What Is The Big Deal?

In the past 3 weeks, the allergy world has gone crazy over the fact Keebler is going to add peanut flour to its cheese cracker sandwiches. People have been contacting the press, saying that it will kill children, and as of late saying the company will cause anaphylaxis and death. All this towards one company for adding a food ingredient. These crackers were never allergy friendly to begin with; they have milk and wheat in them. These crackers posed a risk to dairy allergic children in their current formulation. The lovely cheese can stick to little hands and spread just as those fear the peanut can. But we dairy moms have always found a way to survive around them.

I personally am having a hard time understanding the outcry. When you are a dairy allergy parent or like me a multiple food allergy parent, you are used to having limited options. Almost all snacks have dairy in it. Most kids love goldfish, or Pirate’s Booty–two very common foods that present risk to children with dairy and other allergens. So where is the outcry for them? Where was the outcry every time a company adds milk, egg, soy etc. to a product? McDonald’s is not a place my family goes to, but where was the outcry when they made every single item unsafe for a dairy allergy person?

It is not Kellogg’s that needs to be held responsible for the health and safety of others, it’s the parents of the allergic child. It’s vital to read labels each and every time you give something to a child. Ingredients change all the time!  In addition, I noticed in many food allergy groups the concern is that someone will hand a child the cracker and assume it’s safe. Why do we allow allergic kids to take food that we ourselves don’t supply? I supply and have supplied all snacks and lunch for my children. Truly, it’s the only way to make sure what they are eating is safe. Also, my school district has a no sharing food rule and I have to agree. We must teach our children at a young age never to share food.
It is so sad to see all this effort spent on talking about one company and only one of the top 8 allergens.  Our communal efforts should be spent on education and raising awareness  for ALL food allergies. Instead all we have now is drama and divisiveness.  


Why limit food allergy voices?


Recently, a post was made in the food allergy community talking about tearing down scaffolding yet again. First, I am not really sure why we are using the term “scaffolding” when we talk about food allergies. That being said, I have to assume this post was written because with the Keebler Cracker fall out, there has been division within the food allergy community its self. The Facebook allergy support groups have gotten pretty heated. I read this latest post and I tried to have an open mind. I must, however, highlight what was going through my head reading it. 1st and most obvious the picture yet again had peanuts as the representation of the issue, when in fact we have top 8 allergens, all of which can cause anaphylaxis. What disturbed me most was the request to keep our voices silent if we disagree–to allow a panicked mother to remain in her panic and support her in that state; to not  tell her the risks are low; to not talk her down; to basically yes her. It basically said if you don’t agree, keep quite.

The post also said those who do speak up and say “wait a minute” are divisive and hurting the allergy community as a whole. I can’t understand this. Why would anybody want to live in a such a panic state? To the point they limit themselves from activities when it’s not warranted? Why can’t a mom who has been there say, hey stop! We got through it! and share strategies that don’t include full on limiting of activities such as going to the playground in fear. How can that be bad?

It is ironic that the parents who are often attacked are the ones who speak up against the groups’ popular opinion, not the other way around. I mean if a food allergy parent says they don’t support a peanut ban, or a petition or a lawsuit, you better duck for cover because it gets ugly. We are not allowed to have these opinions.

Facebook groups are not really support groups; they are also not medical diagnostic groups. They are discussion groups. Many people have many different allergens, and many different approaches to how they handle their allergies. As indicated by the most recent scaffolding post, however, we are dealing with a situation where only one voice is allowed to be heard. Our different approaches and opinions should be celebrated not attacked and censored. At the end of the day, we all want happy, healthy and well-adjusted kids. We also want people to know that there are many types of food allergies and ALL need the same respect.


Guest Post by Dr.David Stukus

Navigating the World with Food Allergies
By David Stukus, MD
As a pediatric allergist, I’ve had the opportunity to meet thousands of families living with food allergies. I love this part of my job as I have the chance to help these families establish a proper diagnosis as well as provide information to help them understand, communicate, and prepare for a life with food allergies. I also learn a ton from working with these wonderful families, which helps me better understand the multitude of situations that cause concern or result in accidental ingestion. I then get to ‘pay it forward’ by using this information as anticipatory guidance for other families, particularly those with a new food allergy diagnosis.
In addition to learning the different ways in which families manage food allergies, I also witness a wide variation in levels of anxiety that people experience. There are extremes at both ends, which always concerns me: some people have zero concern or even purposefully feed their child something which they are allergic to in an effort to ‘treat’ their allergies; others are engulfed in fear such that they won’t send their child to school or let them go to the park. Fortunately, the vast majority of families fall somewhere in the middle, with a healthy level of concern that ensures adequate avoidance measures and preparation for accidental ingestion. Most of them never experience another reaction after their food allergy diagnosis is established.

In our world of instant access to countless internet resources and social media groups, I believe it is more important than ever to rely on evidence-based information when making decisions about one’s health. This is the reason that I participate in social media: to help raise awareness and dispel common myths. I hear food allergy misconceptions every day, from not only families, but other physicians as well. I’ve also encountered many concerning websites and social media posts that provide inaccurate and potentially dangerous information. As parents, we strive to make the best decisions for our families based upon the best available information.
Unfortunately, not all food allergy families are savvy enough to spot and ignore scary anecdotes or snake oil salesmen. It is important for anyone with food allergies to understand which measures are important to avoid accidental ingestion, as well as know how to recognize and treat an allergic reaction should one occur. It also helps to understand risks of reaction from various exposures, as well as unlikely sources of exposure.
One example of poor understanding of risk and greater context is in regards to scary stories from individuals who report anaphylaxis from “smelling” peanut butter. While this is theoretically possible in a severely allergic individual, it is also EXTREMELY unlikely. Even if this legitimately occurred to a few select individuals, the vast majority of people with peanut allergy will have no problems at all with this type of exposure. Therefore, to implement widespread precautions given this extremely low level of risk would not only have no effect in reducing a risk that didn’t exist in the first place, but it may distract from other precautions that are much more likely to be beneficial.
Yes, if you have food allergies, then every meal or snack represents the potential for accidental ingestion. Yes, if your child has food allergies, then you are trusting others to ensure their safety. Yes, this can easily raise anxiety for even the most well-adjusted and well-informed people. However, with proper guidance, LOTS of practice, and experience, that anxiety can hopefully be reduced. We can only control what we can control. We can control reading labels from every packaged product (even if eaten before). We can control how and when we communicate with food handlers, teachers, schools, family members, and caregivers. We can control immediate access to epinephrine autoinjectors in case of accidental ingestion. And lastly, we can control what activities we decide to partake in, such as going to baseball games or playgrounds.
Hopefully, families with food allergies have received clear information from their allergist or primary care physician. With every family I meet, I strive to educate about food allergy diagnosis, testing, natural history/prognosis, risks of reaction through various exposures, important methods of communication for schools and caregivers, signs/symptoms of an allergic reaction, and treatment of an allergic reaction, including practice with an epinephrine autoinjector training device. And that’s just at the initial visit! At every follow up visit, I ask questions regarding any accidental ingestion, challenges in communication/management within the school or with caregivers/family members, and also provide anticipatory guidance for the upcoming months such as starting a new school, summer camp, or travel. Most importantly, I expect and welcome questions. I also realize that concerns arise in between visits, so I offer my email address and direct office line for families who are interested.
There are reputable resources available for families who have not received this information from their physician or who have additional questions. FARE, AAFA (formerly Kids with Food Allergies), Asthma and Allergy Network, Allergic Living, and both the American College and Academy of Allergy, Asthma, and Immunology are some examples of sources of evidence based information and advice. I recommend caution for any sites or blogs that do not utilize a medical advisory team, which is important to ensure the proper interpretation and message is being distributed, particularly when discussing the latest research findings.
Lastly, I believe that anyone with food allergies can live a happy, productive life, as long as they understand their diagnosis and establish consistent measures to minimize risk of exposure. Preparation with immediate access to an epinephrine autoinjector at all times is paramount as well since accidents can occur, despite our best efforts. I’ve learned from my own patients that this type of life is not only possible, but should be expected.