Please feel free to post questions and comment on questions in this group. 

Comments

I would love to hear comments about excellent sessions attended at the AAAAI Annual Meeting in Houston or...what you thought was missing from the program?

I really loved seeing more FPIES talks this year.

Marion Groetch replied on

The meeting was great and it was nice to see everyone.

I really enjoy the interactive talks with panels of different providers from different institutions.

I really enjoyed Vivian Trujillo's talk at the Advanced Practice session on Friday.

Maria Crain replied on

How will you be advising your parents of infants with atopic derm and/or egg allergy (or any other food allergy) in light of the LEAP study results?

Marion Groetch replied on

For me the publication has just confirmed our current practice, as we had already used the practice now finally proven by LEAP study. We have been lucky in tertiary centre to be able to test our atopic cohort and if not allergic to nuts/egg then an active introduction.

Rosan Meyer replied on

Do you ever recommend probiotics to infants and if so, has the recent FDA warning (posted below) caused you to make any changes to your practice?  I know we are not typically working with neonates but nonetheless I am always a bit concerned about supplements due to the poor oversite and regulation.

http://www.fda.gov/downloads/BiologicsBloodVaccines/SafetyAvailability/UCM426233.pdf

Marion Groetch replied on

What are you most looking forward too about the 2016 AAAAI Annual Meeting?

Admin User replied on

Will your institution/clinic/practice be preforming OFC to peanut infants?

Admin User replied on

Has your institution developed a protocol for infant oral food challenge to peanut?

Do you have concerns that parents will attempt peanut introduction at home in high risk infants?

Elisabeth Stieb replied on

Is there a concern that parents of high risk infants will introduce peanut at home in infant age group without consulting PMD or an allergist. What recommendations are you offering?

There is no auto-injectable epinephrine dose for infants available. Does this prevent you from recommending home introduction in a lower risk infant?

Elisabeth Stieb replied on

Sensitization does not equal allergy.  What can we do to dispel this misconception?

  •          Peanut reactions tend to be acute onset in the context of an ingestion and tend to produce symptoms up to several hours post ingestion, but generally much sooner.  Asthma, even acute exacerbations, generally have some prodromal symptoms, like decreases in peak flow, decreased exercise tolerance, URI, etc.
  •          Clinical history of peanut reaction is more significant than positive peanut sIgE, which like all sIgE testing has a false high positive rate.  Unnecessary testing is an expense and can result with removal of a food and all the strategies that accompany food avoidance.  How do you manage patients who request large panels of skin or sIgE testing.
  •          Unnecessary removal of a major food protein (peanut) places an undue psychological, social, and financial burdens on patients and families. School system and healthcare systems are further taxed by unnecessary accommodations, clinical encounters, testing, and  medications.   
  •          Peanut has 5% rate of cross reactivity with other legumes.  It is not necessary to avoid asthma MDIs containing soy lecithin due to either peanut sensitization  or peanut  allergy.  Do you find teaching patients about cross-reactivity to be helpful in preventing unnecessary avoidance.
  •          MDIs containing soy lecithin are safe for soy allergic individuals. What can we do as healthcare providers to promote up to date patient education?

Elisabeth Stieb replied on

We know from many studies that the financial burden of allergen free foods is one factor that contributes to lower QOL reports from patients and families with food allergies.  
Food is only one of the added economic burdens of food allergy for families and individuals.
What do you recommend regarding food selection to patients who have limited income? 
What resources do you use in your community?

Elisabeth Stieb replied on

This is a great question.

As a dietitian I always discuss ways in which a patient can prepare food from scratch rather than rely on the specialty allergen-free convenience foods.  For instance instead of using an allergen-free pancake mix (that is expensive and has literally 3 ingredients) or premade cookies from an allergy-friendly company, I provide a simple recipe that uses a safe tolerated flour (whole grain if they are willing). Home prepared foods can also be healthier as one can control the ingredients.I teach them to prepare in bulk and freeze-essentially make their own convenience foods- and everything can be made this way from pancakes, waffles, cookies, muffins to soups, meatballs, chicken tenders and pasta and sauce.  The trick is to always cook more than you are planning to eat at one sitting and then freeze the extra in individual serving sizes- wrap pancakes in packs of three (or whatever portion is appropriate) and store in freezer bags or freeze meatballs and tenders individually on a cookie sheet and then store in a freezer bag (otherwise they become one block of meat and are no longer convenient). Family meals can be made this way too. Those who don't have the extra money to spare may also be short on time and bulk cooking is a handy tool. 

Also there are many foods from the standard grocery store that are fine such as fresh (or even frozen store brands) of vegetables, fruits and meats that are free from the major allergens as well as items like rice, beans, etc. It is helpful to discuss all the foods that are allowed to remind them that these can provide the bulk of the diet.  Purchasing as much as possible from the standard grocery store is best- and avoiding as much as possible the upscale natural stores.  

Lastly, having an awareness of what convenience items are available in the standard grocery store is helpful.  I like the food allergen labeling policy of General Mills (and the many brands that fall under this company) as they label not only for the major allergens but also for sesame.  They also use precautionary statements for all the major allergens plus sesame. As I am sure you are aware, precautionary statements are voluntary and some companies don't use them at all and some choose to use them simply if there is a risk of peanut or tree nut cross contact.  These GM products can be more expensive than store brands generally but less expensive than companies that cater to the allergic consumer.  There are many other products and brands that my patients use from the standard grocery store. I don't mean to promote any one company but it is important to understand the differences between manufacturers and their labeling policies.

I think our patients benefit from expert guidance on allergen avoidance as well as some basic tips to help them avoid at least some of the extra cost and time burden of having a food allergy.I know unfortunately that some extra cost is unavoidable. 

I'd love to hear other ideas!

Marion

Marion Groetch replied on

Thank you for your expertise Marion!  It is great for food allergic patients, especially those with multiple food allergies, to have an evaluation by a nutritionist.  We all focus, appropriately and for reasons of safety, on food avoidance, but patients and families learn a lot about avoidance and not enough about safe and varied options. Aside from calculating caloric needs, growth and development needs, micronutrients, etc., the nutritionists are able to present food allergies in a different light focusing on what can be eaten. It is a very positive view that food allergic patients and families need!  Your specific recommendations on cooking from scratch to lower cost and on cooking  larger amounts and freezing to create at home convenience foods is great.  I am always surprised to learn how many people do not prepare their own food!  It is a mainstay for food allergic families and one of the first recommendations we talk about.  You are your own quality control this way and it is certainly less expensive.

Despite all great efforts, patients do find themselves in financially difficult situations. Allergen specialty foods, especially wheat free, are very costly.  We are hearing reports of local food banks stocking allergen free foods.  Recently a patient with food allergies had her birthday guests donate allergen free foods to a local food bank.   Does your community have a food bank that offers access to specialty foods?  Do you know what system is in place to ensure that the families receiving the allergen free foods are receiving them appropriately?

Have you had any interaction with your local food banks on behalf of patients?

Lisa Stieb

Elisabeth Stieb replied on

Hi Lisa,

I agree the gluten free items tend to be very pricey.  

I have not been in contact with my local food bank.  What a great idea!  Thanks!  

I am sure we can come up with many ways in which we can donate to the local food pantries.  

Maybe the local FARE walks can ask participants to bring a donatation for the local pantry.  

Or during National Nutrition Month (March) we can ask for donations in our hospitals.  

I am sure we can all come up with creative ideas...

Thanks again.  

Marion

Marion Groetch replied on

  • Interesting study on increase ED visits and hospitalizations for food induced anaphylaxis during a 5 ( 2008-2012) year period in Illinois. 
  • ED and hospitalization rates increased rate of  29.3% annually and hospitalization rates increased 18.8%. Do you see this trend in your areas?
  • Hospitalization occurred more frequently due to milk anaphylaxis.  Great teaching point for milk allergy which often is thought of by families and general public as more benign than peanut allergy, for example.

Elisabeth Stieb replied on

The articles posted today (7/13/15) are interesting. I like seeing the news release that might be read by patients and families as well as the PubMed abstract/article. What do you about the info on predictors of bi-phasic reactions?

Anne Borgmeyer replied on

The Article posted by Reno, Brooks and Ameredes discusses the idea that asthmatics are predisposed to sulfur dioxide sensitivity leading to asthma exacerbations. I think it is helpful to read the "science" and possible role of IL-10 and yet the mechanism is still unclear. When I talk with patients I remind them that airways of asthmatics are different from those people without asthma. I talk about the airways being more sensitive. Does anyone have a patient friendly way of talking with asthmatics about this complex subject?

Anne Borgmeyer replied on

It's hard to believe that in the midst of summer activities, that planning for the 2016 Annual Meeting is well underway!  The deadline for submitting abstracts for the 2016 meeting is September 1 - coming up very quickly.  Think about submitting an abstract to showcase the work you do as Allied Health Professionals for our specialty!

Sally Noone replied on

For your patients with EoE following six food elimination diets,are you recommending gluten-free or just wheat-free diets?

Marion Groetch replied on

Has anyone had the experience of a patient who reacts to certain soy ingredients such as soy protein isolate but not other soy ingredients such as soy flour or soy milk? The symptoms are mild (itchy mouth, throat).  

Marion Groetch replied on

FPIES is being recognized and diagnosed more than ever before.  Check this site for articles about FPIES from the diagnostic, family and nutritional education standpoint.

Sally Noone replied on

FPIES is doing great in updating everything and I like this site more and more. I have read a really good articles on diagnosis of astma and as in one of the articles at http://blog.remind.com/17-tips-for-effective-note-taking/  is written that that site helps to renew the knowledge and new sympthoms of some illness.

Grace Wellington replied on

You are right, FPIES is being discussed much more now than ever.  Our FPIES families are feeling much less isolated and glad to see research being done.

Sally Noone replied on

What type of topics would you most like to see programmed at the 2018 AAAAI/WAO Joint Congress?

Admin User replied on