What’s so funny about anaphylaxis?

By Veronica LaFemina, Vice President of Communications at Food Allergy Research & Education (FARE)

Growing up in a food allergy family, I lived in a world where people barely knew what a food allergy was, let alone that it could be life-threatening. It wasn’t always easy to explain to my friends that they couldn’t bring candy or snacks with peanuts or tree nuts over to my house, but this rule was always met with curiosity and compliance – not eye-rolling or jokes.

Today, as someone whose work is dedicated to increasing awareness of food allergy as a serious, potentially life-threatening and growing public health issue, I know there is still much work to be done, but I am heartened by the significant progress that’s been made in ensuring people with food allergies are safe and included. From advances in research and improved laws and regulations at the federal and state levels to national education initiatives, grassroots advocacy movements and nationwide news coverage – all of these efforts have contributed to greater awareness, empathy and action in support of the food allergy community.

One area that’s lagging behind, though, is the portrayal of food allergies in movies and television. These mediums are so powerful in tackling tough issues, shaping our cultural conversations, and shedding light on societal trends in ways that make us think, discuss, question and laugh.

But when it comes to food allergies, many movies and television shows are still living in the Dark Ages. In the last week alone, at least three primetime television shows included scenes that made light of food allergies.

All too often, food allergies are played for a cheap laugh – they’re the topic of a prank or the target of a joke. Reactions are portrayed unrealistically and in such a way that could cost characters their lives, and characters who don’t have food allergies are disproportionately depicted as people who are strangely excited at the possibility of sending someone to the hospital. These portrayals are not only untrue and hurtful – they are dangerous.

Some will say that the mere presence of food allergies and anaphylaxis in popular culture is a sign that the disease is gaining ground in the national consciousness. It is, and that is important. It’s also true that there are many different ways to broach a topic and bring attention to it, including using humor appropriately to educate and raise awareness.

But as a society, we can do better. And as a community, we can help by pointing people in the right direction.

In that spirit, for the producers and writers of movies and television shows who are interested in including food allergies in their story lines, I’d encourage you to keep the following in mind:

  1. Food allergies can be life-threatening. The most insidious fact about food allergy is that there is no way to know how severe a reaction will be until it happens – which means that every reaction has the potential to lead to a hospital visit, or worse. Today, without a cure or preventive treatments that can reduce the risk of life-threatening reactions, avoiding the food completely is critical (and much harder than it sounds). A person with a diagnosed food allergy should also be prepared for a severe reaction (anaphylaxis). That means having two epinephrine auto-injectors with them at all times, and knowing how and when to use them (for young children, it’s important for a responsible adult to carry and know how to use the auto-injector). When a severe reaction does occur, the person must be treated immediately with an epinephrine auto-injector and then 911 should be called to transport them to the hospital for further treatment and observation for at least four hours to ensure the symptoms don’t return.A recent episode of a network television sitcom depicted a character self-injecting epinephrine and then remaining at her desk while co-workers laughed about the incident – in the real world, this scene could have ended in tragedy. To treat it so lightly is irresponsible and could be dangerous. If you’re going to show a reaction, then show what it’s really like – not an unrealistic version that downplays the severity and potential consequences.
  1. 15 million people in the U.S. have food allergies. That’s enough people to be our fifth largest state. Since this is a common disease, it makes sense to incorporate characters with food allergies into your work. But it doesn’t make sense to play into a stale stereotype. Food allergy is an invisible disease that doesn’t discriminate based on race, geography, economic status or any other factor. It affects a diverse array of adults and children throughout the country, disproportionately affects African Americans, and is a reality for professional athletes, scientists, actors, musicians, and even those who live at the White House. When you determine which character will have a food allergy, it’s important to keep these facts in mind.
  1. Food allergy bullying is real and can have dire consequences. Movies and television have taken on the broad topic of bullying and explored the issue in meaningful and poignant ways. So what makes food allergy bullying different? A third of kids with food allergies have been bullied specifically because of them, and half of those kids didn’t tell their parents about it. Watching popular shows model ways in which to bully kids with food allergies is terrifying – for adults and children alike – and for what? A lame filler laugh? If exploring food allergy bullying is important to the story you are trying to tell, avoid showing exactly what happened and be sure to show the consequences the bully faced. Don’t make bullying look cool or even acceptable. You can learn more about this subject via FARE’s “It’s Not a Joke” campaign to address food allergy bullying.
  1. Approach this topic in the same way you would other life-threatening medical conditions. Humor can be excellent for softening difficult scenarios and supporting the healing process. And food allergy certainly isn’t the only disease that movies and television shows poke fun at. But when you’re writing a scene about food allergies, I’d ask you to consider this – would you make the same joke about cancer, or diabetes, or a heart attack? More often than not, the answer will be no. This isn’t about special treatment – it’s about being evaluated by the same standard.

Next Monday, March 31, the food allergy community will remember those individuals who have lost their lives to anaphylaxis, and this spring, we as a community will be promoting events like World Allergy Week and Food Allergy Awareness Week to help increase understanding of and support for our cause. Despite these tragedies and the need for greater understanding, food allergies still face skepticism in a way that other diseases rarely seem to.

We are at a critical time in the national discourse around food allergies. Movies and television shows are in a unique position to shape the cultural conversation about the disease. My hope is that they will continue to include stories about food allergy – because food allergy does touch all of us, and it needs to be better understood – and that they do so in a more realistic and empathetic way.

Veronica LaFemina is Vice President of Communications at Food Allergy Research & Education (FARE). Her father and younger sister have food allergies. You can learn more about food allergies on FARE’s website – www.foodallergy.org.   

Kosher Labeling and Food Allergies

Introduction by Rabbi Yitzchok Lerman

The first time we noticed that our daughter was allergic to milk was when she was six weeks old. My wife was heading back to work, and we added some milk-based formula that we received from the hospital to a bottle of breast milk. Within a half-hour, our daughter had hives all over her chest.

Now four years later, my daughter and her sister are allergic to a combined six foods: eggs, milk, peanuts, tree nuts, fish and sesame.

Food allergies are a big struggle for religious Jews, because most of our culture and religious practices are structured around food. We have large meals with family and friends on Saturday (Shabbat), holidays, and at almost all special ceremonies there is food served. We were recently at a baby naming ceremony, and there was a large spread of cakes containing milk and various nuts! Of course my children wanted it, and it’s not always easy to bring our own cookies from home that can compete with the fancy cakes and cookies that are being served.

Before we go to an event, we sit our older daughter down (she’s three years old) and tell her that before she eats anything she should ask us, because nuts and milk give her a big boo boo. We are constantly on alert, and my wife and I each take one child that we will keep an eye on. As I’m sure many of you have experienced, and can imagine, it can be a bit difficult to socialize and enjoy yourself.

We ALWAYS carry an epinephrine auto-injector and anti-histamine with us wherever we go, because even the minutest cross-contact can cause a reaction (as we have unfortunately experienced).

As Orthodox Jews we keep a special diet called “kosher.” My wife and I were surprised to realize that our kosher diet actually HELPS us keep our daughters safe. But you don’t have to be Jewish to enjoy these benefits. Knowing how kosher certification works can change the way you shop for food.

FARE, in consultation with the International Kosher Council, has compiled some tips for how to decipher kosher labels:

While kosher labeling can be a helpful first indicator that a food may contain your allergens, it is important to note that kosher regulations are different than the labeling regulations enforced by the FDA and USDA. By kosher standards, if a product contains less than 1/60th of the ingredient that is not kosher, it still meets the criteria for the kosher label. Kosher labeling was created as a way for people of the Jewish faith to stick to a kosher diet, not for those with food allergies. So, while kosher products must adhere to strict standards, it is always important to read every label thoroughly and call manufacturers to ask questions if you are unsure whether a product is safe for you.

In the early 1920s, the Orthodox Union of Jewish Congregations in America formed an organization that would monitor products to ensure that they were kosher and this organization is now the largest certifying agent for kosher products. Ever wonder what that “U” in a circle symbol is on your products? It is the organization’s primary kosher symbol (pictured above).

There are hundreds of kosher certifying organizations and symbols, the vast majority are reliable and operate on the same standards. The way these organizations work is that they have access to a list of all the ingredients used to ensure that they are Kosher. Then throughout the year they have thousands of supervisors who make unannounced checks at many companies and factories around the world to ensure that the kosher standards are upheld.

One of the many laws of keeping kosher is that it is forbidden to eat milk and meat products together. They cannot be manufactured together, cooked together, served together or eaten together. Kosher symbols are designed to help consumers find products that abide by this law, and can be helpful to understand if you have a milk or meat allergy.

The OU symbols work as follows:

  • If there is only a “U” inside of a circle (”OU”), then the product meets kosher standards for being considered milk free and meat free. By kosher standards, you must have a 24 hour wait-period as well as adhere to certain cleaning protocols before you can be certified as being milk-free and meat-free and earn this certification. In kosher language, products labeled “OU” are called “Pareve” or “Parve.”
  •           An important note on “OU” labeling is that in order for equipment to be considered “contaminated” with milk or meat, the product needs to have been heated to a certain temperature. This can lead to products being labeled “OU” even if they have been produced on equipment that was previously used with milk or meat ingredients, if they were produced at a cold temperature. For example, if warm chocolate that contains milk was poured into a mold but did not get heated to a high enough temperature, then a product with no milk could be used afterward in the same mold and still be given the “OU” label. For this reason, it is important to always check the advisory label and call the manufacturer with any questions.
  • If a product has a “OUD,”  label that means that it contains milk ingredients or is processed on equipment with milk, and is also kosher. This classification can be confusing, since this symbol can be found on products that one would assume are free of milk. For example, soy milk may be processed on the same lines as a product containing milk after the lines are thoroughly cleaned. While the soy milk may be safe for those with milk allergies to drink, unless the manufacturer waits for 24 hours before producing the soy milk, they cannot use the OU symbol and must use OUD instead.
  • The “OUM” symbol means that it contains meat ingredients or is processed on equipment with meat, but it is also kosher. Although allergies to meat are rare, this symbol may help those who are meat allergic identify which products to avoid.
  • For those with fish allergies, the “OUF” symbol indicates that the product has fish ingredients. However, just because the product is labeled “OU” does not mean that it is completely free of fish. As mentioned above, as long as the product contains less than 1/60th of fish, it may be labeled as “OU”.
  • For those with shellfish allergies, Kosher products may not contain any shellfish. So any product that has a kosher label on it is most likely safe.

Now that we have a better understanding of kosher labels, where do food allergies come in? Well, think of it this way; if a product is meat, or if you walk into a kosher meat restaurant, you can be fairly confident that the products are free of milk. If a “kosher meal” is offered it is very unlikely that there are traces of milk in your meat dinner (and vice versa). However, you should always do your due diligence to ensure that your meal or a product you are consuming is free of milk by checking with the restaurant or manufacturer.

Today, one-third to one-half of the foods for sale in the typical American supermarket are kosher. I’m sure if you look into your pantry, you will find that at least 60% of your products at home are kosher certified. So next time you go shopping or traveling, keep an eye out for those kosher symbols to help you quickly identify products that may be safe for you or your family.

Rabbi Yitzchok Lerman is a Rabbi and Dayan, and currently teaches at YTTL High school in Queens, NY. Rabbi Lerman lives in Brooklyn, NY with his wife Bina and their two daughters. This information was published under the consultation of the International Kosher Council.

Five Things to Know about FARE’s National Food Allergy Conference

Thinking about joining us at our first FARE National Food Allergy Conference? Here are five essential facts to know about the June 21-22 event, which will be held at the Hyatt Regency O’Hare in Rosemont, Ill., just outside of Chicago.

  1. Your conference registration may be eligible for reimbursement under your Health Care Flexible Spending Account.
  2. FARE is working with the Hyatt Regency food and beverage staff to provide allergy-friendly breakfasts and to help ensure attendees have safe options for other meals.
  3. Our conference hotel is conveniently located near O’Hare International Airport and has a free airport shuttle. Additionally, public transportation (the “L”) is across the street and there are many sightseeing options if you plan to make a long weekend out of your trip.
  4. FARE members receive a $25 discount on their conference registration. To obtain the discount code, members must log in to our website, click on “Membership,” and then go to the “Members Only” section.
  5. No matter what stage you are in life – a seasoned veteran of food allergy management or newly diagnosed – there is an educational conference track for you! Our tracks this year are organized into beginner, intermediate, advanced and teen categories.

We hope to see you there! Check out our online conference schedule and register today by visiting www.foodallergy.org/conference!

Advocacy Update: Momentum for the Food Allergy Agenda Builds

Legislative sessions are underway in Washington, D.C. and in state capitals across the country. That means there are many opportunities for food allergy advocates to push legislators on policies that will improve research, access and safety.

In Washington, D.C.
After several years of prodding by the food allergy community, Congress passed the School Access to Emergency Epinephrine Act last November, providing an incentive for states to require the availability of stock epinephrine in their schools. That success raised the sensitivity of lawmakers to the needs of families struggling with food allergies and improves the environment for progress on other fronts.

Building on that success, FARE is focusing on improved funding for food allergy research at the National Institutes of Health and other federal facilities, as well as funding to support the purchase of epinephrine and training programs in the nation’s schools. FARE’s federal agenda also includes initiatives to address surveillance of food allergies (i.e., comprehensive surveys to understand how many people are affected by the disease) by the Centers for Disease Control and Prevention and greater clarity in labeling requirements by the Food & Drug Administration.

In States
Last year 18 states passed legislation addressing stock epinephrine in schools, and that momentum has continued in 2014; new states are providing for stock epinephrine in schools on an almost weekly basis.

The precedent established in the K-12 system is now being seen in higher education as well, with New Jersey becoming the first state in the nation to require its colleges and universities to establish policies to stock and train in the administration of epinephrine on their campuses. Similar legislation has also been signed into law in Indiana, and FARE is staging campaigns in additional states.

The Massachusetts restaurant food allergy awareness law has long been admired by members of the food allergy community and this year FARE is pursuing similar legislation in several states. Taking as its foundation the restaurant training program developed jointly by the National Restaurant Association and FARE, the initiative would require that restaurant staff with food allergy training be available during all hours of operation. Menus would have to advise customers to communicate their allergy and posters in the restaurant would educate staff about the severity of food allergies. Bills are currently pending in other states, and FARE is providing support to advocates pursuing the legislation.

The safety of those with food allergies has increasingly become a public health concern at the state level as well. Bills are being introduced around the country that would make epinephrine, and the training in its administration, widely available in public places, including day care centers, restaurants, theaters, health clubs, and sports arenas, among others. The most important component of these bills is broad liability protection for establishments and “Good Samaritans” using epinephrine on someone they believe is suffering from anaphylaxis.

Your Role
The success of these and other efforts is directly dependent on the involvement of food allergy advocates. In 2014, FARE will continue to speak out for the community and offer opportunities for advocates to make their voices heard. If you haven’t already, please join the FARE Advocates Network by visiting
www.foodallergyadvocacy.org!

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

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.