New Study: Anaphylaxis Hospitalizations Double Among U.S. Children

The number of U.S. children who were hospitalized due to food-induced anaphylaxis more than doubled between 2000 and 2009, according to a new study, which was published online Aug. 7 by the Journal of Allergy and Clinical Immunology. In addition, the authors report that the “charges and costs of [food-induced anaphylaxis] admissions have increased dramatically over time, adding to an emerging literature on the large economic burden of food allergy in the United States.”

The authors, including Carlos A. Camargo, MD (Harvard Medical School), previous recipient of a FARE research grant, analyzed records for more than 12 million inpatient discharges from the Healthcare Cost and Utilization Project (HCUP) Kids’ Inpatient Database. HCUP is part of a family of healthcare databases sponsored by the federal Agency for Healthcare Research and Quality.

Hospitalizations (admissions) due to food-induced anaphylaxis rose from 1,085 in 2000 to 2,253 in 2009.  Throughout this period, demographics remained consistent: the average age of patients was around eight; in 2000, 56 percent were male, vs. 55 percent in 2009; and there were no significant changes in the make-up of patients’ races or ethnicities. Overall, the highest hospitalization rates were in the Northeast, and the lowest were in the South. Except for children who were two years old or younger, significant increases in hospitalization were seen in all age groups. While the average length of patients’ hospital stay remained stable (from 2.3 days in 2000 to 1.9 days in 2009), the researchers report that “total charges more than tripled over the 10-year period, and total costs (data available 2003-2009) also significantly increased.” They conclude that “this trend highlights the need for further research on the inpatient management of [food-induced anaphylaxis] and how to prevent these hospitalizations.”

FARE-CDC Collaboration Results in Resources for Schools

cdccoverThe Centers for Disease Control & Prevention (CDC) published “Voluntary Guidelines for Managing Food Allergies in Schools and Early Care Education Programs” last fall. The information in these guidelines helps schools to avoid, recognize, and treat allergic reactions while ensuring that students with food allergies are safely included in all school activities. FARE has created several useful resources based on the CDC guidelines to help increase awareness around food allergy management in schools.

We encourage you to review, download and bring the following documents to your child’s school:

Keeping Children with Food Allergies Safe at School

cdcthumb1Every student at risk for anaphylaxis should have an individual written accommodation plan. A child’s accommodation plan (Section 504 or other written plan) has two parts: the accommodations or services needed for the child to be safely included in activities, and the emergency care plan (such as FARE’s Food Allergy & Anaphylaxis Emergency Care Plan). Download this one-page handout of important recommendations from the CDC national guidelines.

Recommended Practices for Reducing the Risk of Exposure to Food Allergens and Responding to Food Allergies in Schools and Early Childhood Education Programs

cdcthumb2On pages 41–43 of the CDC guidelines are recommended practices and accommodations to help ensure that children with food allergies are safely included in school. Download this one-page handout of important recommendations from the CDC national guidelines. Recommendations for the Classroom, Cafeteria, Transportation, School Events, and Physical Education and Recess include practices such as:

  • Avoid the use of identified allergens in class projects, parties, holidays and celebrations, arts, crafts, science experiments, cooking, snacks, or rewards;
  • Use non-food incentives for prizes, gifts and awards;
  • Do not exclude children with food allergies from field trips, events, or extra-curricular activities;
  • Encourage hand washing before and after handling or consuming food; and
  • Have rapid access to epinephrine auto-injectors and train staff to use them.

Actions for School Boards and School District Administrators

Data from CDC’s 2006 School Health Policies and Programs Study indicated that only slightly more than 40 percent of school districts have model food allergy policies. District policies are implemented with the support of board members, the district superintendent, and district-level staff members.

cdcthumb3School Boards can adopt written policies that direct and support clear, consistent, and effective practices for managing the risk of food allergies and responding to food allergy emergencies. A comprehensive and uniform set of district policies can promote consistency of priorities, actions, and options for managing food allergies across the district to avoid confusion and haphazard responses, as well as ensuring that practices are aligned with federal and state laws, including regulations, and policies, as well as other established school policies. Download this handout.

cdcthumb4School District Administrators can provide direct assistance to schools to help them meet the needs of students with food allergies, especially when the school does not have key staff, such as a doctor or a full-time registered nurse. Effective management of food allergies in schools requires the participation of many people. Administrators can help ensure that policies and procedures are established in order to identify students with food allergies, and that all school staff understand the school’s responsibilities under the federal laws and regulations that govern food allergies at school including, but not limited to: Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act (ADA), the Individuals with Disabilities Education Act (IDEA), and the Family Educational Rights and Privacy Act of 1974 (FERPA). Download this document.

For additional information, please visit: http://www.foodallergy.org/cdc

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

Find Your Food Allergy BFFs

walkwomenYou have friends you exercise with, go on vacation with, and spend nights out with, but do you have friends who are also managing food allergies? Whether you branch out and make new “food allergy friends” in your town, or you connect online, it’s beneficial to build your support network. Having someone to talk to about challenges you’re facing, swap recipes, and trade tips is invaluable in the day-to-day management of food allergies.

Here are a few ways you can start building or expand your group of food allergy friends and confidants:

  • FARE Events

While all of FARE’s information and resources are available for free online, we know the value of gathering the food allergy community in person. That’s why we host events across the country to bring people together to learn, connect, and raise funds to support our mission. Here are just a few examples of the types of FARE events you can attend with your family and friends:

FARE Walk for Food Allergy Events

FARE Walks for Food Allergy are family-friendly events taking place in more than 60 communities nationwide in 2014. Walks are a great chance to meet other families in your community who are managing food allergies, as well as raise funds for food allergy research, education, advocacy and awareness. Register for a Walk at www.foodallergywalk.org.

Teen Summit

  1. The 9th Annual Teen Summit is a 3-day event, being held November 7-9, 2014 at the Grand Hyatt in Washington, D.C., that gives teens living with food allergies a chance to meet with other teens from across the country. There is also a sibling and parent track for family members to share their experiences and learn from some of our great speakers. You can hear about teens’ experiences at the summit by reading page 11 of our Summer edition of Food Allergy News. Register at http://www.foodallergy.org/teensummit.

FARE National Food Allergy Conference

This annual conference gathers the country’s leading food allergy experts and members of the food allergy community together for a weekend of world-class programming. The 2015 conference is scheduled for May 16-17 in Long Beach, California and registration will open in winter of 2014. Learn more about the 2014 conference at http://www.foodallergy.org/conference.

  • Support Groups

Online and in-person support groups can provide advice specific to your community, such as suggestions for local restaurants, products, and events.

Search FARE’s support group directory for a group in your area.

  • Blogs

Even if you’ve never met your favorite bloggers, you feel like you know them after learning so much about their lives online, and reading their blogs can start to feel like checking in with old friends. Food allergy bloggers are a great source for laughs, recipes, news and opinions about hot topics in food allergies. We’ve listed just a few blogs covering different topic areas here to get you started, and we encourage you to share your favorite food allergy blogs in the comments section!

Research

Food Allergy Mom Doc

Food Allergy Sleuth

Advocacy

The Grateful Foodie

Allergic Girl

Food Allergy Buzz

Food Allergy Mama

Oh Mah Deehness!

Parenting

The Nut-Free Mom

The Food Allergy Mom

Mom Versus Food Allergy

Mothernova

Allergic Kid

Multiple Food Allergy Help

Cooking and Recipes

Making it Milk Free

Don’t Feed My Monkeys

Our Life as an Epi Family

CAFE (Celiac & Allergy Friendly Epicurian)

Food Allergy Feast

Cybele Pascal – The Allergy Friendly Cook

EBL Food Allergies

Nut Free Wok

Adults with Food Allergies

Adventures of an Allergic Foodie

Franny Cakes

The Diary of Ana Phylaxis

Teens with Food Allergies

Food Allergy Froggie

Teen FAAB

Miles with M.E.

Gluten Free and Allergy Friendly

Raising Jack with Celiac

Ginger Lemon Girl

Angela’s Kitchen

Do you have any favorite food allergy blogs? List them in the comments section!

However you choose to reach out and connect to others in the food allergy community – we encourage you to make the effort. Good friends are truly invaluable to have by your side as you’re managing the day-to-day of living with food allergies.

Back-to-School Homework for Food Allergy Parents

busFor some parents, sending a child with life-threatening food allergies off to school can feel like an overwhelming task, especially if the child is entering a new school or attending for the first time. FARE has many resources on our website’s “Managing Food Allergies at School” section, but there are a few key tasks for food allergy parents to complete before the school year starts.

Assignment #1: Get your paperwork in order

FARE’s Food Allergy & Anaphylaxis Emergency Care Plan should be on file for every student with food allergies. It outlines treatment recommended treatment in case of an allergic reaction, includes emergency contact numbers and is signed by the student’s physician.

Students with food allergies should also have a written management plan, such as a 504 Plan, in place. A 504 Plan (named for Section 504 of the Rehabilitation Act of 1973) is a plan that outlines the accommodations, aids or services that a student with a disability needs in order to use, and fully participate in, a free and appropriate public education (FAPE).

Assignment #2: Make your shopping list

Along with new sneakers and a lunchbox, add medical identification jewelry to your Back-to-School shopping list. Wearing medical identification at all times can help give you peace of mind that you are prepared should a life-threatening reaction occur. We have partnered with the MedicAlert Foundation to launch the “MyVoice” program, designed to help protect individuals with food allergies with life-saving services. The MyVoice program provides a 10 percent discount on MedicAlert memberships as well as $10 off a medical identification bracelet for both adults and children. Learn more on the MedicAlert website.

You can also purchase Allergy Caution Labels from Name Bubbles to  label items that travel to and from your house with identification and emergency contact information. Through FARE’s partnership with the company, they will be donating 20% of all allergy product purchases to FARE, with a minimum donation of $10,000 for 2014. Create your personalized labels on the Name Bubbles website

Assignment #3: Talk to your team

Putting a written management plan in place requires communication and coordination with many school staff members, such as administrators, school nurses, food service staff, and your allergist or other doctor.

Teachers are key partners in keeping children with food allergies safe and included at school. Before the first day of school, meet with the teacher to discuss the child’s emergency care and management plans. You can also provide him/her with a copy of FARE’s Teacher’s Checklist, which has 10 basic tips for teachers who have students with food allergies, such as using non-food incentives and having rapid access to epinephrine auto-injectors.

Assignment #4: Send education and awareness posters to your school

Back to School season is a great opportunity to take action and work with your local schools to educate the school community about the serious nature of food allergies. This year, with your $25 donation to our poster drive, we will send three premium posters to the school or community building of your choice to help educate and raise awareness about food allergies. This is a simple way you can provide your school with resources and make a difference!

Assignment #5: Have a family meeting

Talking to your child and explaining or reinforcing some basic safety precautions can help them feel confident entering a new school year. While each child is different, you can focus on a few things they can do each day at school, such as:

  • Knowing where their epinephrine is stored or carrying it with them at all times.
  • Always wearing their medical identification bracelet.
  • Only eating the food you have packed or approved as safe for them.
  • Telling an adult immediately if they feel sick.

In addition to the information provided here, there is a wealth of information about how to successfully manage food allergies at school on FARE’s website, including national guidelines from the Centers for Disease Control & Prevention (CDC), a letter from FARE to school leaders, and information about school access to epinephrine.

A School Nurse’s Perspective on How to Keep your Child With Food Allergy Safe at School

cathyowensby Cathy Owens, RN, M.Ed, NCSN, ERSN

All schools have a duty to provide a safe environment for children and to act appropriately in an emergency.  We know that nearly six million children have a food allergy-which equates to approximately two per classroom! Additionally, according to the CDC, food allergies have dramatically increased since 1997 and many individuals do not have their epinephrine with them at all times.  So, schools need to be prepared to handle allergic reactions-not only in the child with a known allergy, but with those who have not yet been diagnosed.

My passion and advocacy for protecting students with food allergies in school came about because I had to make a decision to give a student another student’s epinephrine auto-injector when the student was suffering from severe anaphylaxis and paramedics had not yet arrived and unfortunately, he had no previous history of anaphylaxis so had no medication at school. Because of my actions, he was able to be safely transported to the hospital and recovered but it did shed light on the fact that without epinephrine available to any student suffering from anaphylaxis, the outcome could be much different.

As a result, California passed a law allowing schools to stock epinephrine for undiagnosed cases of anaphylaxis, but that is not enough because it doesn’t protect all the children, since schools have a choice.  A law, Senate Bill 1266, is now pending that will require epinephrine to be stocked in all schools. But it is important for parents and schools to partner together to reduce the risk of exposure and to ensure quick access to epinephrine.

Parents should work collaboratively with their school nurse, the cafeteria staff, administration and teaching staff with regards to classroom activities involving food (e.g. no peanut products should ever be used for classroom projects or snacks) as well as developing a plan for the cafeteria. Having an identified table for students to be able to sit at is an option or using paper placemats as a means to protect the child’s food from surface contamination and to identify it as a ‘safe zone’ for their food is another option.

Storage and access to the epinephrine should also be discussed. It should be easily accessible (if in a locked cabinet, all staff needs to have a key to the cabinet so critical seconds are not lost waiting for someone to unlock the cabinet. If the student carries their epinephrine, a plan needs to be in place as to who knows where it is and is the backpack with the student at all times. Additionally, field trips and other activities away from the classroom/health office (where the epinephrine is stored) need to be discussed and a plan needs to be developed.

Besides ensuring a safe classroom/cafeteria and storage issues, training of staff is a critical piece of the plan. Staff should be trained on the use of the epinephrine as well as signs and symptoms of anaphylaxis.  An individualized plan such as a 504 plan should be in place for all students with a known food allergy.

In conclusion, parents should work together with their schools and school nurse to develop a plan for a safe environment and also advocate for standing orders for epinephrine! It is important to remember that there is no absolute contraindication for giving epinephrine when someone is having breathing difficulties and most importantly, a child’s life may be saved!

Photo credit: Allergic Living

Discover the Positive Effects of Yoga

At this year’s FARE National Food Allergy Conference, teens with food allergies participated in a 90 minute yoga workshop learning how to enhance their quality of life and experience the mind-body connection. The workshop was led by Kristen Kauke, a licensed clinical social worker and 200-hour registered yoga teacher who teaches yoga weekly. Kristen’s two sons have food allergies, and Kristen also lives with food allergies herself, so she has a wealth of experience in coping with anxiety and living well with food allergies.

We asked Kristen to give us a recap of the mental and physical exercises that she led the group through during her workshop, as well as provide us with information on the positive effects of yoga.

kaukeyoga

By Kristen Kauke

Drawing on my knowledge of psychosocial principles, empirically based treatment modalities, group processes, yoga, and overall wellness, during this workshop I helped teens to quiet their minds, gain awareness of their body, and learn tools for coping with stress and regulating emotions. Research shows that stressors associated with managing life-threatening food allergies can have a negative impact on quality of life. Research also demonstrates that yoga is associated with a decrease in symptoms of anxiety and depression, and an increase in self-compassion. As the body and mind relax and release through breath and vinyasa (flow of postures), so do pent-up emotions and traumatic memories. This workshop allowed teens to experience such positive outcomes of yoga.

During this transformational workshop, I introduced teens to the connection between thoughts, actions and feelings. I call the negative cycle “the Bermuda Triangle” where catastrophic thoughts exacerbate anxious feelings and reinforce protective actions. In exploring the “Bermuda Triangle,” teens shared common anxious thoughts about living with food allergies such as “I’m not in control,” or “Sometimes I’m afraid I might die.” Teens noted correlating feelings such as anxiety, sadness, annoyance, or flabbergasted. And they identified typical protective actions such as isolating or being shaky. I challenged the teens to consider more ideal patterns of thoughts, feelings and actions in living with food allergies. These included more optimistic thoughts, feelings of safety and calm, and actions such as connection with others. I emphasized how changing thoughts changes feelings.

Then I led teens through the action of a gentle yoga flow. In this manner, teens experienced relaxation of the body, and consequently, a shift in baseline feeling. I highlighted how in using an action such as yoga, they could tolerate and even soften feelings.

Finally, through an experiential activity called “Being Willingly Out of Breath,” teens learned about parts of their Self, as well as applied tools to observe thoughts, tolerate emotions in times of stress, and listen to their inner wisdom.

Teens shared freely, laughed, and gained insight. They moved and stretched themselves both physically and emotionally. In the end, they learned that they DO have control over their wellbeing and can utilize tools to achieve calm despite living with food allergies.

Another important takeaway is that any BODY can do yoga! Yoga is for athletes and those who only run when being chased, super bendy people and those who can’t touch their toes, teenagers and silver-haired folk, women and men! Yoga offers something for everyone! If you’ve never practiced before, it’s best to take a class with a qualified teacher or follow a video. There are many different styles of yoga from restorative to powerful. However, the following are some simple and relaxing poses you might enjoy at home:

3 Part/Elevator breath – why and how

Beginning any yoga practice with a centering breath is of utmost of importance. When the breath slows, the thoughts follow. Diaphragmatic breathing signals the relaxation response in the central nervous system. One of my favorite breath exercises is the “elevator” or “3 part breath.”

To begin, exhale!

Then begin to inhale from the low belly and stop at “floor 1.” Pause. Inhale more to mid-belly or “floor 2.” Pause. Inhale to upper chest or “floor 3.” Pause. Then exhale slowly, contracting belly towards spine, tucking pelvis and lengthening spine until empty, or back to “floor 1.”

Begin again and repeat the cycle two more times.

Neck – why and how

We hold a ton of stress and tension in our necks! When our neck and jaw remain tense, it sends a signal to the central nervous system that we are in danger. This signal activates and maintains the stress response. To achieve consistent peace, we are wise to mind our necks!

Sit in a comfortable cross-legged position. Being by inhaling and simultaneously raising the right hand.  As you exhale, bend the right hand over the top of your head and pull down on your ear, moving ear towards right shoulder. Continue to inhale and exhale for three cycles. Then scooch your right hand to the base of your neck. Gently pull down on the base of your neck so your chin eases down and angles towards your right knee. Inhale and exhale for three cycles.

Release your right hand and allow your right palm to press into your forehead, easing your head back to center.

Repeat this process with your left hand over your right ear. First, left ear to shoulder. Then base of neck towards left knee.

Legs up the wall – why and how

If you’re only going to do one yoga pose, this is it!  This pose is like getting an oil change for all your internal systems. Besides increasing strength and flexibility, you reap cardiovascular benefits; you reverse the effects of gravity. This pose balances hormones, increases immunity, soothes the nervous system, and aids digestion and restful sleep.

To begin, scooch your right thigh and glut against the wall. Then shift your legs up, back down. Center your legs against the wall and align hips square.  Allow spine and neck to lengthen and rest on the floor.  Breathe your 3 part breath, allowing spine to sink to the floor, heart to lift with inhalation.  Hold legs up the wall for 3-10 minutes, with increasing amounts each trial.

Thank you to Kristen for providing this summary! We hope those of you reading at home will try some of her sample yoga exercises. For more content from Kristen, you can view a webinar she presented on the topic of “Dating and Intimacy Challenges Associated with Having Severe Food Allergies” on FARE’s website

Questions From FARE’s Mailbag: Allergens in Non-Food Items

mailbagEvery day we receive dozens of phone calls, emails, and letters from individuals and families who have questions about food allergies. Many of these questions are concerning non-food items that may contain food allergens and if they are a risk to those with food allergies. Below are answers to a few questions that we have received recently about non-food items:

  1. Is there any risk from using ant baits that have peanut?

Although it is not required to be labeled since it is not a food product, many ant baits or traps display a label warning that the products contain peanut. As long as these traps are not handled by the person who is allergic (or wear gloves while handling), and they are placed in an area that is out of reach (such as in a garage or behind a bookshelf), they should not pose a threat. There are alternative or natural options for ant baits that do not contain peanuts, however, which may be a better choice if the peanut-containing traps are a worry to you.

  1. Do those with tree nut allergies need to avoid shea nut butter in cosmetic products, such as lotion?

Shea nuts are considered tree nuts, and are designated as such according to the Food Allergen Labeling & Consumer Protection Act. If they are included as an ingredient in food products, they must be labeled. When used in cosmetic products, such as lotion, shea nuts are turned into “butter” by processing their oil, which is highly refined. A 2010 study published in The Journal of Allergy and Clinical Immunology found that shea nut butter poses little to no risk to the peanut or tree nut allergic because it contains no IgE-binding soluble proteins. While the risk is minimal, consult with your doctor if you believe you or your child is allergic to shea nut.

Also note: there is a recent case study that indicated that if you have a skin inflammation such as eczema, using skin cream that contains food ingredients could lead to an allergic reaction. The researchers who piloted the case study remind clinicians and patients that “skin care ought to be bland, advocating avoidance of agents capable of sensitization – especially foods.”

  1. I’ve heard that some asthma inhalers contain lactose (a milk sugar). Are these inhalers a risk to those with milk allergy?

Pharmaceutical grade lactose may contain trace milk proteins and could rarely induce reactions in inhaled or injected medications. A 2014 article in The Journal of Allergy and Clinical Immunology indicated that reactions are “quite a rare phenomenon given the large number of children with milk allergy who use lactose-containing dry powder inhalers uneventfully.”Any inhaler that contains milk should indicate so in the patient information insert.

  1. Is pet food that contains my child’s allergens okay to purchase?

It is best to avoid purchasing food for your pets, especially dogs, that contains your child’s allergen. The food’s proteins can be transferred through saliva if the dog licks your child, or the child may handle or even eat some of the pet food. If there are pets that your child is visiting or encounters outside of your home, you will want to closely observe their interaction.