Food Allergy Living Blog




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Eosinophilic Esophagitis (EoE) and the Six Food Elimination Diet

Posted 5.15.15 | Christine Graham-Garo

Eosinophilic Esophagitis (EoE) is a condition that is continuing to get more and more attention in the medical community, which means the public is learning more about it too. Unfortunately though, the management options for EoE are not black and white. EoE may be managed either with medication, which has known long-term side effects, or nutrition therapy, which has been shown extremely effective, but may be difficult to follow for some families.

Medications used to manage EoE are all steroids, and at this point no medication has FDA approval for EoE. Steroids have been shown to be effective in managing EoE for more than half of patients. However, steroids may not be the best long-term solution for everyone. Many families who choose to use steroids may mix the medication recommended by their physician with Neocate Nutra. This is because Neocate Nutra thickens, so can help to coat the esophagus with the steroid. This use of Neocate Nutra was even studied by a medical team and you can read about their published research here.

As EoE is a chronic condition, management with nutrition therapy is often discussed and preferred by many families over steroids. Here are nutritional therapy options for EoE:

  • Elemental Diet – A diet consisting almost exclusively of amino acid-based (or elemental) products
  • Elimination Diets – The removal of allergens from the diet.
    1. Tailored Elimination – Elimination of specific allergens based on allergy testing
    2. Six Food Elimination – Elimination of 6 top allergens based on the most common allergens seen in EoE patients

The Six Food Elimination Diet

The 6 Food Elimination diet has been gaining in popularity because it bypasses extensive food allergen testing needed for the Tailored Elimination diet. As you may know, allergy tests (skin prick tests and blood tests) are not perfect. There are often false positives which can make the treatment plan more complicated and time consuming, and some allergens may be missed ('false negatives'). So what the 6 Food Elimination diet proposes is that, off-the-bat, patients eliminate the top 6 allergens seen in EoE patients. The top allergens are milk, soy, eggs, wheat, peanuts/tree nuts, and seafood. One study1 confirms there is a 74% success rate when using this type of nutrition therapy for EoE. (As a point of reference, an Elemental Diet shows a 95-98% success rate based on multiple studies.) Researcers are also looking into 4 Food Elimination diets.

Advantages and Disadvantages to consider

The advantages of using the 6 Food Elimination diet approach are that you can still eat solid foods. It also eliminates the need for extensive skin and blood tests to check for food allergies. Important disadvantages to this diet therapy are that it may unnecessarily remove foods from the diet, and many process foods are out, meaning the diet often involves a lot of preparation and careful reading of ingredient lists. Eliminating so many foods can increase the risk of patients being deficient in one or more nutrients. Also, as many of you may know, it is hard just to remove milk and soy from your diet. Try eliminating SIX different allergens that are found in many foods while maintaining your nutritional status! For this reason, many medical teams that manage patients with EoE encourage their patients to supplement the 6 Food Elimination diet with a nutritionally dense, hypoallergenic elemental product, such as Neocate®. This can help ensure the patient is getting all the protein, vitamins and minerals they need per day while ensuring that no allergic reactions will occur with the elemental products. It is vital that EoE patients are monitored by a dietitian. The dietitian will help calculate how much of the elemental product the patient will need per day and also make sure the nutritional status of the patient is maintained.

Again, since research has found a 74% success rate for the 6 Food Elimination diet, it's possible that symptoms will persist after starting the 6 Food Elimination diet. If this happens, your medical team can help you decide the next best step, which may include a careful review of your diet, possibly eliminating more foods, or starting with a more “allergen safe” diet therapy such as an Elemental diet. After a few weeks on the Elemental diet, most teams will work with you to start reintroducing solid foods to figure out which ones may be contributing to your symptoms.

I hope this helped to shed some light on this nutritional therapy options for EoE. Every person will have their own treatment plan that works for them. Is anyone following an elimination diet now? How is it going for you? Have any tips you can share that may help others manage an elimination diet?

-Christine

1 Kagawalla AF et al, Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis. Clin Gastroenterol Hepatol 2006:4(9):363-8


Be Prepared with Allergen-Free Snacks!

Posted 5.14.15 | Nutrition Specialist


For many of us, summer is a time for traveling. Whether you’re spending a day at the pool or a week at a camp site, finding portable snacks for you or your child with multiple food allergies isn’t always easy. However, a little planning can go a long way!

Knowing the chaos that ensues in your daily life, I wanted to save you some time by providing various allergen-free snack ideas. Here you’ll find a list of snacks you can take on-the-go, all of which are free from the top eight allergens (milk, eggs, fish, shellfish, tree nuts, peanuts, wheat, and soy), unless otherwise noted. As always, please read each ingredient label and always contact the manufacturer if you are unsure as to whether the product contains your or your child’s allergen.

“Cooler-worthy” snacks

  • Fresh fruit – banana, apple, plum, peaches, the list goes on! Wash some berries (blueberries, strawberries, raspberries, blackberries) or cut a melon into bite-size pieces and store in a to-go container.
  • Fresh veggies – celery, baby carrots, bell pepper strips, raw cauliflower, broccoli, again the list goes on!
  • Tribe Hummus – Hummus goes great as a dip with those fresh veggies. Tribe claims that their hummus does not contain any of the top eight allergens. https://www.tribehummus.com/
  • Salsa – whether it’s homemade or store bought, this is another “dip” option for those raw veggies.

“Throw-straight-into-your-bag” snacks

  • Popcorn
  • Fruit cups
  • Homemade trail mix – Rice or Corn Chex/Kix, dried fruit, seeds (such as pumpkin or sunflower seeds).
  • Brown rice cake with sunflower butter.  Sun Butter offers sunflower butter in single serve packets. http://sunbutter.com/products/
  • Dried fruit – try a mix to keep it interesting! Ex: Raisins, dried cranberries, dried mangoes, dried pineapples. Create a mixture that sounds most appetizing to you!
  • Corn chips – Pair these with salsa for a great poolside snack. Check out Way Better Snacks which manufactures a variety of sprouted chips that are allergen free. Please note – these products are made in a facility which uses soy, sesame seeds, flaxseed, and dairy. www.gowaybetter.com
  • Enjoy Life products – From cereal to chocolate bars, this company offers a wide array (and when I say wide array, I mean it!) of allergen-free products. http://enjoylifefoods.com/
  • Plum Organic mash ups –These grab-and-go pouches come in a variety of flavors consisting of pureed fruits and veggies. Try throwing these in a cooler for a cool, refreshing snack. http://www.plumorganics.com/products#mashups
  • Libre Naturals - Here you’ll find granola bars, granola, and oatmeal cups all made in a dedicated facility free of all the top food allergens. http://librenaturals.com/
  • The Good Bean – Roasted chickpeas? Yes please! The Good Bean offers roasted chickpeas made in a dedicated nut-free facility and certified gluten-free. http://www.thegoodbean.com/
  • The Real Deal Snacks – Here you’ll find corn pretzels and veggie chips (original and sriracha flavor). Yum! http://www.therealdealallnaturalsnacks.com/

Sweet Treats

This certainly isn't a comprehensive list of ideas or all of the companies that offer allergen-free snacks. Are there any allergen-free snacks that you or your child enjoys that are not on this list? If so, we’d love to hear them!

-Kendra Valle, RDN

http://www.eatingwithfoodallergies.com/allergyfreesnacks.html

Image Artist: Srikanth Jandhyala


E-D-U-C-A-T-E with the National Eosinophil Awareness week

Posted 5.14.15 | Nutrition Specialist

With the efforts of American Partnership for Eosinophilic Disorders (APFED), in May 2007, the House of Representatives passed HB296, designating the third week of May as the National Eosinophil Awareness Week (NEAW). The purpose of NEAW is to create awareness and educate the general public and the medical community with Eosinophil-associated diseases. These diseases are rapidly emerging as a healthcare problem worldwide. But many patients suffering from these disorders go undiagnosed for years due to a lack of information or awareness of these diseases. For a robust factsheet that will enable you to learn more and share information on Eosinophil-associated diseases, please visit: http://bit.ly/1EtkJy3

Across the nation, patients, caregivers, healthcare professionals, friends and family will prepare for NEAW which kicks off from May 17-23 this year. Not sure how you can help? APFED has designed a number of ways for you to get involved http://bit.ly/EosinophilAwareness

The theme for NEAW is to E-D-U-C-A-T-E (Educate, Donate, Unite, Change, Awareness, Thank, and Engage). Each topic corresponds with a list of suggested activities for each day of the awareness week. To view suggested activities and accompanying resources that can be used, please visit this page on the APFED website http://bit.ly/EosinophilAwareness.

These diseases are unknown to many, and with the resources offered by APFED you can start small. The small act of changing your social media profile picture can engage your personal networks by encouraging conversations that will lead to the awareness of Eosinophil-associated diseases.

Tags

food allergies  |  food allergy  |  EoE


Take Action in May to Keep Food Allergies at Bay

Posted 5.5.15 | Nutrition Specialist

Researchers estimate that up to 15 million Americanshave food allergies and it affects 1 in every 13 children (under 18 years of age) in the U.S. The month of May is dedicated towards raising awareness and educating public on food allergies. We have put together a list of initiatives and activities in May to help you do your bit and get involved:

  • Food Allergy Action Month – May 2015: Food Allergy Research & Education (FARE)has called out May to be the Food Allergy Action Month. There are a number of activities and ways to get involved throughout the month of May. Activities are circled around raising awareness, educating others and inspiring action to support the food allergy community. FARE also offers free resources like posters and handouts to help others understand the broad impact and serious nature of food allergies.
  • Food Allergy Awareness Week – May 10-16, 2015: According to a study released in 2013 by the Centers for Disease Control and Prevention, food allergies among children increased approximately 50 percent between 1997 and 2011. Since 1998, FARE has been educating public on food allergies through the Food Allergy Awareness Week which starts from May 10 through May 16 this year. You can start small by creating awareness in your personal networks on social media. Tweet facts about food allergies to inspire others to take action in your networks. FARE has created resources for social media like tweets and profile pictures http://bit.ly/1bKzDbj
  • AnaphylaxisAwareness Day – May 13, 2015: On May 13, FARE wants you to take action by learning how to use an epinephrine auto-injector or training someone else. Every three minutes, a food allergy sends someone to the ER and this day will help reduce that number if each one of you can learn how to deal with a food allergy crisis situation.
  • National Eosinophil Awareness Week – May 17-23, 2015: On May 15, 2007, the House of Representatives passed HB 296 designated the third week of May as National Eosinophil Awareness Week (NEAW). The purpose of this week is to create awareness and educate general public and the medical community on diseases associated with Eosinophil. The theme of NEAW is E-D-U-C-A-T-E (Educate, Donate, Unite, Change, Awareness, Thank, Engage). Each topic corresponds with a list of suggested activities for each day of the awareness week http://bit.ly/EosinophilAwareness

These activities give each one of you a great opportunity to shine light on food allergies – a condition which still remains unknown to many. How do you plan to inspire action this year?


Prepare for food allergy emergencies

Posted 4.24.15 | Nutrition Specialist


A box of bandages just won’t do for a food allergy crisis. Even diligent efforts at allergen avoidance can be thwarted. You never know when a severe food allergy reaction can occur and require emergency response actions. Serious reactions are often unexpected, sudden and require immediate attention. Time is of the essence when there is a risk of an anaphylactic reaction, an extreme, often life-threatening allergic reaction. So like Scouts, its best to “be prepared” with both plans in place and an emergency kit. Following are some suggestions for both.

Plans

  1. Wear a food allergy awareness bracelet
  2. Prepare an Emergency Action Plan
  3. Schedule Calendar alerts for updating allergy-related information and Emergency Kits

Emergency Kit

  1. Decide where emergency kits are needed: home, school and travel/car
  2. Store kits in a temperature-controlled area
  3. Use an easily accessible, durable case that is clearly marked
  4. Supplies:
  • 2 epinephrine auto-injectors, if prescribed
  • Oral antihistamines
  • Small tube of hydrocortisone ointment (for topical application)
  • Fast acting asthma medication (if prescribed)
  • A copy of your Emergency Action Plan
  • “IF FOUND” info card for the emergency kit to be returned

Supply sources suggestions:

Bracelets- Fashionable food allergy bracelets are available that will suit the needs and style of anyone. Consider your local pharmacy or take a look at these website offerings:

  1. Food allergy Research and Education (FARE) has an online store with bracelets and other emergency-related supplies 
    https://store.foodallergy.org/ProductDetails.asp?ProductCode=MBAND5
  2. Allerbling bracelets are both an educational tool and conversation piece
    http://www.amazon.com/Allerbling-Food-Allergy-Awareness-Bracelet/dp/B0058KDN6U
  3. Medicalert has a variety of choices
    http://www.medicalert.org/product/catalog/medical-ids/youth-kids/bracelets

Emergency Action Plans can be found on a number of allergy-related websites. Here are several sources to consider:

  1. Food Allergy Research and Education website
    https://www.foodallergy.org/document.doc?id=234
  2. Food Safe Schools Organization website
    http://www.foodsafeschools.org/FSAG_CD/Resources/FAAN/Food_Allergy_Action_Plan_English.pdf
  3. St. Louis Children’s Organization website
    http://www.schoolwebdata.com/deerfieldwi/docs/Health-Food%20Allergy%20Plan.pdf

What do you keep in your food allergy emergency kit?

-Jody L. Benitz, MS, RDN


New Resource: CMNuA Blog

Posted 4.24.15 | Nutrition Specialist

 

The Children's Medical Nutrition Alliance (CMNuA) is a  nonprofit organization, was developed out of the explicit need for a unified voice to advocate for patients who require medical nutrition to live and thrive. As a national coalition of parents, healthcare providers, advocacy groups and corporations, CMNuA’s mission is to advance the cause of medical foods and formulas (as defined by the U.S. Food and Drug Administration, 21 U.S.C. 360ee (b) (3) 21CFR107) through education, support and advocacy.

By connecting families, healthcare providers, communities and others, CNMuA improves medical foods access by increasing awareness of common food allergies and diseases that routinely require these foods and formulas in their overall medical management. CMNuA also helps eliminate access barriers to these foods and formulas, by being a source of information on medical food matters such as coverage inequalities and the resulting economic impact on American families.

As part of being a source of information on medical foods, CMNuA recently launched its blog where the organization offers resources on how to find appropriate medical food coverage, understanding severe food allergies, and how to build community around disease-specific allergies.

Head over to cmnua.org/blog to learn more information about the organization and the work they are doing.

 


10 Tips for Spring Cleaning Your Home to Control Allergens

Posted 4.22.15 | Nutrition Specialist

The sun is out, the weather is warming up and it’s time to open your windows to the sun and beautiful spring. That said, spring cleaning is on the horizon as well. Whether you like this process or not, it’s necessary for allergy sufferers. While it is impossible to make your home completely allergen-free, below are 10 tips to clear most of allergens from your home:

1.       A well-ventilated house and non-leaking ductwork is the first vital line of defense against allergens. Use HEPA (high-efficiency particulate air) filters in your air-conditioning systems and vacuum cleaners.  Don’t forget to change filters in air conditioners, vacuum cleaners, vent registers, air purifiers and dehumidifiers.

2.       Dust is the most common cause of indoor allergies. Use a wet or treated cloth that attracts dust, minimize dust-catching clutter and clean dusty surfaces regularly so that dust doesn’t have a chance to accumulate.

3.       Vacuum your house thoroughly reaching every nook and corner. Try to vacuum your house atleast once or twice a week. We recommend using vacuum cleaners where you don’t have to replace filters frequently.

4.       Clean the clutter from your house. The less stuff in your house, the fewer places for allergens to hang out.

5.       Dust mites thrive in bedding. At least once a week, wash pillowcases, sheets, and blankets in very hot water and dry them in a hot dryer to kill dust mites. 

6.       Your bathroom is to mold what your bedroom is to dust mites. Be sure to fix any leaks and clean walls with a nontoxic bathroom cleaner.Run an exhaust fan after you take a shower, and replace any bathroom wallpaper with tile or mold-resistant paint. 

7.       If you have pets, vacuum frequently and wash your pet once a week.

8.       Keep your windows closed when pollen counts are highest: in the early morning hours, between 10 a.m. and 3 p.m.

9.       Maintain the humidity level in the house at about 40 percent to keep mold and dust at bay.

10.   Get rid of old rags, newspapers, clothes, other porous items.

Finally, we want you to be safe from allergens while spring cleaning. Consider wearing an allergy relief mask while cleaning to protect yourself from fumes, dust, and allergens.

Do you have any spring cleaning tip that we missed? We would love to hear from you.

 


Exciting News in Pennsylvania

Posted 4.21.15 | Neocate Admin

We are elated to announce Pennsylvania will be joining the list of mandated states to provide insurance coverage for amino acid-based formulas.

Click here to learn more about the Medical Foods Insurance Act of Pennsylvania


Top 5 Food Allergy Apps

Posted 4.15.15 | Nutrition Specialist

It wouldn’t be wrong to say that we live in an ‘Appy World’ with several mobile applications available to manage our day-to-day activities. With rapidly evolving technology, managing food allergies has become easier. There are several apps that tell you what is in your food, show you how to administer epinephrine, and identify safe food options when you’re traveling or away from home. Here are our top five picks for the best food allergy apps:

·    Sometimes it’s difficult to search for an ‘allergy-friendly’ restaurant while you’re travelling across the US. Download Allergy Eats, it offers a database of restaurants organized by city, zip code, or your current GPS location. With this app you can also review peer-ratings of the restaurants’ allergy-friendliness, and post your own ratings. This app is available in the iPhone and Android store for free. 

·         My Food Facts allows you to shop for groceries and identify food allergens in a product by simply scanning its barcode. All you have to do is create a personal profile that summarizes your food allergies. The app sends alerts to the shopper if food allergens are present in the scanned product, taking out the guess work. 

·        The My EpiPlan app includes everything from management to tips. It also has information on step-by-step use of an EpiPen. The app helps you keep track of which allergens you and your family need to avoid, and where your EpiPen (epinephrine) Auto‑Injectors are located and when they expire. The app is available in the iPhone and Android store for free.

·         iAvoid Food Allergy is a simple and user-friendly app designed for the food allergy community that helps to identify and avoid products and ingredients responsible for the eight most-common food allergies.

·         Allergy Journal allows you to track your food allergy symptoms and log what foods you are eating. The journal allows you to quickly scroll through all of the entries you’ve created, showing foods and symptoms in different colors for easy identification.

We would like to hear from you about the apps you use to manage your family’s food allergies. Do you have an app you love more than these? Please share it in the comments. 


Corn Allergy 101

Posted 4.9.15 | Nutrition Specialist


As a Nutrition Specialist here at Nutricia North America, I spend a lot of time talking to patients, parents, and health care professionals. Some of the questions I receive most often are “Do Neocate products contain any ingredients derived from corn?” and “Are Neocate products safe for an individual with a corn allergy?” Before we delve into these questions, let’s discuss the basics of a corn allergy.

Allergic reactions to corn are rare and often difficult to diagnose using standard skin or blood tests. Because a corn allergy can be difficult to diagnose through traditional methods, your allergist may recommend a food elimination diet in which you avoid corn and any derivatives of corn, for a specific period of time (normally two to four weeks). During this time, symptoms will be monitored, specifically to determine if there is an improvement in symptoms while corn is eliminated from the diet, and if symptoms reoccur when corn is reintroduced. If a corn allergy is identified by the allergist, treatment would involve avoidance of corn and ingredients derived from corn.

Corn is not among the top eight food allergens in the United States, for which special label information is required by the Food Allergen Labeling and Consumer Protection Act of 2004. Because corn is not required to be called out on the label, it is important for an individual with a diagnosed corn allergy to become familiar with ingredients that are derived from corn. Some common sources of corn are:

  • Corn starch
  • Corn syrup
  • Maltodextrin
  • Vegetable oil
  • Cellulose
  • Caramel

Please note, these are just a few examples and not a comprehensive list of ingredients derived from corn. If you are ever unsure as to whether an ingredient is derived from corn, it is best to contact the manufacturer.

Now that we have a basic understanding of a corn allergy, let’s address these frequently asked questions as mentioned earlier. The primary carbohydrate source in each of our Neocate products is derived from corn: The primary carbohydrate source in powdered Neocate products is corn syrup solids, while the primary carbohydrate source in liquid Neocate products is maltodextrin. Corn syrup solids are derived from corn starch, and maltodextrin is structurally similar to corn syrup solids. These ingredients are often used in nutritional formulas as a carbohydrate source because they offer a blend of simple and complex carbohydrates. In Neocate products, they are used in proportion with amino acids and fat to provide a balanced nutritional profile. No Neocate products are completely free of corn-derived ingredients.

That being said, the carbohydrates used in all Neocate products undergo extensive refinement in a multi-step process that includes purification, distillation and drying. This process is designed to remove impurities, including protein and fat that are naturally present in corn. As proteins are what the body responds to in a typical allergic reaction, this removes the trigger for patients with a corn protein allergy. With that said, we cannot make the claim that our Neocate products are completely “corn protein free”. In order to make such a claim, each and every batch would need to be tested for the presence of corn protein, which we do not do.

We cannot say with certainty that Neocate is “safe” for anyone – that’s a question for your healthcare team. It is important to note that leaders in food allergy diagnosis and management, such as those at the Jaffe Food Allergy Institute at Mount Sinai School of Medicine, find a majority of patients with corn protein allergies tolerate refined corn syrup solids with no allergy symptoms. In practice they do not restrict corn syrup solids in the diets of patients who are allergic to corn. If you have questions about the safety of the corn syrup solids or maltodextrin in Neocate, it would be best to discuss this with your healthcare team, especially the allergist, to see if they recommend a supervised trial or other testing to see if Neocate is appropriate.

Since we’re on the topic of corn, I figured I would mention two facts that are of importance to many Neocate families. The corn from which Neocate's carbohydrate ingredients are sourced is certified by the suppliers not to be genetically modified. In addition, the corn syrup solids used in Neocate products would not be expected to contain fructose and are not the same as “high fructose corn syrup” or “HFCS”. HFCS is produced from corn starch in which about half of the glucose molecules have been chemically converted to fructose. Many consumers prefer to avoid HFCS for a number of reasons, and we do not use this ingredient in Neocate products.

-Kendra Valle, RDN

References:
http://www.foodallergy.org/allergens/other-allergens
http://acaai.org/allergies/types/food-allergies/types-food-allergy/corn-allergy
http://www.aaaai.org/ask-the-expert/avoidance-corn-allergen.aspx

Image source: Liz West

 



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About Us

Food Allergy Living is a resource for parents of children with food allergies, brought to you by Nutricia, the makers of Neocate. For more in-depth information about our purpose & authors, see our About Food Allergy Living page.