The Asthma and Allergy Foundation of America has published the results of a new study
I can’t remember not having allergies to foods. My mother says they began immediately, when “normal” formulas with dairy made me ill so I was put on soy. (I hated that soy so much I can still remember the taste and to this day will not even try soy milk or other such products – YEEYUCKKK!) But colic, rashes, vomiting can be pretty persuasive for food allergy diagnosis.
I learned early, though, how good dairy tasted. My mother’s father, who would babysit me, was always convinced he knew better than anyone else. He believed allergies were nonsense and some cheese or milk couldn’t hurt me. So he’d give me bits of cheese from his sandwiches as I played on the floor nearby. And I would soon begin to “get sick” – hives, rashes, crying, stomach ache. All too often, by the time Mom got there from work, the allergic reactions had turned into asthma (although he never admitted to a connection between the foods and the reaction).
It didn’t take long for me to make the connection between being so sick and the foods I craved. I didn’t understand why everyone else could eat ice cream, but I had to have popsicles or non-dairy sherbet. Why everyone else at a party could eat pizza, but if I did, I’d be sick all night and likely for days afterward.
I couldn’t eat oranges! Just the release of the citrus oil from the skin of an orange being cut or peeled 1500 feet away – the opposite end of a large house – would cause sneezing, watery eyes. And within just a few minutes (despite staying at the other end of the house), I’d have a small rash on my skin and the inside of my mouth would feel like it had been filled with blisters. Benedryl, here I come.
And those were just the highlights. It has often felt like it would be easier to list what I could eat, instead of everything I was allergic to, or had bad reactions to.
But over the years I learned all sorts of ways to cope.
There were the safe foods – no reaction, at least so far. Reactions are not in a steady-state; they can change slowly, evolve, sometimes suddenly just stop. And new ones start.
Problematic foods – those which I can have a small amount of, if I am not sick or running any worrying symptoms (like peak flows decreasing, other allergic symptoms causing problems, any infections…). I can eat oranges now, in small amounts.
And Hell No foods – the ones that have caused severe reactions or anaphylaxis in the past, or that are related to foods that have triggered severe reactions.
I learned to adapt recipes, initially from my mother, then by studying cookbooks and learning how to exchange certain ingredients. But I also learned how to avoid things. For a while, oranges were a no-no, so I didn’t even buy them. I could eat peanuts and pecans as a child, but in my 20s I developed severe reactions to peanuts and most tree nuts (but oddly, not almonds that have been blanched.) I’ve been allergic to peas since childhood, but just a few weeks ago was served some sugar snap peas (I thought they were a different sort of green beans). No reaction – probably because of the Xolair (but I’ve promised my allergist I will not seek them out). I learned to read ingredient labels compulsively when I was younger, and am careful about new, processed foods.
Now I’m allergic to most legumes – peas, chickpeas, peanuts, lentils are out. But I can eat most kinds of beans, which are also legumes. Go figure.
Restaurants are rarely a problem, but they can be a serious one – sometimes chefs or waiters are careless. And there is nothing like having an anaphylactic reaction to spoil a nice dinner. Or ruin a promising new relationship.
Claudia Wallis is an award-winning science journalist whose
work has appeared in the New York Times, Time, Fortune and the
New Republic. She was science editor at Time and managing editor
of Scientific American Mind.
Feeding infants allergenic foods may be
the key to preventing allergies
By Claudia Wallis
Few things are more subject to change and passing fancies than dietary advice. And that can be true even when the advice comes from trusted health authorities. A dozen years ago the standard recommendation to new parents worried about their child developing an allergy to peanuts, eggs or other common dietary allergens was to avoid those items like the plague until the child was two or three years old. But in 2008 the American Academy of Pediatrics (AAP) dropped that guidance, after studies showed it did not help. And in its latest report, issued in April, the AAP completed the reversal—at least where peanuts are concerned. It recommended that high-risk children (those with severe eczema or an allergy to eggs) be systematically fed “infant-safe” peanut products as early as four to six months of age to prevent this common and sometimes life-threatening allergy. Children with mild or moderate eczema should receive them at around six months.
These are not whimsical changes. They match advice from a federal panel of experts and reflect the results of large randomized studies—with the inevitable cute acronyms. One called LEAP (Learning Early About Peanut Allergy), published in 2015, found that feeding peanut products to high-risk infants between four and 11 months old led to an 81 percent lower rate of peanut allergy at age five, compared with similar babies who were not given that early exposure. Another trial, known as EAT (Enquiring About Tolerance), published in 2016, found that after parents carefully followed a protocol to begin feeding peanut protein, eggs and four other allergenic foods to healthy, breastfed infants between three and six months of age, the babies had a 67 percent lower prevalence of food allergies at age three than did a control group. The results were strongest for peanuts, where the allergy rate fell to zero, compared with 2.5 percent in the control group. Egg allergies also fell, but the AAP is waiting for more data on eggs, says Scott Sicherer, a professor of pediatrics, allergy and immunology at the Icahn School of Medicine at Mount Sinai and an author of the April report. “We don’t want to tell people to do something where there isn’t really good evidence.”
How food allergies develop and why they have become so commonplace remain dynamic areas of research. Both the allergies and eczema (a major risk factor) have been on the rise. A 2010 study by Sicherer and his colleagues found that the prevalence of childhood allergies more than tripled between 1997 and 2008, jumping from 0.6 to 2.1 percent.
A leading theory about how these allergies develop and the role of eczema has been proposed by Gideon Lack, a professor of pediatric allergy at King’s College London and senior author of both LEAP and EAT. The “dual allergen exposure hypothesis” holds that we become tolerant to foods by introducing them orally to the gut immune system. In contrast, if a child’s first exposure is through food molecules that enter through eczema-damaged skin, those molecules can instigate an allergic response. Research with mice strongly supports this idea, whereas in humans the evidence
is more circumstantial. Lack points out that peanut allergy is more prevalent in countries where peanuts or peanut butter is popular and widespread in the environment, mustard seed allergy is common in mustard-loving France and buckwheat allergy occurs in soba-loving Japan. “Parents are eating these foods, then touching or kissing their babies,” Lack suggests, “and the molecules penetrate through the skin.”
A modern emphasis on hygiene may also contribute, Lack notes: “We bathe infants and shower young children all the time, very often once a day or more, which you could argue breaks down the skin barrier.” Researchers are examining whether applying barrier creams such as CeraVe can help stave off food allergies.
Eight foods account for 90 percent of food allergies: cow’s milk, eggs, fish, shellfish, tree nuts, peanuts, wheat and soybeans. Some scientists believe this is so because these foods contain proteins that are unusually stable to digestion, heating and changes in pH and are therefore more likely to cause an immune response.
Early dietary exposure is now the confirmed preventive strategy for peanuts and, pending more research, perhaps the other foods, although this is more easily said than done. In EAT, parents had to get their babies to swallow at least four grams per week of each of the allergenic edibles, and many found it to be challenging. As Lack observes, “It’s just not part of our culture to feed solids to very young babies.”
The Asthma & Allergy Foundation had a really difficult post today (May 9, 2019) – and it’s one y’all should read. I’ve read Peter DeMarco’s moving story about his beloved wife, Laura Levis, before, and about her death, alone on a sidewalk outside a locked ER door in Boston. It never fails to shake me. I have plans in place so it will never happen to me. I’m divorced and live alone, but know how to reach my neighbors on either side. And yet there have been times when it’s been close, when I’ve wondered whether I could get help fast enough.
This story makes me think that I’m too-often pigheaded about inconveniencing others. I have to consciously think now, “Remember Laura.”
Maybe you are thinking, “I don’t want to read that! It’s going to be too sad.”
Avoidance doesn’t save you
But here’s the thing: Many, if not most, of the people who die from asthma MIGHT have been saved!
They didn’t think their asthma was “that bad,” so they didn’t talk to their doctor about the increasing number of nights they’d wake coughing, or have bad “congestion” or colds. Or how much harder it was to do the things they regularly did, like play with the kids outdoors.
They didn’t get their prescriptions filled or let their Epi-pens expire because they couldn’t afford the cost of new ones. Instead of telling the doctor about their situation and seeing if they qualified for free or low-cost ones, they ignored the situation, as if nothing would ever happen. How often people tell me they can’t afford the drugs and then just shrug!
Or they didn’t like the side effects of the preventive medication – and asthma “wasn’t that serious of a disease,” or their case “wasn’t that serious.”
On May 7, 2019, the Asthma and Allergy Foundation of America (AAFA) released our 2019 Asthma Capitals™ report. In the report, we look at three asthma outcomes in cities across the U.S.: asthma prevalence, asthma-related emergency department visits and deaths from asthma.
About 3,600 people die each year due to asthma. That’s about 10 each day. And that’s 10 too many. The people at greatest risk of dying from asthma are black Americans, seniors and women.
In the essay below, you’ll hear from Peter DeMarco of Boston, Massachusetts, who lost his wife, Laura Levis, to asthma. Boston ranks #8 on our 2019 Asthma Capitals report. It has such a high ranking because of a high number of people with asthma and asthma-related deaths.
This Is What Laura Would Tell You About Asthma, If She Could
By Peter DeMarco, Laura’s husband, of Boston, Massachusetts (overall #8 on Asthma Capitals)
Laura was afraid of heights – so she insisted we hike the highest mountains. It wasn’t enough for her to just lift weights at the gym: she had to enter women’s powerlifting competitions. To land her dream job at Harvard University, she endured nine exhausting rounds of interviews.
Laura thrived on challenges, so it’s no surprise that’s how she approached her asthma. It was just another challenge she needed to overcome.
I think that is why she decided to walk alone to the hospital the morning her attack struck. She was staying only a few blocks away, so she knew she’d be there in a couple of minutes, faster than calling an Uber. It was 4 a.m., and I wasn’t there, so maybe she felt embarrassed about waking someone else up to ask for help.
Laura had dealt with asthma for nearly 10 years, so she thought she knew what to expect – she could almost sense when a heavy pollen day, or extreme humidity, or a very dusty room might trigger it. When an attack did become severe, we always made it in plenty of time to an emergency room or to an all-night CVS pharmacy for nebulizer fluid. I would usually have to prod her to go though; she always thought her attack would subside if we just gave it another few minutes.
She always believed she could beat it herself.
Laura was so confident that September morning – so sure this would be just “another” attack – that she threw gym clothes into her backpack, perhaps thinking she could get in an early workout once she left the hospital. Nevertheless, she must have been so relieved when she reached the emergency room door.
But Laura did not beat her asthma that morning, because something terrible happened. Something she could never in her life have anticipated. The hospital door was locked, and there was no one in sight to let her into the emergency room.
Everything that could have gone wrong for Laura did go wrong that morning. The hospital security desk was left unattended all night … her 911 distress call was mishandled … those responsible for finding Laura went to the wrong hospital door. All unexpected. All beyond Laura’s control.
I have written this essay for the Asthma and Allergy Foundation of America because Laura can’t have died for no reason. Her story just has to save someone else’s life.
So this is my message to you – no, this is Laura’s message to you:
Nothing is truly in your control until your asthma is back under control.
Please, please, please factor in the unexpected. Make it your mantra. Your inhaler could have a defective cartridge. You could be stuck in standstill traffic due to an accident. The hospital door you try could be locked, with no one in sight. It’s not about what you know from past attacks. It’s what you don’t know about the next one.
When an attack strikes, don’t be alone – tell someone as soon as you can. Don’t be embarrassed to ask for help or think that by telling someone you are letting asthma win. Without oxygen, you have between three and six minutes to live. Telling someone you’re having an attack could save your life. That is how you beat asthma, by living.
By living.
I wish more than anything in the world that Laura had done that. If only she’d woken up the person she was staying with. If only she’d dialed 911 the moment her attack turned severe. If only she’d called me.
It has been just over two and a half years since her attack. You cannot imagine what it is like to lose the person you love to asthma. Tears are falling onto my keyboard as I type this.
So please, remember my wife. Remember Laura Beth Levis. But more importantly, remember her message.
When an attack strikes, tell someone.
Don’t be alone.
Don’t die alone.
How can we reduce asthma deaths?
What can we do to reduce asthma deaths? Having your asthma under control greatly reduces the risk of dying from asthma. If you have asthma, see an asthma specialist, such as an allergist or pulmonologist, to help you come up with an asthma management plan. This includes:
Following your Asthma Action Plan and acting quickly when you start having symptoms (tell people around you about your asthma and your Asthma Action Plan!)
Every effort you make matters. But it’s more effective if we all work together. Join us during National Asthma and Allergy Awareness Month to spread awareness about asthma. Encourage those around you to do the same. When everyone understands asthma better, we can all work to create more asthma-friendly schools, workplaces and communities. You can also advocate on a local and national level for protections for people with asthma. Here are just a few ways you can help improve asthma in your area:
Share our Asthma Capitals report with local leaders, politicians, schools and health care providers
Sign up for AAFA’s online community to opt-in to be a patient spokesperson, and take action on our advocacy alerts
Reduce your contribution to air pollution
Vote for asthma-friendly policies
Spread awareness on your personal social media account
Get the best explanation from the scientists and physicians working on peanut allergies. And a copy of my emergency medical flight kit components.
I was at a party recently and someone asked me a really good question:
“How is it that someone sitting in the back of an airplane can open a bag of peanuts, and trigger an allergic reaction in someone dozens of seats away, when neither of them has moved and no one has walked by or touched one and then the other?”
I pointed out my obvious lack of credentials and standing, but said I had a secret weapon. I volunteer with the Asthma & Allergy Foundation of America, aafa.org, a truly wonderful organization and source of information. They have a great allergist and I asked him.
Dr. Eagan and Dr. Greenhawt reviewed the evidence on the question regarding risk of reaction for a patient allergic to peanut during air travel. I have often thought of this as well, given my own daughter has severe peanut allergy.
In summary, there are reports of reactions on airlines which are thought to be due to inhalation peanut dust in the cabin. The risk of anaphylaxis with this type of exposure is rare. And it is felt that it would be more likely that there is accidental transfer of protein and ingestion.
I have provided some quotes from their discussion in the article above:
“Although allergic reactions on commercial airlines have been reported, current literature is based on self-report of symptoms, which is subject to bias, so true prevalence is unknown.34–36 Sicherer et al34 surveyed patients in the National Registry of Peanut and Tree Nut allergy and found that 62 of 3,704 individuals reported a reaction on an airplane, with reported ingestion exposures being associated with the most severe symptoms. Among the 14 patients who reported symptoms from inhalational exposure, the timing and exposure history was not convincing in 3, and in the remaining 11 participants, more than 25 passengers were eating peanuts at the time of the reaction in question.34
“Greenhawt et al35 reported similar findings with a more recent survey of participants in the Food Allergy & Anaphylaxis Network. Of the 150 participants who reported having an inflight reaction, 15.7% reported reactions attributable to ingestion, with inhalational, skin, and unknown exposure accounting for 48.6%, 27.9%, and 7.8% of reactions, respectively. Surprisingly, although 33% of participants reported symptoms consistent with anaphylaxis, epinephrine was only used in 10%, highlighting the under treatment of reactions.35 “
“Although there is a report of peanut protein being recovered from airline air filters, representing a cumulative exposure,38 studies on inhalational and contact exposures to allergens do not support the notion of systemic reactions with casual contact. As well, it is unclear what particle denoted in an air filter represents because these particles could be pulled from circulation without passage through the cabin (Fig 1).39 Therefore, it remains somewhat likely that the reported inhalational reactions were caused by unnoticed ingestion (peanut inadvertently consumed through casual hand to mouth contact of uncleaned residual levels on surfaces) or another source, such as anxiety-induced symptoms. 35 Overall, inflight medical emergencies are rare, with allergic reactions contributing to a small portion of all events, and it appears that most peanut allergic passengers fly without event. Therefore, there appears to be no evidence to support that commercial air travel is dangerous or should be contraindicated for the peanut allergic patient.”
“Although the risk of reaction is low, all patients with a food allergy who fly should have emergency medications with them, including 2 epinephrine autoinjectors, and should ensure that epinephrine is used for treating severe symptoms.8 The decision to travel on a commercial airline that serves a culprit allergen is individual, but again the available evidence demonstrates that the presence of an allergen is of low risk, likely not to cause any problem as long as the allergen is not directly ingested. We believe that peanut or tree nut allergy should not serve as contraindication for travel in most circumstances, given a low likelihood of an event occurring and multiple risk-reducing behaviors that passengers can implement.”
Douglas T. Johnston D.O. FAAAAI, FACAAI Medical Scientific Councilmember, Asthma and Allergy Foundation of America
Assistant Professor of Internal Medicine / Allergy & Immunology Edward Via College of Osteopathic Medicine – Carolina Campus
Adjunct Professor, Department of Public Health Sciences College of Health and Human Services University of North Carolina at Charlotte
We encourage you to register for AAFA’s online community for additional information and support: https://community.aafa.org/join.
Travel asthma emergency kit
I found this reassuring. In all the traveling I’ve done, I’ve seen medical emergencies, including asthma, and a couple of allergy issues, but never requiring more than Benedryl. I’ve never seen an obvious need for Epi-pen on a plane. I’ve had a few bad times on airplanes, but again, never to the level of needing help beyond moving me to a different seat (and those were triggered by perfume in one case and a cat smuggled into the cabin in another).
What always amazes me, though, is just how often parents of highly allergic children, who have witnessed their children almost dying from anaphylaxis, will fail to have a fully equipped emergency asthma/allergy kit with emergency instructions (called anAsthma Action Plan – AAP) printed out and easy for others to find. As in ON THE CHILD or immediately next to the seat.
Having it in your carry-on, crammed above seats several rows behind you, and not obviously known as yours, will do you no good in an emergency. Same for your child. It should ALWAYS be physically on you/him or her in a fanny pack or obvious medical bag. (Get one with a big cross or asthma & allergy or KFA* printed on it.) I carry a large brightly colored tote on board, with all kinds of things medically necessary in an emergency in it, medical kit front-and-center.
PS – People frequently ask me what precautions I take when I travel, and the meds I take along. So here’s the emergency asthma & allergy part of that:
Two Epi-pens, unexpired;
Benedryl capsules and Benedryl liquid;
Benedryl ointment for skin contact;
Zyrtec;
Flyp portable nebulizer (an incredible tiny, battery-powered nebulizer not much larger than a deck of cards – what an improvement!) and nebulizer solutions;
Prednisone (10 mg.) tablets;
Rescue inhaler (levalbuterol), azelastine nasal spray and eye drops;
Disposable masks and gloves, medical grade;
Individually wrapped alcohol pads (make sure they are still “juicy”); and
Alcohol-based hand sanitizer.
Be sure and ask your doctor the maximum number of Benedryl capsules and Zyrtec (or other antihistamine) you can take in an emergency and write it down on your plan. Ideally ask your pharmacist put it on a label for the package, and put that into your emergency kit.
Sometimes a few sips of liquid Benedryl can help ease any throat swelling and allow me to swallow capsules, but too much will cause me to choke and vomit. Discuss what to do in that situation with your doctor and put that in your emergency plan.
I board planes early because of my disability. Using alcohol pads, I wipe off the light and call buttons, armrest, belt buckle, tray table, even the parts of the seats I might touch. (I have trouble reaching above my head to the luggage bins, so those usually get a pass. I also regularly wipe off the handles and outside of my luggage, walker and purse with alcohol.)
*KFA – Kids with Food Allergies – is a wonderful off-shoot of AAFA, with helpful info on food allergies for us adults, too. I only wish this would have been available when we were little. My mom struggled so to keep us safe, and balance that with our normal kid preferences and our desire to be like the other kids! It definitely would have made her life, and ours, so much easier.
