Food Allergy Living Blog

Nutrition Specialist Column

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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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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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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It only takes a cupcake…

Posted 2.13.15 | Nutrition Specialist


…to cause a cascade of unfortunate events for a child with a food allergy. Besides having to say “NO” to the tasty treat due to potential allergy-triggering ingredients, the student may encounter taunting and teasing from classmates for having an allergy- insult icing!

Both the number of children with food allergies and bullying incidents of these kids are on the rise. According to a 2013 study by the Centers for Disease Control and Prevention, food allergies have increased in children approximately 50% between 1997 and 2011, estimated at nearly six million children, or 8% of kids in the U.S and roughly two in every classroom. Unfortunately about one-third of these kids are bullied because of their allergies. This can run the gamut from being barred from activities involving food by teachers to name calling by peers or even threats to the allergic child using the potential food allergen. Faced with this, the allergy-challenged child experiences increased stress and anxiety. This may lead to their not eating during school, avoiding school or even succumbing to peer pressure and forgoing the off-limits food, in spite of possible harmful side effects. Bullying can be both emotionally and physically damaging.

Parents, teachers, and the community can be instrumental in curbing food allergy bullying. Scripting responses, role playing scenarios and running interference with school personnel are ways parents can help. Kelly Huth writes about these and offers suggestions and supporting information for parents on this website.

Guidelines for schools and training materials are available through the Food Allergy & Anaphylaxis Network (FAAN) on their website. The School Nutrition Association has training available to members on their School Nutrition University website. Online training for non-healthcare school personnel developed by FAAN and the Food Allergy Initiative can be found on their website.

 The Food Allergy Research & Education (FARE) has an online public campaign - “It’s Not a Joke” - that has sparked a lot of media attention to food allergy bullying. Their PSA, along with other materials, are available on the campaign website www.foodallergy.org/its-not-a-joke.

Webinars
What Every Parent Must Know about Managing Food Allergies at School: Must-know facts for establishing a safe and inclusive school environment.

CDC Guidelines: The Gold Standard for Food Allergy Management in Schools: Highlights from the CDC Guidelines: Developing a Food Allergy Management and Prevention Plan (FAMPP); Following Federal Laws; Recommendations for Safety and Inclusion; Actions for District and School Administrators and Staff

For additional information and resources consider: http://www.cdc.gov/healthyyouth/foodallergies

Sharing information and resources on the serious nature of food allergies and increasing awareness of the dangers of food allergy bullying is a way to be a change agent for kids with allergies. Spark some attention to this- spread the word. Be the icing on an allergy-free cupcake!

-Jody Benitz

References

1.        Allergy statistics. American Academy of Allergy, Asthma, and Immunology website.
2.       Food allergies: what you need to know. US Food and Drug Administration website.
3.       Lieberman JA, Weiss C, Furlong TJ, Sicherer M, Sicherer SH. Bullying among pediatric patients with food allergy. Ann Allergy Asthma Immunol. 2010;105(4):282-286.

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Tube Feeding: Troubleshooting Tips

Posted 2.3.15 | Mallory West

Many Neocate babies and children receive their formula through a feeding tube. Common Neocate formulas that are received through feeding tubes include Neocate Infant DHA/ARA, Neocate Junior, Unflavored, and Neocate Splash, Unflavored. Enteral tube feeding provides nourishment to individuals who are unable to consume adequate nutrition by mouth. If your child uses a feeding tube, you know that there may be some occasional tube feeding complications. This blog will provide some general troubleshooting tips for the most common tube-feeding problems.

Clogging of the Feeding Tube:

Sometimes a feeding tube will become blocked so that no food can go through.

How to Fix Clogs:

  • First, using a syringe to gently remove the liquid on top of the blockage, if possible (throw away the fluid removed).
  • Next, gently flush the tube using lukewarm water, using at least a 30 mL (1 oz) syringe. Gently plunge the water back and forth to clear the blockage.
  • Unless directed by a healthcare professional, do not use acidic solutions such as fruit juices or cola as they may curdle the formula.
  • If the tube is still clogged, clamp the tube for around 10 minutes and then try flushing it again.
  • If the tube the clog remains, gently squeeze the tube between your fingers along the length of the tube as far as possible.
  • If you are still unable to clear the blockage, contact your healthcare professional for advice. Sometimes, the physician will prescribe a special enzyme which can dissolve the clog. If the clog cannot be cleared, the tube will have to be replaced.

How to Avoid Clogs:

  • Tube flushing is the most important factor for preventing the feeding tube from clogging. Use a syringe to flush 20 mL of warm water through the feeding tube before and after feedings and medications (or as directed by your healthcare team). If your child receives a continuous feed, your healthcare provider may recommend flushing with water during the feed to prevent clogging.
  • Use liquid medications whenever possible. If pills are necessary, crush them well and mix them with a small amount of warm water. Use a syringe to draw up the solution and insert it into the feeding tube. If pills are coated or time-released, discuss this with the physician because these types of pills are typically not meant to be crushed.
  • Do not mix medications together and do not mix medications in formula unless instructed to do so by your healthcare provider.

Tube Site Irritation or Infection:

Redness, pain, swelling or unusual/excessive drainage, as well as fever, can all be signs of an infection at the stoma site (the surgical opening through which a gastrostomy tube (g-tube) or jejunostomy tube (j-tube) enters the stomach or small intestine).

How to Avoid Irritation or Infection:

To avoid infection, it’s important to keep the stoma site clean and dry. Your healthcare provider should give you specific recommendations for how to clean the stoma site each day. For more information on keeping the stoma site clean (from a parent’s point of view), check out this informative article from Complex Child E-Magazine.

A Dislodged Feeding Tube:

If the feeding tube comes out, call the doctor and go to the hospital right away. The stoma can close up very quickly so the tube needs to be replaced promptly. Cover the site with clean dressing or bandage to prevent leakage and immediately seek medical attention.

Sometimes the healthcare provider will train you to replace the feeding tube yourself (temporarily or permanently) but you should ONLY do this if directed and properly trained by your child’s physician.

How to Avoid:

Young children occasionally pull the tube out themselves. Keep the tube covered with clothing to prevent this. Onesies work well for infants and toddlers. It’s also important to secure the tube during activities so that it doesn’t get pulled out. You can use various methods to secure the tube. Some companies make special wraps and clothing for protecting and accessing the feeding tube:

Do you have any troubleshooting tips to share with other tube-feeding families? What problems have you encountered and what tricks have you learned?

- Mallory


Enteral Tube-Feeding: Understanding the Basics

Posted 1.29.15 | Mallory West

Although most Neocate users drink their formula, many patients receive Neocate through a feeding tube. This is referred to as “enteral nutrition”. Those of you with tube-fed family members are already experts on the subject, however, I hope this post will be useful for those of you who are new to tube feeding or for those of you who are just interested in learning how it works.

Tube feeding provides nutrition to someone with a medical condition that impairs his/her ability to eat or drink (or impairs their ability to consume enough to sustain his/her nutritional needs). Nutrition is provided by a special liquid food that is given through the feeding tube.

The liquid food contains all components of nutrition (protein, fat, carbs, vitamins and minerals) so it provides everything a person needs to live and be healthy. Some people are exclusively tube-fed while others continue to eat food while supplementing with tube-feeds. Fluids and medications (most of them) can also be given through the tube (which is a nice perk for kids who require some bad-tasting meds!).

Types of Feeding Tubes

There are various types of feeding tubes. A nasogastric or nasoenteral tube is inserted through the nose into the stomach or small intestine[1]. Alternatively, a tube may be surgically inserted through the skin and directly into the stomach or the small intestine in a procedure called a gastrostomy or jejunostomy, respectively. You may hear these refered to as a “g-tube” (short for gastrostomy tube) or a “j-tube” (short for jejunostomy tube). Patients with g-tubes may get a feeding port (commonly known as a MIC-KEY button or a mickey tube), so that the outside feeding tube only needs to be attached during feedings.

Methods of Tube-feeding

There are 3 ways that tube-feeds are administered:

  • Gravity: With gravity feeds, a bag of formula hangs above the patient so that the formula flows down the tube.
  • Syringe: With syringe feeds, formula is administered by hand using a syringe to push the formula through the tube.
  • Feeding pump: An electronic pump moves formula through the feeding tube at a controlled rate. Common brands of feeding pumps include the Kangaroo pump and the Infinity pump.

Feeding Rates

  • Bolus feedings: Bolus feedings are relatively large in volume and given over a relatively short period of time. Feedings are given several times a day and the schedule more closely resembles “mealtimes” in comparison to a continuous feed.
  • Continuous/drip feedings: Feedings that are given at a slow rate, over a relatively long period of time. Continuous feeds may be indicated for patients who are unable to tolerate large volumes.
  • Combination: Some people may do a combination of both types. For example, they may receive bolus feeds during the day and a continuous feed overnight.

Enteral nutrition is such an amazing example of the impact that medical technology has on our lives. Before there was enteral nutrition, the inability to eat was a life-threatening situation. Although nobody wants to rely on a feeding tube unnecessarily, it is such a blessing for those who could not live without it.

My younger sister Caroline got her G-tube about 6 years ago (she was 11). We tried to avoid it for so many years but once she got it, it turned out to be such a blessing in disguise! She has never looked healthier; she gained some much-needed weight, her hair and skin look so much healthier, and she’s so much stronger. Our family is so thankful for it! If you have come across this post because your little one is getting a feeding tube, I hope this gives you a new and optimistic perspective!

Do any of you have experience with a feeding tube? What impact did it have on your child’s life? What are the biggest obstacles you experience with a feeding tube?

-Mallory


[1] American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). http://www.nutritioncare.org/About_Clinical_Nutrition/What_is_Enteral_Nutrition/

 





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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.