Food Allergies in 2013: A Year in Review

What a remarkable year! As a community, we have accomplished so much to make life better for those with food allergies. With so many important milestones taking place in 2013, we decided to take a look back at some of the significant moments in food allergies from this year:

10. New auto-injectors became available
In 2013, two new epinephrine auto-injectors came on the market, providing more options to patients.

9. World Allergy Week and Food Safety Month were dedicated to food allergies
Demonstrating the growing prevalence and awareness that food allergy is a global public health issue, both World Allergy Week in May and Food Safety Month in September were dedicated to educating the public about food allergy.

8. Sports teams showed their support
Northwestern University hosted the first-ever peanut-free college football game in 2013. Additionally, Major League Baseball teams across the country welcomed families managing food allergies for nut-free or nut-controlled games. The Seattle Mariners, along with other teams, even invited kids with food allergies to throw out the first pitch.

7. The Centers for Disease Control & Prevention (CDC) published the first national school food allergy guidelines
These guidelines are intended to support the implementation of school food allergy management policies in schools and early childhood programs, and guide improvements to existing practices. Implementing these guidelines may help schools reduce allergic reactions, improve response to life-threatening reactions and ensure current policies are in line with laws that protect children with serious health issues.

6. Celebrities raised awareness
Celebrities like Julie Bowen, Adrian Peterson, Jerome Bettis, Jo Frost and Kenton Duty stood up to help bring awareness to the serious nature of food allergies. They spoke up on talk shows and public service announcements, and told their stories about their connection to the cause. Additionally, prominent bloggers gathered for the first annual Food Allergy Blogger’s Conference (FABlogCon) for a weekend of learning, support and inspiration.

5. FARE launched a public awareness campaign about food allergy bullying
During Food Allergy Awareness Week in May, FARE released a public service announcement about the growing concern of food allergy bullying. The video has more than 36,000 views on YouTube and helped bring attention to the issue. In December, a bill was filed which would require schools to put in place a policy that addresses food allergy bullying.

4. The media shined the spotlight on food allergies
The New York Times made a splash with their “Allergy Busters” article about the latest treatment for food allergies; they also ran an opinion column by author Curtis Sittenfeld urging increased availability of epinephrine in schools. And Anderson Cooper hosted teens Danielle and Lauren Mongeau, who advocated for the successful passage of a bill in Rhode Island that created a food allergy awareness training program for restaurants. Also related to restaurant awareness - FARE and the National Restaurant Association partnered to create the first comprehensive, interactive national training program for restaurant personnel to help them become more food allergy aware.

3. The FARE Walk for Food Allergy had a record-breaking season
The 2013 FARE Walk for Food Allergy season was the largest in its history, raising $3.6 million for food allergy research, advocacy, awareness, and education – a $1.2 million dollar increase from 2012.

2. The Discovery Channel aired a special documentary about food allergy
Narrated by Steve Carell, this documentary explored what it is like to live with life-threatening food allergies, how families and individuals managing food allergies are working to raise awareness in their communities, and the vital research underway to find effective treatments and a cure.

1.  The School Access to Emergency Epinephrine Act was signed into law
On November 13, President Obama signed this historic and potentially lifesaving legislation – the first federal law encouraging schools to stock epinephrine for use in allergic emergencies. At the signing ceremony, the president revealed that his own daughter, Malia, is allergic to peanuts.

Thank you to everyone who has volunteered, donated, and helped raise awareness about food allergies in 2013. We look forward to building on the momentum of this banner year to bring us even further toward fulfilling our mission in 2014: safety and inclusion for those with food allergies, while relentlessly seeking a cure.

Make a New Year’s Resolution to Benefit Those with Food Allergies

When it comes to food allergies, resolve to make 2014 a safe and fulfilling year for you and your family. The beginning of a new year is a good time to take a step back and think about what more you can do for yourself, a loved one with food allergy, and the food allergy community. We hope you’ll join us in making this year a great one by being prepared, raising awareness, and advocating for all those with food allergies. Here are a few New Year’s resolutions to add to your list:

1. Be prepared in case of an allergic reaction
Accidents happen. Make it your goal to take every precaution necessary to be prepared in case of an allergic reaction.

  • Wear emergency medical identification at all times. Through our partnership with MedicAlert, we offer discounted medical IDs and services through the MyVoice program. Whether you have a food allergy yourself or are the parent of a child with food allergies, the MyVoice program is there for you to help communicate your vital medical information in an emergency situation.
  • Always carry your epinephrine auto-injector wherever you go. Make it your goal to never leave home without your medication!
  • Develop an action plan. Work with your doctor to fill out a Food Allergy & Anaphylaxis Emergency Care Plan. This document outlines recommended treatment in case of an allergic reaction, is signed by your physician and includes emergency contact information.

2. Volunteer your time to raise awareness about food allergies
There are many opportunities to get more involved with educating others and advocating for those with food allergies.

  • Sign up for a FARE Walk for Food Allergy or volunteer to help make your local event a success.
  • Give a presentation at a school, library, or workplace. You can use one of our template presentations to educate others and raise awareness in your community. You can also purchase a children’s book to read to a classroom at a local school.
  • Sign up for the FARE Advocacy Action Center to make sure you are notified when legislation in your area is pending that needs your support.

3. Learn something new about food allergy
Educating yourself and others about the serious nature of food allergies is critical to moving our cause forward.

  • Sign up for our free monthly webinars. FARE hosts educational webinars designed to help you live life well with food allergies. Each month, we feature leading experts discussing the topics related to food allergy that you most want to hear about.
  • Subscribe to our blog to keep up with the latest news. Our blog features recipes, news, activities, and more about all the most important matters in food allergy today.

Thank you for your support in 2013, and we look forward to fulfilling our New Year’s resolutions along with you!

6 Tips for Celebrating the Holidays with Food Allergies

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It’s that time of year when holiday parties fill the calendar. Whether you’re a guest or hosting a party yourself, food allergies shouldn’t hold you back from seeing family and friends during holidays. Here are some tips that could help alleviate worries and allow you to enjoy celebrating the season.

RSVP – ASAP! Be a great guest by contacting your host as soon as your invitation arrives. Start by communicating gently and by educating others; remember, your host is hoping to plan the “perfect” holiday party or meal.

Discuss your concerns about food allergens, the possibility of cross-contact, and how you can best create a safe environment. Talk to your host or hostess about asking guests to wash their hands after eating if allergen foods are present. By having an interactive conversation about food allergies in general, you have an opportunity to educate without offending your host.

BYOSF (Bring Your Own Safe Food). Offer to bring safe food so that you know there will be something there that you or your child can eat and your host doesn’t have to worry about separate food preparations. Share dishes that would be allergen-free and a delight for everyone attending. If you are inviting guests to your house, ask them to contribute non-food items such as cups, napkins, or their own beverages.

Ship ahead. If you’re flying to visit friends or family, you may want to make some simple allergy-free foods that travel well and ship them to your host ahead of time.

Start the trend. Include an ingredient listing card with your food contribution to the party. Also, add an ingredient card to all food gifts you send out from your kitchen. If you are hosting, keep all labels from the food you prepare in case one of your guests has a food allergy as well. This is a great opportunity to raise awareness at a party and with friends.

Tag-team to keep an eye on young ones. Plan ahead with your partner or another adult to divide the task of supervising your young child. Create a signal for silently alerting each other to switch. With designated “on duty” times, your child will be supervised, and each adult will have time to socialize. This keeps little hands away from allergens that may be out (such as a bowl of chocolates or nuts).

The rules. Go over “the rules” for parties with your kids in the car so that the most important safety rules, such as not eating a food unless he or she has checked with you first, will be fresh in their minds when you arrive.

As always, be sure to ask about ingredients, check labels when possible, and carry medications with you in case of a reaction.

Happy Holidays!

The Promise of the School Access to Emergency Epinephrine Act

George-800By: George Dahlman, Vice President of Advocacy & Government Relations

Parents of children with food allergies across the country celebrated when President Obama signed into law the School Access to Emergency Epinephrine Act in November. They did so with good reason. Here was a federal recognition and remedy for the risks that children with food allergies face in our schools.

To be sure, the successful passage of the legislation was a landmark achievement for the food allergy community, raising awareness and sensitivity to the issue, and for FARE, which had been working on it for over two years. But it’s also important to recognize what the Act does — and what it doesn’t do.

The law provides a financial incentive to states that require their schools to (a) stock non-designated epinephrine (i.e., epinephrine not prescribed to a specific student) and (b) provide training for staff in how to use an epinephrine auto-injector. It does not require schools to stock epinephrine. The governance of schools has traditionally been a state and local issue, and so Congress is reluctant to mandate requirements. This incentive approach (rather than a mandate) is used commonly in Congress in other laws affecting state and local issues.

So what does the federal legislation mean for your school? It means that the presence of stock epinephrine in your school is still determined by your state legislature and your local school authorities. The federal government has simply offered a financial incentive for these entities to require the measures noted above.

Currently, only four states – Maryland, Nebraska, Nevada and Virginia – require their schools to stock epinephrine. They are the only states that are eligible for the federal incentive. While another 26 states have laws or guidelines in place allowing schools to stock epinephrine, they are not eligible for the federal incentive. In those states, the burden is on local school authorities.  They have been given permission to stock epinephrine. They now need to acquire the epinephrine and train personnel on administration. Frequently, that means the burden is on food allergy advocates to educate, motivate and assist their local schools in making it happen.

Certainly it’s FARE’s hope that the Act will serve as the catalyst for states to recognize the need, not only to allow schools to stock epinephrine, but to require that this important medication be available to all students, and to ensure that a variety of personnel are trained to administer it.

At the end of the day, it is parents and supportive school staff that will make sure our kids have the protection they need – but this new federal law and sound state and local policies will strengthen their hands and safeguard even more children.

Common Questions & Answers

Does the passage of this law mean that schools will now be required to have “stock” epinephrine?
No. The School Access to Emergency Epinephrine Act only provides an incentive to states that require their schools to provide stock epinephrine. It is up to the individual states to determine if they require or simply allow their schools to stock epinephrine. Only states that require it will be eligible for the federal incentive.

What is the incentive?
States that require their schools to stock epinephrine will be given a preference in the eligibility for asthma education grants. These grants were funded at about $22 million nationally in 2013.

How many states require their schools have stock epinephrine?
Currently, there are 30 states that have laws or guidelines that allow schools to stock epinephrine. But only four of these – Maryland, Nebraska, Nevada and Virginia – require their schools to have stock epinephrine. The other 26 are permissive, allowing or authorizing local school districts to acquire and stock epinephrine.

Couldn’t the federal government just require that all states have stock epinephrine?
Schools are generally governed at the state and local level, and “unfunded mandates” by the federal government are unlikely to win much support in Congress. The strategy of this Act is to provide an incentive to states by providing additional federal funding.

Does the bill provide for incentives for training?
In order to be eligible for the federal incentive, states have to require their schools to stock epinephrine and authorize trained personnel to administer it.

Is there liability protection for school personnel who might administer the stock epinephrine in an emergency?
Liability law is most often governed at the state and local level.  Accordingly, the Act requires that the state Attorney General certify that there are sufficient liability protections for school personnel in those circumstances.

What is the next step in making sure that schools have stock epinephrine?
For those 20 states that currently do not have any stock epinephrine law on their books, the federal Act offers a powerful incentive to pass their own legislation.

For those 26 states that “allow” for the stocking of epinephrine – but don’t require it – it offers an incentive to revisit the question and give parents, children and school personnel the reassurance of safety. In the meantime, school districts and authorities in those states should take advantage of their state authorization to adopt policies to acquire, stock and train appropriate school personnel on epinephrine.

If stock epinephrine is allowed in my state, what are the next steps?

Since most state statutes authorizing stock epinephrine defer to local education authorities, the policy and process of acquiring, maintaining and training is left to local school boards or individual schools. The first step for a parent or advocate would be to alert school authorities to their ability to provide this security. They may need help developing procedures, identifying a physician who can write a prescription, identifying training resources and securing the epinephrine auto-injectors, which can currently be secured free in the first year through the EpiPen4Schools program.

How do I get a physician to write the prescription?
Each state has its own policy guidance for allowing physicians to write a script for a non-designated epinephrine prescription. The schools’ authorities should be familiar with that provision and the guidance it provides. Allergists who can write a prescription can be found through the American Academy of Allergy Asthma & Immunology – Find An Allergist service.

Emotional Health for Parents of Children with Food Allergies

Herbert_Linda_02102013_12smBy: Linda Herbert, clinical psychologist in the Department of Allergy and Immunology at Children’s National Medical Center in Washington, D.C.

If you’re reading this newsletter, you probably already know that parenting a child with a food allergy can be stressful! Daily management is time-intensive and you may experience a mix of emotions, such as sadness, worry, confusion, uncertainty, frustration, anger and anxiety.

The first thing to remember is that these are all very normal reactions to food allergies and you are not the only parent to experience them! Research shows that parents of children with food allergy sometimes experience elevated stress, anxiety and worry, and sometimes report lower quality of life as a result of food allergies.

It’s also normal to go through periods of time when you experience these emotions in different amounts. For example, transitions to new schools or new play groups, developmental changes – such as increased adolescent independence – and reading about a scary food allergy-related event in the news can be particularly stressful. But you may also have times when you feel okay. This is also normal!

The second thing to remember is that learning and practicing ways to improve your ability to cope with stressful food-allergy related situations will not only help reduce your stress and anxiety, but your child’s too! Modeling positive coping strategies will have a positive impact on your family. Below are a
few strategies to bear in mind:

1. Use deep breathing throughout the day to calm yourself during stressful situations. You can do this any time and any place because it’s just breathing! Some parents find it helpful to do this every morning before starting their day and every evening before bed.

How to do this: Make yourself aware of your body. Check for tension; begin with your feet and move upward to your head, allowing a comfortable wave of relaxation to wash away any tension. Pay attention to your breath as it enters and leaves your body. Take a deep breath. Inhale slowly through your nose. Notice your lungs and abdomen expanding. Hold it for a moment, then exhale even more slowly through your mouth, letting your body relax. Repeat this process for 2-3 minutes until you feel the tension leaving your body.

2. Use problem solving techniques to manage situations that you can control. Learning ways to improve your problem solving ability will help you solve your problems instead of worrying about them.

How to do this: Use a problem solving technique to anticipate and address situations early. First, IDENTIFY all aspects the problem. Second, DEFINE each aspect of the problem, including the perspectives and goals for everyone involved. Third, EXPLORE all possible solutions—even ones you don’t think will work! Fourth, ACT on the solution. And fifth, LOOK BACK and reflect on the results. Try another solution if needed.

3. Acknowledge that sometimes you can’t change the situation, but you CAN change how you react to it. We all respond to situations with automatic thoughts, behaviors, and consequences. When we’re stressed, most of these thoughts are negative. Changing negative thoughts into positive thoughts will reduce your stress and improve the situation.

How to do this: Identify negative thoughts, such as, “I can’t control my child’s food allergies,” and change them to positive thoughts, such as, “I know how to explain food allergies to my child’s teacher and other parents. I’m a good parent and food allergy manager!” The hardest part of changing your thinking is identifying negative thoughts, so write down negative thoughts and then write a positive thought next to it. Repeat this positive thought to yourself as needed.

4. Expand your network of support. It is important to recognize that it takes a team to manage food allergies and keep your child on track developmentally.

How to do this: Think about all of the people who contribute to your child’s growth and development. Is there something missing from your team? Is there a type of help that you are not getting? In what ways would you like the level of support on your team to be different? Think about the answers to all these questions and start to identify people who can help you.

5. Take time for yourself! Parenting a child with food allergies is only one of the roles that you have, so it is important to acknowledge your other roles, such as spouse, friend, employee, sibling, etc.

How to do this: It’s very important to try to find something you like to do that you can work into your regular routine that encourages a healthy lifestyle for you and your child. Identify things that you can do. Examples include exercise, reading a book, talking on the phone with a friend, taking a bubble bath, playing a musical instrument, etc. Schedule at least one of these activities a week. And remember that taking time for yourself makes YOU healthier, which makes you better able to care for your child!

This article was originally published in the Fall 2013 issue of FARE’s Food Allergy News. Read more of the newsletter here.

A Letter from Santa to Your Child with Food Allergy

We all know that Santa Claus loves when kids leave him milk and cookies on Christmas Eve. Santa knows all about food allergies though and wants your kids to help him spread some cheer!

You can download and personalize this letter from Santa to help get your kids in the kitchen and involve them in making some allergy-friendly holiday treats, all in an effort to help Santa’s elves.

Download and customize the letter.

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Thinking Outside the Gingerbread Box

By: Gina Clowes, Director of Education, FARE

In our family, we don’t have a ton of traditions. Although I like things orderly, I was never one to insist on things being done the same way year after year.

One of the silver linings of this mindset is that I can think outside of the box pretty easily, which came in handy when my son Daniel came along with multiple food allergies. During the holiday season, delectable gingerbread houses seemed to pop up everywhere,  and with allergies to seven of the top eight allergens, 90% of the ingredients weren’t safe for him.

I wanted a decoration that my son could help build, but also one that would not pose a danger if he decided to sneak a piece during the holiday festivities (something that was guaranteed to happen).

As I perused the baking aisle, the flour, buttery frostings, nuts, coconut, marzipan, puddings, cookies, and piecrusts were all off limits.

So I switched my focus to what he could have and as I did, the sugar cubes caught my eye. I knew that we would build an igloo and we started that night! Daniel and I had a blast wedging each little sugar cube in place over the frosted bowl and placing the little gummy pine trees in place. It was adorable and my son was really proud of our creation. I hope you enjoy it too!

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Icy Igloo!

An allergy-friendly alternative to a gingerbread house.

This igloo is an adorable alternative to the traditional gingerbread house. And the kids can help make it!

Here’s what you’ll need:

  • Cake board (purchase from a party supply or craft store)
  • A bowl (ours was 6 inches wide and 5 inches deep)
  • Safe white icing (about 2 cups)
  • One box of sugar cubes
  • One ice cream cone
  • Pearl sugar (or white snowflake sprinkles)
  • Spearmint leaves
  • 4 large white gumballs
  • Fruit roll-ups or taffy
  • Safe sprinkles and jimmies
  • Gummi penguins

First, put a few tablespoons of icing in the center of the cake board. Spread it around a little wider than the bowl. Turn the bowl upside down into the icing so that it is secured onto the cake plate.

Frost the bowl generously with about a cup of icing. Beginning at the bottom, place the sugar cubes all around, going row by row until you reach the top.

Using a serrated knife, gently cut the narrow end off of the ice cream cone, and then cut that in half, vertically. The remaining shape should be like a “C” and you may discard the rest of the cone. Place a tablespoon of icing on the cake board, in front of the igloo, and place the piece of cone, open side down, to form the entrance of the igloo. Place a piece of blue taffy or fruit-roll up inside the entrance. Frost and cover with sugar cubes. (You can also use an empty paper towel holder for the entrance.)

Spread the remaining icing in the area around the igloo. Decorate with gumball snowmen, penguins, or other safe decorations. Sprinkle everything with the pearl sugar, pressing it into the icing that surrounds the igloo. And it’s done!

Holiday Gifts that Give Back

Supporting the causes that mean the most to you and your family can be a great way to celebrate the holiday season. As you start thinking about holiday gifts, there are many ways to give back and support food allergy education, research, advocacy and awareness programs – from purchasing a FARE membership for a family member, to books, clothes and jewelry that help support food allergy awareness. You can get your holiday shopping done and start making a difference today!

Membership
The gift of membership is one that makes an impact every day in the lives of the individuals and families affected by food allergies and anaphylaxis. Your gift gives the recipient access to our outstanding member benefits, while connecting them with other individuals and families managing food allergies.

MassCanvas Food Allergy Awareness T-shirts
Kids and adults alike love wearing these shirts to help raise awareness about food allergies. They were designed by professional designers and selected by you! Below are the official winning designs, sold in support of FARE’s mission – 20% of net proceeds go to FARE.

 

Holiday Cookbook
Stuffed with more than 150 tempting recipes, this cookbook offers helpful tips for substituting foods, cooking, and hosting safe celebrations throughout the year. With many common allergens avoided in every recipe, this will be your first reference for festive, allergen-free recipes.

Children’s Books

Nutley the Nut-Free Squirrel
This educational picture book about a squirrel with a nut allergy is written by a mother of three children with food allergies. Reading it to your children or in a classroom can help raise awareness about food allergies in a fun and entertaining way. All proceeds from the sale of the book go to FARE!Nutley_cover

Mangos for Max
Written by a food allergy mom, this children’s book aims to introduce food allergy to preschool and young elementary school children in a gentle manner. The author is donating 10 percent of proceeds from the book to FARE.

What Treat Can Ruben Eat?
By writing this book, food allergy dad John-Ruben Aranton hopes to educate more people on the potential dangers of food allergies and raise awareness to help create a safer environment for his daughter and others. A portion of the proceeds will be donated to FARE.

She Beads and He Beads Food Allergy Awareness Bracelet
The perfect gift for someone in your life who wants to raise awareness about food allergies in style! From every bracelet sold, $12 will be donated to FARE.

MedicAlert “MyVoice” Program and Medical Identification
Wearing medical identification at all times can help give you peace of mind that you are prepared should a life-threatening reaction occur. The MyVoice program is there for you to help communicate your vital medical information in an emergency situation. In addition to a 10% discount on new memberships, 20% of the proceeds from new and renewing memberships through the MyVoice program will support FARE.

More Items Available in FARE’s Online Store
From educational booklets and training tools, to more cookbooks and food allergy awareness materials, FARE’s online store has a variety of resources to help you live well with food allergies.

Thank you for your continued support, and we wish you a wonderful holiday season!

Your Questions Answered: Anaphylaxis

In our October webinar, Dr. Robert A. Wood, a professor of pediatrics and chief of Pediatric Allergy and Immunology at Johns Hopkins, and professor of International Health at the Johns Hopkins Bloomberg School of Public Health, focused on anaphylaxis, a severe allergic reaction that is potentially fatal.

Dr. Wood, who is also a member of FARE’s Medical Advisory Board, discussed the risks, symptoms and treatment of anaphylaxis; dispelled myths; and answered questions from the audience. Dr. Wood’s full presentation can be viewed on our website, but here are his responses to some of the questions submitted by audience members.

  1. How can you distinguish between symptoms of anaphylaxis and other illnesses? (e.g., asthma attack, random hives, stomach cramps, or anxiety attack)
    The symptoms can be identical. What we want to do is interpret the symptoms in the context of the overall situation and the chance that there’s been a food exposure. So if your child gets random hives or stomach aches and they’ve been home for the last several hours, and you know what they’ve eaten, and you’re confident they’ve not had an exposure; you can be quite confident these are random hives or stomach cramps. On the other hand, if you’re out at a family party for the holidays, and the food has not been under your complete control, and they show up with these same symptoms, we would be more worried that this may indicate a food exposure and the beginning of an anaphylactic reaction.
  2. Are there any clear differences in the way anaphylaxis progresses in children versus adults?
    The overall answer is no. The thing that does change is that as people get into middle age they’re actually more prone to the cardiovascular or blood pressure effects of an allergic reaction. One reason we don’t see blood pressure being the cause of death in children is that the heart and blood pressure systems in kids and young adults is very strong and typically can keep going in spite of a reaction. But as we hit middle age and older, our blood pressure system may not be as sturdy, and adults in that age group will be more prone to have the low blood pressure or anaphylactic shock.
  3. Is there any way to find out how much allergen it would take to cause an anaphylactic reaction in our child?
    We generally don’t have a clear answer to this. With the patient who comes in and has had 10 or 15 or 20 reactions, we can carefully look at each of their exposures and be able to say, “Okay, with this reaction, with this much exposure and that’s how they reacted.”  Otherwise I cannot look at a test result, I cannot look at a prior reaction or two and make any real prediction about what the reaction will look like or how much allergen it will take to cause that reaction. Some people want to undergo formal food challenges to get this answer. In a food challenge, we’re obviously intentionally feeding someone what they might be allergic to, and many times inducing an allergic reaction. But it is not designed to answer the question posed here, which is how much allergen it would take to cause an anaphylactic reaction. It doesn’t answer that because when we do a food challenge, we stop the challenge at the first sign of the reaction. We don’t push it to say, “How much more would it take to lead to anaphylaxis?” That would not be an ethical way to practice. So even a food challenge does not typically answer that question.
  4. If a person is having an anaphylactic reaction and doesn’t respond to epinephrine, is there anything that a hospital can do at that point?
    Absolutely yes. Now, there are cases where the reaction has gone too far by the time the patient gets to the hospital that there is nothing more to do. But, if for example someone was still having breathing problems after getting epinephrine, it is possible in those cases to put a breathing tube in place or to put a tracheotomy in place to make sure that air is still being provided into the lungs to maintain breathing. If someone is having low blood pressure because of their reaction that epinephrine didn’t stabilize, IV fluids and the use of these other medications can be extremely helpful. So, thankfully in most instances, if we’ve done the appropriate home management of an anaphylactic reaction, the response you get from the emergency room is, “What are you doing here? Your child looks fine.” The truth is that they look fine because you treated them appropriately. In most instances, a single dose of epinephrine along with a dose of antihistamine will completely reverse the reaction. So they do look fine but it doesn’t mean they shouldn’t be there. You want them there for the 20% of the time that additional medications are needed.
  5. Are people with asthma more at risk of fatal anaphylaxis, and why?
    Yes. Because the main reason that people die of anaphylaxis is that their airways shut down. Because of the underlying asthma, your airways are likely to be more sensitive to an allergic reaction.
  6. Does the risk of an anaphylactic response increase with each exposure to an allergen?
    Absolutely not. The next reaction is completely unpredictable. The biggest variable in that next reaction will be the dose of exposure. Since we have no idea what that dose will be, we can’t predict the reaction severity. Think back to the examples I was giving: If this reaction occurred to a contaminated cookie that had 1/100th of a peanut, and the next reaction occurred to eating a full cookie that had well-disguised peanut that had the equivalent of five peanuts in it, that reaction just had a 500-fold higher dose and will be much more severe than the one before. Again, you can’t take any reassurance that the last reaction wasn’t severe. If someone has had a huge exposure with only a mild response, that is a little bit reassuring. But because these allergies can change over time, even that wouldn’t make us say, “Throw away your epinephrine.”
  7. For people with peanut or tree nut allergies, how dangerous are ball games, airplanes, and other places with lots of nuts?
    As a general rule, because ingestion is the main root of exposure that poses risk, being around nuts is not going to be dangerous. Now, airborne reactions can occur. They will typically only happen though if the nuts are being disturbed in a way that will create a dust and if you are in a very confined space. So if you think about how that might happen, you will definitely get more peanut allergen in the air if you’re cracking open nuts, especially if you’re throwing nuts on the floor and walking on the shells. Each of those activities may create some dust that does contain allergen. If you’re in a contained space – if you’re in the waiting area of a restaurant and everyone is cracking open nuts, and the floor of that waiting area has an inch-thick peanut shell on it – that is a place that you could have a dangerous airborne reaction. That same amount of peanut at a ball game, though, virtually never causes problems. In the outdoor air, it’s very rare to see true airborne reactions. Now on airplanes, if everyone was cracking open nuts, airplanes would be a scary place. But the truth is that just by opening bags of peanuts, there’s very little peanut allergen getting into the air. We can’t say that it’s a zero risk situation. I can’t say that ball games are zero risk; I can say they’re very low risk. For me and my peanut allergy, I don’t worry about ball games or flying at all. I have no concern about it whatsoever. If my patients want to avoid ballgames or be on peanut-free flights, I don’t say that’s wrong. Although I think that normalizing life as much as possible and finding a cooperative airline that won’t serve peanuts, at least for peace of mind, may be a reasonable approach to be less anxious and still enjoy a family trip or vacation.
  8. You have had several anaphylactic reactions. In your own words, can you please describe what you or someone experiencing this type of reaction may be feeling?
    I can tell you that I’ve been very fortunate going nearly 20 years since my last anaphylactic reaction. But the memory of my last reactions is still very vivid, so this is something that sticks with you. I can tell you that my reactions, of which I’ve had 5 or 6 in my lifetime in the very severe category requiring epinephrine, one requiring multiple shots of epinephrine, all looked different. None of them looked the same. One had a very abrupt onset, one took 20 or 30 minutes, one had a lot of GI symptoms. All of them thankfully gave me an immediate reaction in my mouth, so I had a warning sign that I was eating a problem food. I was eating a food that was supposed to be completely safe, was promised to be safe, but while I was eating it I recognized that my mouth was itchy and I knew something was wrong. Then I could intervene, obviously to stop eating but also to begin treatment. Since I have this history of severe reactions, I will immediately administer epinephrine; there would be no reason for me to wait at all.

Questions about Treatment:

  1. Should RAST [blood test] or skin test scores be used to change an emergency care plan? If not, what are they useful for from a severity standpoint?
    The answer to the first question is absolutely not. They have no bearing on an emergency care plan. For the second question – they have very little use from a severity standpoint. So these are valuable tests to make a diagnosis. They are problematic even in making a diagnosis, but they are truly not useful in designing your child’s emergency care plan. You can have people with low scores and severe reactions, people with high scores and less severe reactions. If you take a large group, if you took 100 people with peanut allergy, you would see somewhat more severe reactions in those at the very high end of the scale. But you would see dramatic exceptions at either end. Meaning you would see some people at the very high end of the scale who have very minor reactions and some people at the very low end of the scale with very severe reactions. So we have never, and until we get better tests never will, devise our action plan around a test score.
  2. Can a person’s allergy severity worsen to the point that their anaphylaxis plans should change?The answer is absolutely, positively yes. One of the most important things that we do, is every time a reaction happens, we review that reaction. We review it from several standpoints. One of them is we want to think about how it happened – is it a situation that could be avoided the next time? There are always lessons to be learned from a prior reaction that may help the next one. We want to think about what was done during the reaction – was it done consistent with or not consistent with the action plan that we’d established? And was the reaction different than we expected? We may get very good news. We may get news that this child has virtually outgrown their milk allergy because they just got a whole big slug of milk and they barely reacted. That would downgrade their action plan. But more so we want to be in the knowledge of worse reactions to be able to upgrade the emergency care plan to have a more aggressive treatment plan if someone has presented with a more severe reaction than what we anticipated.
  3. Can antihistamines help after epinephrine is given?
    Antihistamines have no life-saving capacity, but they can help. They can help some more mild symptoms. We’ve seen people get epinephrine up front in a reaction, look very good, and then get hives later. I think that giving the antihistamine up front may prevent some of those later hives from happening.
  4. Is it ever worth giving oral antihistamines if that might mean losing time to administer epinephrine during what might rapidly progress to an anaphylactic reaction?
    Clearly, if we knew that reaction was progressing rapidly to anaphylaxis, we wouldn’t wait around and give an antihistamine. But if we’re in one of these situations where we interpret that this might not be such a severe reaction, giving antihistamine at that moment might be very appropriate, while having the epinephrine immediately on hand to administer if the reaction progresses.

We host an educational webinar every month. A recording of our November, “Safely Navigating the Restaurant Scene,”  is available on our website here: http://www.foodallergy.org/tools-and-resources/webinars

Food Allergy Bloggers Come Together in Las Vegas

Last week, FARE staff had the privilege to participate in the first ever Food Allergy Bloggers Conference (FABlogCon) and connect with dozens of food allergy bloggers, health care professionals and community members. FARE is a proud sponsor of this event, which received support through our community grants program.

The weekend brought together bloggers and other advocates from across the nation – some with food allergies, some with children who have food allergies, and some representing the celiac disease and food intolerance communities – for a weekend of learning, support and inspiration. Conference attendees discussed some of the major challenges facing the food allergy community today, shared personal experiences, and learned about important ways to advance the community’s messages about life-threatening food allergies. This remarkable group proved that although our community is spread across the country and diverse in many ways, we are all united by a common cause: to make the world a safer and better place for those living with food allergies.

FARE is also grateful to the bloggers who joined us at the FARE Walk for Food Allergy in Las Vegas. Their team raised $3,500 to support FARE’s mission!

Thank you to all of the organizers, sponsors and attendees for making this event possible, especially conference organizers Jenny Sprague (Multiple Food Allergy Help) and Homa Woodrum (Oh Mah Deehness!).