricane victims right now. San Antonio is clear and sunny and having no issues with roads closures or mail delays (unlike Houston).

San Antonio Food Bank
FOOD ALLERGY FRIENDLY
5200 Enrique M. Barrera Pkwy
San Antonio, TX 78227-2209

(210) 337-3663
Info@safoodbank.org
Mon-Fri 8am-5pm
https://safoodbank.org/

The information on the “Hurricane Harvey Emergency Response” pops up on their main page…scroll down to see all options.

•Folks can donate “MONETARY DONATIONS” and put in the NOTES section (at the bottom) that they want their donation to go to “FOOD ALLERGY FRIENDLY FOODS” – this may make the most immediate impact.

•Food allergy companies or donors can send “MATERIAL DONATIONS” food allergy products directly to the San Antonio Food Bank (address above) and clearly mark them as FOOD ALLERGY FRIENDLY – If possible, include a clear message that it’s food allergy friendly on the outside of the box, in the second address line, and on the inside of the box.

•Shipments direct from AMAZON: If you are sending allergy-friendly items directly from Amazon.com, you can enter “FOOD ALLERGY FRIENDLY ” in the “Address line 2” field for the address and include it in a “gift message” which would be inside the box, to help with package sorting.

*San Antonio Residents – You can donate food allergy friendly items to the SA Food Bank or the City Council Offices listed. Please clearly mark them as “FOOD ALLERGY FRIENDLY” inside and outside and if possible pack them in a sturdy box. You can sign up to volunteer at the SA Food Bank (you must sign up ahead of time).

FYI FARE and KFA/AAFA have blog posts with additional details. Enjoy Life and Sunbutter companies are already planning to send donations. AAFA is working with someone from the EoE community. If you happen to have a personal corporate connection looking to donate, please have them contact Chad Chittenden, Director of Food Industry Partnerships at cchittenden@safoodbank.org (210) 431-8313, but I’m sure he’s swamped and other organizations are already reaching out to companies.

–Susan & Selena — San Antonio Food Allergy Support Team (volunteer leaders & FA moms)

P.S. There are many other organizations that need general help (including the Red Cross and Blood Bank). Thanks to any of you who are helping in whatever way works for you.