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!

FARE Researcher Receives NIH Grant

We are pleased to announce that a FARE-funded researcher, Dr. Cathryn Nagler of the University of Chicago, has received a multi-year, $1.4 million grant from the National Institutes of Health (NIH). Over several years, FARE has provided more than $1.5 million to Dr. Nagler and her team.

FARE’s support has enabled Dr. Nagler to identify a new strain of “good” intestinal bacteria that may protect the body against allergic sensitization to food. In September 2013, FARE awarded a bridge grant to Dr. Nagler, which allowed her to pursue her studies while awaiting the NIH’s response to her application for a more extensive grant that continues to explore the therapeutic potential of these bacteria.

Dr. Nagler and other experts believe that genetics alone cannot account for the dramatic increase in food allergies. They are exploring the theory that environmental stimuli interact with the immune system to promote allergic disease. To this end, researchers are studying how the microbiome – the vast collection of microbes, such as bacteria and viruses, that inhabit our bodies – influences our health. While some of these microbes cause disease, others keep us healthy. For example, some probiotics (that is, “good” bacteria) help us digest our food, while others regulate the immune system and protect us against “bad” bacteria.

Dr. Nagler and her team have been studying mice to learn how specific environmental factors – such as diet, antibiotics, intestinal worms, and “bad” bacteria – alter the environment of the gut, making the rodents more susceptible to food allergies. Data from previous studies support their theory. Antibiotic use in infancy, in particular, has been linked to the rising incidence of allergic disease. Dr. Nagler has shown that administering oral antibiotics to mice before they are weaned depletes populations of good bacteria from the intestines. As a result, these mice are predisposed to allergic responses to food.

If successful, this mouse model ultimately may enable scientists to develop and test new probiotic formulations, which would be used to prevent food allergy in infants or to enhance the protection that  existing treatments, such as oral immunotherapy, might provide. It is important to keep in mind that, while promising, this potential therapy has not yet been studied in humans.

This innovative research exemplifies a crucial goal of FARE’s strategic plan for food allergy research: attracting gifted investigators to the field of food allergy by providing long-term support that allows them to advance their work and generate enough data to merit larger grants from the NIH and other federal agencies.

To learn more about current FARE studies and our research vision, please visit www.foodallergy.org/research.

Recipes for an Allergy-Friendly Super Bowl Sunday

superbowlblogSuper Bowl Sunday is almost as much a celebration of food as it is football. Try these crowd-pleasing recipes as you watch the Seattle Seahawks take on the Denver Broncos – all are free of the top eight allergens!

No-Fuss Spicy Chickpeas

  • 1 (19-oz. can chickpeas, drained and rinsed)
  • 1 T. olive oil
  • 1 tsp. chili powder
  • 1 1/2 tsp. ground cumin
  • 1 1/2 tsp. dried oregano
  • 1/4 tsp. salt
  • dash of pepper

Preheat oven to 350 degrees. Line baking sheet with aluminum foil. Set aside. In small bowl, combine all ingredients, mixing well to coat peas. Spread peas onto prepared baking sheet. Bake 1 hour 15 minutes, or until peas are golden and crispy.

White Chili

  • 1 T. olive oil
  • 1 cup onion, chopped
  • 2 T. garlic
  • 1 T. ground cumin
  • 1 lb. ground turkey
  • 2/3 cup rice, uncooked
  • 1 (15-oz.) can garbanzo beans, drained and rinsed
  • 6 cups chicken broth*
  • 1 tsp. dried marjoram

In large frying pan over medium-high heat, add olive oil, onion, and garlic and saute for 5 minutes. Stir in cumin. Add turkey and cook until browned. Place turkey mixture into a deep soup pot and stir in remaining ingredients. Bring mixture to a boil at medium-high heat. Reduce heat, cover, and simmer over low heat 30 minutes, stirring occasionally. *Check ingredients of all canned items.

Quarterback Ribs

  • 2 1/2 to 3 lbs. pork spareribs
  • 3/4 cup maple syrup
  • 2 T. tomato paste, 3 T. hot water, 1 T. light brown sugar; mixed together
  • 1 T. apple cider vinegar
  • 1/4 tsp. onion powder
  • 1/2 tsp. salt
  • 1/2 tsp. dry mustard
  • 1/4 tsp. ground black pepper

Lightly grease baking sheet. Set aside. Place spareribs in large pot and cover with water. Bring to a boil over high heat. Reduce heat; simmer 40 minutes. Remove from heat and drain. Preheat oven to 350 degrees. In small bowl, combine remaining ingredients and mix well. Place spareribs on prepared baking sheet. Brush half of sauce on ribs. Bake 40 minutes or until tender, turning every 8 to 10 minutes, basting with remaining sauce.

We hope you have fun cheering on your favorite team!

Does Early Exposure to Nuts Lower a Child’s Allergy Risk?

ImageAre children more likely to develop a peanut or tree nut allergy if their mothers eat nuts during pregnancy or while nursing? Over the years, a number of studies have attempted to answer this question, but the results have been inconclusive. According to a new FARE-funded study, eating nuts during pregnancy does not cause food allergies in children. Further, although more studies are needed, it is possible that eating nuts may prevent a child from developing a food allergy.

In an article published online by JAMA Pediatrics on December 23, a research team affiliated with Harvard Medical School reported on their study, which suggests that mothers who do not have allergies and who eat nuts during pregnancy may lower their children’s risk of developing a peanut or tree nut allergy. The study, which was funded by FARE, received considerable media coverage.

The team, led by Dr. A. Lindsay Frazier, looked at the history of 8,205 participants in the Growing Up Today Study 2 (GUTS2) – children who were born between 1990 and 1994. The researchers reviewed records of the mothers’ diet immediately before and during pregnancy, and shortly after the infants’ birth. Of this group, 308 children had a food allergy, including 140 cases of peanut or tree nut allergy.

The incidence of peanut or nut allergies was significantly lower among the children of mothers who did not have food allergies themselves and who ate nuts at least five times per month compared to those who ate these foods less than once per month. “Our study supports the hypothesis that early allergen exposure increases the likelihood of tolerance and thereby lowers the risk of childhood food allergy,” the researchers concluded. They noted, however, that additional studies are needed. “The data are not strong enough to prove a cause-and-effect relationship,” commented one of the authors, Dr. Michael Young. “Therefore, we can’t say with certainty that eating more peanuts during pregnancy will prevent allergy in children. But we can say that peanut consumption during pregnancy doesn’t cause peanut allergy in children.”

A study that should shed more light on this issue is currently underway. The LEAP (for “Learning Early About Peanut Allergy”) Study, conducted by Dr. Gideon Lack and colleagues at King’s College London, has been following 640 children since infancy to determine whether or not exposure to peanuts early in life can prevent the development of peanut allergy. This study, which is co-funded by the National Institutes of Health and FARE, should be completed in 2014.

2014 Patient Assistance Resources for Epinephrine Auto-Injectors

If you have been prescribed epinephrine, FARE recommends that you carry two epinephrine auto-injectors with you at all times to make sure you have quick access to this life-saving medication. It’s also important to replace any expired auto-injectors right away so that you always have an up-to-date device.

We know those prescription costs can add up, so we encourage individuals and families who are managing food allergies to take advantage of the following options to help make this medication more affordable.

copaycard-cc1. Mylan Specialty’s “$0 Co-Pay Offer” for EpiPen® Auto-Injector

Available to both cash-paying and commercially insured patients, the “$0 Co-Pay Offer” is valid for up to three EpiPen 2-Pak® cartons or EpiPen Jr 2-Pak® cartons per prescription, as patients may need to access two EpiPen or EpiPen Jr® (epinephrine) Auto-Injectors in multiple locations. Eligible patients can use the offer with an unlimited number of prescriptions until the coupon offer expires on December 31, 2014.

Learn More

auviq2. Sanofi’s “$0 Co-Pay Offer” for Auvi-Q® Auto-Injector

With the savings offer, most insured patients will pay $0 out of pocket for their Auvi-Q prescription. Cash-pay patients can receive up to $100 off per two-pack of Auvi-Q, up to a maximum of three two-packs per prescription. Fill out the form to join the “Support & Savings Program” to access the offer. This offer can be used an unlimited number of times until the coupon offer expires on December 31, 2014.

Learn More

genericcoupon3. Lineage Therapeutic’s “$0 Co-Pay Offer” for Generic Epinephrine Auto-Injector

The approved generic for Adrenaclick® is available as of June, 2013 and may provide a lower-cost option to patients. Commercially insured patients will receive their epinephrine auto-injector at $0 cost. Cash paying patients will receive up to $300 off their out-of-pocket cost (This offer is valid for a maximum savings of $100 per pack (limit of 3 packs)).

Learn More

Be advised that the devices operate in different ways, so it is important to discuss your options with your doctor and be properly trained to use the device. You can find tips for getting the auto-injector you want and links to important information about each product, and training videos on how to use them on our the epinephrine auto-injector page of our website. Please note that these offers are not valid for prescriptions covered by or submitted for reimbursement under Medicaid, Medicare, or similar federal or state programs.