Food Allergy Living Blog




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Find a Pharmacy: New Zip Code Search

Posted 3.31.15 | Nutrition Specialist

At Neocate we are always looking new ways to improve our community experience. It is critical that the families who rely on Neocate have access to the most accurate and reliable information. This includes knowing where to find Neocate. 

To ensure the search is seamless, we have created a new zip code search tool on our website. The zip code search will allow parents and caregivers to enter their zip code and locate the closest pharmacy carrying Neocate.

 

With this new tool, families can spend less time worrying about where to find Neocate and more time enjoying precious moments with their families.

You can access the new tool here. If you have any questions about Neocate our customer support center is always ready to help. Give us a call at 1-800-365-7354.


Food allergies, food allergies go Away!

Posted 3.26.15 | Nutrition Specialist


Thumb-sucking, diapers, and baby talk are outgrown at some point by most children. So what about outgrowing food allergies?

Allergies are the result of the immune system gone awry, when the body mistakenly believes a food to be dangerous and overreacts to protect itself. Food allergies can be short-lived or can last a lifetime. Today, there are more kids with food allergies, fewer kids are outgrowing them, and for those who do outgrow them, it’s happening later in life. Food allergies that are outgrown may even resurface later in life. It would be great if food allergies were like a Houdini act and we could make them disappear! Sometimes food allergies are a guessing game, but we know of a number of factors that we think influence food allergy longevity and when a child outgrows them. Here are just a few standouts.

Influencing factors

  1. The Food Culprits
       There seems to be a pecking order to outgrowing food allergies. Milk, eggs and soy tend to be outgrown more easily and earlier than allergies to nuts and seafood. Research findings point to the easy breakdown of milk and egg proteins in food preparation, especially in baking as the dry heat is able to break down the proteins. Other food proteins are built tougher, are more resistant to breakdown, and are thus more allergenic even after cooking.
     
  2. Mean Genes
       Ethnicity, gender, and genetics may impact whether and when you see diminishing or disappearing food allergies. Odds are stacked against African American children, females, children with multiple food allergies, those with more severe food allergic reactions, and those with food allergy that develops later in life.
     
  3. Location, location, location!
       Where you live may play a role in your allergy profile too. This may be associated with different environments and eating habits of your home and neighborhood. Southern living in America may find you more prone to developing allergies than your Northern countrymen, and urban dwellers may be more prone to allergy than their rural counterparts.

Treatment, testing and tolerance

Approaches abound for tolerance testing and even inducing tolerances to certain allergies. Following are a few of the trending tests and tolerance inducing approaches. These should always be conducted under medical supervision, as potential for severe reactions is possible.

  1. Under the tongue
       Known as sublingual or oral immunotherapy (SLIT or OIT), this is a method associated with allergy testing and may also be effective in building tolerance to certain foods. A small amount of offending food is placed under the tongue or in the mouth and reaction monitored. Ask your allergy care team if this is an option for you.

     
  2. Bites of baked goods
       Sometimes called the baked good challenge, children are given samples of pancakes, muffins and other baked goods with incremental increases in the portion size offered when positive tolerance is demonstrated.

     
  3. Early Exposure
       Recent research has suggested that offering foods that are common allergens to infants when they are ready to start solid foods may actually help prevent the risk of developing food allergies for some. This is counter to the still common approach of waiting until later ages (1 to 2 years old) to introduce these foods, which may actually increase the risk of developing a food allergy for some individuals, especially those deemed at high risk for food allergies.

Efforts continue to explore the science behind the basis of food allergies as many mysteries remain. Still hard to explain is the who, what, when, why, and where of allergies. As it is, there is no magic pill, potion, or trick that can make food allergies go away. Yes, some children will have their food allergies diminish and disappear and some children will outgrow them. While waiting for Houdini to make them go away for good, there are support and resources that can help.

Consider the following organizations:

What has your family’s experience been with outgrowing food allergies?

-Jody L. Benitz, MS, RDN


References:

Painter K. Food allergies outgrown by more than one in four kids. USA Today website. http://www.usatoday.com/story/news/nation/2012/11/10/food-allergies-outgrown/1695451. Accessed March 23, 2015.

NIAID-Sponsored Expert Panel, Boyce JA, Assa’ad A, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010;126(6 Suppl):S1-S58.

Gupta RS, Springston EE, Warrier MR, et al. The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics. 2011;128(1):e9-e17.

Food Allergy Sensitization — New Study Finds Geography Plays a Role. By Sherry Coleman Collins, MS, RDN, LD.Today’s Dietitian, July 2014, Vol. 16 No. 7 P. 12.

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Eosinophilic Esophagitis and Adults

Posted 3.25.15 | Nutrition Specialist


I thought eosinophilic esophagitis (EoE) was only a medical problem for children!

We write a lot about children, but adults can have food allergy-associated disorders as well.  One such medical problem that can occur in adults, as well as children, is eosinophilic esophagitis (EoE), which is now more frequently diagnosed as a disease in adults.  EoE may affect up to one in 1,000 people.

What is EoE?

EoE defines a specific inflammatory disease of the esophagus (the tube from your mouth to your stomach) that is characterized by the infiltration of a large number of eosinophils, a type of white blood cell, in the lining of the esophagus. Eosinophils aren’t normally found there!

These are digital pictures of stained eosinophils from an electron microscope.  The top two pictures are eosinophils from circulating human blood (where eosinophils are normally found).  The bottom two pictures are eosinophils in mouse bone marrow and culture.

Eosinophils travel to various structures of the body, primarily the digestive tract, and function to help fight different types of infections. However, eosinophils are not normally found in the esophagus.  When they are present, this is an indication of inflammation, which may be due to food allergens (e.g. milk, soy, egg) and perhaps environmental allergens. 

What are the symptoms of EoE?

EoE symptoms can vary between individuals and can be similar to other conditions, such as gastroesophageal reflux disease (GERD) (acid reflux) and other conditions. 

These symptoms may include:

  • Nausea and/or vomiting 
  • Heartburn or acid reflux that does not improve after taking appropriate medications
  • Chest and/or abdominal pain
  • Dysphagia (difficulty and/or pain with swallowing)
  • Feeling that food is stuck in the throat or chest
  • Food impaction (food that gets stuck in the throat)

When should I visit the doctor if I think I have problems with my esophagus?

Always see your doctor sooner vs later, if you think you have any medical problems.  Medical problems can worsen over time or increase your risk for other diseases.

One of the major complications of EoE is stricture formation (extreme narrowing) of the esophagus.  One study of about 350 patients found that a longer delay in EoE diagnosis was linked to the occurrence of esophageal strictures.  Thus the risk of developing esophageal strictures is significantly associated with the length the time period from appearance of first symptoms to establishment of EoE diagnosis.

How is EoE diagnosed?

In order for your doctor make a diagnosis, a thorough history will need to be taken to determine potential causes for your symptoms.  The most reliable test for EoE is made by endoscopy and biopsy.

An endoscopy is a medical procedure that allows your doctor to look inside the digestive tract. A thin, flexible, lighted tube called an endoscope is guided into the mouth and throat, then into the esophagus, stomach and duodenum (start of the small intestine). The endoscope allows your doctor to view the inside of this area of the body, as well as to insert instruments through a scope for the removal of small tissue samples called biopsies.  A pathologist reviews the biopsies to determine the quantity of eosinophils and signs of tissue damage.  A high level of eosinophils could indicate that you have EoE.

If you are diagnosed with EoE, you will probably be tested for food allergies.  In some situations, avoiding certain food allergens will be an effective treatment for EoE.

How is EoE nutritionally or medically managed?

Diet changes and/or medications can help with the EoE symptoms and prevent further damage to the esophagus.

Nutrition management of EoE is helpful for many people.  Healthcare professionals may recommend a “food elimination diet” that removes between four and eight of the most common allergenic foods, which includes milk, soybeans (soy), eggs, tree nuts (e.g., almonds, walnuts, pecans), peanuts, wheat, fish (e.g., bass, flounder, cod) and crustacean shellfish (e.g., crab, lobster, shrimp).  A Registered Dietitian Nutritionist (RDN) can be of great help with the “elimination diet” and nutrition management of EoE.  Some healthcare professionals eliminate the foods that tested positive through allergy tests.

In some cases, an elemental diet is required; this diet does not contain any whole or partial proteins for the body to react to.  An elemental diet is usually a liquid formula that contains amino acids (the building blocks of proteins), fats, sugars, vitamins and minerals.  Elemental formulas are developed to meet all or most individual’s nutritional needs; the amount of formula recommended is based on your specific nutritional requirements.  These elemental formulas include products such as Neocate® Junior, Neocate® Junior with Prebiotics and Neocate® Splash or E028 Splash. Neocate® Nutra is an amino acid-based semi-solid food that allows people on an elemental diet to keep some variety in the diet.

If there are improvements of symptoms and/or decreased eosinophils in the esophagus after the elimination diet or elemental diet, food trials with reintroduction of individual foods begins.

Some individuals do not respond fully to nutrition management, so medications are an option.  Although the Food and Drug Administration (FDA) had not approved any medications for management of EoE, doctors have found that certain types of steroids can help decrease the esophageal inflammation.  Drugs, such as budesonide or fluticasone propionate, are swallowed so that the drug directly touches the esophagus to help decrease the inflammation.  Some individuals find that EoE symptoms completely resolve, but if the drug is discontinued the symptoms return.

What other questions do you have about EoE?

-Kathy

 

References:

National Institute of Health, National Institute of Allergy and Infectious Disease. Food Allergy.  Available from http://www.niaid.nih.gov/topics/foodAllergy/understanding/Pages/eoe.aspx Accessed March 19, 2015.

National Institute of Health, National Institute of Allergy and Infectious Disease.  Eosinophilic Gastrointestinal Disorders.  Available from http://www.niaid.nih.gov/topics/EosinophilicDisorders/understanding/Pages/gastro.aspx Accessed March 19, 2015

Schoepfer AM, Safroneeva E, Bussmann C, Kuchen T, Protmann S, UweSimon H, Straumann A.  The Delay in Diagnosis of Eosinophilic Esophagitis Increases Risk for Stricture Formation in a Time-Dependent Manner.  Gastroenterology 2013 Dec; 145 (6): 1230-1236.e2.  Published Online: August 15, 2013 DOI: http://dx.doi.org/10.1053/j.gastro.2013.08.015 Accessed March 19, 2015

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Do You Know the Signs? Understanding Cow Milk Allergy

Posted 3.23.15 | Nutrition Specialist

With the rise in food allergies among children, it is increasingly important for parents and caregivers to recognize the signs and symptoms of food allergies. Among foods that are common allergens, cow milk allergy (CMA) remains the most prevalent in infants and children. 

In the following video, "8 Signs of a Cow Milk Allergy," our nutrition specialists Rob, RDN and Mallory break down eight of the most common signs of CMA, which were provided by a pediatric allergist.

 

Click the image below for the video:

 

 

For more information on cow milk allergy, check out the following resources:


Overcoming Feeding Tube Fear: A Parent’s Perspective

Posted 3.12.15 | Guest Blogger

Hillary Savoie, PhD is the Chief Communications Maman at the Feeding Tube Awareness Foundation(FTAF). She is also the founder and director of the Cute Syndrome Foundation(TCSF). Her daughter Esmé, who has two rare genetic disorders PCDH19 Epilepsy and SCN8A, is four years old and the inspiration for her work with FTAF and TCSF. This post has been adapted from a post on The Cute SyndromeHillary’s blog about life with her Esmé.

Hillary Savoie

 

 

 

 

 

 

 

 

Photo credit: Tracey Buyce Photography, Photo courtesy of The Cute Syndrome Foundation

My daughter Esmé has never had an uncomplicated relationship with food. Her very low tone and poor swallowing reflex makes it extraordinarily difficult for her to eat or drink by mouth easily or safely. So, at 3 ½ months-old Esmé had a feeding tube (G-tube) surgically placed in her abdomen. In the four years since then she has consumed virtually all of her calories, water, and medications this way.

I wish I could tell you that I was welcoming of this change, that I was proud of Esmé’s tube from the day it was placed. But I wasn’t. It is embarrassing for me to say, given how I now feel about my daughter’s feeding tube, but I was very resistant to tube-feeding at first.

It took months before I was able to realize that tube-feeding Esmé wasn't a parenting failure. It was a parenting triumph.

And the thing is, my love for the tube now seems so simple to me: My daughter’s feeding tube gave her a chance at life, a chance she would not have otherwise had. What is less simple, however, is why it would take me so long to learn to be proud of the small plastic device that helps keep my daughter alive, thriving, and safe. When I stop to think about it, I believe that my initial fears about tube-feeding had so much to do with my ignorance of feeding tubes.

Like many people I didn't really know much about feeding tubes—until I was faced with the prospect of Esmé having one.

The only experience I had with a feeding tube prior to having Esmé was one that I only understand now that I mother a child who has a tube. I went to Kindergarten with a little boy who I knew had some kind of health challenges. He wore a bandage on his stomach every day. I recall that we knew to be gentle with him—that there was something different about his body—but no one ever really talked to us about how or why.

It was a mystery to me. He and I were friends in the manner of many little kids—he chased me on the playground and tried to kiss me. I could outrun him, but I didn’t. I can still remember playing with him one day at the swing set. He lifted his arms up and as his shirt rose, I could see the large piece of gauze stretched across his belly. I was curious, so I asked him about it. He tried to explain something to me about how he ate, lifting up his shirt so I could see more, but before he could show me he was herded away by some well-intentioned adult. I felt ashamed, certain I had done something wrong. I’m quite sure he did as well.

It makes perfect sense to me now. He must have had a feeding tube, and he was not supposed to show it or talk about it. I have thought about that moment hundreds of times since Esmé's tube was placed. I have thought about how, if he had been allowed to explain, to show the phenomenal device that helped keep him able to chase me, that years later I might have understood sooner that this same tube could help my daughter have a fuller life.

I might have agonized less if I had known more.

The Feeding Tube Awareness Foundation

I joined the Feeding Tube Awareness Foundation staff two years ago. I am so proud of the work that we do helping parents of children who are tube-fed share their knowledge with each other and with medical professionals. We help to establish a positive image of feeding tubes, to spread knowledge about life with feeding tubes, and to support families to help feel empowered to care and advocate for their children who are tube-fed. I feel confident that, as a direct result of that work, if I were a little girl on the playground today being chased by an adorable little boy with a feeding tube, my question about his tummy would more likely be met with an open dialogue about the miracle that is tube feeding—that he would have been able to proudly display the little device that kept him thriving.

And then, we'd have gone back to playing.

 

 


Benefits of Early Epinephrine

Posted 3.9.15 | Rob McCandlish, RDN


We like to share important research that we learn about related to food allergies. Here’s a study we heard about recently through Kids with Food Allergies (KFA) related to the use of epinephrine in cases of food-induced anaphylaxis. You can read KFA’s original post here. You can actually read the full article (for free!) on the website for the Journal of Allergy and Clinical Immunology: In Practice. For those of you who don’t want to take the time to read it, we’ll be happy to provide a summary!

The primary author, Jude Fleming, MD, is associated with Hasbro Children’s Hospital in Rhode Island. Dr. Fleming and the rest of the researchers examined the association between early use of epinephrine and hospitalization. Basically, they wanted to know if people who get epinephrine sooner in a case of food-induced anaphylaxis end up admitted for a longer stay at the hospital any more or less often. The previous research on this topic had been inconclusive. The research team looked through six years of medical records for patients who came to the emergency department (ED) at Hasbro Children’s Hospital with food-induced anaphylaxis.

The team found 234 cases of patients visiting the ED for food-induced anaphylaxis who received epinephrine at some point. They grouped the patients based on whether they got epinephrine before they arrived to the ED or after. Then they looked at how many patients in each group were admitted for a longer stay at the hospital.

Dr. Fleming and the team found that the patients who got epinephrine before they arrived to the ED were much less likely to be hospitalized. They concluded that it’s better to give epinephrine promptly in cases of food-induced anaphylaxis versus waiting for the epinephrine to be given in the ED.

If you aren’t sure what this means for you or your loved one, make sure to discuss it with your healthcare team.

Rob

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March is National Nutrition Month!

Posted 3.4.15 | Rob McCandlish, RDN


Believe it or not, March has already arrived and with the arrival of this month comes National Nutrition Month! Dietitians around the globe are all familiar with this campaign; however allow me to provide a brief explanation for those of you who are just hearing about this for the first time. National Nutrition Month® (NNM) is a nutrition education and information campaign created annually in March by the Academy of Nutrition and Dietetics. The campaign focuses attention on the importance of making informed food choices and developing sound eating and physical activity habits.(1)

NNM has a new theme each year in order to focus on specific nutrition and physical activity messages. The theme for 2015 is “Bite into a Healthy Lifestyle”, which encourages everyone to adopt eating and physical activity plans that are focused on consuming fewer calories, making informed food choices and getting daily exercise in order to achieve and maintain a healthy weight, reduce the risk of chronic disease and promote overall health.(2)

Although, optimal nutrition is important all year round, Registered Dietitian Nutritionists (RDNs) dedicate even more time to educating individuals on the benefits of living a healthy lifestyle during this month. RDNs are the food and nutrition experts who can translate the science of nutrition into practical solutions for healthy living. They are especially helpful members of the healthcare team for families managing food allergies, for whom healthy eating takes on a different meaning. RDNs are advocates for advancing the nutritional status of Americans and people around the world.(3) March 11, 2015 has been declared ‘Registered Dietitian Nutritionist Day’! Please make sure to thank your RDN for her/his commitment to helping you live a healthier life!

In honor of NNM, here are some fun nutrition facts created by the Texas Heart Institute at St. Luke’s Episcopal Hospital:

  • Frozen fruits and vegetables are just as nutritious as fresh as the freezing process locks in the nutrients.
  • The average 16 fl oz soda contains 29 sugar cubes and no vitamins or minerals.
  • Individuals who eat from smaller plates tend to eat smaller portions.
  • Blueberries are one of the only foods found in nature that are truly blue in color.
  • Bright, warm colors can stimulate hunger, which is why many fast food restaurants use red, yellow, and orange colors for logos and packaging.

Happy National Nutrition Month®! What activities do you have planned to recognize this campaign?

-Kendra Valle, RDN, LDN


1) http://www.nationalnutritionmonth.org/nnm/
2) http://www.nationalnutritionmonth.org/nnm/
3) http://www.eatrightpro.org/resources/about-us/what-is-an-rdn-and-dtr
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How to Travel with Neocate

Posted 2.27.15 | Rob McCandlish, RDN

by Kathleen Smith, RDN, LDN

As the weather starts to warm up and you start to consider travelling, you have lots to consider: where to go, how to get there, and what to pack. Whether you travel by car, bus, train or plane, an advance plan for the transportation and amount of Neocate you or your family member will need for your trip will save you from additional trip stress.

First things first, calculate exactly how much formula you will need for the entire trip. You don’t want to underestimate and run out of formula, as the chances of a local pharmacy having Neocate are small! (Check here if you find yourself in that situation.) We recommend packing an extra can just in case your travel plans change unexpectedly.

Next you will want to plan the amount of prepared formula to bring with you. Neocate powdered formulas can be prepared ahead of time and kept in a refrigerator for up to 24 hours. Neocate can be kept at room temperature for up to 4 hours as long as the bottle or container has not been “touched” (i.e. no formula has been consumed). So if you have a long flight or car trip, consider bringing a little cooler for your bottles; the cooler should be maintained at a temperature of less than 40°F. Also, pack some extra Neocate powder in your formula bag in case of lost luggage or spillage of formula.

If you are flying, the Transportation Security Administration (TSA) has regulations about flying with liquids for you or your family member. Formula, breast milk and juice for infants or toddlers are permitted to be brought on board the aircraft. Older individuals (older child, teen or adult) may also travel with Neocate. Travelers must tell the TSA officer at the beginning of the screening process that they wish to bring formula, breast milk and juice in excess of 3.4 ounces in their carry-on bag. These liquids do not have to fit within a quart-sized bag like other liquids. The formula, breast milk and juice are typically screened by X-ray, and any of these liquids in excess of 3.4 ounces will receive additional screening.

Travelers are encouraged to travel with only the amount of formula, breast milk and juice needed to reach their destination. Ice packs and other accessories required to cool formula, breast milk and juice are also permitted through the screening checkpoint but may be subject to additional screening. We’ve learned from Neocate families that some TSA officers may not have encountered an older individual requiring a medical food like Neocate before. If you or your loved one is older, it may also help to bring a doctor’s note explaining that Neocate is medically necessary. TSA recommends that if you plan to travel with large quantities of medically necessary liquids you should coordinate your screening by contacting a Passenger Support Specialist prior to your flight.

For more detailed information from TSA about flying with formula, visit http://www.tsa.gov/tsa-kids/parents-page prior to your flight.

For more information about the screening of passengers with disabilities and medical conditions, go to www.tsa.gov/traveler-information/travelers-disabilities-and-medical-conditions. Here, passengers will find information about the TSA Cares program, how to secure the services of a Passenger Support Specialist (who is trained in assisting passengers with disabilities and medical conditions through the checkpoint screening process), and what to expect during the security screening process. In addition, passengers may ask to speak to a Passenger Support Specialist or a Supervisory TSO while at the checkpoint if they need assistance. Passengers also may report concerns by emailing TSA’s Disability and Multicultural Division at TSA.ODPO@tsa.dhs.gov.

We hope you and your family have a safe and wonderful trip!

-Kathy

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Neocate Shipping and Storage

Posted 2.24.15 | Rob McCandlish, RDN


It’s a cold, blustery evening on your drive home from a long day at the office. As you approach your front door you notice the Nutricia North America box sitting at your doorstep. Your initial thought is, “Oh no, can we use this after it’s been sitting here in these cold temperatures all day?”

During these cold winter months (as well as those hot summer days that will soon be upon us) it is not uncommon to wonder if our products are safe after the temperatures they have been exposed to during shipping and delivery.

Short-term exposure to temperature extremes that our products experience during shipping (e.g. being left on a porch in cold or hot weather) typically does not pose a risk to product quality or stability. Those extreme temperatures would become a concern if the product is left at those temperatures for an extended period of time, for example several days or weeks.

The temperatures that are printed on our product labels are recommended storage temperatures, which cover long-term storage of the product. They are based on the effects that extreme temperatures can have on the products over extended periods of time, typically much longer than those experienced during shipping. (With this said, Nutricia’s products are not required to be shipped in a temperature-controlled environment.)

Of note, freezing Nutricia's liquid products may affect the product's consistency, as the thawing process can affect the ability of emulsifiers to maintain a stable solution. In addition, freezing of our liquid products could also have an impact on the water-soluble vitamins (specifically Vitamin C and the B vitamins) which is certainly important to take into consideration for those individuals who rely on our products as their sole source of nutrition.

If you are ever unsure as to whether or not the Nutricia product you have received is safe to use, please do not hesitate to call a member of our Nutrition Services team to discuss your concerns.

-Kendra Valle, RDN, LDN

 

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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.