Allergy Shmallergy

Simplifying life for families with food allergies.

Food Allergy or Food Intolerance? January 14, 2019

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Following an illuminating study conducted by Ruchi S. Gupta and her colleagues Christopher M. Warren, et al, it is clear that most Americans don’t understand the difference between a food allergy and a food intolerance.  The study found that in the U.S.  20% of adults claim to have a food allergy, but when evaluated by a medical doctor only 10% have symptoms consistent with a true allergy.

 

What is a food allergy? What makes it unique?

Food allergies are an immune system response to food.  When the body mistakes a food as harmful, it produces a defense system (in the form of antibodies) to fight against it.  These antibodies in the immune system – called immunoglobulin E (IgE), found in the lungs, skin and mucous membranes – release a chemical that sets off a chain reaction of the vascular, respiratory, and cardiac systems.

 

Food allergic reactions can vary from hives, swelling of the mouth, lips and face, and vomiting to respiratory issues (such as wheezing), drop in blood pressure, fainting, and cardiac arrest.  Anaphylaxis is a very serious and potentially fatal condition that is characterized by a sudden drop in blood pressure, loss of consciousness and body system failure.  Epinephrine (administered by an auto-injector) is the only medication that can slow or stop anaphylaxis.

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The most common foods that cause a food allergic reaction are:  peanuts, tree nuts (such as walnuts, pistachios, pecans, etc), dairy, eggs, wheat, soy, fin fish (salmon, tuna, etc), and shellfish.  But almost any food can cause an allergic reaction.

 

 

What is a food intolerance?  How does it differ from a food allergy?

Food intolerances also make people feel discomfort.  However, this discomfort is not life-threatening.  Food intolerances are a digestive response that occur when food irritates the digestive system or makes it difficult for a person to break down the food.

 

Symptoms of a food intolerance can include bloating, gas, nausea, stomach discomfort/pain, vomiting, diarrhea, heartburn, headaches, and irritability.  Dairy, or lactose intolerance, is the most common trigger.

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What are some other differences?

 

Food allergic reactions can occur with even the smallest amount of food ingested.  In addition to the range of major symptoms when ingested, it can also cause a skin reaction just upon contact.  A food allergy is a reaction to the protein contained in a food (such as gluten with a wheat allergy).

 

With food intolerances, amount of food consumed matters.   The more food consumed, the worse the digestive reaction.  Food intolerances occur because the body cannot break down the sugar in a given food (like lactose in milk).

 

Food allergies are diagnosed in several ways.  The golden standard is an oral food challenge – where a patient eats their suspected allergen under medical supervision to note the reaction.  Patients may take an IgE blood test or be asked to take a skin prick test to diagnose and monitor food allergy.

 

When a food intolerance is suspected, patients are often asked to keep a food journal or diary in which they note the foods they ate as well as the symptoms they experience.  Patients may also be asked to eliminate a particular food from their diet and note symptoms for a period of time.

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In both cases, a doctor will help give an official diagnosis and guide the patient through any changes that need to be made to their lifestyle.   Those with food allergies will also discuss issues like cross-contamination, emergency action plans, and epinephrine.  Those with food intolerances may talk about medications that can help to ease symptoms. Avoidance of problem foods will be suggested for food allergies as well as food intolerances.

 

Knowing the difference between a life-threatening food allergy and an uncomfortable food intolerance will help keep you safe, make appropriate lifestyle changes and get you the relief you need sooner.  

 

 

 

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.

 

 

 

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!

 

 

#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 an antihistamine for minor allergic reactions.  In the case of anaphylaxis or when two or more organ systems are involved (for example, vomiting AND hives – which is gastrointestinal and skin), patients will still need epinephrine to stop this type of severe allergic reaction.  However, if someone is experiencing minor reactions involving only one organ system (for example: hives, itchy mouth) antihistamines will help make things more comfortable.  **Continue to monitor patients after giving antihistamines to make sure a reaction hasn’t returned or isn’t progressing into anaphylaxis.**

 

 

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?

 

Food Allergies: Overcoming Disagreements November 27, 2017

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The holidays are a magical time – filled with hope and kindness.  But when you have food allergies, holiday gatherings are sometimes filled with the possibility of being excluded, disappointed, or the fear of having a food allergic reaction.

As parents and patients, we feel like we are constantly educating others about food allergies.  Our extended families and friends surely should know by now how real and severe a food allergy can be – shouldn’t they?!  Unfortunately, many times our family and friends don’t understand.  They underestimate the severity of a reaction and the amount of time and energy we put in to preparing for a regular day – never mind a holiday!  We often feel let down and angry when others don’t take food allergies into consideration or are set on upholding their traditions at the expense of someone else’s health and safety.

These disagreements around the holidays can set off a chain of unhealthy interactions that could cause relationships to strain.  Don’t end your relationship with family or friends.  Try the techniques outlined in the article below first and see if you can teach them about what your life with food allergies is really like.

Please read this article I wrote, published in the magazine Allergy & Asthma Today by the Allergy & Asthma Network, for more information.

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The Dangers of a Dairy Allergy November 17, 2017

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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.