Lyme Disease Support Group

Reasons to Do Food Challenges

Food challenges are performed to answer a variety of questions and play a vital role in the evaluation and management of patients with histories suggestive of food allergy.

Indeed, their necessity is supported by studies revealing that more than half of patients with histories of adverse reactions to a food fail to react during blinded challenges to that food.

There are a number of reasonable explanations for this that underscore the importance of food challenges.

Given the possibility of severe reactions, food challenges should only be performed in a medical setting with the necessary medications, equipment, and personnel experienced in the treatment of severe allergic reactions (anaphylaxis).

Decisions about who should be challenged are reached only after a thorough evaluation and discussion of the risks and benefits with the patient or his or her family.

Few procedures in medicine answer a posed clinical question as directly as a properly performed food challenge. The information obtained can be life-altering.

Learn more about this useful test by watching our Food Challenge video.

Four Primary Reasons

There are four primary reasons for doing a food challenge:

1. Determine whether the wrong food is suspected as the cause of symptoms.

Inaccurate or misleading assumptions about which specific food is to blame can be based on history, skin testing, and lab testing results.

Contamination of a food by other allergens is one way the history may lead to inaccurate conclusions.

For example, a child having reacted to a French fry cooked in peanut oil might be suspected of being allergic to peanut when the actual cause of the reaction was fish protein from fish fried in the same oil.

Or, sometimes the reaction is caused by a nonfood contaminant such as latex proteins deposited on foods by handlers wearing latex gloves.

A reaction to dust mites in mite-contaminated baked goods is another example.

Differences between how patients react to allergens in a testing environment compared to how they react in ‘real life' may lead to inaccurate conclusions as well.

Sometimes the food responsible for the reaction is not apparent from skin testing or laboratory testing.

For example, a patient may have a positive skin test to several suspected foods and food challenges may be necessary to determine which, if any, of the foods is the culprit.

Determining which food actually caused the reaction is necessary to aid in preventing future reactions and to avoid needlessly eliminating foods from the diet.

2. Prove that a food is NOT the cause of symptoms.

An example is a patient who has been mislabeled as allergic to one or more foods despite an unconvincing history or suspicious skin test or laboratory test results.

Giving the food under medical supervision reassures patients that they can eat the food safely.

Furthermore, sometimes the reactions are not related to food but are brought on by other things such as medications, toxins, parasites, allergen exposures by inhalation or contact, viral illness, exercise, or panic.

3. Verify whether a patient has outgrown food allergies.

Many children born allergic to milk, egg, wheat or soy outgrow their food allergies by their third to sixth birthday.

Studies over the past few years have even shown that about 20 percent of children with allergic reactions to peanut and about 10 percent of children with allergic reactions to tree nuts may outgrow their sensitivity.

A carefully performed food challenge can safely document when the food can be returned to the diet or at least when the likelihood of a significant reaction is drastically reduced.

4. Discover the degree of sensitivity.

Discovering the degree of sensitivity is another reason for performing food challenges, although this is the least common of the above reasons why we perform food challenges.

Some patients, or their families, become concerned that exposure to even tiny amounts of a food might cause a life-threatening reaction.

These concerns occasionally interfere with participation in normal activities and can lead to social isolation.

Although some patients are very sensitive, others find that more of the food than was expected could be tolerated without a severe reaction - even though positive skin tests and histories may suggest otherwise.

This can be a relief for patients who have avoided activities out of concern for the possibility of extreme sensitivity.

Alternatively, some patients are found to be more sensitive than was previously suspected.

In this case, the importance of strict avoidance, as well as being thoroughly prepared to treat severe reactions, is reinforced.

..More Food Allergy Information

•Overview

•Symptoms

•Seafood Allergy

•Diagnosis

•Treatment

•Reduce Exposure

•Holiday Tips

•FAQ

© 2011 National Jewish Health1400 Jackson St, Denver CO 802061-800-423-8891

http://www.nationaljewish.org/healthinfo/conditions/allergy/ allergens/food/diagnosis/food-challenges.aspx

The best way to prevent an allergic reaction is to eliminate exposure to the specific type of food allergen.

•Know the different names of foods to which you are allergic. (For example, lactate solids are a milk product.)

•Read labels carefully to identify foods in packages.

•Ask about ingredients in food served at a restaurant or a friend's home.

•Educate caregivers about food allergies.

•Encourage children with food allergies not to eat food given to them by friends.

•Have a Food Allergy Action Plan.

Precautions

•Use and understand allergy medications.

•Carry injectable epinephrine (Epi-Pen or TwinJect) and an oral antihistamine (Benadryl, preferably in the liquid or fast-melt preparation) as prescribed for emergencies.

Learn more about your food allergies and how to avoid foods you are allergic to by talking with your doctor or a registered dietitian.

Another reliable resource is the Food Allergy and Anaphylaxis Network website (foodallergy.org), which is regularly monitored and updated by allergists.

..More Food Allergy Information

•Overview

•Symptoms

•Seafood Allergy

•Diagnosis

•Treatment

•Reduce Exposure

•Holiday Tips

•FAQ

http://www.nationaljewish.org/healthinfo/conditions/allergy/ allergens/food/reduce-exposure-.aspx

© 2011 National Jewish Health1400 Jackson St, Denver CO 802061-800-423-8891

[b]Three of the world's top experts in the field discuss the latest research advances and evidence of future treatment possibilities.

Saturday, March 19 3:30 p.m. ET, 2:30 CT, 12:30 PT

2 here; haven't had time to listen to these yet; but it's the latest news out here folks![/b]

http://www.medpagetoday.com/MeetingCoverage/AAAAI/25302? utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&em

By Crystal Phend, Senior Staff Writer, MedPage Today

Published: March 24, 2011

video 3+ minutes w/comm. chair!

SAN FRANCISCO -- The long wait for recommendations on diagnosis and management of food allergies is over, according to this exclusive InFocus report from the American Academy of Allergy, Asthma & Immunology meeting.

The recently released AAAAI practice parameters discussed at the meeting had been "sorely lacking for a number of years, so this is going to provide a new diagnostic framework," James Gern, MD, of the University of Wisconsin Madison and chair of the conference program committee explained to MedPage Today Senior Staff Writer Crystal Phend.

Other highlights of the meeting included similar practical guidance on allergic eye disease and immunotherapy, he noted.

The conference also offered a "good dose of technology" with discussion of how nanotechnology may lead to new diagnostics and perhaps therapeutics, as well as progress in treatment of food allergy and in sorting out how early life exposures affect a range of allergic disease and asthma, Gern said.

http://www.medpagetoday.com/MeetingCoverage/AAAAI/25515? utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&em=

© 2011 Everyday Health, Inc. All rights reserved.

Study finds many restaurant workers uninformed about allergens in food, heightening fears

Wednesday, April 27, 2011

TUESDAY, April 26 (HealthDay News) --

Every time her teenage daughter Jordyn leaves the house, Nancy Geller worries about the food her daughter might choose to eat.

Jordyn has a severe peanut allergy, and exposure to even a small amount of a peanut-containing food could cause a life-threatening allergic reaction.

"It's a big worry, especially now that she's a teenager and is eating out with her friends," said Geller, who lives in Croton on Hudson, N.Y.

Geller isn't alone with her concerns. According to the Food Allergy and Anaphylaxis Network (FAAN), as many as 12 million Americans have a food allergy.

Milk, eggs, peanuts, tree nuts, shellfish, soy and wheat are responsible for most food allergies, according to FAAN.

While it's easy to control your environment at home to be sure you or your allergic children aren't exposed to the offending food, many people choose to eat food prepared in restaurants, where the risk of being exposed to a food allergen is much greater.

Still, many feel if they let the wait staff know about the allergy, they can be assured a safe meal. But new research indicates that that's not always the case.

In a study that included managers, waiters and chefs at 90 restaurants in Brighton, a popular British resort town, researchers found that just a third said they'd had specific food allergy training.

However, 81 percent said they still felt confident they could provide a safe meal to a customer with food allergies.

When the researchers pressed for more specific information, they found that 38 percent of restaurant workers erroneously believed that people with food allergies could drink water to dilute the allergen and lessen the severity of the allergic reaction.

Another 23 percent mistakenly thought that eating a small amount of a food allergen would be safe.

About one in eight restaurant workers didn't realize that food allergies could cause death.

Sixteen percent believed that cooking food could prevent food allergies, and 21 percent mistakenly thought they could simply remove the food allergen from the finished meal and it would be safe.

Results of the study were published in the May issue of the journal Clinical and Experimental Allergy.

Christopher Weiss, vice president of advocacy and government relations for FAAN, said the U.K.'s study results are similar to those of a study done in the United States.

"I wasn't overly surprised by the results. But, if you look at today versus five years ago, we've made significant advancements. Overall though, we've still got a way to go before the vast majority of restaurant workers understand food allergy," he said.

There was some good news from the U.K. study:

Almost half of those surveyed expressed an interest in learning more about food allergies.

In the U.S. study, Weiss said that figure was 60 percent.

"So, we developed a training guide with the National Restaurant Association along with a video that's easy to watch. The more restaurants that take advantage of these tools, the better," said Weiss.

Sue Hensley, a spokesperson for the National Restaurant Association, echoed Weiss' sentiments, and said her organization "is working diligently to address the issue of food allergic customers in restaurants by educating our restaurants and their employees on food allergens."

Geller said that there has been a noticeable difference in food allergy awareness where she lives -- the New York metro area -- in the past few years.

"In the past, many restaurants just wouldn't take any responsibility. It was very tough to feel comfortable in a restaurant. Now, we definitely see more understanding," she said.

For others dealing with food allergies, Geller advised talking to the waitstaff and letting them know what your specific needs are.

Weiss added that a lot of people with food allergies also call restaurants in advance, or go in and visit before they go to eat so that they can "gauge whether or not that facility would be able to serve them a safe meal."

SOURCES:

Nancy Geller, mother of Jordyn, Croton on Hudson, N.Y.; Christopher Weiss, PhD, vice president, advocacy and government relations, Food Allergy and Anaphylaxis Network;

Sue Hensley, senior vice president, public affairs communications, National Restaurant Association, Washington D.C.;

May 2011, Clinical and Experimental Allergy

HealthDay

Copyright (c) 2011 HealthDay. All rights reserved.

http://www.nlm.nih.gov/medlineplus/news/ fullstory_111413.html

A new treatment may be a safe and effective form of immunotherapy for children with peanut allergy, according to researchers at Duke University Medical Center and Massachusetts General Hospital.

Currently, there are no treatments available for people with peanut allergy.

The double-blind, placebo-controlled study, funded in part by NCCAM and published in The Journal of Allergy and Clinical Immunology, investigated the safety, clinical effectiveness, and immunologic changes with sublingual immunotherapy—a treatment that involves administering very small amounts of the allergen extract under a person’s tongue.

Researchers randomly assigned 18 children (ages 1 to 11 years) with known peanut allergy to receive either peanut sublingual immunotherapy or placebo.

Participants in the peanut group received increased doses of peanut extract every 2 weeks for 6 months.

Following each dose increase, participants continued the same daily dose at home.

Once a maximum dose of 2,000 micrograms of peanut protein was reached, participants continued to take this daily maintenance dose at home for approximately 6 more months.

After a total of 12 months of sublingual immunotherapy, participants underwent a food challenge, which involved taking increasing doses of peanut protein in the form of peanut flour mixed with food.

The food-challenge placebo consisted of oat flour mixed with food given in the same increments.

Allergy skin prick tests were performed, and participants’ blood samples were taken at different points throughout the study.

The researchers found that the participants who had received peanut sublingual immunotherapy could safely consume 20 times more peanut protein than those who had received the placebo (1710 mg vs. 85 mg).

This level of desensitization is clinically significant because it represents protection from accidental ingestion of peanut, which is often less than 100 mg (or one peanut).

In addition, allergy skin prick tests showed a decreased allergic response to peanut in the treatment group.

The blood tests showed immunologic changes in the treatment group, suggesting a significant change in allergic response.

The researchers concluded that these findings are promising, but more study is needed to determine whether sublingual immunotherapy can increase long-term tolerance to peanuts in children with peanut allergy.

Reference

Kim EH, Bird JA, Kulis M, et al. Sublingual immunotherapy for peanut allergy: clinical and immunologic evidence of desensitization. The Journal of Allergy and Clinical Immunology. 2011.

Department of Health and Human ServicesNational Institutes of Health (NIH)

NCCAM

National Institutes of Health

9000 Rockville Pike

Bethesda, Maryland 20892 USA

E-mail: info@nccam.nih.gov

http://nccam.nih.gov/research/results/spotlight/022011.htm

When in Doubt, Leave It Out

Since 2006, it has been much easier for people allergic to certain foods to avoid packaged products that contain them, says Rhonda Kane, a registered dietitian and consumer safety officer at the Food and Drug Administration.

This is because a federal law requires that the labels of most packaged foods marketed in the U.S. disclose—in simple-to-understand terms—when they are made with a “major food allergen.”

Eight foods, and ingredients containing their proteins, are defined as major food allergens. These foods account for 90 percent of all food allergies:

milk

egg

fish, such as bass, flounder, or cod

crustacean shellfish, such as crab, lobster, or

shrimp tree nuts, such as almonds, pecans, or walnuts

wheat

peanuts

soybeans

The law allows manufacturers a choice in how they identify the specific “food source names,” such as “milk,” “cod,” “shrimp,” or “walnuts,” of the major food allergens on the label. They must be declared either in:

the ingredient list, such as “casein (milk)” or “nonfat dry milk,” or

a separate “Contains” statement, such as “Contains milk,” placed immediately after or next to the ingredient list.

“So first look for the ‘Contains’ statement and if your allergen is listed, put the product back on the shelf,” says Kane.

“If there is no ‘Contains’ statement, it’s very important to read the entire ingredient list to see if your allergen is present. If you see its name even once, it’s back to the shelf for that food too.”

There are many different ingredients that contain the same major food allergen, but sometimes the ingredients’ names do not indicate their specific food sources.

For example, casein, sodium caseinate, and whey are all milk proteins.

Although the same allergen can be present in multiple ingredients, its “food source name” (for example, milk) must appear in the ingredient list just once to comply with labeling requirements.

"Contains" and "May Contain" Have Different Meanings

If a “Contains” statement appears on a food label, it must include the food source names of all major food allergens used as ingredients.

For example, if “whey,” “egg yolks,” and a “natural flavor” that contained peanut proteins are listed as ingredients, the “Contains” statement must identify the words “milk,” “egg,” and “peanuts.”

Some manufacturers voluntarily include a “may contain” statement on their labels when there is a chance that a food allergen could be present.

A manufacturer might use the same equipment to make different products.

Even after cleaning this equipment, a small amount of an allergen (such as peanuts) that was used to make one product (such as cookies) may become part of another product (such as crackers).

In this case, the cracker label might state “may contain peanuts.”

Be aware that the “may contain” statement is voluntary, says Kane. “You still need to read the ingredient list to see if the product contains your allergen.”

When in Doubt, Leave It Out

Manufacturers can change their products’ ingredients at any time, so Kane says it’s a good idea to check the ingredient list every time you buy the product—even if you have eaten it before and didn’t have an allergic reaction.

“If you’re unsure about whether a food contains any ingredient to which you are sensitive, don’t buy the product, or check with the manufacturer first to ask what it contains,” says Kane.

“We all want convenience, but it’s not worth playing Russian roulette with your life or that of someone under your care.”

This article appears on FDA's Consumer Updates page, which features the latest on all FDA-regulated products.

May 11, 2011

Food Allergies: What You Need to Know

Food Allergy and Anaphylaxis Network

Food Allergies: Reducing the Risks

Food Label Helps Consumers Make Healthier Choices

Problems Digesting Dairy Products?

Page Last Updated: 05/13/2011

http://www.fda.gov/ForConsumers/ConsumerUpdates/ ucm254504.htm

Spring 2011 Table of Contents

Photo: Michael Kent Photography

Joanna Karpinski and Josh Widzer share married life together and a common problem—severe food allergies. NIH MedlinePlus magazine’s Naomi Miller caught up with them recently to learn more about how they cope.

What foods are you allergic to?

Joanna: Tree nuts, peanuts, and cinnamon.

Josh: I am allergic to milk and all dairy products. This includes cream, cheese, butter, and milk.

When did you start having problems with food allergies?

Joanna: My severe nut allergies developed when I was about 3 years old. The less severe peanut and cinnamon allergies began in my mid-20s.

Josh: I was too young to remember, but my Mom says that she fed me macaroni and cheese when I was around two years old. I immediately started swelling up and turning blue.

How did you find out what the allergies were? Did you work with an allergist?

Joanna: We learned about my nut allergy the hard way: I had an anaphylactic reaction to a pecan treat when I was three.

After that, my mother took me to an allergist, who used scratch tests to diagnose my other food allergies. As an adult, we used an elimination diet to diagnose my peanut and cinnamon allergies.

Josh: After the emergency room visit, we went to an allergist who diagnosed the milk allergy.

What are your symptoms? What do you do when you feel them coming on?

Joanna: If I eat a tree nut, within about three minutes I’ll develop anaphylaxis: my throat swells, it gets hard to breathe.

I break out in a rash on my chest and hands, and can get itchy all over. I immediately use an EpiPen (one type of epinephrine injector) and go to the ER.

With cinnamon and peanuts, I get a bad rash on my hands and face within a day and have to take antihistamines.

Josh: If I just touch milk products, I itch and swell very badly. Benadryl usually clears up the skin reactions. I have a full anaphylactic reaction when I eat milk products, in which case an EpiPen and emergency room visit are required.

How has having food allergies changed your lives?

Joanna: It’s difficult to eat out because I can’t trust food that I haven’t seen prepared.

Grocery shopping requires a bit more time because I have to read all of the labels thoroughly.

Since Josh and I both have different allergies, it can be a challenge to make food we can both eat.

But it has encouraged me to be very creative! I now have a hobby baking fancy cakes because no bakery could promise us an allergy-free wedding cake when we got married. So I learned to make my own wedding cake.

Josh: My allergies limit my choices of protein, so my meals contain more meat than average. Because most desserts contain milk products, I almost never eat them. Finding a cookie or cake I can eat is a special treat. Eating out also comes with some risk.

What kinds of treatments and prevention have been helpful?

Joanna: There is no cure for adults with food allergies. Medications like epinephrine injections and antihistamines can treat symptoms, but avoiding the trigger foods and carrying my EpiPen at all times is how I stay safe and healthy.

Read More "Food Allergies" Articles

Coping with Food Allergies / Married...with Food Allergies / Food Allergies: Symptoms, Diagnosis, Prevention and Treatment

Spring 2011 Issue: Volume 6 Number 1 Page 23

http://www.nlm.nih.gov/medlineplus/magazine/issues/spring11/ articles/spring11pg23.html

Spring 2011 Table of Contents

Allergic reactions to food can range from the uncomfortable to life threatening. Here are some useful tips and tools to avoid and treat them.

What Is an Allergic Reaction to Food?

An allergy is an adverse health reaction triggered by your immune system to substances called allergens.

A food allergy occurs when the immune system responds to a food as if it were a threat.

The first few times a person at risk of developing a food allergy is exposed to the food, no symptoms are likely to occur.

But the body has now been primed, and, in the future, that food may trigger an allergic response and one or more clinical symptoms.

The symptoms of a food allergy can mimic those of a food intolerance, an unrelated disease that does not involve the immune system.

An allergic reaction to food usually takes place within a few minutes to several hours after exposure to the allergen.

The process of eating and digesting food and the location of immune cells involved in the allergic reaction process affect the timing and location of the reaction.

How Food Allergies Develop

Food allergies are more common in children than in adults. Most kids will naturally outgrow allergies to milk, eggs, soy products, and wheat.

Allergies to peanuts or tree nuts often are lifelong.

An allergy that begins in adulthood, such as to shellfish, also tends to be lifelong.

Food allergies often co-exist with other diseases, such as

asthma, eczema (atopic dermatitis), and eosinophilic esophagitis, a disorder that causes severe heartburn, nausea, vomiting, weight loss, and difficulty swallowing food.

If your family has a history of allergy, and you have eczema, then you are at greater risk for developing food allergies than someone who does not have them.

The risk of harm to an individual with food allergy is hard to determine because the severity of any future reactions cannot be accurately predicted from the severity of past ones.

Fast Facts

•About one in 20 children and one in every 25 adults in the United States has a food allergy.

•In the United States, the most common food allergies are to eggs, milk, peanuts, tree nuts, wheat, crustaceans (shellfish), fish, and soy products.

•A severe, whole-body allergic reaction, known as anaphylaxis, can begin suddenly and may lead to death if not treated right away.

To Find Out More

•MedlinePlus: Food Allergy

www.nlm.nih.gov/medlineplus/foodallergy.html

•National Institute of Allergy and Infectious Diseases:

www.niaid.nih.gov/topics/foodallergy

•FoodSafety.gov:

www.foodsafety.gov/poisoning/causes/allergens/

•Centers for Disease Control and Prevention: Healthy Youth! Food Allergies

www.cdc.gov/HealthyYouth/foodallergies/

•Food and Drug Administration: Food Allergies—What You Need to Know

www.fda.gov/Food/ResourcesForYou/Consumers/ucm079311.htm

Spring 2011 Issue: Volume 6 Number 1 Page 22

http://www.nlm.nih.gov/medlineplus/magazine/issues/spring11/ articles/spring11pg22.html

Case report suggests that it's possible, but experts say there is no cause for alarm

Wednesday, May 18, 2011

WEDNESDAY, May 18 (HealthDay News) --

A boy with a peanut allergy had a severe reaction after receiving a blood platelet transfusion that may have contained bits of undigested peanut protein, according to a new case report published in a major medical journal.

Though the findings suggest that people with nut allergies may be susceptible to an allergic reaction from blood products, experts stressed there is no cause for alarm.

Not only does the report document only a single case, the boy received a platelet transfusion, which contain lots of blood serum (the liquid components of blood that don't contain red or white blood cells), explained Dr. Scott Sicherer, chair of the American Academy of Pediatrics' section on allergy and immunology.

That's different from a typical blood transfusion, in which the blood is "washed" and only red blood cells are transfused, said Sicherer, also a researcher at Jaffe Food Allergy Institute at Mount Sinai School of Medicine in New York City.

"A blood transfusion would have a lot less of the liquid from the bloodstream, and that would presumably mean if there was any peanut in the blood it would have been washed away," Sicherer noted.

The case report was published in the May 18 issue of the New England Journal of Medicine.

After a person eats nuts, some of the proteins circulate in the blood, Sicherer said. That's led experts to speculate whether or not someone with a nut allergy who receive donated blood products could react to peanut proteins in the blood.

For people with severe peanut allergies, ingesting even tiny amounts of peanut protein can set off a life-threatening allergic reaction called anaphylaxis.

But it's premature to encourage blood donors not to eat peanuts before giving blood or for questions about diet to become part of the screening process, said the report authors.

"Our case report will not change any of the current protocols surrounding blood donations," said Dr. Johannes F.M. Jacobs, of Radboud University Nijmegen Medical Center in the Netherlands.

"Further research is needed before evidence-based decisions on this point can be taken. In our case report, we only wanted to create awareness for this phenomenon among clinicians."

Sicherer agreed that the possibility that peanuts in blood products -- or other tree nuts or other foods, for that matter -- could cause an allergic reaction is worth further study.

The 6-year-old boy in the case report was being treated for leukemia and received a platelet transfusion, which helps with clotting.

The boy experienced swelling, low blood pressure and difficulty breathing, all signs of anaphylaxis. The boys' mother said he'd had a similar reaction after eating peanuts as a 1-year-old.

He was given adrenalin and recovered, according to the report.

Three of the five platelet donors reported eating several handfuls of peanuts less than 24 hours before donating blood.

Researchers never actually tested the blood product that the boy received, but they did test the boy's blood for peanut-specific IgE antibodies, the results of which indicated the boy had a peanut allergy. In addition, the boy had other prior platelet transfusions and had no reaction, Jacobs said.

Peanut proteins are more resistant to digestion that other foods, according to the authors.

"One percent of the population has peanut allergy and people get blood transfusions all the time," Sicherer said. "Allergic reactions seem to be exceedingly rare if it happens."

SOURCES:

Johannes F.M. Jacobs, Ph.D., M.D., Radboud University, Nijmegen Medical Center, the Netherlands;

Scott Sicherer, M.D., chair, American Academy of Pediatrics, section on allergy and immunology;

associate professor, pediatrics, and researcher, Jaffe Food Allergy Institute, Mount Sinai School of Medicine, New York City;

May 18, 2011, New England Journal of Medicine

HealthDay

Copyright (c) 2011 HealthDay. All rights reserved.

http://www.nlm.nih.gov/medlineplus/news/ fullstory_112210.html