Allergy Shmallergy

Simplifying life for families with food allergies.

#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.

 

 

 

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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.

http://bit.ly/2ncAJHY

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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.

 

Parenting Positively in the Face of Food Allergies September 29, 2017

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Last year, I had the pleasure of speaking with Lyndsay Edwards of Allergy Blog Awards UK.  In her podcast, she asked a lot of thought-provoking questions on the topic of parenting a child with food allergies.

 

Because of the challenges and risks associated with food allergic reactions, it is critical to raise food allergic children to be confident, resourceful, and self-advocating.  And all of that begins with a good attitude towards food.

 

Here is the transcript of Lyndsay’s well-crafted podcast [or listen here: Allergy Blog Awards UK – Allergy Shmallergy Living Positively with Food Allergies].

 


 

So, I know your son was diagnosed with a dairy allergy at 6 months old and other allergies by the time he was just 15 months old, can you just take us back to that time and what it was like for you getting the diagnosis?

 

Despite his eczema, acid reflux and asthma (conditions that I now understand to be related to food allergies), I was in denial.  Even though I followed her instructions to the letter, I scoffed at our pediatrician’s recommendation to avoid feeding my son a whole host of allergens as we introduced first foods.  “He’s probably not allergic to any of these!” I remember saying.

 

When she called us to discuss the results of my son’s blood test, revealing that he was allergic to eight different foods in addition to environmental allergens, I was completely overwhelmed.  I couldn’t stop wondering:

 

What does this mean Not only the test results, but also in a bigger sense:  what does this mean for his life?  Will he have a normal life?  And more importantly, what can I feed him for dinner tonight?!!

 

I found myself grieving for the hopes and dreams I had imagined for my child (like baking cookies and spontaneous trips to get ice cream), but then my husband snapped me out of it.  He reminded me that we would find work arounds.  And, if they didn’t exist, we’d create them!  Very quickly, THAT became my focus.

 

 

How do you cater for your son at home?  Do you all eat the same?

 

Because my son was allergic to so many foods, I had to learn how to cook (and fast!).  Unbelievably, he’s my most adventurous eater.  He loves everything seafood (no matter how crazy the dish), sushi…  and he’s consistently adding requests to his list.

 

These requests inspire me to learn how to cook all kinds of intimidating international cuisine.  No one who knows me would have EVER guessed that I regularly cook Chinese food or Persian or make all kinds of sushi.  In high school, I once burnt soup!  SOUP!

 

When he was a toddler (and an only child), I was making separate meals for my son.  But being a short order cook isn’t my strong suit and I didn’t want my son to feel like I was treating him differently because of his allergies.  In his own home, he should feel safe and included.  As I got better at reading recipes, swapping out his allergens for substitutes, I started serving only one meal (what a relief!).  I also began finding meals with optional parts (like tacos that you could stuff with cheese or not and make-your-own pizza night).  I now have quite a collection of tried and true recipes that are free of peanuts, tree nuts, sesame seeds, dairy and in many cases egg (an allergy my son has since outgrown).

 

 

When did you start your blog and what inspired you to do so?

 

It was very important to us to raise a confident child who felt capable in the world.  Food allergies are very stressful.  I wanted to share simple solutions with other parents and put out useful information so that families can remain calm and make informed decisions.

 

 

One of the things that really stood out for me on your blog is how you focus on teaching your son about his food allergies in such a positive way so that he doesn’t feel left out or sad, can you just explain how you do that and what has worked for you and your son?

 

We have repeated the message that everybody deals with something – sometimes that “something” is invisible to the eye, like food allergies.

 

We try to downplay the importance and emphasis on food.  For example, we try to reward achievements with activities rather than treats.

 

And, we remind all of my kids that the best party of any party is always the company, hardly ever the cake.

 

Involve your kids in problem solving.  We can’t control the fact that my son has food allergies, but I can give some control OVER them by getting his input on overcoming obstacles.

 

Prepare, prepare, prepare to provide special treats in anticipation of special events.  Bring a gluten-free cupcake to the party; pack a sesame-free hamburger bun for the barbeque; carry a little dairy-free butter out to dinner.  Create positive experiences around food and demonstrate how easy it is to overcome challenges.

 

Let him vent!  We’ve taught my son the names for his feelings and encouraged him to talk about them.  First, children need to know the language to use to express their emotions.  Then they can engage in an open dialogue to release stress and give parents an insight into how they are experiencing the world.

 

 

Ok, before I get to my last question, can you tell everyone where they can find you on social media, your website, etc?

 

Yes, of course!

[You all know where Allergy Shmallergy is! shmallergy.wordpress.com]

Twitter: @shmallergy

Facebook:  Allergy Shmallergy

Instagram: shmallergy

 

 

And my final question is if you could give allergy parents one tip, what would it be and why?

 

Help prepare your child to negotiate the real world: practice asking questions, allow them to speak to a waiter, in short: EMPOWER them!  Give them the tools to tackle the world!

 

And, provide a safe place for them to come home to. A safe home environment (free of allergens) as well as a safe space psychologically where they can relay their triumphs and articulate their frustrations without judgment or anxiety and find support.

 

That’s two tips (sorry!), but I hope they’re both helpful!

 

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.

 

 

The Fire Drill – 5 Key Lessons from an Intensely Scary Night February 22, 2017

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I had been home from the restaurant only ten minutes with my preschooler almost tucked into bed when I got the call.

 

“Miles isn’t feeling well. He’s nauseous and is having terrible asthma. We’re heading home early,“ my husband informed me calmly. My husband and two sons left our regular sushi dinner to attend a tennis lesson, still chewing as they walked out the door.

 

My oldest son has suffered from asthma since he was 10 months old, but this just didn’t sound like the typical onset of asthma for him. Something about Eric’s voice suggested something “other.” “Do you think it could be a food allergy reaction?” I asked.

 

“I don’t know; but we’re getting home as quickly as possible.”

 

Completely abandoning my daughter in her bed, I walked to our emergency medication and unsheathed the freshest EpiPen. I was reviewing our emergency action plan as headlights tore into the driveway.

 

Calm but focused, I greeted my son at the door. He was red and hot and choking out words as I tried to check in with him about his symptoms. He could barely speak. He felt nauseous and clutched his stomach as he made his way into the bathroom, afraid he would throw up. His description of his symptoms came out in – sometimes inaudible – spurts. He was fighting for breath. He felt and looked worse than I had ever seen him.

 

While my hand calmly rubbed his back and my eyes scanned his face assessing the situation, a million thoughts raced through me in a nanosecond. Was it something he ate? Was he possibly reacting to a new allergen? Was this anaphylaxis or pure asthma…or both? The flu and other upper respiratory viruses were spreading so rampantly that nearly a third of my son’s class was out that week. And, he had mentioned having a headache and feeling a little nauseous after school – something that had seemingly subsided by dinner.

 

No matter how I weighed my options, a few small words reverberated in my brain: two systems. Most emergency action plans state that if two or more essential systems (gut/stomach, lungs, skin, heart) are affected in an allergic reaction, epinephrine should be administered immediately. I held up the auto-injectors behind my son’s back, signaling to my husband that we might need to use them. Neither of us have had to use an auto-injector on my son before (knock on everything wooden). We knew it was probably the right call now. We were both looking for the other to validate that decision.

 

As with all things, I wanted the use of the auto-injector to be the absolute right decision. I called my father-in-law, a doctor of more than 40 years, for one last vote on how to proceed. It was a brief conversation. “Get him breathing! Give him albuterol, I’m coming right over.”

 

Having caught sight of me waving the EpiPen in the air to my husband, my son had now begun to sweat with panic – making everything much worse. I sat him on the couch and tried to cool him off for just a moment – considering the facts again. Asthma. Nausea. No throat, mouth, or tongue swelling. No hives. No clear relationship between this reaction and food – but always a real possibility.

 

I looked at my sweet boy once again, suffering for breath, and noticed his pallor wasn’t quite as red any longer; it was now tingeing blue. I grabbed the epinephrine and pulled off the safety cap. At that very moment, my brother-in-law (another doctor) and father-in-law walked through the door. With stethoscope in hand and exuding a calm and caring in doses that make me tear up in appreciation even now, they examined my son and set him up on a nebulizer – a machine that delivers asthma and other respiratory medications as a penetrating, breathable mist.

 

We monitored Miles’ pulse (which was steady) and his breathing (which was labored and difficult). It took a lot of medication and effort, but Miles began processing air more efficiently. I didn’t realize until the second hour of treatment that I had been clutching his auto-injector the entire time.

 

As Miles’ color returned and the dust began to settle, he began to recall details about his day – clues that might have been helpful earlier. Like, the fact that he experienced asthma during recess at school. As he continued to improve, we noted that he was simultaneously experiencing a migraine, which can bring about nausea. Together, we determined that this was likely an acute asthma attack and not a result of his food allergies.

 

All four adults watched Miles for another several hours (well into the night) before anyone was willing to even entertain sleep. And, by then, sleep didn’t come so easily. I awoke in a gasping sweat several times that night and slipped into my son’s room to check on him. At around 5:45 am, I placed my hand on his back and he broke the quiet of the pre-dawn, humorously stating, “Mommy. Your hand is like a furnace!” Smiling and with great relief, I knew the sun would come up that morning and all would be well.

When I relayed these events to my own father, he captured it perfectly. “You had a fire drill last night.” We certainly did. And, as with any good training exercise (intentional or not), we learned some valuable lessons that night.

 

  1. Trust your instincts. I knew we needed to use epinephrine. Had there not been two doctors in the family within arms’ distance from me, I would have absolutely used it. And, so would my husband. Even though it was not anaphylaxis and everything turned out well, I STILL regret not having used the auto-injector sooner. I had my doubts about a food allergy reaction for a number of reasons. The afternoon nausea as well as the absence of hives and swelling gave me pause – which is why I called my father-in-law. But, did being right about his diagnosis make me feel better about my hesitation? No. Severe food allergic reactions can present themselves with a number of symptoms and they can escalate very quickly.

 

  1. Always, ALWAYS carry your epinephrine auto-injector with you. EVERY TIME. And, make sure that your friends, family and/or whoever is caring for your child knows how to use it (procedures are slightly different for Auvi-Q, the Adrenaclick and the EpiPen, so I recommend reviewing often). In our case, we accidentally forgot to transfer the auto-injectors from my purse to my husband’s bag, taking for granted that he’d no longer be around food; out only for an hour to play tennis. Thankfully, we live two minutes from the tennis courts. But had they been further, my husband would ABSOLUTELY have needed those auto-injectors.

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  1. As if you needed an extra reason to carry your auto-injectors: Those who have asthma are more likely to suffer from severe food allergic reactions– particularly if that asthma is not well-controlled. Asthma can complicate food allergies. Asthma occurs when there is narrowing of the airways, making it difficult for an individual to take in the proper amount of air. In my son’s case, his lungs were taking in so little air that initially my father-in-law couldn’t hear any movement with his stethoscope. No wonder he was turning blue. In an emergency situation, epinephrine can be used to treat a severe asthma attack. We were milliseconds from using it.

 

  1. If you use an epinephrine auto-injector you must go the nearest emergency room immediately. This is not because you gave the injection. Rather, those having severe food allergic reactions need additional medication and treatment. Furthermore, patients can suffer something call a bi-phasic reaction – that is, a second, delayed bout of anaphylaxis. It is estimated that up to 20% of patients suffer such a reaction.

 

  1. Once Miles went to sleep, we recapped the night with my father-in-law, who’s served in some fast-paced emergency rooms. I’ve been repeating something he said that night to everyone who will listen:

“We used to tell surgical residents,” he began, “‘If you’re considering performing a tracheotomy, then you need to do a tracheotomy.’”  The same holds true for anaphylaxis. If you think you might need to use an auto-injector, then you DO need to use one. If you’re considering it, then the time is now.

 

I’m beyond grateful that our story ends happily.  I pray you all never have to experience the intensity of a severe reaction (whether that be from food allergies or acute asthma).  But I hope that by sharing our experience and the lessons we learned, your story will end happily, too.

 


 

Essential Resource:

I can’t recommend enough this informative piece on when to give what medication during a severe allergic reaction. The information contained in this article echoed in my head during the above incident.

 

From the Food Allergy Treatment Talk blog:

Putting the Fire by Dr. Brian Schroer