Q&A with Dr. Michael Young: Does Early Exposure to Nuts Lower a Child’s Allergy Risk?

Last month, we received significant feedback from the food allergy community on our blog post about a recently published study, “Prospective study of peripregnancy consumption of peanuts or tree nuts by mothers and the risk of peanut or tree nut allergy in their offspring,” which was published in JAMA Pediatrics. To help clarify some of the key takeaways from the study, we asked Dr. Michael Young, one of the study’s authors, to answer a few questions about the study’s results and what that means for individuals and families managing food allergy.

1. Briefly, can you explain the findings of this study?

The children of women who ate peanut/tree nuts 5 or more times a week while pregnant had a 70% reduced risk of developing peanut/tree nut allergies compared to the children of women who consumed nuts less than once a month while pregnant.

2. In one sentence, what’s the main take away?

If a mother eats peanut/tree nuts while pregnant, it does not cause or increase the risk of peanut/tree nut allergies in her children.

3. How do the findings compare to other studies on this topic? 

There are other studies examining the correlation of eating peanuts during pregnancy and the risk of peanut allergy in the children. Some show increased risk, others show that diet makes no difference. One of the strengths of our study is in the methodology, which minimized recall bias (meaning that the reports that mothers gave on their diets were as accurate as possible). Also, our analysis consisted of cases of clinical peanut allergy (both a positive allergy test and history of reaction to peanuts) rather than cases with only one of those components. Our study is the only study to show that higher levels of maternal nut consumption leads to a reduced risk of children with nut allergies, which is more consistent with current studies on early infant diets showing that earlier exposure to food allergens, such as peanut, milk, egg, and wheat, is associated with reduced risk of allergies to these foods.

4. We’ve heard from many women who ate nuts while pregnant and had children who were born with allergies to peanuts and/or tree nuts. Can you explain why their personal experiences differ from what you found?

While our study shows a reduction in risk of approximately 70% with increased nut consumption, it is not 100% risk reduction; there are undoubtedly other risk factors. The cause of the increased prevalence of peanut allergy is presently unknown, but likely has many factors. Further research may well reveal other risk factors that will help explain why this is happening.

5. Based on the findings of this study, what would your message be to mothers who have children with nut allergies?  

The conclusions from our data should reassure these mothers that eating nuts during their pregnancy did not cause their children to develop peanut and tree nut allergies.

6. What about to women who are wondering if they should or should not eat nuts during their next pregnancy? 

Our study did not specifically examine the diets of mothers of children with known nut allergies during subsequent pregnancies and clinical outcomes. In general, our data would indicate that eating peanuts/tree nuts during pregnancy does not cause nut allergies in children. So, a pregnant woman who wished to include nuts in her diet should feel free to do so.

Questions from FARE’s Mail Bag

Every day we receive dozens of phone calls, emails, and letters from individuals and families who have questions about food allergies. Below are answers to just a handful of these questions that we have received recently and thought others may benefit from knowing as well.

Can a person with a peanut and/or tree nut allergy eat nutmeg?

Although the word “nutmeg” contains the word “nut,” it is actually a seed, not a nut. Used as a spice in baking and many ethnic cuisines, nutmeg is safe for everyone who does not have an allergy to nutmeg itself.

Can having a blood transfusion cause an allergic reaction because of allergens in the donated blood?

Dr. Scott Sicherer addresses this question in his book “Food Allergies: A Complete Guide for Eating When Your Life Depends On It.” He says, “When blood transfusions are processed, the liquid (serum) is washed away, so even if trace food proteins had been in the blood donation, the amount left in the material that is transfused would be negligible. There have not been reports of reactions in this situation, although it may be reasonable for a donor providing a directed donation to a person with a food allergy to avoid the allergen for several hours prior to the donation. There is one report of a platelet donation causing a reaction in a child with a peanut allergy (platelets are the blood-clotting component transfused without being separated from the serum). The report is not completely verified, but there may be risk.”

If a product is labeled “Kosher Pareve,” is it safe for someone with a milk allergy?

Kosher pareve is a kosher classification for a food that contains neither dairy nor meat, generally speaking. Kosher classifications do not address cross-contact, however, so a product can still be considered pareve if the product is made in the same facility as or has come in contact with milk. We advise you to not use Kosher labeling as a guide for if a product is safe for those with milk allergies.

I’ve heard some cities are using cheese brine mixed with ice salt as a de-icing agent for roadways. Does this pose a threat to those with milk allergies?

FARE investigated this question with the City of Milwaukee Health Department. Information provided by the Health Department and reviewed by allergists indicates this is a very low risk practice. There is an extremely small amount of protein content in the salt brine, roughly equivalent to three drops of milk per square yard of roadway. This amount is further diluted by mixing with melting snow and ice. It is very unlikely that a reaction could occur from this practice, and any reactions would likely be localized to the skin contact area.

Celebrating Food Allergy Friends

A good friend can make you laugh, have your back, and be there for you when you have a tough day. We hear from kids with food allergies all the time that their friends are such an important part of their support system. Tayvon and Katie are two remarkable kids – while they do not have food allergies themselves, they are helping their friends stay safe, educating others about food allergies, and setting an example for other kids in their communities.  We want to give a shout out to Tayvon and Katie, who are truly great pals to their friends with food allergies!

Tayvon

amylee

At seven years old, Tayvon is already an amazing advocate for his 5-year-old friend and neighbor Amylee, who is allergic to egg and peanuts. Without being asked, he washes his face and hands before going to Amylee’s house to play, and has even changed his clothes to be certain he didn’t bring any peanut into her home when he had eaten peanut butter cookies earlier in the day. He keeps a protective eye on Amylee and makes sure to warn other kids who may be eating or playing near her about her allergies. Thank you for being a great food allergy friend, Tayvon!

Katie

Girlscouts

When kids don’t have food allergies themselves, it’s not always easy for them to “get” what it means to live day to day managing the disease. At 11 years old though, when Katie learned that a friend in her Girl Scout troop had a peanut and tree nut allergy, she “got it” and set out to have her troop learn more about food allergies to earn the food allergy badge. She also volunteered at the FARE Walk for Food Allergy in Las Vegas last year, which was especially relevant to her since her dad  has a poultry and egg allergy. Katie will be volunteering at the walk again this year, and is excited to help her community and her friends with food allergies. She said that she hates that kids with food allergies get made fun of, which is why she wanted to get involved. Thanks to Katie for showing us that even at a young age, kids can make a difference for their friends and in their communities!

FARE Kids Who Care: Connor deMayo

connermayoConnor deMayo, a high school sophomore, just became an Eagle Scout after completing a community service project designed around making restaurants in his town more allergy aware. He enlisted the help of the boys in his Boy Scout troop and set out to educate the restaurants in New Canaan, Connecticut on food allergy safety. With guidance from a local FARE-affiliated group, he was able to reach chefs, owners, managers, and wait staff in more than 25 restaurants. We asked Connor to tell us more about his project:

1. What are your food allergies? What’s it like having food allergies?

I was diagnosed at age one to the following foods: milk, eggs, sesame, peanuts and tree nuts. 

Having food allergies means you can never let your guard down and always be vigilant. By understanding what you eat and reading labels carefully and being careful when ordering in restaurants you can make eating less scary and more enjoyable.  

2. Tell us about your Eagle Scout project.

My Eagle project was to provide local restaurants in my town awareness training of food allergies and cross contact, including ideas on how to serve food-allergic customers. I put together a 30 minute awareness presentation, including FARE’s restaurant video. Then, I organized and led more than 16 friends/scouts into four teams and we each set out to all the restaurants in my town (more than 25). I put in more than 170 hours from beginning to end.

We trained owners, managers, kitchen staff and wait staff.  They all were all eager to learn more. I also gave each restaurant FARE’s kitchen posters of the top allergic foods as well as a folder with copies of the presentation. The restaurants were all very surprised at the rise in food allergies, many of the staff had no idea a customer could actually die from a food or even from cross contact. My friends who have food allergies as well noticed a big difference when they ordered at these restaurants. They definitely made changes in their restaurant procedures after hearing my presentation.

3. Why did you want to do it? Why was it was important to you?

Eating out is scary for many food-allergic people. Increasing awareness makes this safer and more enjoyable, especially for pre-teens and teens who are just starting to navigate eating out without their parents. A few simple precautions may save lives. If I saved one life by putting in all these hours and training then it was all worth it.

4. How would you advise other kids or adults who want to do something similar?  

Recruit your friends and an adult to help. I was fortunate to have Mrs. Helen Jaffe as my mentor during the project; she is the Chairperson of a FARE-affiliated group in Connecticut.  She was very helpful to me during this project. Ask your local Boy Scout troop to help you as well.

5. How can you be a good friend to someone with food allergies?

Treat others the way you would want to be treated!  My friends have my back and ask me if it’s ok to go to a certain restaurant for dinner and if it’s safe for me to eat there. 

6. What advice would you give a younger kid who was just diagnosed with food allergies?

Take it seriously; have your epinephrine on you at all times; always read labels; and work with your parents to get educated. I would direct them to FARE and their great website with lots of resources. 

Thank you, Connor, for helping to make eating out safer for your friends and neighbors with food allergies! Visit our website to learn more about dining out with food allergies and the ServSafe Allergens Online Course for Restaurants.  

Food Allergy Reactions – What to Do in an Emergency

Food allergy reactions are unpredictable. The way that your body reacts to a food allergy one time cannot be used to predict how it will react the next time.

Because the symptoms of anaphylaxis — a severe allergic reaction that is potentially fatal — can worsen quickly, reactions must be treated right away. Seconds count!

Symptoms of a food allergy reaction can affect different parts of the body. They can be mild (itchy nose or a few hives) or severe (trouble breathing, repetitive vomiting, etc.).

Epinephrine, which helps reverse the symptoms of a severe reaction, is the only treatment for anaphylaxis. Antihistamines may be used to relieve mild allergy symptoms, such as a few hives, but they cannot control anaphylaxis and should never be given as a substitute for epinephrine. Mild symptoms can quickly turn into a life-threatening reaction. Anyone having a reaction to a food allergen should be watched closely.

Following are the general guidelines for treating an allergic reaction, using FARE’s Food Allergy & Anaphylaxis Emergency Care Plan. This plan was developed under the guidance of FARE’s Medical Advisory Board, comprised of the country’s leading food allergy experts. Everyone with a diagnosed food allergy should work with their allergist to fill out an Emergency Care Plan that is right for them. General recommendations:

  • Administer epinephrine (using the individual’s easy-to-use epinephrine auto-injector)  and call 911 for any of the following severe symptoms:
    • Lung: shortness of breath, wheezing, repetitive cough
    • Heart: pale, blue, faint, weak pulse, dizzy
    • Throat: tight, hoarse, trouble breathing/swallowing
    • Mouth: significant swelling of the tongue and/or lips
    • Skin:  many hives over body, widespread redness
    • Gut: repetitive vomiting or severe diarrhea
    • Other: feeling something bad is about to happen, anxiety confusion
    • Or a combination of mild or severe symptoms from different body areas
  • Antihistamines may be given, if recommended by a physician, for a single mild symptom, such as:
    • Nose: itchy/runny nose, sneezing
    • Mouth: itchy mouth
    • Skin: a few hives, mild itch
    • Gut: mild nausea/discomfort
    • If these symptoms worsen, give epinephrine.

Epinephrine is a safe and relatively harmless drug, and allergists advise that if you have any doubt about whether to use epinephrine, you should go ahead and use it. Your allergist may prefer that epinephrine be used before symptoms or with only mild symptoms if a food allergen was eaten.

It’s important to note that this lifesaving drug should be given first, followed by a call to 911. We also advise that you let dispatchers know that you are giving epinephrine, and that you are requesting an ambulance with epinephrine.

Again, when in doubt, give epinephrine! This is critically important. You could save a life.

For more information about food allergies, please visit www.foodallergy.org.

For more information about treatment and management of an allergic reaction, please visit http://www.foodallergy.org/treating-an-allergic-reaction.

This article was reviewed by Scott H. Sicherer, M.D. professor of pediatrics, allergy and immunology at the Icahn School of Medicine at Mount Sinai.

Sparking Valentine’s Romance Without Triggering Allergies

By: Kristen Kauke

love logValentine’s Day is the ancient rite of celebrating love by exchanging romantic expressions with the person who embraces your heart. Gifts such as cards, candy, flowers and other tokens attempt to convey your utmost adoration and affection for your Valentine.

If your Valentine has food allergies, you might find traditional attempts at cherishing your Valentine challenging as many candies, chocolates and flowers could trigger allergies instead of sparking romance. However, by following simple tips for couples who navigate food allergies, romance can reign!

  • I believe in the motto “no askin’, no gettin’.” Sometimes you need to direct your partner on how to best meet your needs. I’ve found sharing those “subtle hints” to not be so effective. I have no shame in clipping pictures from catalogs, circling the price and where to purchase. And be sure to let your loved one know about websites that sell your favorite allergy-friendly treats so they can order you chocolates, cupcakes, or other goodies that are safe for you.
  • Sometimes the most memorable tokens of affection are homemade! Don’t underestimate the power of the handwritten note! My husband won me over with the first Valentine’s card he ever gave me. It was made from yellow construction paper, with a lopsided heart drawn on the front. Inside he wrote, “To set the record straight, I swear I did look for a card, but nothing sounded like me.” His own words proved personal, sentimental, and superior to a store-bought card. Another one of my favorite gifts from him was a mix tape.  I know, I know, mix tapes are basically extinct.  So update the idea; just think of how touched your Valentine might be by a virtual video slideshow.
  • Priceless gestures might actually be priceless! Do something for your Valentine that eases their burden – run an errand, clean the bathroom, take their car for a wash. The task might even be mutual like walking the dog or trading backrubs.
  • If you’re heading out for a romantic meal, be sure to follow FARE’s tips for dining out with food allergies. Selecting the right restaurant, calling ahead, and remembering to bring a chef card and medication can help ensure you have a safe and enjoyable night together.
  • Cooking is a labor of love! Cooking together can be a very romantic experience.  Additionally, nothing says “I’m into you” better than when you take the time to plan and execute an allergy-free dinner for your Valentine. My husband makes great milk-free, egg-free, soy-free, peanut-free pumpkin & chocolate chip pancakes.
  • If you’re hoping for a kiss from your Valentine’s Day date, you will want to ask your date to avoid your allergens as well. Have this conversation prior to the day of your date.  The (unattractive) hives and wheezing that erupt are way more awkward than  just saying, “Dude, if you want to be with me later, don’t be with peanuts now.” You can learn more about the findings of “The Kissing Study,” which was specific to peanut allergy, on FARE’s website.
  • Valentine’s Day doesn’t have to involve food at all! Some of my favorite dates involve hiking, playing pool, or even rock wall climbing.

Kristen Kauke is a Licensed Clinical Social Worker, who also happens to parent two boys with life threatening food allergies, as well as live with food allergies herself. She will be facilitating free educational webinar with FARE on February, 12 at 1:00 p.m. titled, “Safe and Sound: Relationships, Dating and Intimacy Challenges Associated with Having Severe Food Allergies.” Register to attend here: http://www.foodallergy.org/tools-and-resources/webinars.

Happy Valentine’s Day!

Valentine’s Day Tips for Parents

Homemade ValentineValentine’s Day is the sweetest of all the holidays, both in sentiment and in sweet treats. But with candy and confections being shared and parties being thrown, it’s also a good time to review some basics of effective food allergy management.

Here are some helpful reminders for parents of children with food allergy as this holiday approaches:

  • Remember that candy manufacturers may change packaging for holidays like Valentine’s Day. For example, a peanut butter cup might come in the form of a foil-wrapped heart instead of the tell-tale cup shape. Don’t assume anything. Read every label, every time. If a label is not available, don’t take chances and avoid the treat.
  • Buy some safe candy or inexpensive toys or trinkets and prepare a special Valentine’s goodie bag for your child. Or have these items available for a trade in case your child receives treat that he or she cannot have. Re-emphasize to your child that these sweets shouldn’t be eaten unless a trusted adult has read the labels and said it’s okay.
  • Invent your own holiday tradition, such as making homemade Valentine’s cards or baking allergy-friendly treats together and decorating them in keeping with a Valentine’s theme. (Need inspiration? Check out this recipe for Valentine’s Day Cake Pops on our Teen Blog)

Happy Valentine’s Day!