FARE Supports Research Community at AAAAI’s 2014 Annual Meeting

For the food allergy research community, the annual meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI) is one of the most important events of the year. FARE maintained a high profile at this year’s meeting, which was held in San Diego from February 27-March 4.  FARE’s Medical and Research Advisory Boards met, and FARE representatives offered information about our programs at our booth in the exhibit hall. Most importantly, FARE-funded researchers, along with our medical advisors, gave presentations and led informative sessions.

Less than 10 years ago, few sessions focused on food allergy. This year’s meeting showed how far the field has come, with a wide range of sessions and presentations devoted to potential new therapies, basic science, managing food allergies in schools and restaurants, and psychosocial issues.

Of particular note, researchers presented data on potential treatments for food allergy, with a strong focus on oral immunotherapy (OIT).  Although OIT is one of the most promising treatments in development, researchers still have many questions, including:  What is the optimal dosage?  How can we prevent patients on OIT from experiencing serious reactions?  Can OIT result in tolerance – long-lasting immunological changes that will protect patients even after they stop the treatment? Several new studies are bringing us closer to finding the answers. (It is important to note that the results discussed here are preliminary, and have not yet been published in peer-reviewed scientific journals.)

  • Researchers at the University of Virginia reported on a clinical trial of patients who had been desensitized to peanut after a course of OIT.  By eating a daily maintenance dose of one or two peanuts, some participants were able to achieve sustained unresponsiveness – meaning that they were able to eat peanut without having an allergic reaction.
  • On the other hand, prolonged avoidance of peanuts after completing OIT may lead to a reversal of the beneficial effects of the treatment, according to a study conducted by investigators at the University of North Carolina at Chapel Hill.
  • In a late-breaking abstract, researchers reported that combining OIT with omalizumab (Xolair®), an asthma medication, significantly reduced dosing-related side effects and the time needed to reach the maintenance dose in patients with milk allergy. FARE and the National Institutes of Health (NIH) are funding this multi-center study – the first randomized, double-blinded, placebo-controlled trial to demonstrate the effects of this combination therapy.
  • For more than a decade, FARE has provided partial funding for the development of a Chinese herbal treatment, Food Allergy Herbal Formula-2 (FAHF-2).  A Phase 2 clinical trial is currently underway to test the effectiveness and safety of FAHF-2 in treating peanut, tree nut, fish, shellfish and sesame allergies. At the AAAAI meeting, Dr. Xiu-Min Li (Icahn School of Medicine at Mount Sinai) presented the results of a pre-clinical study, which showed that combining the Chinese herbal formula with OIT reduced adverse reactions and produced greater post-OIT protection in mice with multiple nut allergies. Further studies are needed to evaluate this combination therapy in humans.

As the world’s largest source of private funding for food allergy research, FARE is committed to partnering with AAAAI to attract the most talented investigators to the field. At a benefit held during the meeting, AAAAI announced that FARE had contributed $50,000 to help establish the Allergy, Asthma & Immunology Education and Research Organization, Inc.’s (ARTrust™) $4 million Donald Leung and JACI Editors Allergy/Immunology Research Fund. Currently, the two leading contributors to the fund are FARE and Steve & Nancy Carell. In addition, since 2008, FARE has funded the AAAAI/Food Allergy Research & Education Howard J. Gittis Memorial Fellowship/Instructor Research Awards, which aim to shape the next generation of food allergy investigators. The recipient of the 2014 Gittis Award, who will be selected by an AAAAI committee, will be announced within the coming weeks. Finally, FARE invited young researchers to a reception, where they learned about our research grant program and strategic plan.

To learn more about current food allergy research, visit www.foodallergy.org/research.

Diet Dilemmas – Safe and Nutritious Food Substitutes

By Cassandra Sova, MS, RD, CD, CNSC

Finding safe food substitutes for some food allergens may be a difficult task, and many commonly used substitutes are not nutritionally equivalent to their allergenic counterparts. This article will guide you through food substitutes for some of the most common food allergens, helping you find safe food substitutes that are nutritious and delicious.

When first using food substitutes in cooking or in baking, start by finding recipes that are already allergen-free. Try recipes from the FARE newsletter, allergen-free cookbooks or reputable allergy friendly websites.

Always remember to read labels of all ingredients used in a recipe to make sure it is allergen-free.

Once you become more comfortable cooking allergen-free, you can try adapting your family recipes. To begin easing into the process, try finding recipes that only require one substitution. This will allow you to see how each substitute changes the final product.

Substitutes for Common Allergens:

Milk
There are many milk substitutes available such as soy, rice and almond milk. Always choose “enriched” or “fortified” versions. This indicates that calcium and vitamin D have been added. These milks are not created equal. Soy milk is the most nutritious option as it provides almost as much protein, vitamin D and calcium as regular milk. Rice and almond milk are low in protein and fat, but provide comparable amounts of calcium and vitamin D.

These milk substitutes often work well for cooking and baking. Choose the safe milk substitute with the highest content of protein and fat to help make a finished product that is closer to the original. Avoid using infant formulas for cooking and baking because heating them to high temperature can destroy the nutritional quality and may have a negative effect on flavor. Replace butter with milk-free margarine.

There are several yogurt substitutes that are comparable to the milk-based versions. Read the label to ensure that the yogurt has calcium added. These yogurt substitutes vary in protein content. Soy yogurt provides a good source of protein and overall is most similar to milk-based yogurt.

More cheese substitutes are now available in the marketplace. Be cautious, as they are typically not nutritionally equivalent to milk-based cheeses. For example, most soy cheese is lower in fat than milk-based cheese. Veggie cheeses are usually low in calories, protein, fat and calcium. Although the nutrition is not comparable, the taste and texture help make delicious meals. With both milk-free yogurt and cheese, read the ingredient label very carefully to ensure there is no milk cross-contact.

Wheat
For everyday cooking, create a meal with wheat-free sides and entrées. Try loaded baked potatoes, stir-fry over rice, or quinoa stuffed peppers. There are many wheat-free grains available, such as rice, corn, millet, potato, tapioca and quinoa. Many of these grains are also made into wheat-free flours.

Wheat-free flour blends typically produce a better texture in baked products than replacing wheat with a single grain flour. Wheat-free flour blends are available in your grocery store or health food store, or you may make your own flour mixture using the following recipe:

  • ½ cup millet
  • ¼ cup potato starch
  • ¼ cup oat flour

Many wheat-free recipes rely on refined flours like white rice flour instead of whole grains. These flours are usually less nutritious than regular versions. They may be lower in iron, folic acid, other B vitamins, and fiber. Try using more nutritious flours like brown rice flour, quinoa flour or chick pea flour. Eat more fruits and vegetables for a boost of vitamins and fiber. Take a complete multivitamin/multimineral supplement if you are avoiding wheat to meet all your vitamin and mineral needs.

Eggs
Try a commercial egg replacement, or use one of the following substitutes for one egg for baked goods:

  • 1½ tablespoon water, 1½ tablespoon oil, and 1 teaspoon baking powder
  • 1 teaspoon baking powder, 1 tablespoon water, and 1 tablespoon vinegar
  • 1 teaspoon yeast dissolved in ¼ cup warm water.

Try using tofu to replace the egg in meatloaf. Use soy milk as a binder to help
the crumbs stick to chicken tenders.

Peanuts and Tree Nuts
Mix seeds with raisins or other dried fruits. Add dry cereal or allergen-free chocolate chips to create your own trail mix. You can also use sunflower or soy nut butter as peanut butter substitutes. These products are versatile and great for making allergen free sandwiches or incorporating in all kinds of recipes from snacks to cookies to allergen-free shakes. Check out the manufacturers’ websites for recipes using their products.

Focus on Taste and Nutrition:
When choosing safe food substitutes, focus on both taste and nutrition. Read
the food label to find food products that are nutritionally similar to the foods they
are replacing. It is also important to eat a variety of foods from all food groups. Talk to your doctor or dietitian if an entire food group is eliminated because of your food allergies.

Cassandra Sova, MS, RD, CD, CNSC, is a clinical dietitian specialist in the Allergy and GI Department at Children’s Hospital of Wisconsin.

This article was originally published in the Winter 2014 issue of FARE’s Food Allergy News. Read more of the newsletter here.

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.