AllergyEats.com

I got a great email recently.

As a father of 5 children, 2 of whom with food allergies, I am very aware of the difficulties and anxieties that go along with having to manage food allergies/intolerances on a daily basis. In my experience, dining out has been one of the greatest challenges and sources of frustration.

As a result of this, I decided two years ago to create an easy-to-use online guide to allergy-friendly restaurants for the benefit of our entire community. I am writing you today in an effort to introduce you to this new website, AllergyEats (www.allergyeats.com), with the thought that you might find it a valuable tool to share with your readers.

AllergyEats is a peer-based guide with a database that includes over 600,000 US restaurants. Individuals with food allergies or intolerances can rate any restaurant experience by answering 3 simple questions (adding comments if they like). The process can take under a minute. The answers to these questions are translated into a simple “allergy-friendliness” rating.

Other users can then go to AllergyEats when seeking an allergy-friendly restaurant. By simply typing in the geographic location they’re interested in, users can see a restaurant’s “allergy-friendliness” rating, as well as other useful information where available, such as menus, allergen lists, gluten-free menus, nutrition guides, industry certifications, and more.

AllergyEats is new, having been live for roughly 10 weeks. However, where awareness has blossomed, initial reaction has been fantastic and word-of-mouth has driven many ratings quickly (the Boston metro area achieved over 200 ratings in this short amount of time!). Each additional rating, anywhere in the country, increases the value of AllergyEats as a tool for our entire food allergy community. That is why major food allergy and Celiac organizations have endorsed or become friends of AllergyEats so quickly (please see these tabs on the site)... and there are more to come!

The overall look of the site is great and easy to use. Typing in at least your state and zip code is necessary to narrow down that huge database, but you can search by distance, by restaurant name, and by ten allergens: Peanuts, Dairy, Wheat, Fish, Sesame, Tree Nuts, Eggs, Gluten, Shellfish, and Soy. If you find a restaurant that looks good you can get a Google map and directions.

The problem, of course, is that 99% of local restaurants have not been rated yet. Chains do have very useful links to nutritional information and allergen pages, however.

It's the usual chicken and egg problem. The site would be more helpful if people used it and added ratings, but getting people to use a site with no ratings is a challenge.

That's why Paul emailed me, to get the word out, and I'm glad to help. Go there, rate a few restaurants, and tell your friends.

More Desensitization Therapies for Allergies

The Boston Children's Hospital did a major and apparently successful test of desensitization treatments. I reported on them and a series of videos on the progress of the treatments in "Desensitization: the Hot New Word In Allergies and Desensitization Injections Cured Boy's Milk Allergy.

Today a report emerged from Dallas of another desensitization treatment, a different one of a different type. Take a look at Controversial Treatment Ends Food Allergies by Deborah Ferguson of the Dallas NBC affiliate.

Both treatments do have the same basic idea. Start with tiny quantities of the allergen, so tiny that the immune system can handle them with antibodies, and then so gradually increase the dosage that the body can keep up. It's based on well-tried cures for other allergy types.

"We fool the body's allergy and immune system by kind of sneaking up on it. We give very, very teeny doses of the food that causes the problem and gradually increase over time," is how Dr. Richard Wasserman described his food desensitization program. "This is an approach that has been done for one thing or another for a hundred years. It just hasn't been done for foods very often, and developing the protocol we use has allowed us to make a difference and take care of a lot more children."

Even in the small, 50 person trial, however, it's not all successes and champagne.

"Sometimes people do have problems and can't tolerate the food even with this procedure," Wasserman said. "This is a demanding thing for a patient and family."

The increasing number of successes is certainly promising and the fact that some insurance plans will pay for it is a cause for that champagne, especially for a $5000 program.

What's also great is that these programs are treating children who have had allergies for years. One 10-year-old who had to avoid dairy since infancy can now have milk.

Small clinical trials don't always translate into mass programs that everyone can use. The fact that several different programs are reporting good results is a good sign. Parents should talk to their pediatricians and keep informed.

Anaphylaxis - Life-Threatening Allergy

I found an excellent article on anaphylaxis on the AAIR (Asthma and Allergy Information & Research) site. Information and Research. My heart is beating faster already.

And much good informtion there is.

How can you tell if someone is having anaphylaxis?
Anaphylaxis usually happens quickly.
Anaphylaxis can produce:

• An itchy nettlerash (urticaria, hives)
• Faintness and unconsciousness due to very low blood pressure. Unlike an ordinary fainting attack, this does not improve so dramatically on lying down.
• Swelling (angioedema)
• Swelling in the throat, causing difficulty in swallowing or breathing
• Asthma symptoms
• Vomiting
• Cramping tummy pains
• Diarrhoea
• A tingling feeling in the lips or mouth if the cause was a food such as nuts
• Death due to obstruction to breathing or extreme low blood pressure (anaphylactic shock)

And a table of epinephrine injectors.

What is the best treatment for anaphylaxis?

Although there are several important treatments, by far the most important
is:

Adrenaline (epinephrine)

There is one drug which will work against all the effects of all the dangerous substances released in anaphylaxis. It is adrenaline (epinephrine). For serious attacks, it is a vital treatment. You need to inject it; inhalers may no longer be an option.

There are special syringe kits to make injection easy:

Name of injection kit	Country (incomplete list)	Dose	Source	Comment
Epipen	USA, Europe	Adult 0.3 mg Child 0.15 mg	Dey Laboratories (USA) ALK (Eur)	Long-established
Anapen	UK	Adult 0.3 mg Child 0.15 mg	Lincoln Medical Limited, UK	Identical drug & dose to Epipen. Easy to use.
AnaKit	USA	2 doses of 0.3 mg: other doses possible	Bayer	Long-established. Red box also contains antihistamine tablets and flimsy tourniquet (for bee or wasp sting).
Anaguard	USA,also available elsewhere.	As AnaKit	Bayer	Syringe as AnaKit, pen-like container is compact and strong, no tablets or tourniquet.
Min-I-Jet	UK	1 mg, other doses possible	IMS, UK	Seems designed more for hospital use.

LI Links - World

I've updated my LI Links page in my Lactose Intolerance Clearinghouse. I've culled the dead links, so all the links are currently live. Many are new to the page.

The links go to pages that deal with every topic that I cover on this blog, so they include not just pages on lactose intolerance, but also ones on allergies, dairy-free foods, other diseases, getting calcium into your diet, and much more.

For your convenience I'm also listing them here. This post is for Multi-country and travel to multiple country links. If you have others to suggest that I've missed please put them in a comment. I'll try to update the LI Links page more regularly in the future.

World Links

Gluten Free Product Sources - Multi-Country

http://www.enabling.org/ia/celiac/vendors.html

Travel Links

Food Allergy Translation Cards

http://www.selectwisely.com/selectwisely/content_pages/traveling_with_food_allergies.htm

Vegetarian Travel and Restaurants FAQ

http://www.vrg.org/nutshell/faqtravel.htm

"Food Detective" Home Allergy Test Flunks

Intolerances are not the same as allergies. Lactose intolerance is defined as having symptoms because of the body's inability to digest the lactose sugar in milk. A milk allergy is caused by antibodies that react to the proteins in dairy products. They are totally different. I know that. If you've been reading this blog from more than about five minutes you know that.

And the makers of the "Food Detective™, the world’s first food intolerance self test" kit know that. They have a whole page devoted to the difference.

And yet they keep calling the Food Detective a food intolerance kit. It isn't. It tests for protein antibody reactions. Not the same.

Why make a big deal of this? Many people, especially in the UK where the Food Detective is based, confuse the terms or even use them interchangeably. But I'm cynical. And as their own food intolerance page says, as many as 45% of the population of the UK may have food intolerances, but only 2.5% have food allergies. Now which set would you rather your marketing department pitch your product to?

And that's assuming that the product can possibly work as claimed. You take a mere pinprick of blood and put it into the tiny test tube in the kit. Pour on some developer and in 40 minutes you'll know if you have allergies to any of the following:

Cereals
Corn, Durum Wheat, Gluten, Oats, Rice, Rye, Wheat.

Nuts & Beans
Almond, Brazil Nut, Cashew, Cocoa Bean, Peanut, Legume Mix (pea, lentil, haricot),
Soya Bean, Walnut.

Meats
Beef, Chicken, Lamb, Pork.

Fish
Freshwater Fish Mix (salmon, trout), Shellfish Mix (shrimp, prawn, crab, lobster, mussel), Tuna, White Fish Mix (haddock, cod, plaice)

Vegetables
Broccoli, Cabbage, Carrot, Celery, Cucumber, Leek, Peppers (red, green, yellow), Potato.

Fruits
Apple, Blackcurrant, Grapefruit, Melon Mix (cantaloupe, water melon), Olive, Orange & Lemon, Strawberry, Tomato

Other
Egg (whole), Cow's Milk, Garlic, Ginger, Mushroom, Tea, Yeast

That's amazing. Too good to be true? Well, I'm always a skeptic.

You see, the makers of Food Detective are Cambridge Nutritional Sciences CNS), which has done this testing for several years if you mail them a sample of your blood. And the British newspapers have not been kind to CNS.

In You and Yours on Which? Investigation into Food Intolerance Tests, Dr. Mike Walker of CNS reveals that the tests don't test for IgE, the antibody that causes true allergies. It tests for IgG, an antibody which causes hypersensitivities. Some researchers do lump the various antibody reactions together as allergies, some don't. All, to my knowledge, agree that only IgE reactions cause the anaphylactic reactions that are the ones to take most seriously.

Tests on similar testing kits have a large fail sign pasted on them. As Jenny Hope reported in The Daily Mail:

The tests found a total of 183 intolerances, even though the researchers had just one medically confirmed allergy and one already recognized food intolerance between them.

Different test results were produced from identical blood and hair samples sent to the same company under different names. There was little or no overlap of test results from different companies for the same researcher.

A panel of medical specialists and a dietician concluded that none of the tests, which cost between £45 and £275, had ' diagnostic value' for genuine allergies or intolerances.

It's nice to think that one tiny pinprick of blood can tell you what foods not to eat. It's also too good to be true.

The Four Types of Allergies

True allergies are reactions of the IgE antibody system. But there are other antibody systems in the body too and they can produce their own sets of usually different symptoms, creating much confusion. The two types of reactions are sometimes both lumped together as allergies, but they're better thought of separately as allergies and hypersensitivities respectively.

I have a page on my web site, Lactose Intolerance versus Milk Allergy, talking about this. I've posted about it before as well, in The Different Types of Dairy Allergy.

I thought about those when I ran across a column by Dr. Jeff Hersh on the Norwood, MA Daily News Transcript website. He answers a pertinent question from a reader.

Q: My daughter had a blood test which showed she has a delayed IgG egg allergy rather than an immediate IgE (immunoglobulin E) allergy. Can you tell me what this really means?

The whole column is too long to quote here but has a good number of technical details in it that may help people, especially parents, understand allergies better. A few excerpts:

1. IgE helps defend against parasites. It also binds to allergens (things that trigger allergies) to trigger histamine release from mast cells, although how this helps defend the body is not understood.

2. IgG and IgM help "tag" many types of infections, with IgM forming during an acute infection and IgG serving as a "memory" to fight a future similar infection. ...

The types of hypersensitivity are classified according to the part of the immune system causing the problem (although other classification systems exist):

Type 1 is an immediate reaction (usually within minutes to hours) due to IgE and is very common, affecting 50 million Americans. It may be due to foods, environmental allergens (pollen, grasses, etc.), insect stings, medications or many other causes. Typical symptoms include rashes (such as hives), gastro-intestinal symptoms (such as nausea, vomiting and/or diarrhea), swelling (angioedema) and/or respiratory symptoms (such as runny nose, nasal congestion, cough, or even asthma). An estimated 500 people die each year from anaphylaxis, a life-threatening hypersensitivity reaction where symptoms are so severe breathing may be compromised and blood pressure can drop.

Type 2 is due to IgM, IgG and/or complement, and includes conditions where the body's immune system attacks normal body cells such as in autoimmune hemolytic anemia (the red blood cells are attacked), Goodpasture's disease or others.

Type 3 is due to immune complex, IgG and/or complement and can lead to serum sickness or other conditions. It may also lead to allergy symptoms similar to type 1, however with delayed (usually within hours to days) onset.

Type 4 is also delayed onset, but is due to T-cells. It is responsible for contact dermatitis (such as poison ivy), as well as other conditions.

Blood Tests Overdiagnose Allergies

Tara Parker-Pope's [corrected name] column in today's New York Times makes a point that every parent of an allergic child - or possibly allergic child - should read.

The blood tests that many parents are turning to as an easier and faster diagnostic for food allergies than the old skin prick tests aren't reliable. They identify many children as being allergic when they really aren't. These are known as false positives.

A 2007 issue of The Annals of Asthma, Allergy & Immunology reported on research at Johns Hopkins Children’s Center, finding that blood allergy tests could both under- and overestimate the body’s immune response. A 2003 report in Pediatrics said a positive result on a blood allergy test correlated with a real-world food allergy in fewer than half the cases.

“The only true test of whether you’re allergic to a food or not is whether you can eat it and not react to it,” said Dr. David Fleischer, an assistant professor of pediatrics at National Jewish Health. ...

Blood tests may be unreliable because they fail to distinguish between similar proteins in different foods. A child who is allergic to peanuts, for instance, might test positive for allergies to soy, green beans, peas and kidney beans. Children with milk allergies may test positive for beef allergy.

Nobody is saying that the blood test shouldn't be used. Instead, it should be used as a first method of screening for allergies. A quick, easy test that shows up negative means that your child is spared longer or more invasive tests.

However, further testing is necessary if a number of allergies are detected. Usually this testing involves food challenges. Foods that have been removed from the child's diet because of a positive result are put back into the diet, carefully and in small quantities, to see if a reaction occurs. Reactions to actual food are the best evidence of an actual allergy. Remember that very young allergic children often outgrow allergies to milk as well as to eggs, soy and wheat.

Reintroducing food should only be done under the supervision of a doctor. If the child remains allergic a severe reaction could occur and doctors can control this.

The risks of a serious allergic reaction are real. However, so are the risks of taking children off of common foods unnecessarily. Cases of malnutrition have been reported from overly restricted diets. And the chances of a reaction when the food is reintroduced - deliberately or accidentally - are increased.

Allergies are increasingly widespread. That also means that some parents are assuming allergies where they don't exist, creating a vicious cycle. Doublecheck all positive results from testing, especially from blood tests. And make sure they are real tests from the best trained doctors. There are too many quacks preying on peoples' fears to take any chances with your child's health.

Divvies Holiday Allergy-Free Tips

Divvies is a dedicated nut- and dairy-free gourmet bakery. Owners Lori and Mark Sandler are masters of promotion and publicity as well, putting out press releases with amazing frequency. Fortunately, their releases have more meat to them than most. Like this long list of " simple ideas to help make the Holiday's [sic] more palatable for children with food allergies."

1. R.S.V.P. as soon as your family receives an invitation. You want to make sure you give your hosts (and yourself!) plenty of time to comfortably work out allergy-free solutions. This gives them the opportunity to purchase "safe" foods (like those offered by Divvies.com) or prepare foods using allergen-free ingredients.

2. Bring an allergy-safe and delicious dessert that everyone will enjoy. Make sure the dessert you bring not only tastes great but looks intriguing and festive. And that means serving platter included. Don’t bring over something the hostess has to scrounge around for a platter to put it on. She’s busy, don’t add to her work.

3. When home baked foods show up at your home as gifts and you are not sure of the ingredients, have alternative "safe" foods available for your child, so she doesn't feel left out of the celebration. These should be special treats, not the usual fare.

4. Ingredients in packaged goods sometimes change due to the season or recipe changes by the manufacturer. Always check ingredient lists and manufacturing practices on packaging to make sure that foods are still safe.

5. If you are the host for a large gathering where there are a lot of children and close supervision of what is being eaten might be difficult, steer clear of offering any items known to be highly allergic (e.g. peanuts, tree nuts, shellfish, etc.). Make the whole table largely allergy-safe so everyone can relax and enjoy.

6. If you are a host for a smaller gathering where close supervision is less of an issue, serve a variety of food, but make sure the items, that are free of common allergens, are well-marked.

7. When hosting parties, know your guests and don’t be afraid to ask if anyone planning to attend your party has any allergies. Find out ahead of time and avoid making guests feel self-conscious about their allergies during the party.

8. Say, "Thank you!". After the party make sure to express your appreciation for all that your host did to make the event a safe, fun and inclusive occasion.

My tip: hire PR firms that are literate or at least can hire someone to proofread their releases.

Take In Case EpiPen Holders

Need to be sure your child or loved one has an EpiPen on his or her body at all times? Don't want to take the chance that it got left behind, or stuffed in the wrong pocket of the wrong coat? TAKE IN CASE provides a variety of solutions as close as clothing.

According to the press release the company just issued,

Halloween Safety experts Kim Hartman and Maureen Cooney ... invented and produced TAKE IN CASE(TM) as a comfortable, discreet, secure, wearable sleeve-like case to be worn on the shin, thigh, upper arm by people with severe allergies who are on the go and need to have their EpiPen(R) Auto-Injectors with them at all times.



"When my son was diagnosed with food allergies, I knew it wasn't going to be easy," says TAKE IN CASE(TM) co-creator Kim Hartman. "As a mother, being vigilant about his well-being is second-nature. Making sure that he always has his EpiPen(R) Auto-Injectors and that he knows how to administer them properly is very important. TAKE IN CASE(TM) achieves two goals, it enables my son to carry his medicine in a convenient, discreet manner to movies, ball games or a friend's house and it also gives me peace of mind knowing that he's safe!"

You can check out their complete line of products at their website, www.takeincase.com.

Soy Milk Doesn't Start Peanut Allergies

I hadn't heard that some researchers thought that giving soy products to children would trigger peanut allergies. In fact, if you had asked me, I'd had told you it was a nutty internet factoid that simply wasn't true.

Fortunately for me, it isn't true.

A recent study, Soy consumption is not a risk factor for peanut sensitization" published in the Journal of Allergy and Clinical Immunology by Jennifer Koplin et al. Volume 121, Issue 6, Pages 1455-1459 (June 2008) clears up the confusion.

Background
A recent cohort study suggested that intake of soy milk or soy formula was associated with peanut allergy. If this finding is confirmed, it suggests an avenue for modification of diet as a peanut allergy prevention strategy.

Objective
To investigate the relationship between soy consumption and peanut sensitization in a prospective cohort study of children.

Methods
A total of 620 babies with a family history of allergic disease were recruited. Dietary information was obtained from telephone interviews every 4 weeks from birth until 15 months and then again at 18 months and 2 years. Skin prick tests to peanut, milk, and egg were performed at 6, 12, and 24 months. A wheal size ≥3 mm was considered positive for sensitization.

Results
Children whose parents elected to introduce soy formula or soy milk into their children's diet were more likely to be sensitized to peanuts at 2 years (odds ratio, 2.02; 95% CI, 1.04-3.92; P = .039). However, this relationship was explained by feeding of soy to children who had siblings with milk allergy or were themselves sensitized to milk. After adjusting for these factors, there was no evidence of an association between soy consumption and peanut sensitization (odds ratio, 1.34; 95% CI, 0.64-2.79; P = .434).

Conclusion
The association between soy consumption and peanut sensitization is not causal but merely a result of preferential use of soy milk in infants with a personal or family history of cow's milk allergy. Future studies should take the confounding effects related to dietary modifications by parents into account when investigating the association between diet and childhood allergic diseases.

In simpler language, parents whose older children already had allergies gave their younger children soy in the hopes of preventing dairy allergies in them. This didn't always work. Some children developed peanut and other allergies anyway. Once those families were removed, the correlation vanished.

From now on, it is just a nutty internet factoid. Ignore it.

Different Allergy Tests: Different Results

When you go to your doctor for a blood test to see if you have allergies, the test the doctor picks may or may not give you the right answer.

That's the depressing news from a study published in the May issue of the Journal of Allergy and Clinical Immunology.
"Correlation of serum allergy (IgE) tests performed by different assay systems," by Julie Wang, James H. Godbold, and Hugh A. Sampson, Volume 121, Issue 5, Pages 1219-1224 (May 2008)

Methods
Fifty patients from the Mount Sinai Pediatric Allergy practice were prospectively enrolled. For each deidentified sample, specific IgE levels were measured to egg, milk, peanut, cat, birch, and Dermatophagoides farinae at different laboratories, each using a different assay system (Phadia ImmunoCAP, Agilent Turbo-MP, and Siemens Immulite 2000). Results were analyzed to determine whether IgE measurements were equivalent. Food allergen–specific IgE levels were correlated with clinical data and around empirically determined thresholds that predict probability of clinical disease in 50% or 95% of subjects.

Results
Variable degrees of agreement existed among the 3 assays. Immulite 2000 overestimated all specific IgE levels compared with ImmunoCAP. Turbo-MP overestimated for egg but underestimated for birch and D farinae. Differences for milk, peanut, and cat were observed, without a trend toward overestimation or underestimation. Furthermore, several values for the food allergens were discrepant around the 50% and 95% positive predictive values for clinical reactivity.

Conclusion
Discrepancies in specific IgE values from 3 different assays can potentially lead to altered management and treatment. The predictive values for clinical reactivity associated with food-specific IgE levels determined by ImmunoCAP should not be applied to results from other assays.

This is a fairly specialized result, aimed at practicing doctors rather than patients. While it implies that current results are not always as accurate as they could be - hardly news to many people with allergies judging from the complaints I hear about testing - being able to tell in the future which test works best for different allergies can help to improve the accuracy of diagnoses, so if these results hold up they would be good news for allergy sufferers.

Tips for Buying Allergy-Friendly Foods

I've written before about Enjoy Life, the fast-growing maker of gluten-free and allergen-free snacks. They had Gina Clowes, founder of the popular AllergyMoms.com blog, put together a list of tips for consumers buying allergy-friendly products.

• Have an unbreakable rule: no label = no thank you. Never eat a food that does not have a label.
  
  
• Always carefully read ingredient statements. Different versions of the same food can have different ingredients (for example, chewy Spree candy contains egg white while original Spree does not).
  
  
• Know that different sizes of the same foods can contain different ingredients. (For example, some “mini” versions of Laffy Taffy do not contain egg, but the large size does contain egg.)
  
  
• Don’t rely on common sense to determine if foods are safe. Tuna and flavored water can contain dairy, egg rolls and chili can contain peanut butter, licorice and soy sauce can contain wheat, and the list goes on.
  
  
• Take all precautionary warnings seriously. Manufacturers use different statements to warn consumers like “may contain” or “processed in a facility with.” However, the language used does not indicate the level of risk.
  
  
• Know that precautionary warnings are voluntary. If a product does not have a warning, it does not mean that the product is free of cross contamination. When in doubt, call the company to find out where and how the product was processed.
  
  
• Don’t play ingredient roulette. Even if you or your child once ate a product with a warning, that does not mean the next batch will be safe.
  
  
• Beware of hidden allergens. Potent allergens like sesame and mustard can hide behind the words “natural flavors” or “spices.”
  
  
• Know where the food is made. Seek out products that say they are made in a "dedicated peanut-free, nut-free, soy-free or allergy-free facility," depending on your diet restriction. This provides even further assurance of the food's safety.

International Study on Special Diets Published

Last year, many websites that promote a gluten-free or allergy-sensitive diet encourages their readers to take part in a survey of experiences while eating out or traveling.

The final study, titled Understanding Gluten and Allergen-Free Experiences of Guests & Hospitality Worldwide, summarizes the findings from over 2700 customers and businesses in 35 countries.

The reports states, not surprisingly, that 80% of of those with food allergies or celiac disease eat out less because of concerns with foods they haven't prepared or vetted themselves.

The full report will cost you $380. However you can get a free executive summary at www.allergyfreepassport.com or at www.glutenfreepassport.com. A related site, www.glutenfreeonthego.com, provides access to "the world's largest directory of gluten-free establishments."

The Two Types of Food Allergies

For some real facts, let's turn to a good summary article I found on MedicalNewsToday.com.

IgE-Mediated Food Allergies

The parts of the immune system responsible for immediate on-set reactions (the most dramatic example of which is food anaphylaxis) are IgE antibodies.

In allergic individuals (who are sometimes referred to as being "atopic") eating certain food proteins (such as whey and casein protein contained in cow's milk) results in the production of specific IgE antibody molecules directed against the protein. The second time the individual eats the food, these specific IgE molecules interact with each other, and the protein, to cause the release of harmful chemicals (such as histamine) from special mast cells. This causes the damage associated with the symptoms of food allergy. Damage may occur to the skin, respiratory system or gastrointestinal tract, where the symptoms of food allergy are almost exclusively seen.

Non-IgE-Mediated Food Allergy

"T-cells" are the components of the immune systems responsible for delayed-type food allergic reactions. In individuals with a predisposition for delayed on-set food allergy, initial ingestion of food protein leads to the production of specific types of "T-cell". When the food is subsequently ingested, the food protein is "processed" in a variety of ways and "presented" to the previously generated food-specific T-cells. These T-cells then "invade" the area of the body about to suffer damage, as the skin or the bowel. This processing, presenting and invasion can take 24-48 hours which explains the delayed response. T-cells release chemicals that, through a chain of events, lead to the damage associated with symptoms of food allergy.

IgE mediated reactions are sometimes referred to as "true" allergies, while non-IgE mediated reactions are sometimes called hypersensitivities. Unfortunately, these names are not consistently applied inside the medical profession or by the press.

You should also check out the entry on my website, Lactose Intolerance versus Milk Allergy, for a quick reference chart of the differences.

Our Greatest Weapon is Fear...

Parents, do you like being scared out of your shoes for no good reason at all? What about guilt trips? Do you prefer to make your purchasing decisions based on how horrible you'd feel if something happened to your child, no matter than the product has nothing useful to offer? Do the latest buzzwords slide down your brainstem to lubricate the pathway to your wallet?

If so, then you are the target audience for the BabyBam Collection.

The rest of us may be forgiven if we take a pass.

I'll just quote the one relevant section here, although the entire press release has a rising gorge factor of ten.

As the number of infants with gluten, soy, and lactose intolerance rises each year - so do severe skin allergies. Our exceptionally soft onesies, pants, pajamas, and towels are naturally hypoallergenic, anti-microbial, moisture wicking and anti-bacterial thus preventing odor and skin irritations," added [BabyBam Collection CEO Jody Graziano] Jonas.

No indication exists that the number of infants with lactose intolerance is rising. Probably the opposite is true. Lactose tolerance is a dominant mutation. If you receive the gene from either one of your parents you will become lactose tolerant. The number of adults with lactose tolerance increases every year.

Very few babies are naturally lactose intolerant. Only the tiniest handful are born lactose intolerant. Most of humanity - that's the four billion or so of us who are lactose intolerant - do not lose the ability to digest lactose until after the age of weaning. Some babies do become temporarily lactose intolerant because their intestines are affected by common "stomach flus" - really gastrointestinal ailments - and a much smaller number are affected by more serious problems that damage the delicate lining in their intestines. Even if you add them all up, the vast majority of infants - more than 99% - are not and never will be lactose intolerant.

But let's say that all the lies are truth. Say that lactose intolerance is a scourge that is ravaging our precious children. Say that lactose intolerance is, despite all medical evidence, increasing rather than decreasing.

Even in that upside-down, Bizarro world, where day is night and sweet is sour, nothing - repeat, nothing - that you could put onto your infant would make one particle of difference. Lactose intolerance is not an allergy. It comes solely because of the lack of an intestinal enzyme, lactose. Contact with milk, milk products, or milk byproducts has never produced a single case of lactose intolerance in the history of humanity.

Using lactose intolerance to sell onesies is pure pig ignorant fear-mongering.

The only thing we have to fear is fear itself. True. Still true. Always true.

Do not let your fear, your guilt, your hopes or dreams or nightmares, start you down the path to acting irrationally, to blindly blunder down the pathway to darkness, to imagine feverishly that you can avert the doom peddled by the ignorant or the cynical or the heartless, by swallowing their snake oil.

More Reactions to Allergy Reaction Reactions

On Sunday I wrote about the contentiousness of allergy issues in Our Reactions to Allergy Reaction Reactions. I noted that parents of children with serious food allergies have a legitimate sensitivity to the frequently disparaging comments made by those who have no stake in the issue while at the same time unnecessary fears have been generated by those who appear to feel that everything is a risk.

If I had waited one more day, The New York Times would have dropped a magnificent example into my lap.

Last week science writer John Tierney expounded on our culture of fear and what it is doing to our health in Living in Fear and Paying a High Cost in Heart Risk. His point is that worrying about fear may be costlier to our collective health than the actual risks posed by what we fear.

He started with what I would consider to be a perfectly innocuous sentence:

Although it’s impossible to calculate the pain that terrorist attacks inflict on victims and society, when statisticians look at cold numbers, they have variously estimated the chances of the average person dying in America at the hands of international terrorists to be comparable to the risk of dying from eating peanuts, being struck by an asteroid or drowning in a toilet.

He's quoting actual comments by statisticians concerning small risks rather than making these comments himself, note.

Yet Ellen Urich wrote a letter of complaint to the Times:

As the mother of a child with a life-threatening food allergy, I was greatly disheartened by John Tierney’s grouping the chances of dying from eating peanuts with being struck by an asteroid or drowning in a toilet. Public awareness and understanding of anaphylaxis and food allergies has grown enormously in the past decade, but it is my fear that this type of analogy trivializes a growing health condition that requires a serious attitude in order to save lives.

This may be taking a parent's concern way too far. Tierney trivializes nothing in his article. He properly quotes others as pointing out that the risks of death by terrorism is real by highly unlikely, as highly unlikely and as small in number as some other risks.

The statisticians are numerically right. The Center for Disease Control recorded only 12 deaths from food allergies in 2004. The Consumer Product Safety Commission warns parents that:

Toilets are often overlooked as a drowning hazard in the home. The typical scenario involves a child under 3-years-old falling headfirst into the toilet.

Yet that same page indicates the number of drowning victims is probably in the same range as the 14 that the CDC estimates for food allergy deaths.

The number of deaths from terrorism in the U.S. in recent years. Zero.

Any such avoidable death, especially the death of a child, is tragic and should never be trivialized. Everything reasonable that can be done to prevent such tragedies should be.

We've gone far beyond reasonable over the past six years. The world today is exactly as dangerous as it was on Sept 10, 2001, probably neither more so or less than. Nothing new there. The world has always been dangerous, from events both large and small. As Tierney notes, both public figures and the media have created a climate of fear. I'd go further, and accuse the Administration and its partisan toadys and the bootlickers in the media of doing so deliberately to further their aims and concentrate their power.

For all their crimes - and they are legion - even the Administration did not create a fear of peanuts. On that issue, both the fearmongers and the trivializers run rampant across the media and the internet. In a culture of fear fears will multiply and reason will flee.

The best thing we can collectively do is to break out of the culture of fear. In the next 10 months of a presidential race, you'll hear fear as a constant: fear of strangers, fear of change, fear of the future, fear of the unknown, fear of uncertainty, fear of "Them." Don't allow the fearmongers to triumph. More than that: don't allow their fearmongering to go unchallenged. Reason must triumph.

As Franklin D. Roosevelt said in his first inaugural speech, fighting against a climate of fear as deep and pervasive if not as deliberately created as the one today, "The only thing we have to fear is fear itself." If you've ever wondered what he meant by that, just look around you.

Nightmare Advice on Allergies

I write fantasy and science fiction professionally. Even so I swear I could never make anything up as wild as homeopathy.

Homeopathy is based on the ancient folklore of "like cures like." Practitioners take herbs that create symptoms superficially similar to those produced by a disease or ailment and then dilute them until nothing but water and a "memory" of the herb is left. This magically creates a cure.

You can therefore use homeopathy to cure just about anything that creates symptoms. Ricky Hussey in The American Chronicle want to cure eczema this way.

Treatment

Homeopathy Apis, Graphites, Pulsatilla, Rhus tox., and Sulfur may be helpful. Herbal Medicine Marigold tea, calendula ointment, or aloe vera gel are all helpful. Aromatherapy Add 12 drops of fennel, geranium, or sandalwood to 2fl oz/60ml of carrier oil.

Pulsatilla? It's "the weather cock among remedies." What? Huh? Even after reading this site I can't figure out what that's supposed to mean.

The disposition and mental state are the chief guiding symptoms to the selection of Pulsatilla. It is pre-eminently a female remedy, especially for mild, gentle, yielding disposition. Sad, crying readily; weeps when talking; Changeable, contradictory. The patient seeks the open air; always feels better there, even though he is chilly. Mucous membranes are all affected. Discharges thick, bland, and yellowish-green. Often indicated after abuse of Iron tonics, and after badly-managed measles. Symptoms ever changing. thirstless, peevish, and chilly. When first serious impairment of health is referred to age of puberty. Great sensitiveness. Wants the head high. Feels uncomfortable with only one pillow. Lies with hands above head.[bolding and punctuation as in original]

Wow. If this were the 60s, everybody would know what this guy was on, and they wouldn't think homeopathy.

What's even worse is that many, if not most, homeopathic pills are made out of lactose. The Organic Pharmacy dips its toe into the world of science.

Homeopathic products are very clean-meaning they have no binders, fillers or coatings. The soft molded lactose tablets are made to dissolve almost instantly when placed in the mouth. Because the remedies dissolve in the mouth, they are absorbed by the mucous membranes in the mouth and carried directly into your system. For this reason, the remedies work faster than conventional medicines because conventional medicines are usually coated and don't get absorbed into the system until the coating is dissolved by the stomach acid, and that generally takes about twenty minutes.

In standard, or allopathic, medicine, this is called sublingual administration. It can be very effective, but doctors and pharmacists will note that not every chemical works well this way, with some not mixing well with saliva or containing chemicals too large to be absorbed.

Besides, if lactose isn't a binder or filler, then what conceivable role does it play?

For even more evidence that homeopathists understand nothing of chemistry, here is another mind-busting statement from the pulsatilla site:

[Q.]Does anyone know if there can be a problem using the homeopathic tablets which are lactose tablets when a person is lactose intolerant?

[A.]Probably no problem. But if you wish you can disolve them in water further diluting any lactose content.

Dilution solves everything! Yay!

Lactose is lactose. The amount you take in counts. It doesn't matter if the amount is concentrated in a pill or spread through a glass of water. That same amount will enter your intestines.

This is absolutely the most basic chemistry of digestion. If the homeopaths don't know this, you shouldn't allow them or any of their products within a thousand feet of your intestines.

And I shouldn't have to tell you that people with serious dairy allergies will avoid any product that contains lactose in the first place.

Homeopathy is a nightmare of pseudoscience and its most ignorant peddlers are dangerous.

No Evidence That Avoiding Foods While Breastfeeding Prevents Allergies

Women whose infants have known milk protein allergies or whose families have known allergies are properly told to avoid drinking milk themselves while breastfeeding. Milk proteins from the food can travel through the bloodstream and enter the breast milk, triggering allergic responses in the infants.

This advice has been widely disseminated in recent years. Perhaps too widely. The American Academy of Pediatrics (AAP) is afraid that women whose infants have no such allergies may be denying themselves foods out of fear of triggering allergies, even when those are unlikely.

In fact, the AAP feels this is such a problem that it has issued updated guidelines that reassure nursing mothers that no good evidence exists that avoiding certain trigger foods will prevent allergies from occurring.

Carla Johnson of the Associated Press reported the new policy in a story that I'm glad to see was widely covered. (The link goes to the Houston Chronicle, which reprints more of the article than some other newspapers.)

In August 2000, the doctors group advised mothers of infants with a family history of allergies to avoid cow's milk, eggs, fish, peanuts and tree nuts while breast-feeding.

That advice, along with a recommended schedule for introducing certain risky foods, left some moms and dads blaming themselves if their children went on to develop allergies.

"They say, 'I shouldn't have had milk in my coffee,'" said Dr. Scott Sicherer of the Mount Sinai School of Medicine's Jaffe Food Allergy Institute in New York. "I've been saying, 'We don't really have evidence that it causes a problem. Don't be on a guilt trip about it.'"

Mothers of high risk infants should still breast feed exclusively for at least the first four months, though.

The study is in the journal Pediatrics. You can read the full text online at Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas by Frank R. Greer, MD, Scott H. Sicherer, MD, A. Wesley Burks, MD and the Committee on Nutrition and Section on Allergy and Immunology. PEDIATRICS Vol. 121 No. 1 January 2008, pp. 183-191 (doi:10.1542/peds.2007-3022)

Here's the Summary:

It is evident that inadequate study design and/or a paucity of data currently limit the ability to draw firm conclusions about certain aspects of atopy prevention through dietary interventions. In some circumstances in which there are insufficient studies (pregnancy and lactation avoidance diets, timing of introduction of specific complementary foods), the lack of proven efficacy does not indicate that the approach is disproved. Rather, more studies would be needed to clarify whether there is a positive or negative effect on atopy outcomes. The following statements summarize the current evidence within the context of these limitations.

1. At the present time, there is lack of evidence that maternal dietary restrictions during pregnancy play a significant role in the prevention of atopic disease in infants. Similarly, antigen avoidance during lactation does not prevent atopic disease, with the possible exception of atopic eczema, although more data are needed to substantiate this conclusion.

2. For infants at high risk of developing atopic disease, there is evidence that exclusive breastfeeding for at least 4 months compared with feeding intact cow milk protein formula decreases the cumulative incidence of atopic dermatitis and cow milk allergy in the first 2 years of life.

3. There is evidence that exclusive breastfeeding for at least 3 months protects against wheezing in early life. However, in infants at risk of developing atopic disease, the current evidence that exclusive breastfeeding protects against allergic asthma occurring beyond 6 years of age is not convincing.

4. In studies of infants at high risk of developing atopic disease who are not breastfed exclusively for 4 to 6 months or are formula fed, there is modest evidence that atopic dermatitis may be delayed or prevented by the use of extensively or partially hydrolyzed formulas, compared with cow milk formula, in early childhood. Comparative studies of the various hydrolyzed formulas have also indicated that not all formulas have the same protective benefit. Extensively hydrolyzed formulas may be more effective than partially hydrolyzed in the prevention of atopic disease. In addition, more research is needed to determine whether these benefits extend into late childhood and adolescence. The higher cost of the hydrolyzed formulas must be considered in any decision-making process for their use. To date, the use of amino acid–based formulas for atopy prevention has not been studied.

5. There is no convincing evidence for the use of soy-based infant formula for the purpose of allergy prevention.

6. Although solid foods should not be introduced before 4 to 6 months of age, there is no current convincing evidence that delaying their introduction beyond this period has a significant protective effect on the development of atopic disease regardless of whether infants are fed cow milk protein formula or human milk. This includes delaying the introduction of foods that are considered to be highly allergic, such as fish, eggs, and foods containing peanut protein.

7. For infants after 4 to 6 months of age, there are insufficient data to support a protective effect of any dietary intervention for the development of atopic disease.

8. Additional studies are needed to document the long-term effect of dietary interventions in infancy to prevent atopic disease, especially in children older than 4 years and in adults.

9. This document describes means to prevent or delay atopic diseases through dietary changes. For a child who has developed an atopic disease that may be precipitated or exacerbated by ingested proteins (via human milk, infant formula, or specific complementary foods), treatment may require specific identification and restriction of causal food proteins. This topic was not reviewed in this document.

Are Food Labels Giving the Right Info?

The Food Allergen Labeling and Consumer Protection Act that went into effect on Jan. 1, 2006, requires foodmakers to identify, in plain language, the presence of any of the eight major food allergens. For example, a product that contains casein must specify that it contains a milk derivative.

Most firms go much farther than that. You'll commonly see statements about possible cross-contamination at the bottom at a food label. Take Newman's Own Organics' Fig Newmans, one of Paul Newman's product line. There's wheat and milk in the ingredients and those are noted. But underneath the label is a statement that the cookies are made on "equipment that may process products containing peanuts, other nuts and milk powder."

Great, right? Even the possibility of the presence of an allergen is covered. What more could anybody want?

Well, nothing satisfies everyone. And complaints are being raised even about this vast improvement over the old labeling, says an article by Julie Schmit in USA Today.

One complainer is someone I frequently quote, Anne Munoz-Furlong, founder of the Food Allergy & Anaphylaxis Network (FAAN). She's worried that manufacturers try to game the system by putting overly-broad disclaimers on the packages so that they don't have to closely monitor their manufacturing processes.

Munoz-Furlong gives one example:

Some Harry & David products include an advisory that is so broad FANN's Munoz-Furlong calls it "ridiculous." The statement: "May contain peanuts and/or trace amounts of allergens not listed in the ingredients."

Harry & David do gourmet food packages, making 571 different products in one facility. They counter by saying:

The company has "robust quality systems" checked by two sets of outside inspectors, [senior vice president Thomas] Forsythe says. Equipment and production lines are sanitized to minimize contamination risks.

Schmit continues:

Still, Harry & David had four allergen recalls in the past year. Three resulted from the wrong labels being applied. One cause was never identified. Three recalls covered products other companies made for Harry & David. Two of those companies are no longer used, Forsythe says. The other stepped up its label-control procedures, as did Harry & David. No illnesses were reported in any of the recalls.

I agree that saying merely "other allergens" is not living up to the spirit of the regulations. The impression I get is that Munoz-Furlong wants Harry & David to identify each possible cross-contamination for each food. From the limited information given in the article, it's not clear to me how the firm could effectively do that. Some compromise might be needed here.

As a general rule, however, I'm not seeing massive wrongdoing. Given that somebody always has to be the worst case in any line of work, I don't doubt that somewhere out there some firm is not keeping the highest quality standards.

The reality is, though, that the worst firm would be the worst firm regardless. And a broad label does keep the most sensitive away. It may keep too many away, to be sure, but I don't see that that's a bad thing. Before labels were required the worst firms were doing all the worst things and not warning people at all. The current system has to be an improvement over that.

The other worry in the article is that the new warnings are confusing for consumers or that they collectively drive up fears about the safety of the food supply.

Again, I'm dubious. People who have experience in checking labels should find the information given to be clear and direct and vastly better than the way things used to be. Those first encountering the world of specialty diets may be overwhelmed at the beginning but I guarantee you that this was equally true when I learned I was LI back in 1978 and I would have shouted for joy to be given labels with the current information on it.

Fearmongers might be using allergy warnings to scare consumers. I read far more articles from people who appear to think that the need to have these warnings at all is ludicrous. They're wrong. More info about our food is a good thing, and the extra line at the bottom of some ingredients lists is about as scary as the Munsters.

Munoz-Furlong has done fine work in the past. She many be seeing examples that I haven't and that USA Today didn't bother to mention. Reality is a constant compromise. We're currently at a pretty good balance, superior to where we were pre-2006. Tweak the system if necessary but keep it going. It's good for all of us.

Studentz Ar Dumm

Good grief. Patricia Kirk of WebMD.com reported on a new study by the University of Michigan Health System (UMHS). It found that 42% of students with a known food allergy still ate foods that contained that ingredient.

Why?

[R]esearchers were given answers such as: "I thought I could eat around it," "The food item did not contain enough to cause a reaction," "I knew it could be treated," or "I've outgrown my allergy," says Matthew Greenhawt, MD, a pediatrician and fellow in the division of allergy & clinical immunology at UMHS.

Greenhawt added that:

"Many of these students are accustomed to their parents being in charge of their health care. Now that they're in college, they have to take this responsibility for themselves."

How big doofuses are these students?

Only 22% of students who reported a history of allergic reaction said they possessed a self-injectable device, such as an EpiPen or Twinject, to treat a severe reaction. About 28% of those who have one say they always carry it with them. Of the 55 students reporting a severe reaction to a food allergen in the past, 27 of them did not have the device.

Blame all around on this one. Parents, schools, doctors. And the doofuses themselves, who if they are old enough for college are old enough to know better.