Food Allergy Living Blog Tagged Results

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.

One more thing to watch out for – hidden allergens in medications!Yep, those medications that are supposed to help us feel better can also be harmful to those with food allergies.

Nita wrote a post about hidden allergens that could be lurking in vaccines, Christine wrote about hidden allergens in non-food related items and it led me to think of other places allergens could be lurking.We sometimes get questions about a sudden and mysterious onset of rashes or change in bowel movements or other types of allergy symptoms and after reviewing all the potential causes we often end up with a change in medication or a new medication as the culprit.

Corn and wheat are the two common allergens you’ll find in a variety of medications. But dairy, potatoes and coconut are also common. Lactose is used in more than 20% of prescription drugs and about 6% in over-the-counter medicines. Many inhalers, such as Advair® or Serevent® contain lactose which can affect someone with a milk allergy. Some medications used to treat asthma and/or allergies such as Claritin®, Benadryl® and Prednisone® can also contain lactose.

It’s good to be aware of FDA regulations for labeling food and medicine; they are not quite the same. For example “starch” on a food label means cornstarch.On a medicine label, it could mean potato, corn, tapioca or wheat starch.

Generic vs. Brand Name Drugs

Be careful when taking generic drugs vs brand name drugs. A generic drug must be chemically identical to its brand name equivalent and must pass through tests to prove its strength. However, the generic drug does not necessarily contain the same inactive ingredients. Kids with Food Allergies has more information about ingredient differences in generic vs brand name drugs on their website.

Even different dosages of the same medications can have varying ingredients.The 10 mg tablets of Singulair® also contains lactose, however the 4mg and 5mg versions do not.

As with foods, make sure you read the label for medications prior to purchase and watch out for hidden allergens.It’s always good practice to consult with your physician before starting or switching any medications.

Have you experienced an allergic reaction due to a hidden allergen in any medications?

- Sarah

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Although there are over 160 foods identified as allergens, eight foods account for 90% of all food allergic reactions[1]:

• Milk
• Egg
• Peanuts
• Tree nuts (such as walnuts, almonds, hazelnuts, coconuts, cashews, pistachios, pecans and brazil nuts)
• Fish (such as salmon, tuna, halibut, bass, flounder or cod)
• Shellfish (such as shrimp, crab and lobster)
• Soy
• Wheat

These foods are designated as “major food allergens” by the Food Allergen Label­ing and Consumer Protection Act of 2004 (FALCPA). FALCPA applies to all foods whose labeling is regulated by the FDA (both domestic and international). The law officially went into effect on January 1, 2006.

FALCPA:

Under FALCPA, food manufacturers are required to list major food allergens or any ingredient that contains protein derived from food allergens in simple, easy-to-understand terms. If the ingredient includes the name of the allergen that it contains (such as buttermilk or soy beans), this meets the FALCPA requirements. However, if the ingredient name does not include the name of the allergen (remember our blog about hidden allergens?), the allergen must be declared either in parenthesis next to the ingredient (for example, “flour (wheat)”) or after the ingredient list (for example, “Contains soy”).

Points to Consider When Reading Food Labels:

Manufacturers are not required to account for cross-contamination. “Cross-contamination” or “cross-con­tact” occurs when a food contains a trace amount of an allergen as a result of coming into contact with other foods containing that allergen during the manufacturing process. For example, a milk-free infant formula may be made in the same manufacturing site as a milk formula. Although milk is not an ingredient of the milk-free formula, it may pick up some trace amounts of milk protein from the shared equipment. However, the manufacturers are not required to list milk on the ingredient list. (Neocate moms, don’t worry; Neocate is the only formula made in a 100% dairy-free manufacturing site). If you have any doubts about a product, call the manufacturers and ask about the possibility for cross-contamination. If they can’t assure you its safe, it may not be worth the risk.

Certain foods are not subject to FALCPA requirements. Foods that are regulated by agencies other than the FDA will have different allergen labeling requirements. Examples of such foods include:

• Poultry
• Most meats
• Certain egg products

If you are unsure if a food is safe for your child, contact the USDA’s food and poultry hotline. Also keep in mind that most alcoholic beverages are not subject to FALCPA requirements. This obviously isn’t applicable to your little ones right now but it’s a good thing to be aware of as they grow up.

FALCPA requirements only apply to foods sold in the US. Food allergen labeling requirements will vary by country so if you are traveling internationally, be extra careful to read the ingredient lists and look for hidden allergens.

Have you found the FALCPA requirements to be helpful or confusing? What tips do you have for finding top 8 allergy-friendly foods in your grocery store?

- Mallory

[1] Food Allergy and Anaphylaxis Network. http://www.foodallergy.org. [Image: Flickr]

The American Academy of Pediatrics (AAP) doesn’t recommend the use of multivitamins for all children because eating a balanced diet (with iron-fortified foods) is usually sufficient to meet a child’s vitamin and mineral requirements. However, for a child with a restricted diet, a multivitamin may be necessary. We’ve been getting a lot of inquiries about Phlexy Vits, our powdered micronutrient supplement, so I wanted to use this blog post to provide some more information on it.

Phlexy Vits are a powdered micronutrient supplement containing vitamins, minerals and trace elements. They were designed to meet the nutritional needs of older children (11+) and adults. Occasionally Phlexy Vits are used in children but the dosage must be adjusted and this should only be done under the direction and supervision of a healthcare professional.

Phlexy Vits were actually originally developed for patients with Phenylketonuria or PKU, who require a restrictive, low protein diet. However, they may be useful for anybody with a medical condition that requires them to follow a restrictive diet. We have received inquiries about the use of Phlexy Vits for patients with multiple food allergies because many popular multivitamin brands contain hidden allergens.

Hidden Allergens in Children’s Vitamins

Below is a list of popular children’s multivitamins and the food allergens that they contain:

• Centrum Children’s: contains milk, soy and wheat (as well as lactose)
• Flintstones Complete and Flintstones Plus Immunity: contain soy
• Flintstones Gummies: contains wheat and tree nuts
• One-A-Day Scooby Doo Gummies: contains wheat and tree nuts

Vitamins for Children 11 and Older with Food Allergies

For older children (11+) with food allergies, Phlexy Vits may be a great option because they are free of milk and soy proteins, gluten and the sugars lactose, sucrose and fructose. There are no corn proteins in Phlexy Vits; however, certain nutrients are derived from corn so discuss this with your health care provider if your child is very sensitive to corn derivatives. Keep in mind that Phlexy Vits were developed for individuals over 11 years of age so do not use for younger children unless advised by your health care professional. The daily intake will have to be adjusted for a younger child.

For those of you with children on Neocate products, a multivitamin probably isn’t necessary. Neocate products are nutritionally-complete and were designed to meet all nutrient needs: protein, fat, carbohydrates, vitamins and minerals.

- Mallory

It seems like every kid I know is talking about Toy Story 3 so chances are that your child is begging to go see it. However, a trip to the movie theater is a bit more complicated for a child with food allergies. Today we’ll go over some tips for having a safe and enjoyable movie theater experience.

The Movie Theater Concession Stand

If your child’s food allergies occur from ingesting food allergens, it’s much easier to control what they are exposed to. Your main obstacle will be the concession stand. Of course, we should all avoid this kind of food as much as possible but for a special occasion like going to the movies, it is fun to indulge a little.

Make sure you call ahead to inquire about any foods or ingredients that you are unsure about. For example, some movie theaters serve buttered popcorn that contains dairy while others are dairy-free. Use your discretion; if they can’t guarantee its safe, don’t risk it.

With prepackaged candies, its easier to identify ingredients and any potential allergens. Check the ingredients ahead of time to see what is safe for your little one! Some candies may be made of mostly sugar so although not healthy, they may be a safe special treat. For example, below are the ingredients for Sweet Tarts and Sour Patch Kids, both of which are free of the 8 major allergens.

• Sweet Tarts: Dextrose, Maltodextrin, Malic Acid, and Less than 2% of Calcium Stearate, Artificial Flavors, Blue 1 Lake, Blue 2 Lake, Red 40 Lake, Yellow 5 Lake, Yellow 6 Lake.
• Sour Patch Kids: Sugar, Corn Syrup, Modified Corn Starch, Citric Acid*, Tartaric Acid, Natural and Artificial flavors, Yellow 5, Yellow 6, Red 40, Blue 1.

*Keep in mind, some kids can be sensitive to Citric Acid and certain food dyes.

Allergies to Airborne Particles

If your child reacts to airborne particles, such as with peanut allergies, it’s more difficult to prevent exposure but there are various ways to keep the risk to a minimum. Here are some ideas:

• Try to see the movie at a time when the theater is not too crowded. This way, you can separate yourself from other viewers who may be eating unsafe snacks.
• Bring a seatcover. Not only are Plane Sheets great for when your little one with allergies is traveling, they can do double duty as a movie theater sheet!
• Bring Clorox wipes to clean the arm rests.
• There is often candy and other snacks dropped in the aisle, so if your child reacts on contact, dress him/her in pants vs. shorts and closed-toe shoes vs. sandals.

No matter how safe you are, it can be difficult to 100% eliminate the risk for an allergic reaction so be sure to pack your Epi-pen.

Alternatives To Help Avoid Allergens

• Bring Your Own Snacks: Although this is no-no most of the time, try calling the movie theater and explaining your situation. If they don’t offer any foods safe for your child, they will probably allow you to bring your own.
• Drive-in Movie Theater: Believe it or not, there are still some of these around! The great thing about the Drive-ins is that you can bring your own snacks and seats, plus you can control how far you sit from other people and their snacks.
• Bring the Movie Theater Home: With features like On-Demand, you can get movies still in theaters right in your home. Invite some friends over and prepare some allergy-friendly snacks.

Have you picked up any tips or precautions for taking a child with food allergies to the movies?

-Mallory

As we near the end the month of May, our series on Hidden Food Allergens is wrapping up. Mallory and Nita wrote great entries with tips and ideas on how to best avoid hidden dairy, soy and gluten allergens in food. Usually, there is a long list of items to avoid, so as Mallory mentioned, it’s helpful to print out your own list, laminate it, and take it with you on your grocery trips. It’s nearly impossible to memorize all those potential allergens you need to look out for on the product label. Having a list handy will cut back on the time you spend examining labels and make it easier for you to get what you need from the store and get on with your day!

Always remember, if you are uncertain whether a produce may contain an allergen, call the manufacturers and ask! The more educated you can be, the better.

Belonging to a food allergy social group or network can also allow you to share experiences and learn from other families who are in similar situations. Some groups you can join are the Food Allergy and Anaphylaxis Network (FAAN), Facebook and/or Twitter groups dedicated to food allergies (including the Neocate Facebook page), Kids with Food Allergies (KWFA), and the Food Allergy Initiative (FAI). For example, if you just found out (from the manufacturer) that a certain food, surprisingly, had some traces of a particular allergen, you could share that information with others and help prevent accidental exposure from happening to another family.

So keep those Hidden Food Allergens lists handy and keep an eye on those labels! What other actions have you done to help avoid those hidden allergens? We always appreciate hearing your advice!

- Christine

This month we are doing a series of blog posts on hidden food allergens. So far we have discussed hidden sources of the allergens dairy and soy, and this week we will discuss hidden sources of gluten.

If your little one has a gluten allergy or intolerance, you are quite aware of the many challenges it causes. Gluten is a protein commonly found in all forms of wheat and related grains like rye, barley and possibly oats. It is also in many other foods consumed daily, such as cereal, breads and pasta. Depending on the severity of the intolerance to gluten, different side effects may occur. They may be limited to GI discomfort, such as diarrhea, gas and bloating. A more severe intolerance would be classified as celiac disease (CD), a lifelong digestive disorder that causes damage to the small intestine and prevents absorption.

Gluten-Free Diets

If you or a loved one is following a gluten-free diet, it is important to be aware of where gluten may be hidden. Luckily, a gluten-free diet is not as limiting as it used to be. Now, gluten-free breads, pastas and prepared foods are available, which really aid compliance on a tricky diet! You can purchase these gluten-free foods from most grocery stores or online.

As a general rule of thumb, if following a gluten-free diet, you should avoid the following ^1,2 :

Wheat and Gluten Ingredients:

• Anything which contains: wheat, rye, barley, spelt and millet
• Hydrolyzed wheat protein, sprouted wheat or barley malt
• Anything with the term “gluten”
• Words that refer to the specific kind of grain or wheat
  • Ex: bulgar, durum, farina, macha, matzo or matza, kamut, graham, semolina, seitan, fu, udon, couscous, tabbouleh

Generalized terms which should be avoided with gluten allergies:

• Malt/Malted milk/malt extract/malt syrup
• Soy sauce/Teriyaki sauce
• Flour
• Beer (most contain barley or wheat)
• Bran
• Germ
• Orzo (pasta)
• Cookie crumbs/cookie dough
• Bread crumbs
• Gravy
• Seafood analogs (imitation crab contains wheat)
• Bouillon or broth

Everyday products which may contain hidden sources of gluten:

• Lip balm
• Sunscreen
• Children’s stickers
• Stamps and envelopes
• Soaps and shampoos
• Washing machine detergent
• Toothpaste and mouthwash
• Medicine and antibiotics
• Ground spices

For a complete list of foods to avoid and other resources about celiac disease, visit www.celiac.com

Can you think of any other hidden sources of gluten that weren’t mentioned?

-Nita

Sources:

1. Hidden Ingredients Containing Wheat or Gluten: Tips and Tricks on How to Discern Gluten Ingredients http://food-allergies.suite101.com/article.cfm/hidden_ingredients_containing_wheat_or_gluten#ixzz0oD3Qh3V2

2. http://gfcf-diet.talkaboutcuringautism.org/hidden-sources-of-gluten.htm

Food allergens can be disguised by alternate names and hidden in the long words of an ingredient list. Unless you know what words to look for, it’s easy to overlook an allergen. As parents of children with food allergies, you all know how serious such an oversight can be. This month, we are doing a blog series on hidden food allergens to help you recognize hidden ingredients so that this doesn’t happen to you and your little one.

Hidden Sources of Soy:

Last week, Nita discussed hidden names and sources of dairy. Today, we’ll focus on soy. Soy is especially tricky to avoid because it is often found in unexpected places such as in baked goods, cereals, crackers, infant formula, canned tuna, prepared meats (like sausage and lunch meats), sauces and soups. In fact, soy is found in an estimated 60% of processed foods! Therefore, if your child is allergic to soy, it’s incredibly important to always read and decipher food labels. Kids with Food Allergies (KFA) provides a great list of “Ingredients to Avoid”. It may be helpful to print this out, laminate it, and take it along to the grocery store as a guide. They also have a travel card that you can take along on trips, when dining out, etc.

Soy Oil:

Refined soy oil is usually safe for patients with soy allergies. The FDA exempts refined soybean oil from being labeled as an allergen. Talk with your child’s health care provider to determine what’s appropriate for your child. It’s important to note that not all soy oil is refined so unless it is specified as such, you should not assume it is safe. For example, the ingredient list for Neocate Infant specifies that it contains refined soy oil because our purification process removes all soy proteins to make it safe for patients with soy allergies. Soy oil described as “cold pressed”, “expeller pressed”, or “extruded” is not safe for those with soy allergies.

Managing a Soy Allergy:

Deciphering labels can be time-consuming and avoiding soy may seem to limit your child’s diet drastically. However, there are still many soy-free food options and plenty of soy substitutions for recipes. The main food limitations are with processed foods, which we could all probably use less of in our diets anyways! Plus, research shows that half of kids grow out of their soy allergy by the age of 7[1].

I must say, I was most shocked by the fact that soy is in canned tuna! Have you come across any other surprising hidden food allergens?

-Mallory

[1] Kaeding AJ, Matsui EC, Savage JH, Wood RA. The natural history of soy allergy. J Allergy Clin Immunol. 2010 Mar;125(3):683-6.

Grocery shopping is always a hard task, but it is even harder when you are shopping for someone with food allergies! Worse, the ingredients your little ones may be allergic to can be hidden within the food label. With our latest series, we will aim to uncover some of the sources of hidden allergens.

New food labeling laws require the top eight food allergens to be listed on food labels. This is really helpful for those reading food labels; however, sometimes allergens can be hidden in the long words in the ingredient list.

Dairy is one of the ingredients which tends to be hidden in foods that you may have otherwise thought were safe. I wanted to share with you a list of some ingredients to watch out for. Some of these definitely contain diary, while others only possibly contain diary.

When viewing the list below, it’s important to always err on the side of caution. If you think there may be traces of dairy in something, call the manufacturer of the product you would like to purchase and inquire. If they cannot guarantee that the product is free of dairy, avoid it!

Foods with dairy ingredients:

• Milk and milk products(including condensed, derivative, dry, evaporated, goat’s milk and milk from other animals, low-fat, malted, milkfat, milk protein hydrolysate, nonfat, powder, protein, skimmed, solids, whole)
• Butter, butter fat, butter oil, butter acid, butter ester(s), buttermilk
• Casein, casein hydrolysate, caseinates (in all forms)
• Cheese
• Cream
• Diacetyl
• Ghee
• Lactalbumin, lactalbumin phosphate, lactoferrin, lactulose
• Pudding
• Recaldent®
• Rennet casein
• Sour cream, sour cream solids, sour milk solids
• Tagatose
• Whey (in all forms), whey protein hydrolysate
• Yogurt

Foods with potential dairy ingredients:

• Artificial or natural flavorings (anything which is derived from butter, cream and egg flavors)
• Chewing gum
• Deli meats
• Fat replacers
• Many types of chocolate (although dark chocolate is often free of dairy)
• Margarine
• Prebiotics (galactooligosaccharides, also known as GOS, are derived from dairy sources. Don’t worry, Neocate Junior with Prebiotics only contains prebiotics in the form of fructooligosaccharides, also known as FOS, which are derived from vegetables.)
• Salad dressings

For a more complete list of foods to avoid when accommodating for a dairy allergy, visit the Food Allergies and Anaphylaxis Network website or check out Alisa Marie Flemming’s book Go Dairy Free: The Guide and Cookbook for Milk Allergies, Lactose Intolerance, and Casein-Free Living and website for more resources.

Can you share any foods you have found that have surprising hidden dairy ingredients?

- Nita

Back in our vitamin series we often referenced the ingredient list on formula & food labels and helped identify some of those long words as vitamins. This sparked us to think about ingredients in general and the importance of understanding ingredients when dealing with food allergies.

There is so much more to ingredients then what’s listed on the label. So, of course, we decided to blog about it! Understanding fats, carbohydrates and proteins will be the topic of our next series. Within the next few months we hope to cover some common inquiries such as types of fat, healthy vs. unhealthy fats, types of carbohydrate including corn, identify sugars, and hidden allergens such as dairy, and explain the building blocks of protein.

A few things to keep in mind while reading those labels and looking at ingredient lists:

• The FDA requires all manufacturers to list all ingredients in the food on the label.
• Based on the Food Allergen Labeling and Consumer Protection Act of 2004, manufacturers are required to list the top eight foods which account for the most food allergies in commonly used terms. This does not include allergens accidentally introduced during manufacturing or packaging through cross-contamination.
• Ingredients are listed in order of predominance. The ingredient used in the greatest amount is listed first, followed by those in smaller amounts listed next, in descending order.
• There are several different types of ingredients such as:
  • Preservatives (ascorbic acid, citric acid) to prevent food from spoiling
  • Emulsifiers (soy lecithin, mono-and diglycderides) which allow smooth mixing and prevent separation
  • Sweeteners (saccharin, aspartame, acesulfame potassium) to add sweetness with or without the extra calories
  • Color Additives (citrus red no. 2, beta-carotene) which offsets color loss due to exposure to light, air, temperature extremes or moisture

Don’t forget to check back with us next week as we kick-off our ingredient series with the topic of fats. Do you have any questions on what’s listed in the ingredients on food labels?

- Sarah

I came across this article the other day in The Washington Post about a woman in Las Vegas who has been fighting for her life since eating a tube of cookie dough contaminated with E. coli bacteria. The article highlights the real dangers of food contamination. While this is always a concern for those with food allergies who could have severe reactions to food that is contaminated with unknown allergens, the general public now also runs the risk of bacterial contamination in the food supply.

Fortunately, as the article reports, Congress is taking action:

“In July, the House approved legislation that would give the Food and Drug Administration broad new powers and place new responsibilities on food producers. The bill would speed up the ability of health officials to track down the source of an outbreak and give the government the power to mandate a recall, rather than rely on food producers to voluntarily pull tainted products from the shelves.”

This bill also gives the FDA the power to act quickly in response to food that contains undeclared allergens, which is great news for those living with food allergies. Hopefully this important legislation will be passed by Congress and help prevent tragedies like this one.

-Mallory

Fortunately, her son was ok, but this is a great reminder that sometimes milk and other allergens can show up in unexpected places and it’s important to carefully read all labels. To read the entire story, click here.

(As a side note, if you have a baby with a milk protein allergy, check with your doctor about whether your little one might also be allergic to soy. According to the American Academy of Pediatrics, as many as 70% of babies with milk protein allergies are also allergic to soy.)

Be sure to post advice on any other labeling pitfalls you come across!

-Mallory