For a parent who is not familiar with food allergies, having a food allergic child over to play may seem intimidating. This blog is intended for parents whose children do not have food allergies who would like to know more about food allergies in order to safely host a food-allergic playmate.

Meals and Snacks

Obviously meals and snacks are the most critical times to be vigilant when you are caring for a child with food allergies. Follow these steps to keep your guest safe.

• Prior to the play date, arrange for the child’s parents to pack enough safe foods for the time they will spend at your house. Let them know if you plan to have a certain food so that they can provide an allergy-free alternative for their child and nobody feels left out. The most important thing is to only give the child the food that their parents provided. Food allergens are often hidden ingredients and it takes a lot of time and practice to master the art of reading food labels and detecting potential allergens. Never assume a food is safe.
• Make sure to clean the surface of the kitchen or table to remove any food protein residue from earlier meals. Soaps and commercial cleansing agents work well on counter tops, but dishwashing liquid is not enough.
• Be sure to wash your hands before and between handling foods. It’s important to remind the kids to wash their hands before eating as well. Use soap and water; hand-sanitizers will not get rid of food protein residues.
• When preparing food for the kiddos, be careful to avoid cross contact, where the proteins from one food mix in with another food. Even a tiny amount is enough to cause an allergic reaction in some people. To avoid it, use separate utensils when preparing food for the kids (or yourself).
• For the younger children, be sure to monitor the kiddos during meal or snack time and explain that it’s not safe for them to share or trade foods.

Airborne Allergens

Most children’s allergic reactions occur from actually eating the food that they are allergic to so as long as you keep the kid’s foods separate, you don’t need to worry about what your family eats around them. However, some kids have airborne allergens where they can have an allergic reaction by just being near the allergen. For example, you’ve probably heard of the “peanut-free” schools or lunch tables which are intended to protect children with peanut allergies who can react by just being around other kids eating foods with peanuts. You’ll need to use extra caution with these kiddos and be sure to not have any foods containing that allergen while the child is around.

Arts and Crafts

It’s important to note that food allergens can be triggered by non-food items too. For example, Play-Doh and most stickers are not safe for a child with a wheat allergy. For more information on allergens hidden in non-food items, refer to Christine’s blog post, from earlier this year.

Emergency Plan

No matter how careful you are, it’s still important to know the signs and symptoms of an allergic reaction just in case exposure occurs. Symptoms typically appear within minutes to two hours after a child is exposed. If you suspect an allergic reaction has occurred, call the child’s parents immediately. If the child is having a serious allergic reaction and having trouble breathing, call 911 first, then call the parents.

Some allergic children experience anaphylaxis, a severe allergic reaction that progresses rapidly and can lead to death. These kids are usually prescribed an automatic epinephrine injector (aka an “Epi-Pen”), which must be kept with them at all times. It’s up to the child’s parents to notify you if their child carries one and explain to you how to use it just in case of an emergency. FAAN provides some online videos that demonstrate how to properly use an epinephrine auto-injector, which may help you feel more comfortable using one yourself.

We shared our top 4 Tips for Celebrating Halloween Without a Food Allergy Scare. But with Halloween coming up this weekend we wanted to share a round-up of all the great “Halloween with Food Allergies” tips we’ve seen recently. Here is some more great advice from our favorite blogs and advocacy groups!

Tips for a Food Allergy Safe Trick or Treating

• Kids With Food Allergies recommends pre-positioning safe candy at friends houses along with other advice for safe trick-or-treating and school parties.

• Gina Clowes of Allergy Moms has 15 Halloween Safety Tips in her latest newsletter. She recommends pulling a “switcheroo” and buying two of the same treat collectors, letting your little one trick-or-treat, but then swapping their loot out with the safe version once you get home.

• Over on Go Dairy Free, Alisa Fleming answers a question about dairy-free candy options.

• The Food Allergy and Anaphylaxis Network has ten tried and true tips for keeping your child safe on Halloween. We love their idea of having children leave any unsafe candies for the “Good Witch”, who collects them and leaves safe treats instead!

Have you read any great ideas for having a safe, but fun, Halloween? Be sure to share the links!

- Sarah

If you have a child with a milk protein allergy, you’ve probably wondered if they will ever outgrow it. There is a chance your child will eventually develop a tolerance to milk and outgrow their allergy, although it is less likely than previously thought. A study conducted at Johns Hopkins University in 2007 showed that 19% of children outgrew their milk allergy by age 4, 42% had outgrown it by age 8, and 79% were milk allergy-free by age 16.

So how can you tell if your child is no longer allergic to dairy products?

Conducting a Milk Trial

Often your pediatrician or allergist may suggest a milk trial to test their tolerance once your child is over 12 months old and hasn’t had any diary in their diet for at least 6 months. A milk trial typically consists of giving your child a small about of dairy, often starting with products like yogurt or cheese which can be tolerated better than cow’s milk. If your child does not experience any adverse reactions (such as diarrhea, vomiting or gassiness) then you can continue to give increasing amounts of dairy products, slowly working up to 100% cow’s milk.

Milk Trial Precautions

It is important to remember that if your child originally had a severe reaction to milk, such as anaphylaxis, then you should have the milk trial conducted under medical supervision. Do not try re-introducing milk at home! Even if your child had a less severe reaction it is always important to get the go-ahead from your doctor ahead of time, just to be on the safe side.

Failing a Milk Trial

If your child is not able to tolerate the dairy you introduce in the milk trial, this simply means you will need to continue eliminating it from their diet. Your doctor may want to try again with another milk trial in 6–12 months. In the meantime, it is important to make sure that they are getting all of the nutrients they need. One option is to switch them to an elemental toddler formula, like Neocate Junior, which is specially formulated to be nutritionally complete for children 12 months and older with food allergies and related GI conditions.

Have you tried a milk trial with any of your little ones with milk protein allergies? How did they go?

- Sarah

As many of you may know, food allergy symptoms can appear in a variety of ways. One of the most concerning symptoms of a food allergy is when a person goes into anaphylactic shock. In fact, food allergies are believed to be the leading cause of anaphylaxis outside the hospital setting. The CDC reported that food allergies result in over 300,000 ambulatory-care visits a year among children.¹ Because this is the most life threatening response to food allergens, we wanted to review what the signs of anaphylaxis look like.

Anaphylaxis – What to Watch For

The signs of anaphylaxis may occur within seconds of exposure, or be delayed 15 to 30 minutes or even an hour or more after exposure (which is most typical of reactions to aspirin and similar drugs). Early symptoms are often related to the skin and include:

• Difficulty breathing; wheezing
• Changes in consciousness (including confusion, light-headedness, or stupor)
• Rapid swelling throughout the body
• Hives
• Blue skin
• Severe abdominal pain, nausea, or diarrhea
• Flushing (warmth and redness of the skin)
• Itching (often in the groin or armpits)

Throat and tongue swelling, difficulty swallowing, and difficulty breathing frequently follow the above symptoms. Vomiting, diarrhea, and stomach cramps may also develop.

If you know a child or adult with food allergies and suspect they are having an anaphylactic reaction, the most important consideration is time. Calling 911 or driving the person to the emergency room are the first things that should be done. Also, it is important to have an Epi Pen on hand for those times.

How You Can Protect Yourself or Others

• Follow-up with your doctor or allergist if you or your little one had a severe reaction.
• If you’ve been prescribed self-injectable epinephrine (i.e., EpiPen® or Twinject®), carry it at all times. (Here’s a great recent post on EpiPen usage)
• Educate others about your allergy. Teach them what you need to avoid, the symptoms of an allergic reaction, and how they can help during an allergic emergency. (Check out this post I did on being a PAL to a person with food allergies.)
• Teach yourself and others how to use an epinephrine auto-injector. Practice until it becomes second nature.
• Wear medical identification jewelry noting your allergy.

Have you or your little ones ever had an anaphylactic reaction? If so, what have you done to help minimize the risk of such a reaction?

- Christine

We’ve talked about EpiPens before on Food Allergy Living, including how to travel with them and what to do in case of an accidental injection of epinephrine. With the new school year upon us, many parents of children with food allergies are faced with the dilemma of where to store their child’s EpiPen at school. Should they carry it with them at all times? Should it be stored in the nurse’s office? What happens on the playground or on a field trip?

Carrying an EpiPen at School

If your child is old enough, some schools will allow them to carry the EpiPen with them at school or on a field trip and self-administer in the case of a reaction. While many states have passed legislation to allow this, New York, Pennsylvania, Rhode Island and Wisconsin have not. To find out specific details about what the legislation mandates in your state, you can visit the Allergy & Asthma Network website which provides links to each state’s current law regarding anaphylaxis medications.

EpiPens in the Classroom as well as the Nurse’s Office

If your child is not old enough to carry their own EpiPen, or their school will not allow it, you will want to determine whether or not one can be stored in their classroom (in addition to the nurse’s office). If they are in multiple classrooms each day, you may want to store one EpiPen in each room to be safe. You will also want to make sure that all of your children’s teachers are properly trained in how to administer the EpiPen.

Planning for EpiPen Use When Outside the Classroom

One thing that can help you address where your child’s EpiPen or other medications are stored at school is a 504 plan. A 504 plan refers to Section 504 of the Americans with Disabilities Act, which ensures that children with special needs get a level playing field from government services like public school. Depending on the details of your child’s food allergy, he or she may qualify for a 504 plan for the school to follow. The plan will outline not only where their EpiPen is stored, but also where they will eat, what allergens are permitted on school grounds, and how teachers and other personnel are trained to react in the event of an anaphylactic reaction.

Planning ahead is key to ensuring that your child will be safe at school in the event of an allergic reaction. What plans do you have in place for your children?

- Sarah

We had such a great time last year attending the FAAN Walk for Food Allergy in different cities around the country, that we are doing it again! These walks are organized by the Food Allergy and Anaphylaxis Network to raise public awareness, to provide advocacy and education, and to advance research on behalf of all those affected by food allergies (such as peanut, egg, soy & dairy) and anaphylaxis.

Here is a list of the FAAN Walks Neocate will be participating in:

• Houston, TX - September 11
• Philadelphia, PA – September 12
• Baltimore, MD – October 2
• Charlotte, NC – October 2
• Long Island, NY – October 10
• Tampa Bay, FL –November 13

For a complete list of cities and to register for a walk in your area or donate money, visit the FAAN website. Are any of your families attending a walk in your city or organizing a team? We’d love to hear about your plans! And if you are going to be attending any of the walks mentioned above, make sure you stop by the Neocate booth and say hi!

- Sarah

Self-administrated shots of epinephrine (often referred to by their brand names: EpiPen and Twinject) are life-saving devices which can halt an allergic reaction and give a patient time to get to a hospital. For children and adults who experience anaphylaxis, an epinephrine shot is a matter of life or death. But it’s important for patients and caregivers to know how to properly work an automatic epinephrine shot. An incorrect or accidental administration can have dangerous consequences.

Accidental Epipen Injections & the Consequences:

In order for epinephrine to work properly, it must be injected into the thigh muscle. The greatest risk of an accidental or an incorrect injection is that injecting the epinephrine elsewhere can delay or impair the effectiveness during a time-critical emergency.

Aside from this, there are also risks of an accidental injection in and of itself. An accidental intravenous injection (which is very rare and would be fairly difficult to do on accident), is especially dangerous and can lead to hypertension and/or heart problems[1]. Most accidental injections (an estimated 94%) occur when a patient or someone trying to help them accidentally jabs their finger or thumb[2]. An accidental injection to the hands or feet can impair blood flow to these areas and can potentially cause tissue death. This however, is the worst-case scenario.

Symptoms of an accidental injection are not usually so severe and may include temporary numbness or tingling, pain and swelling at the injection site, elevated heart rate and/or heart palpations. Regardless, you should always seek medical attention in the event of an accidental injection; it’s better safe than sorry!

Know How To Use the Epipen:

It never hurts to refresh your memory on how to use your child’s epinephrine shot. You may even want to print out the instructions and keep them in a handy place (for example, fold it up and keep it with the epinephrine shot). Both EpiPen and Twinject have several resources to teach patients about the proper use of epinephrine shots.

• EpiPen
  • Downloadable instructions
  • Demonstration video

• Twinject
  • Downloadable instructions
  • Demonstration video

For best results, ask your child’s health care provider to demonstrate how to properly use an epinephrine shot[3]. Research shows that parents who receive hands-on training are better able to properly demonstrate how to use their child’s epinephrine shot[4]. Remind them to be careful! An ironic side note: An estimated 10% of accidental epinephrine injections occur in health care providers when demonstrating to their patients how to use it!

How many of you carry Twinject or EpiPens for your children? Have you ever had to deal with an accidental epinephrine injection?

-Mallory

[1] Epinephrine. Drug Facts and Comparisons. Efacts [online]. 2008. Available from Wolters Kluwer Health, Inc.
[2] Accidental EpiPen injections becoming more common. Annals of Allergy, Asthma and Immunology, April 2009.
[3] Pediatr Pharm.2008;14(5)©2008Children's Medical Center, University of Virginia.
" [4] Arkwright PD, Farragher AJ. Factors determining the ability of parents to effectively administer intramuscular adrenaline to food allergic children. Pediatr Allergy Immunol 2006;17:227-9.

As the weather warms up and school lets out, many of you are likely planning a summer vacation with your family. When you have a child with food allergies, traveling can be stressful because you are out of your comfort zone. By planning ahead, you can ensure that the trip goes smoothly and that your child gets to experience all of the fun. It will also take away a lot of your anxiety so that you can relax and enjoy your vacation time too! Here are some tips for planning your next vacation.

Automatic Epinephrine Injectors (EpiPens)

If your child has an automatic epinephrine injector (or EpiPen), make sure it isn’t expired and consider packing an extra just in case. Have it handy at all times and get an insulated carrying case to prevent it from getting too hot or cold.

Air travel

Traveling by plane can be incredibly stressful for those with food allergies, especially those with peanut allergy and anaphylaxis. However, there are steps you can take to minimize the risk for an allergen exposure.

• Ask ahead if you can pre-board so that you can clean the area around your child’s seat.
• Bring a sheet or cover for the seat. You can buy washable or disposable covers from Plane Sheets.
• Call ahead to alert the airline of your child’s food allergies and find out about their policies. Some airlines are more allergy-friendly than others so do your research. For example, Continental does not hand out snacks that contain peanuts. Delta will create a “buffer zone” of 3 rows where they will not serve snacks containing peanut ingredients.
• Request a special meal that accommodates your child’s dietary restrictions if you are flying on an extended flight where a meal is served.
• Prepare for anything! Even when all precautions are taken, you can never completely eliminate the risk for allergen exposure. Have emergency plans and medication handy at all times.

Road trips

Road trips are generally less stressful because you have control over what comes into the car. However, it still requires a lot of planning to ensure you bring along enough safe foods for the trip. Check out Kids with Food Allergies for some great tips on how to plan effectively for your vacations & road trips.

Amusement Parks

In addition to being the happiest place on earth, Walt Disney World in Orlando, Florida is also perhaps the most accommodating place on earth. With ample notice, Dining Services can accommodate just about any dietary restriction. Disney Land, in Anaheim, California, also strives to accommodate dietary restrictions. Other parks, like Six Flags and Busch Gardens, will usually provide an exception to the rules about bringing food into the park when a person has a food allergy or intolerance.

More articles on travel with food allergies

• Camping with food allergies
• Trouble-free travel
• Allergy and asthma travel tips check-list
• Cruises with food allergies

Resources

• Chef cards
• International chef cards (translations for your food allergies)
• Food allergy t-shirts

Based on your experiences, what tips can you offer other parents about traveling with a child with food allergies?

- Mallory

This fall, Neocate will be attending the FAAN Walk for Food Allergy in several different cities around the country. These walks are organized by the Food Allergy and Anaphylaxis Network to raise public awareness, to provide advocacy and education, and to advance research on behalf of all those affected by food allergies and anaphylaxis.

Here is a list of the walks Neocate will be participating in:

Houston, TX – September 12
Long Branch, NJ – September 12
San Francisco, CA – September 12
Chicago, IL – September 26
Fairfax, VA – September 26
Boston, MA – October 4
Baltimore, MD – October 10
Long Island, NY – October 11
Ridgewood, NJ – October 18
Philadelphia – October 31
Dallas, TX – November 14

For a complete list of cities and to register for a walk in your area, visit the FAAN Web site. Are you and your children planning on attending a walk or organizing a team? If so, we would love to hear how you are participating! And if you are going to be attending any of the walks mentioned above, make sure you stop by the Neocate booth and say hi!

-Nita

The Mayo Clinic reported in the December issue of the Journal of Allergy and Clinical Immunology that a new study indicates that there is a “higher incidence of anaphylactic reactions then previously reported.”

The study, called “The etiology and incidence of anaphylaxis in Rochester, Minnesota,” concluded that there are 50 emergency room visits per 100,000 people per year caused by anaphylaxis — this is a 10% increase in anaphylaxis cases over a 10-year period.

Dr. Wyatt W. Decker, M.D., and his team said 1/3 of the anaphylaxis cases were from food allergies.

What does this tell us? Even with all the urgency put on food allergy education, people are still suffering. Please be watchful of any potential allergens and teach your little ones to do the same. And as always, never leave home without the EpiPen!

- Christine

While we usually write about common food allergy symptoms, such as diarrhea or eczema, more severe reactions like anaphylaxis are possible for many children and adults with allergies. Allergens that cause anaphylaxis include food, insect stings, drugs, latex, and even exercise.  When anaphylaxis happens as a result of contact with an allergen, a rapid immune reaction occurs that can quickly make breathing very difficult.  For those patients an immediate injection of epinephrine can prevent very serious complications.  Sometimes even the few minutes it takes emergency medical care to arrive is too long, and a personal device with automated injectable epinephrine, an auto-injector, such as the EpiPen® Auto-Injector, is essential.

The EpiPen, made by Dey Pharma, works by delivering a quick shot of epinephrine to the thigh.  There are also similar devices available, such as the Adrenaclick® and TwinJect®, both made by Shionogi Inc. Twinject is unique in that it has a built-in backup dose of epinephrine, which can take the place of two auto-injectors in an emergency.

Epinephrine helps the body to keep the airway open so that breathing does not become as difficult, allowing time for emergency medical care to arrive. But many parents worry that one auto-injector might not be enough or that something might go wrong that could require additional auto-injectors. For instance, someone nearby might experience a severe allergic reaction and need to use your child’s auto-injector. Or what if your child’s only auto-injector was unknowingly broken? What if the auto-injector were accidentally put in the fridge or left in the sun? What if the contents were cloudy? Or if it had expired? So many scary possibilities!

So, what is the right number of auto-injectors? The answer to that question depends on a number of factors. Bear in mind that the Twinject has two doses of epinephrine, but according to the company the second dose should only be used as a backup to the first dose and should not be saved for future allergy emergencies.

How Many to Carry?

On their websites, Dey Pharma and Shionogi recommend that patients at risk for allergic emergencies carry two doses of epinephrine. This is because up to 20% of patients who have an allergic emergency requiring epinephrine will require a second dose. At all times the injector should be kept close to room temperature, out of sunlight, and replaced by the expiration date. You can even sign up for an expiration date reminder on either of the websites. It’s a good idea to occasionally check the solution in the auto-injector to make sure it hasn’t discolored, which can be a sign of a possible loss of effectiveness.

If a long trip is planned, especially one overseas where similar products may not be readily available in pharmacies; two auto-injectors (or one that contains two doses) may not be enough.

Should you or your child carry more than two auto-injectors? Not necessarily. Additional backups would likely be for peace of mind. A second dose of epinephrine may be needed in an emergency, but more than two doses during an emergency should only be given with medical supervision. Some caregivers choose to carry two auto-injectors from different lots for added precaution.

Multiple Locations

Some patients who use auto-injectors prefer to carry the standard two with them and also keep backup injectors in one or more strategic locations. These might include an extra one or two at work, school, daycare, and/or a relative’s house. These are great because they can serve as backup in case someone forgets their daily go-everywhere auto-injectors. Just make sure you follow the recommended storage instructions everywhere you keep an auto-injector and check your backups for discoloration and expiration dates. Knowing that you have extra auto-injectors in places like this, in addition to the daily carry-with auto-injectors you have, may bring you more comfort.

How about you? How many auto-injectors does your family keep on hand, and where? Please share your thoughts in the comment section of this blog post.

- Rob

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