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.

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

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

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

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

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

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

New Study: Asthma Medication May Facilitate Peanut Oral Immunotherapy

In numerous studies, oral immunotherapy (OIT) has successfully desensitized a significant number of individuals with food allergies, with most able to ingest more of the food protein than prior to treatment. However, the desensitization process can take months, and patients can experience allergic reactions. Led by Drs. Lynda C. Schneider and Andrew Mac Ginnittie, researchers at Boston Children’s Hospital/Harvard Medical School conducted a pilot study to determine whether combining OIT with omalizumab (Xolair®), an asthma medication, might speed up the desensitization process and reduce the number and severity of allergic reactions during treatment. The study evaluated this treatment regimen in 13 children with peanut allergy who were at high risk for severe reactions.

This study, which was co-funded by FARE and featured in the December 2013 issue of the Journal of Allergy & Clinical Immunology, had encouraging results. Before treatment, all 13 children failed an oral food challenge, during which they were fed peanut flour in doses of 100mg or less. Within a median period of eight weeks of combination therapy, 12 of the children were able to reach the maintenance dose, 4000mg of peanut flour per day. They then stopped taking omalizumab and continued on the maintenance dose. A final oral food challenge showed that all 12 were able to tolerate 8,000mg of peanut flour, the equivalent of 20 peanuts. During the maintenance phase, most patients had no reactions or only mild reactions, but three required treatment with epinephrine. The researchers believe that longer treatment with omalizumab might reduce the number of reactions.

These results are promising, but larger studies that include a comparison group not treated with Xolair® must be conducted to determine the effectiveness and safety of this approach.  A randomized trial of milk OIT/Xolair® with 56 participants, performed at Mount Sinai (NY, NY), Johns Hopkins (Baltimore, MD) and Stanford University (Stanford, CA) is near completion.  Additionally,  FARE recently approved funding for a new clinical trial, the PRROTECT study (“Peanut Reactivity Reduced by Oral Tolerance in an anti-IgE Clinical Trial”), which is recruiting 36 patients at four sites – Boston Children’s/Harvard, Children’s Hospital of Philadelphia/University of Pennsylvania, Stanford University (Stanford, CA), and Lurie Children’s Hospital/Northwestern University (Chicago). For more information, please visit this link on ClinicalTrials.gov.

Take Me Out to the (Food Allergy-Friendly) Ballgame 2013

photo 1At baseball games across the U.S., thousands of fans may sing “buy me some peanuts and cracker jacks,” but for families managing food allergies, these traditional snacks can affect the decision about whether to attend a game in person. With shelled peanuts often found in the stands and other allergen-containing foods served throughout the ballpark, a baseball game can feel like an allergic reaction waiting to happen.

Luckily, many minor and major league teams are stepping up to the plate and hosting games that cater to families dealing with allergies.

There are a number of food-allergy-friendly baseball games coming up this summer. Check out the list below, and let us know if you have any additions of food-allergy-friendly games in your area. Be sure to check with the team/stadium about the specific accommodations they will be making.

View our list of baseball games for 2014 here. 

Major League

Minor League

You can also learn about new games as they are added by visiting FARE’s Regional Offices page on our website, where you can find a link to the FARE office nearest you with calendar listings of events.

View our list of baseball games for 2014 here. 

Father’s Day Guest Post: Pete and Dave, Founders of Skeeter Snacks

Dave & RemyIn this special Father’s Day guest post, food allergy dad Dave Leyrer discusses why all dads need to be educated about food allergies. Dave partnered with another food allergy dad, Pete Najarian, to start Skeeter Snacks, a line of cookies and snacks made specifically for those with tree nut and peanut allergies.

Tell us about your family and the food allergies affecting your family.

My wife and I have two children, and our 4-year-old son Remy is allergic to tree nuts and peanuts. Pete and his wife have two kids as well and his 12-year-old daughter Abby is also allergic to tree nuts and peanuts.

How do you manage food allergies in your family? What have been your biggest challenges?

At different ages you employ different strategies. With Remy we teach his older sister to be his advocate and protector as he learns what to avoid. Abby is older so the challenges are different—with pre-teens the job seems to be more about getting her to slow down and remember her allergies and to avoid peer pressure.

What advice would you give to other dads with kids with food allergies?

This is a team effort, and dads have to be as involved as moms. For example, dads who coach sports are often responsible for snack decisions for an entire team, and on most teams there are a variety of different allergies that need to be addressed. We think that all dads need to know about food allergies because whether their kids are allergic or not they are probably going to be tasked with providing snacks for allergic kids at one point or another.

Studies have shown that moms and dads react differently to food allergies in their families. In your experience, is that the case?  

There’s a perception that guys are a bit lazier on the margin, so some might think that dads don’t take it as seriously as we should. But in our experience dads are really on top of things. Pete and I probably take it more seriously than some dads considering we started a company that makes the kind of products we couldn’t find for our kids! Remy and Abby are the reasons we started Skeeter Snacks. We were frustrated consumers; we couldn’t believe that a brand didn’t exist that made it easy to be safe.

From all of us at FARE, we’d like to wish a Happy Father’s Day to Pete, Dave, and all food allergy dads!

EDITOR’s NOTE:  Skeeter Snacks is a FARE Corporate Partner and their products can be found at many of our FARE Walks for Food Allergy. 

Father’s Day Guest Post: Trials and Triumphs of a Peanut Allergy Dad

In honor of Father’s Day, we asked Michigan dad Tim Burns to write a guest blog post for us about what it’s like to be a father to a daughter with food allergies. Read on for Tim’s advice to other food allergy dads, and to learn more about a Halloween event that he spearheaded in his community geared toward creating an inclusive experience for kids with food allergies.
tim burns

Tell us about the food allergies in your family and how you manage the day to day challenges they can present.

A few years ago I was a first-time dad juggling the responsibilities of being a parent with a demanding professional career. Our twin son and daughter spent most of their weekdays either at daycare or being looked after by one of their grandmothers while my wife and I were at work.

One nice summer day I decided to take a day off to enjoy with my kids. My wife called me around lunch time. She had never given our children peanut butter before because she was worried about all the things she had read on the Internet about food allergies. She asked me to give some to my son and daughter so that if there was a problem I would be there to deal with it rather than a daycare provider or one of our mothers. I remember telling her it couldn’t be that big of a deal – no one in our family had food allergies, and I hadn’t heard anything about peanut allergies, so how bad could it be? Half an hour later I was in the emergency room dealing with a life-or-death situation; my 18-month-old daughter’s eyes and throat had swollen shut as she went into anaphylaxis from a severe reaction to the peanut butter I had given her.

It has been more than two years since that traumatic food allergy reaction. My daughter is four years old now and doing fine. Interestingly, her twin brother doesn’t have any food allergies. Here are a  few  ways we manage her food allergy:

  • not allowing peanut/tree nut ingredients or products that may contain these allergens into our house;
  • avoiding going to high risk places;
  • not letting her eat foods that were prepared in someone else’s home;
  • being active with informing people about her condition, and;
  • reading lots and lots of ingredient and warning labels.

Many of the changes impacting our family have been “little” things that I had simply taken for granted in the past. For example, I’m a big Detroit Tigers fan and going to the ballpark was a regular date night for my wife and me before we had kids. I had been planning on buying season tickets for our family. Now we only go as a family to the one baseball game a year where the Tigers sell tickets to a peanut allergy-friendly suite.  We don’t go out to get ice cream or buy dessert at restaurants because of ingredient and cross-contact issues. I rarely read ingredient labels before my daughter’s food allergy, now that’s standard operating procedure before she eats anything.

The biggest challenges with our daughter’s food allergy have been her own understanding of it and others peoples’ responses to it. My daughter knows she can’t eat “nuts” or she will get sick and have to go to the hospital, but she still really doesn’t grasp the details and dangers that this presents. I worry that if someone offered her candy or a cookie she would take it and eat it without thinking about it. Our other big challenge is that businesses often don’t understand that food can be dangerous without having peanuts as an ingredient because of cross-contact.

What advice would you give to other dads with kids who have food allergies?

Speak up! Most people don’t understand the seriousness and complexity of severe food allergies. I have to say that I was clueless myself until our family was impacted. You need to be your child’s most vigilant advocate by educating everyone and being willing to say no to others when it presents a risk to your child. It’s not easy or comfortable having to constantly speak up to a teacher or other parents to require and enforce rules that safeguard your child, but if you don’t do it, no else is likely to stand up for you.

Also it is unacceptable for your child to be excluded or isolated because of their food allergy. My daughter’s preschool started sending her to the office during snack time so they wouldn’t have to take precautions for her in the classroom. I stopped that quickly and we switched schools the next year. Be alert for behavior that excludes your child, and be prepared to intervene.

Food allergies don’t make life worse, they just make it different. We actually eat healthier now because we have more of a focus on our diet. Help your family make the best of the situation!

Studies show that moms and dads react differently to food allergies in their families.  In your experience is that the case?

My wife is definitely more active in researching information concerning my daughter’s food allergy than me. She is also more protective when it comes to restricting my daughter’s activities to limit her exposure to potentially dangerous situations. I don’t want my daughter to grow up in fear of her allergy, so I am more open to allowing her to go places and try things, as long as we take precautions to be safe.  I believe my wife and I do a nice job of balancing each other’s tendencies so that my daughter can experience a childhood that is both fun and safe.

Tell us about the Trick-or-Treasure event you started in your community.

Taking my daughter trick-or-treating has to be the most nerve-racking experience of my life. I try to stand in front of her to screen the candy first, but people have given her peanut butter cups before I could say anything, or have tried to give them to her even when I’ve said no. Some people have even argued with me at their doorstep that food allergies aren’t that big of a deal.

I loved Halloween as a kid and didn’t want my daughter, or other kids like her, to not be able to enjoy it, so I partnered with local businesses to create Trick-or-Treasure. This event allows children to go trick-or-treating for candy that has been prescreened to avoid peanuts and tree nuts, as well as comic books, toys, and other fun trinkets. Last year, we had Star Wars characters take photos with the kids, a bowling alley gave out passes for free games, and a magician made balloon animals.

This Halloween will be the third year we’ll he holding Trick-or-Treasure and we are expanding the event beyond peanut/tree nut to screen the candy we give out for the eight most common allergens. I don’t want to see any child ever have to be excluded from a fun time because of a food allergy. Helping local kids be able to enjoy Halloween has probably been my biggest success as a peanut allergy dad.

Thanks to Tim for encouraging inclusion for kids with food allergies in his community and for sharing this great advice with us. Happy Father’s Day!

Read more about Tim’s Halloween “Trick or Treasure” event>