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

[Image Source]

A question we get are getting more and more from parents is whether Neocate uses Genetically Modified Organism (GMO) ingredients.  The answer to that is ‘no’!    

GMO ingredients are genetic materials in a food item (or even in an animal) that have been altered in some way and Nutricia North America’s (the makers of Neocate) goal is to use ingredients from traditional origins.  Our ingredients are considered non-GMO.  This can not be said for other elemental formulas currently on the market. 

Research on the use of GMO ingredients is relatively new and is finding to be controversial.   

One of the main concerns of using GMO ingredients and/or foods is that the altered ingredient or food item may contain new allergenic substances due to the introduction of new and different genes.  In fact, a proposal to incorporate a gene from Brazil nuts into soybeans was abandoned because of the fear of causing unexpected allergic reactions.¹  This concern holds the most weight with scientists in regards to possible human health risks in using GM foods and ingredients. 

Another concern is that genetic engineering often involves the use of antibiotic-resistance genes as "selectable markers" and this could lead to production of antibiotic-resistant bacterial strains that are resistant to available antibiotics we have today.²  

Other research looks to the potential benefits of GMO food items as they may help to decrease hunger and starvation to millions because GMO crops can produce large amounts of foods, and can be more resistant to drought or pests. 

The labeling of GMO foods is also a hot topic.  There is much debate as to whether companies should label that a food has GMO ingredients or not.  This is an ongoing debate and we will have to wait and see what comes of it.  If consumers show preference for GMO labeled foods over non-labeled foods, then industry will have the incentive to regulate itself or risk losing the customer. 

Because this is still being investigated, more will have to be studied to understand the true implications of GM ingredients.  But for the time being, it is good to know that all of our Neocate products use non-GM ingredients. 

- Christine

1. Identification of a Brazil-nut allergen in transgenic soybeans New England Journal of Medicine, Vol 334, No 11, pp 688-692, 1996). 

2. Bakshi A (2003). "Potential adverse health effects of genetically modified crops". J Toxicol Environ Health B Crit Rev 6 (3): 211–25

Cross contamination is a big concern among food allergy sufferers.  According to Kids with Food Allergies, cross contamination can be defined as “a food being inadvertently contaminated with food proteins other than those listed on the food label during the course of its being prepared, stored or served”.

During Manufacturing and Production:

One way that cross contamination may occur is during the manufacturing of a food. For example, when a safe food is manufactured on the same equipment as an unsafe food, there is a chance for trace amounts of the unsafe food to end up in the safe food. For those with food allergies, even trace amounts of an allergen can lead to serious allergic reactions.

Although the Food Allergen Labeling and consumer Protection Act of 2004 (FALCPA) requires manufacturers to clearly list the top 8 allergens on the food label, this rule does not account for cross contamination. Sometimes you will see “may contain (allergen)” or “made in a facility that also produces (allergen)” on a label but the manufacturers are not required to list this information. If you have any doubts, call the manufacturers and ask about the possibility of cross contamination. If your child’s allergies are severe and the manufacturer can’t guarantee it is safe, its probably not worth the risk.

By the way, this is why we are proud to say that Neocate is the only amino acid-based infant formula prepared in a 100% milk-free manufacturing site, eliminating the risk for cross contamination!

At Home:

Cross contamination can also happen in your home. Kids with Food Allergies provides some helpful tips on minimizing this risk: http://www.kidswithfoodallergies.org/resourcespre.php?id=65.

Eating Out:

Eating out can be intimidating for those with food allergies because you have less control over how foods are handled and efforts to minimize cross contamination. For helpful tips, check out this article from Food Allergy Gourmet.

Food Safety for Everyone:

The risk of cross contamination is not limited to allergy sufferers. Cross contamination of bacteria from foods (such as raw meat, seafood and eggs) is a concern for everyone. To keep you and your loved ones safe, follow these tips from the USDA Food Safety and Inspection Service.

Have any of your children experienced an allergic reaction as a result of cross contamination?  Any advice to offer other parents?
 

-Mallory

Based on clinical research, Neocate has shown to be successful in the management of a number of GI and food allergy

related conditions including:

·         Cow and soy milk allergies

·         Multiple food protein intolerance

·         Short Bowel Syndrome (SBS)

·         Eosinophilic Esophagitis (EoE)

·         Malabsorption

·         Gastroesophageal reflux disease (GERD)

·         Other GI disorders

We have blogged about each of these conditions, but one area we wanted to focus on was the “Other GI Disorders” section. Other GI disorders can include conditions such as Colic and Failure to Thrive.

One ‘other GI disorder’ that has been getting a bit more notice recently is a condition called Food Protein-Induced Enterocolitis Syndrome (or FPIES pronounced ‘F- pies’ for short). FPIES can be a serious condition if not managed properly. Unfortunately, FPIES is a condition that is often under-recognized and misdiagnosed despite studies suggesting that the prevalence of FPIES may be increasing.

Management of FPIES is to avoid the offending protein (which is usually milk or soy) and supplement with a hypoallergenic formula, such as Neocate (if breast milk is not available).

There is a strong need for more healthcare professionals to be educated on this condition. Happily, there are doctors out there who are striving to do just that. The hope is to reduce prolonged suffering of patients, reduce hospital admissions, and to save money and time.

If your little one has FPIES, check out the International Association for Food Protein Enterocolitis (IAFFPE). This can be a great forum to learn more and connect with other families managing FPIES.

Does your child have FPIES? What resources helped you to best manage the condition? We would love to hear so we can share with other families!

-          Christine

PS. Feb 29, 2012 was Rare Disease Day! We would like to send a special recognition to those with rare diseases including FPIES.

References:

Jean-Christoph Caubet & Anna Nowak-Węgrzyn, Current understanding of the immune mechanisms of food protein-induced Enterocolitis syndrome. Expert Rev. Clin Immunol.2011.7(3). 317-327