Allergy Shmallergy

Simplifying life for families with food allergies.

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

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

 

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

 

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

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

 

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

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

 

Symptoms of a severe reaction (called anaphylaxis) include:

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

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

 

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

 

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

 

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

 

 

FDA Approves First Generic EpiPen September 6, 2018

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

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

 

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

 

 

 

In-Flight Free-From Meals – Airlines Addressing Dietary Restrictions August 29, 2018

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If you’re taking to the air soon, you may be pleased to be able to request a special meal from your air carrier.  Airlines all over the world are responding to calls for special meals ranging from low-sodium and halal (made without pork or alcohol) to gluten-free.

 

Requests for special meals have increased over the years.  Historically, passengers have asked for specific meals for medical reasons or those that adhere to their belief system.  Experts wonder if the number of requests has increased because of the popularity of certain diets or the idea that special meals may be healthier or better tasting than those regularly served.  While that remains to be seen, the willingness to offer such meals is uplifting to patients with food allergies.

 

Both domestic and international travelers can take advantage of special orders covering a wide range of meal choices, but which ones your airline offers will vary from carrier to carrier, ticket type and destination.

 

Here’s a sampling of available allergy-friendly meals by airline.  As you will see, the meals Click on each airline to be directed to their site more details, including their policies on nuts and other allergens.

 

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Domestic Flights:

 

American Airlines

Glutose-Intolerant

Lactose-Intolerant

Vegan

 

Delta Airlines

Gluten-free

Vegetarian

 

United 

Vegetarian

Gluten-Intolerant

United policy for passengers with food allergies

 

 

International Carriers:

 

ANA

Allergen-Free Meals (choice between the 7 Allergen Free Meal and the 27 Allergen Free Meal)

7 Allergen Free Meal for Children

Gluten-Friendly

Low-Lactose

Seafood Meal (does not contain meat)

 

British Airways

various Vegetarian Meals

Gluten Intolerant

Low Lactose

 

JAL 

Gluten-Free

Vegetarian

Seafood Meal

Minimal Allergen Menu Meals

 

Luftansa

Gluten-Intolerant

Lactose-Intolerant

Vegan

Vegetarian

 

Malaysia Airlines

Gluten-Intolerant

Low Lactose

Vegan

various Vegetarian Meals

Seafood Meal

Special Meals

 

Qatar Airways

Gluten-Free

Non-Lactose

various Vegetarian Meals (also excludes fish, seafood, eggs and dairy)

 

Singapore Air

various Vegetarian Meals

Vegan

Gluten Intolerant

Low Lactose

Non-Strict Nut Free Meal

 

Turkish Airlines

various Vegetarian Meals (also excludes fish, seafood, eggs and dairy)

Gluten-Free

Low-Lactose

 

 

Please comment below if you’ve had one of these meals and let us know how it was!

 

Visiting Amusement Parks with Food Allergies June 18, 2018

Headed to an amusement park this summer?  It’s a good time to plan your meals ahead so you don’t have a meltdown on your hands.  And, navigating an amusement park can be easy!  In fact, you may be surprised to see how many major amusement parks are well-prepared for guests with food allergies.  If you’ve recently visited an amusement park, please be sure to leave us a comment and let us know how it went!

 

Headed to an amusement park?  Consider these tips:

 

  • Pack (or ship to your hotel) snacks and hard-to-eat-safely items like breakfast, hamburger rolls, granola bars and desserts.
  • Bring a collapsible cooler (AND freezable cooler packs) to tote into the parks for the day.  They are great at storing safe food as well as keeping epinephrine auto-injectors cool during long, hot days.
  • ALWAYS carry two auto injectors.  Everyone wants to carry as little as possible to an amusement park, but two auto-injectors MUST come with you.  Consider a small backpack with a zipper so you’re not bogged down with a spillable purse or tote bag.  You’re going to need sunscreen anyway…!
  • Contact culinary services at least a week in advance to ensure you have a fun, easy and SAFE day at the park!

 

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Walt Disney World, Disney Land and Associated Properties

Disney is renowned for how it accommodates guests with food allergies.  They are truly the gold standard.  Guests can review menus and have access to chefs to obtain further information.  It is recommended that you discuss your food allergies with each server, as always.  There’s lots of excellent information and suggestions online, including contacting them prior to your trip should you have 4 or more allergens and how to bring safe food into the parks.

Disney Special Dietary Requests

 

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Universal

Universal Orlando recommends prepping for your trip by reviewing menus and discussing your allergies with a Guest Services advisor.  Plus, they outline how to bring your own food into the park should you need to!

If you’re headed to Universal Studios Hollywood, you’re in luck:  you can easily view what’s safe online.  Call Guest Services if you have multiple food allergies or further questions.

Universal Orlando Food Allergy info

Universal Studios Hollywood Dining Food Guide

 

Legoland

Legoland refers guests with food allergies to a Dietary Guide that doesn’t connect at the present moment.  They also suggest contacting  LLF-Food@legoland.com prior to your visit to answer specific questions.  Per their guidelines, outside food and drinks may be brought into the park for dietary needs.

Legoland Florida – Food Allergies

Outside Food and Alcohol Policy

 

 

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Seaworld

Did you know that Seaworld has designated dining facilities for visitors with food allergies?  There is at least one restaurant in each of their parks that is best suited to handle food allergy issues and preparation.  Click each link to read more about Seaworld’s food allergy preparations and policies.

Seaworld Orlando Food Allergy Info

Seaworld San Diego Food Allergy Info

Seaworld San Antonio Food Allergy Info

 

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Hershey Park

In addition to making allergen menus available at most of Hershey Park’s restaurants, dining for those with food allergies has just gotten easier with the addition of a gluten-free, nut-free, fish and shellfish-free restaurant.  Hershey notes that every nursing station is equipped with EpiPens, but – as always – remember to bring your own.

Hershey Park Food Allergen Information

Hershey Park Food Allergen Information

 

Sesame Place

Sesame Place keeps its allergen information to individualized questions.  They ask that guests ask specific questions to  AllergenfriendlySPL@sesameplace.com at least 3-5 business days in advance for additional information. A culinary representative will work with each guest to ensure a safe dining experience.  Guests with food allergies are allowed to bring in safe food.

Sesame Place Food Allergen Information

 

 

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Six Flags

Six Flags have a variety of restaurants at each park.  While you cannot see an allergen menu on their site, you may be able to get the name of food vendors and research ingredients that way (for example, Six Flags Great Adventure has a Panda Express that a visitor could research).  Should you have food allergies, you can bring food inside the park.  If you plan on eating at one of the parks’ restaurants, be sure to ask LOTS of questions about ingredients and prep including french fry oil and cross contamination.

Six Flags

 

Busch Gardens

Busch Gardens seems to take food allergies seriously.  They answers a lot of excellent questions right on their website and provide ways of obtaining even more specific information should it be needed. Busch Gardens Tampa even offers allergen friendly dining facilities.  Again, collapsible coolers are allowed for those with dietary restrictions.

Busch Gardens Tampa Food Allergen Info

Busch Gardens Williamsburg Food Allergen Info

 

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Cedar Point

Cedar Point’s website identifies dining locations that serve certain allergens as well as a few that do not serve certain allergens.  If you have multiple food allergies, this may take a little cross referencing to find a few things that are safe.  They do not list information about brining in safe food from outside – so you may have to contact them directly.

Cedar Point Special Dietary Needs

 

Knott’s Berry Farm

Knott’s Berry Farms follows the same process as Cedar Point in identifying products and locations that use allergens.  They also identify certain locations and products that are free from specific allergens.  Again, they do not list if you can bring in safe food from outside the park. Contact them directly should you need additional information.

Knott’s Berry Farm Dietary Needs

 

Canada’s Wonderland

Once again, Canada’s Wonderland follows the same process as Cedar Point and Knott’s Berry Farm in helping guests navigate the park.  They list dining options by allergen, so if you have multiple food allergies, expect to cross reference these lists.  They do not state whether or not you can bring in safe food from outside of the park.  Contact them directly with additional questions.

Canada’s Wonderland Dietary Needs

 

 

 

Food Allergies on the Big Screen February 12, 2018

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Sony Pictures and the creators of the upcoming movie “Peter Rabbit” are facing a backlash from parents across the globe after it was revealed that the rabbits use a gardener’s food allergy to attack and impair him.

 

Food allergies are among several disabilities that are used as cheap gags in movies and on TV.  Sometimes, such as in the movie “Hitch” and on the TV show “Modern Family,” they garner laughs because the symptoms of anaphylaxis are so severe and fast-acting that they take the audience by surprise.  Sometimes they are used to show weakness or to emphasize low social status, like nerdiness.  In a recent Party City ad slated to run during this year’s Super Bowl, having a food allergy was deemed “gross” to convey it as annoying.

 

What makes the “Peter Rabbit” use of food allergies particularly distasteful is that 2017 was speckled with stories of food allergy bullying across the world; including the arrest of two young teenagers who knowingly used a peer’s food allergy against her sending her into anaphylaxis and at least one death – that of a 13 year old at the hands of his classmates who had snuck cheese into his sandwich at lunch.

 

The exclamation point on the “Peter Rabbit” case is that the rabbits reportedly state that food allergies are “made up for attention.”  Unfortunately, this plays on some people’s already-formed perception of food allergies and undercuts how serious they truly are.

 

The use of food allergies to prompt laughter reinforces stereotypes, spreads misinformation and strengthens the idea that food allergies are a choice meant for self-importance or as an inconvenience to others.  The use of food allergies in children’s media prays on the worst fears of children with food allergies and their families.  [1 in 13 kids in the United States have food allergies – that’s nearly 20 kids – and about 80 family members – in every screening of “Peter Rabbit” who live with the anxieties of the very severe consequences that just a small crumb of an allergen can trigger.]  These children are watching their nightmare come to life on the big screen.

 

The food allergy community is accustomed to hearing food allergies become the butt of a joke. Jokes, as distasteful as they are to some, may have their place in adult-oriented films and television shows (as is the case with the movie “Hitch” and “Horrible Bosses”).  But when it’s placed in children’s programming, it becomes unacceptable.  Exposure to such imagery, dialogue and attitudes during such a formative time in their lives can affect young audiences with food allergies (and influence those without) both psychologically and socially.  It can scare and scar those with food allergies.  And, showing it “even in a cartoonish, slapstick way” (as Sony describes it in their apology) teaches others that food allergies are not to be taken seriously.  By watching “Peter Rabbit,” kids are learning that using someone’s food allergy against them is both humorous and without consequence.  Meanwhile, children with food allergies are watching – horrified – while the audience jovially cheers the rabbits on. It’s amazing that storylines, such as this one, pass through vast numbers of people for approval without being questioned for their impact on children.

 

Thankfully, Sony has issued an apology recognizing the insensitivity of the “Peter Rabbit” material.  Let’s hope that other production companies learn from this lesson.  Apologizing after the fact is the easiest thing in the world.  How can we ensure that this doesn’t happen in the first place?

 

Nut or Not? Food Allergy Facts and Myths January 2, 2018

When you get a food allergy diagnosis, there is so much to learn… including what foods ARE and ARE NOT safe to eat. Let’s clear up some of the confusion surrounding different allergens and which food groups they belong in.  As always, speak with your allergist before adding any new food into your diet.

 

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COCONUT:  Coconuts are actually a member of the palm fruit family.  And, although they have “nut” in the name, they are not officially a nut.  That said, the FDA classifies them as a nut so you will see “TREE NUTS” listed on many U.S. product labels when coconut is an ingredient.

Verdict: While some people are allergic to coconut, most patients with a tree nut allergy can safely eat it.  Speak with your doctor before trying.

 

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NUTMEG:  Nutmeg is a spice that comes from seeds, not nuts.  Again, although “nut” is in the name, it’s technically NOT a tree nut.

Verdict:  According to the American Academy of Allergy, Asthma and Immunology (AAAAI), it can safely be consumed by those with tree nut allergies.

 

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PINE NUTS:  You may have heard the rumor that pine nuts are actually seeds.  And, that’s true.  BUT, there is some evidence of cross-reaction between pine nuts and peanut and almond allergies.  Doctors and researchers cannot isolate whether reactions to pine nuts are due to cross-reaction or to a separate pine nut allergy.  The FDA labels it as a tree nut.

Verdict:  Those allergic to tree nuts should AVOID eating pine nuts.

 

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WATER CHESTNUTS:  Another case of mislabeling.  Water Chestnuts are an aquatic vegetable.  They are named for their shape that resembles a chestnut.  Like any food, occasionally people find themselves allergic to water chestnuts.  But they are not tree nuts.

Verdict:  Those with tree nut allergies do NOT need to avoid water chestnuts.

 

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SHEA NUT:  Shea nut butter and shea nut oil can be found in many skin and beauty products.  Both shea nut butter and shea nut oil are derived from the seed of the shea tree’s fruit.  The shea nut is a distant relative of the Brazil nut and, as such, FDA considers shea nut a tree nut and will label it as such on ingredient lists.  Per Dr. Sicherer (via Allergic Living, read more here), studies have shown that only trace amounts of protein reside in shea nut butter or oil and no reports of topical immediate reaction or ingestion have been reported.

Verdict: Although allergy to shea nut appears to be unlikely because shea nut butter and oil lacks protein, please discuss with your allergist to get individualized guidance.

 

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ARGAN OIL:  Argan oil comes from the nut of a tree commonly found in the Moroccan desert.  Because the oil is cold-pressed, it is likely to contain protein. Argan oil is becoming an increasingly common ingredient in hair products such as styling oil, shampoo, conditioner as well as other beauty products.  You should check out how they’re made; it’s surprising!

Verdict:  If you’re allergic to tree nuts, it’s probably best to avoid Argan oil until you discuss with your allergist.

 

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BUTTERNUT SQUASH:  Again, it’s a misnomer:  there is “nut” in the name, but not in the product.  As you guessed, butternut squash is a vegetable.

Verdict:  Butternut squash is not only safe for those with tree nuts to consume, it’s also delicious!

 

THE BOTTOM LINE:  Most of the above products are safe for those with food allergies (woohoo!), but you should always discuss your particular allergies with your doctor before adding any food you are unsure of to your diet.

 

For your reference, here is the US Food and Drug Administration’s list of Tree Nuts:

  • Almond
  • Beech Nut
  • Brazil Nut
  • Butternut
  • Cashew
  • Chestnut
  • Chinquapin
  • Coconut
  • Filbert/Hazelnut
  • Ginko Nut
  • Hickory Nut
  • Lichee Nut
  • Macadamia Nut/Bush Nut
  • Pecan
  • Pine Nut/Pinon Nut
  • Pili Nut
  • Pistachio
  • Sheanut
  • Walnut/Heartnut/Butternut

Tree Nut or Not_

 

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.