Practice Makes Perfect: Food Allergy Emergency Response Training

Although awareness of food allergies is increasing, it is important to periodically convene as a community to review the signs and symptoms of a severe reaction, understand when and how to use an epinephrine auto-injector (EAI), and most importantly, practice using EAIs to ensure that you are ready to respond.

Last week my team and I had the privilege of connecting with over 80 community members, including 45 children, to discuss how to best manage an anaphylaxis emergency and practice using EAI trainers.  A group of engaged moms organized the training alongside providing dinner and space for dodgeball as a fun way to help educate their children’s friends on how to respond in a food allergy emergency. 

As many of you know, severe reactions like anaphylaxis often occur where children live, learn, and play – many times outside the home and can be caused by food, venom, latex, and medication. While a person may be allergic to any type of food, the most common food allergens are: milk, egg, peanuts, tree nuts, finfish, shellfish, soy, and wheat.   

Common signs and symptoms discussed at the training included: shortness of breath, itchy skin and hives, vomiting, swelling of lips or tongue, headache, loss of consciousness, and dizziness.  In short, a severe reaction is considered when a person is showing signs from more than one organ system.

To ensure proper management, especially in case of an accidental ingestion, it is important for your child and their peers to know when and how to use an EAI. It is essential that the person with the life-threatening allergy carry two EAIs everywhere, every day.

Once a severe reaction is identified, it is important to administer epinephrine as soon as possible.  To effectively administer an EAI, you’ll want to remember 5 simple steps:

1.     Remove the safety cap or needle covering.

2.     Inject the epinephrine into the outer thigh until you hear a click. The device will go through clothing.

3.     Hold for 3 seconds.

4.     Remove the device and massage the area for 10 seconds.

5.     Call 911 and person’s emergency contacts.

For more information on signs and symptoms and how to best respond during a food allergy emergency, please check out our videos and educational materials designed for children, adolescents, and young adults: http://www.ruchigupta.com/kidstalk/

Allergic to Eggs? Try These Eggcellent Ways to Celebrate Easter and Passover

Easter and Passover traditions often include eggs, either as part of a fun holiday activity or a recipe. For people with life-threatening egg allergies, the key to staying safe is to be aware and prepared for an unexpected exposure. 

Approximately 1-2 percent of young children have egg allergies*,” says Ruchi Gupta, MD, MPH, Associate Professor of Pediatrics & Medicine; Director, Science and Outcomes of Asthma and food Allergy Research (SOAAR); Director, Program for Maternal and Child Health at Northwestern University and Anaphylaxis Community Experts volunteer in Chicago, IL. “Creating traditions without the threat of egg exposure is easy to do. A little planning and creative thinking is what’s required to have a fun and tasty celebration.”

Kids with egg allergies can participate in Easter games and Passover activities. Consider the following ideas:

- Coloring eggs is a safe activity, as long as the person with egg allergies does not eat the eggs. Touching the hard shell poses no threat.

- Instead of placing a hard-boiled egg on a Seder plate, consider using a flower or a plastic egg.

- Use plastic eggs for your egg hunt and fill them with toys, money, stickers, or candy. Just be sure to read candy labels first! You can also use plastic eggs instead of real ones when playing the “egg in a spoon” race.

Getting together with family for the holiday? Be sure to include egg-free recipes when cooking meals and ask about ingredients in recipes made by others.

For each egg required in a recipe, substitute one of these mixtures:

- 1 and 1/2 tablespoons water, 1 and 1/2 tablespoons cooking oil and 1 teaspoon of baking powder

- 1 teaspoon baking powder, 1 tablespoon water and 1 tablespoon vinegar

- 1 teaspoon apricot puree

- 1 packet of plain gelatin mixed with 2 tablespoons of warm water. 

Source: Texas Children’s Hospital, Houston, TX

“Easter and Passover celebrations should be fun and inclusive. But, everyone with life-threatening food allergies should be prepared for the unexpected accidental exposure. Preparation includes always carrying two doses of your prescribed epinephrine auto-injector and knowing what the signs and symptoms are of an anaphylactic reaction,” says Dr. Gupta. 

   * Gupta RS, Springston EE, Warrier MR, Smith B, Kumar R, Pongracic J, Holl JL. The prevalence, severity, and distribution of
childhood food allergy in the United States. Pediatrics 2011 Jul; 128(1):e9-e17.

About Anaphylaxis Community Experts
The Anaphylaxis Community Experts (ACE) program is developed by Allergy & Asthma Network in partnership with the American College of Allergy, Asthma & Immunology (ACAAI), National Association of School Nurses and American School Health Association and is sponsored by Mylan Specialty L.P. The program goal is to save lives through showing parents, school staff, emergency responders, and others how to recognize and respond immediately to anaphylaxis symptoms. 

About Allergy & Asthma Network
Allergy & Asthma Network is the leading national nonprofit organization dedicated to ending needless death and suffering due to asthma, allergies and related conditions. Allergy & Asthma Network specializes in sharing family-friendly, medically accurate information through its award-winning publication Allergy & Asthma Today magazine, E-newsletter, website at http://www.AllergyAsthmaNetwork.org and numerous community outreach programs. Follow Allergy & Asthma Network on facebook.com/AllergyAsthmaHQ and twitter.com/AllergyAsthmaHQ. Join at www.AllergyAsthmaNetwork.org/join.

About ACAAI

The ACAAI is a professional medical organization of more than 6,000 allergists-immunologists and allied health professionals. The College fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy and research. ACAAI allergists are board-certified physicians trained to diagnose allergies and asthma, administer immunotherapy, and provide patients with the best treatment outcomes. For more information and to find relief, visit AllergyandAsthmaRelief.org. Join us on Facebook, Pinterest and Twitter.

The Best Possible Outcome

Justin Zaslavsky

Most lawyers are familiar with President Abraham Lincoln’s words: “He who represents himself has a fool for a client.” The interpretation I’ve always heard – as the son of a criminal defense lawyer – is that being so engrossed in a situation can blind you to its realities, making it difficult to achieve the best possible outcome.

This concept is obviously detrimental in criminal trials, but I recently understood it in a pretty unorthodox context when I went into anaphylaxis during my time working as a research assistant at the Food Allergy Outcomes Research Program with Dr. Ruchi Gupta at Northwestern University in Chicago.

I’ve struggled with food allergies all my life. I spend my day with two EpiPens, forever asking if there are tree nuts or chickpeas or sesame in anything I eat. I was lucky to grow up with a strong parental support system that allowed me to go about my childhood virtually worry free – mainly because my mom worried enough for the both of us. She even made sure that I met with the campus dietitian at Tufts University when I started college to talk about food on campus, so that I could feel safe when eating in dining halls.

Despite all of (or possibly because of) what my mom has done for me, I have been disturbingly careless when it comes to my allergies. As an Emergency Medical Technician (EMT), I am well aware of the dangers of the multi-system allergic reaction known as anaphylaxis. Regardless, I still feel invincible – just like all my other 19-year-old counterparts – when it comes to the impact my allergies have in my life. It is in part this teenage naiveté (or less euphemistically, ignorance) that led to my most recent attack.

The story of that day is well-known in the allergy world: I had thought I read the ingredients on a package of kale chips, but ended up eating a kale chip that included cashews (one of my allergens). My throat began to tingle almost immediately, so I ran out and bought Benadryl. Back in my office, I threw up (a lot) and felt my throat closing tighter and tighter. By the time my supervisor convinced me to go to the hospital emergency department  (about 15 minutes later), I was barely able to breathe. It was one of my worst reactions ever – requiring the equivalent of three EpiPens and three courses of albuterol, to open up the airways in my lungs. I was ultimately admitted to the hospital.

The nuances of this story, however, are less simple. My first mistake: I hadn’t told Dr. Gupta that I had food allergies. I didn’t think it was appropriate or relevant to my ability to do the work requested of me in the lab. This only added to the embarrassment I felt during my reaction, and it made me more inclined to downplay my reaction when it occurred. This also had the potential to create a situation during which epinephrine would be further delayed if I had lost my ability to advocate for myself (e.g. tell her I was going into anaphylactic shock), endangering myself even more.

My second mistake: I delayed using my EpiPen. Typically, an epinephrine auto-injector should be used at the first sign of a severe reaction, but being so well versed in allergic reactions from the perspective of an academic and provider made it difficult for me to recognize the severity of my reaction and respond accordingly. I should have known I needed epinephrine not as an EMT, but as a self-aware person with allergies. Finally, I forgot to follow the tenet of living with severe allergies: always carry your epinephrine auto-injector.

I was very lucky that I worked so close to an emergency department, and I was even luckier that I was with people who understood food allergies. I can assure you that I now always carry my auto-injectors, and that I will try to be more aware of what my body needs. It’s a hard practice – balancing food allergies with a strong work ethic and disdain for being a burden on anyone – but it is something I need to develop. I need to have an internal frame-shift from encumbrance to acceptance of my condition that occasionally requires my full attention and trust in others, so that I survive.

I can’t help but think how I’ve developed my current, skewed understanding of my allergies. Is it that my mom always carried my auto-injector for me and I didn’t need to worry? Is it the mindset that surrounds food allergies in our society? A sense of invincibility? Does one need to have a serious reaction to start taking their allergies seriously? I wish I had the answer, but I sadly do not. For now, though, I am just going to hope this post-reaction hyper-awareness persists.

***

Dr. Ruchi Gupta: Insights of a witness to anaphylaxis

Dr. Ruchi Gupta

Before this reaction, Justin had been working on many of our food allergy and asthma related studies, but I was unaware of how personal both of these topics were to him until the day of his reaction in our lab – a day that will forever be etched into my memory.

I am a pediatrician, food allergy and asthma researcher, and a mother of a child with food allergies. I speak around the world about anaphylaxis management (coincidentally, I frequently speak about teens, independence, and risk-taking).

On this day, I learned how complex “doing the right things, in the right order” really is. After I realized Justin might be having a severe allergic reaction, my mind was flooded with thoughts. What should I do? Did Justin have his EpiPen? Should we head to the Emergency Room two blocks away? Should I listen to Justin, a young adult, or can I tell him what to do?

I was able to see first-hand what I research, and I learned a tremendous amount because of that. I learned just how hard it is in the moment, even as a physician, to know when to call a reaction anaphylaxis and then take the necessary steps to intervene.

I believe Justin taught me more this summer than I taught him. We both learned the importance of always checking labels, being prepared with epinephrine, making sure to react quickly, educating people around you, and the importance of having strong support systems. We both learned how difficult identifying an anaphylaxis emergency and acting on it can be.

We also learned what I often preach  trust your instincts and if there is a suspicion this could be serious, always act! Luckily, even after the confusion, we did act and Justin is doing well and is all the wiser (as am I).

Dangerous Bites: Cultural Implications of Food Allergies

If you have a chance, I highly recommend checking out this article about the cultural implications of food allergies in Asian American communities.  It was published yesterday by Grace Hwang Lynch, a Bay Area writer who I've gotten to know over the last year as she conducted research for the piece.   Her article is one component of "Off the Menu: Asian America", a multimedia project which also features a one-hour PBS primetime special.  Hope you like it!  

Five Fabulous Femmes!


Last night I had the enormous pleasure of attending the premiere anniversary gala held by the amazing non-profit, Demoiselle 2 Femme. If you're not already familiar with their work, their mission is to provide holistic services, education, instruction and training to assist adolescent girls in a successful transition to womanhood. Over the last two decades Demoiselle 2 Femme has provided prevention and education programs to more than 3,000 girls ages 13-19 in the Chicagoland community! Through their programs, girls are challenged and empowered to utilize critical thinking skills to make healthy decisions as they navigate adolescence.

I have long admired the work of D2F and feel so deeply honored to be acknowledged as one of their 2015 Five Fabulous Femmes for my research and advocacy. My fellow honorees last night were:

  • Darlene Hill, Anchor and Host of FOX-TV's Good Morning Chicago
  • Toni Preckwinkle, Cook County Board President  
  • Elizabeth L. Corey, Business Lawyer at Foley & Lardner LLP & 
  • Katherine Darnstadt, Architect and Founder, Latent Design
Thank you so much Demoiselle 2 Femme for the TRULY FABULOUS work you do on behalf of girls and women throughout Chicago!