Food Allergy Living Blog

Nutrition Specialist Column

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


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?


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.

 


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. 


Allergy-Friendly Easter Egg Hunts

Posted 4.2.15 | Nutrition Specialist

Easter egg hunts put the fun into Easter Sunday and are a great way to engage kids in physical activity. We LOVE egg hunts!  Here are great tips to plan your own allergy-friendly Easter egg hunt this weekend:

1.      A win-win-win trade in:  Have the kids participating in the egg hunt exchange plastic eggs for prizes of their choice.  Prizes can be anything! This way you don’t have to worry about food allergies, stuffing individual eggs and it’s a healthier option because it deducts excessive sugar.

2.      Let the clue come to you:Older kids can enjoy finding eggs filled with clues for a grand prize at the end of the hunt. The grand prize can be a basket with goodies like cool school supplies, small tech prizes or gift cards.

3.      Safe for all: It’s always better to be safe than sorry. If you plan to stuff the Easter eggs, make them all safe. Little ones can get shy while talking to adults who are not their parents. Keeping this in mind, keep all the stuffing allergy-friendly.

4.      Think beyond food treats: Non-food prizes can make great gifts inside or outside the Easter eggs. There is a wide variety of gifts for kids which include: mechanical pencils, tattoos, coloring books, boxes of crayons and cool erasers which you can distribute worry-free. These treats keep the little ones occupied and engaged in the egg hunt.

5.      Pre-planning for candy options: There are many allergy-friendly candy options available in the market for your little guests with food allergies. You can research on these options before hand by getting in touch with the parents of invitees for the egg hunt. Share the final list with all the parents to make sure all the candies listed are safe for all.

6.      Healthy finger foods:It doesn’t harm to have a few food items for the egg hunt. Fresh and thin cut veggies like carrots, celery and roasted peppers are safe and healthy.

With numerous special occasions and festivals each year, we are sure that kids with food allergies have learnt to advocate for themselves. Keep preparing your kids the same way. Neocate wishes its community a delicious allergy-friendly Easter! 


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.

Image Source


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.

 

 



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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.