In The News: Food Allergy

Uploaded ToAllergy Friendly Chocolate Chunk Cookies

Allergy-Friendly Chocolate Chunk Cookies

The kids have been out of school for a while now. Many of you may be working from home as well. Are you running out of stay-at-home activities?

When done the right way, cooking with kids can give them something to do and teach them important life skills while having a good time!

We tried this amazing recipe for “Big Chocolate Chunk Cookies” we found in “Allergic Living Magazine”, and honestly… they’re so delicious… we had to roll through the house because we ate so many of them! This recipe is a great opportunity to get into the kitchen with your kids and have a bit of fun!

Ingredients:

2 cups all-purpose flour (or gluten-free variation)

2 tsp baking powder

½ tsp baking soda

½ tsp cream of tartar

½ tsp salt

1 cup allergy-friendly chocolate chunks

½ cup canola, grapeseed or rice bran oil

½ cup maple syrup

4 tsp vanilla extract

  1. Preheat the oven to 350 F. Line baking sheets with parchment paper.
    • Note: When we tried this recipe, we didn’t use parchment paper and the cookies crisped quickly.
  2. In a medium bowl, whisk together flour, baking powder, baking soda, cream of tartar and salt. Stir in chocolate chunks.
  3. Put brown sugar, oil, maple syrup and vanilla in a medium mixing bowl. Beat with a hand mixer until emulsified, about 1 minute.
  4. Stir flour mixture into a wet mixture until fully combined. The dough may be a little greasy.
  5. Shape dough into 1 ½ balls and place 2 inches apart on baking sheets. Lightly flatten the dough and press in any loose chocolate chunks. This recipe should make 24 cookies.
    • Note: The warmer the dough got, the harder it was to mold. Mold what you can and put the rest in the refrigerator for about 5 minutes while you bake the cookies you were able to roll out. Do this process as many times as needed until all the dough is used.
  6. Bake for 8-12 minutes. It will be light in color.
  7. Let cool on baking sheets for 2 minutes, then transfer to wire racks to cool completely.

Free of dairy, eggs, nuts, peanuts and soy.

Gluten-free oatmeal cookie variation: Using a spice grinder, process 1 cup certified gluten-free quick oats into flour. Substitute the oat flour, ½ c starch (corn, tapioca or arrowroot) and 1 ½ cups certified gluten-free quick oats for the all-purpose flour in the above recipe.

Wondering if you or someone you know has food allergies? Schedule an appointment with one of our board-certified allergists today.

 

 

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A table full of ethnic foods

Ethnic Food Allergies

What allergens are found in ethnic foods?

In Charleston, we’re very proud of our unique local cuisine. Whether you’re dining in or enjoying takeout at home, there are so many options to explore! The Lowcountry is a melting pot of people from various countries around the world, and they brought with them diverse and exotic cuisines. Elements of these cuisines are finding their way into the Charleston culinary scene. While delicious, unfortunately, these new foods with their variety of ingredients can have an impact on individuals with food allergies.

Food allergy experts say people with food allergies should apply the same degree of caution to ethnic foods as they do to any other foods they might eat. Language barriers, unknown ingredients and different preparation techniques can magnify the challenges for individuals with food allergies. This is especially important when consuming food outside of the restaurant through takeout. As many are practicing social distancing, it’s important to be aware of allergens before placing a pick-up order.

Researching common ingredients in a cuisine can point out food allergens to avoid. Thai food, for example, incorporates a wide variety of peanut products while Mexican and Italian foods use cheese to flavor and garnish dishes.

Asian cuisines like Japanese, Chinese, Thai and Korean can vary greatly in flavor but they share several of the big eight food allergens as major ingredients including peanut, fish and shellfish, soy, and eggs. Interestingly, soy sauce, always found in Asian restaurants, is usually well tolerated by those with a soy allergy because the soy proteins are destroyed by the fermentation process.

With French food, the emphasis is on fresh local cuisine but salad dressings and vinaigrettes can be hidden sources of nuts, eggs and seed oils. Expensive, hand-pressed oils such as walnut, almond and sesame are frequently used for their intense flavors and can be more allergenic than refined oils because they contain more nut protein. Mustard and mustard seed are common ingredients in French cooking and are a growing concern in France. In 2003 a French study reported mustard allergy accounts for 1.1% of food allergies in children.

A major theme of Indian cuisine is the use of a lot of spices. Some of the most common spices include bay leaves, coriander, cardamom, fenugreek, ginger, garlic and turmeric. These are usually ground-up and mixed into masalas as a flavorful base for vegetable and meat curry. The biggest risk with Indian food, however, is not going to be spices, as traditional spices are not particularly allergenic. Curry sauces can be thickened with cashew or almond paste. Lentils and legumes are a major source of protein in India with a large vegetarian population and can also trigger allergies. Allergies to the legume chickpea (garbanzo bean) is prevalent in India.

Italian food has become popular in the United States, but many common ingredients in it are highly allergenic. These include cheeses and dairy products, bread, pasta and pesto sauce which contain nuts (usually including pine nuts but occasionally walnuts).

Mexican food is typically edgy and saucy and while sauces can add flavor and spices, they can also be problematic for individuals with allergies. The sauces can contain nuts, chilies, cinnamon and garlic.

One of the most prominent allergens in African cuisine is peanuts often referred to as “ground nuts.” They are used in soups, stews and sauces for meat and rice dishes. Cornmeal and millet, starch staples of foods across Africa, can be a safe alternative for those with a wheat allergy.

Foods from areas around the Mediterranean Sea can produce earthy flavors based on a balance of citrus and herbs with liberal amounts of olives and olive oil. Seeds and nuts are prevalent in Middle Eastern cooking and are probably the biggest allergy-inducing culprits in the cuisine. Sesame seeds are particularly pervasive in Middle Eastern food, either as an oil or ground-up in a thin sauce called tahini. Baklava, a pastry made of layers of filo dough, may contain pistachios or walnuts.

So, as you or a family member ventures into an ethnic dining experience to explore the exciting and delicious flavors of another culture, do your due diligence and be aware of hidden food allergens in these foods. And most importantly, always be prepared with your EpiPen or Auvi-Q.

If you think you might be experiencing symptoms of food allergies, contact our team to schedule an appointment with a board-certified allergist today.

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Girl smiling in front of a bowl of food.

Tackling food allergies

Food oral immunotherapy? You’re probably wondering what that means exactly. Let’s break it down into two parts. “Immuno” is derived from the word immune which means to protect from and “therapy” means the treatment of a disease or disorder that entails some type of rehabilitating process. So, when we provide oral immunotherapy to our patients we are providing a therapy by mouth to reduce a person’s sensitivity to foods that cause allergic reactions.

Food oral immunotherapy helps patients tolerate food proteins (allergens) they would otherwise be allergic to by introducing small amounts of the proteins on a daily basis. It is important to note that food oral immunotherapy only works on food allergies caused by allergy antibodies. These are antibodies released from your immune system that cause your allergic reaction.

How does it work?

If you and your board-certified allergist decide food oral immunotherapy is right for you, you will start eating gradually increasing amounts of the specific food over an extended period of time. The amount of food is precisely measured in milligrams based on protocols developed from oral immunotherapy research. This dose will increase over time to reduce your body’s sensitivity to the food allergen. This is known as building tolerance. Tolerance for a food allergen only continues if the food is eaten regularly. 

What is involved?

Oral immunotherapy requires a significant commitment of time and attention. Before you can begin this type of therapy your allergist will want to make sure all other allergic conditions are under control and routine immunizations are up-to-date. Depending on your allergy history, additional steps may need to be taken before starting oral immunotherapy.

The first step in oral immunotherapy is called escalation. This takes place in your allergist’s office and may last up to eight hours. It is important that the first step is monitored closely. After your first dose, the same amount will be eaten at home once a day until the next escalation dose.

Subsequent escalation visits can be as often as every one to two weeks. During these visits the patient will eat the new higher dose and then be observed for one hour to ensure there is no reaction. The goal is to reach what is called a “maintenance” dose. Once maintenance is reached, that dose is continued at home with no more planned escalation visits. At this point, the patient now has a significantly reduced risk of severe allergic reaction if they accidentally eat their food allergen and they do not have to avoid processed foods at risk of cross-contamination with their food allergen.

Whether it’s peanuts, tree nuts, milk, or some other food, oral immunotherapy may be an option to help you lessen the fear of allergic reactions from hidden food allergens and allow you to be more involved in life.  

What are the risks?

As with any type of therapy, there are risks. Adverse reactions to oral immunotherapy are common but the goal is to minimize the reactions through careful monitoring and escalation visits.

In carefully developed research studies, reactions occur in a significant number of patients. Most reactions are mild such as itchy mouth or abdominal pain and resolve without treatment or with antihistamines alone. Abdominal pain, nausea, heartburn and vomiting can be bothersome for patients after doses and can sometimes lead to changes in the treatment protocol. Our experienced physicians can tailor each treatment plan to the individual patient.

Anaphylaxis can occur with oral immunotherapy and families must be prepared to administer injectable epinephrine if needed. Studies show that less than 15 percent of patients are treated with epinephrine for a reaction during home dosing.

There have been reports of eosinophilic esophagitis (EoE) occurring more frequently in patients on oral immunotherapy. Eosinophilic esophagitis (EoE) is an inflammatory condition of the lining of the esophagus that can cause difficulty swallowing, severe reflux, nausea and/or abdominal pain.

Approximately 25 percent of patients discontinue oral immunotherapy before reaching the “maintenance” point. The most common reasons are reactions, especially gastrointestinal side effects, difficulty adhering to the protocol and rest requirements after dosing.

If all steps are closely followed under physician supervision and careful monitoring, oral immunotherapy can be a viable option for some patients and provide lifetime freedom from food fears and stress. If oral immunotherapy sounds like an option for you or a loved one, we encourage you to speak with your board-certified allergist

For more information and differing viewpoints of food allergy management, we recommend the following websites:

OIT101.org

AAAAI.org

ACAAI.org

FoodAllergy.org

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FDA approves first peanut allergy treatment graphic.

Peanut Allergy Treatment Approved

On January 31, 2020, Palforzia became the first FDA-approved “medication” for peanut allergy. Dr. Meredith Moore states, “As a board-certified allergist who has been providing oral immunotherapy (OIT) to patients for peanut, tree nuts, multi-nut and wheat for the past three years, I have been excitedly awaiting FDA approval of Palforzia.” The FDA’s decision helps move OIT to a more accepted option for food allergic patients. Additionally, the safety and efficacy data for Palforzia is comparable to the methods being employed by OIT allergists for 10+ years using other sources of peanut protein.

Palforzia treatment doses start at 0.5 mg peanut protein and gradually build to a 300 mg daily dose over a period of about six months. The 300 mg daily dose is equivalent to about one whole peanut or ¼ teaspoon of peanut butter. The studies show that 67% of patients in the Palforzia study were able to eat at least two peanuts without having allergic symptoms. Palforzia showed success in reducing reactions to amounts that would be expected to occur in accidental ingestions or cross-contamination.

The protocol used for patients undergoing OIT at Charleston Allergy & Asthma for the past three years uses a peanut flour that has been analyzed for OIT use and then transitions to whole roasted peanuts that can be purchased at the grocery store. The ingested amount starts at 0.005 mg and builds to 2000 mg as a daily maintenance. This maintenance has been shown to allow patients to safely eat up to 6000 mg of peanut protein or two tablespoons of peanut butter. Some patients may not want that high of a safety goal in which case our OIT protocol can be customized for each patient’s needs and preferences.

Multiple news sources have reported that Palforzia’s annual price has been set at $10,680 (or $890 per month). At this point, it is not known how much, if any, health care insurers will cover of this drug cost. Charleston Allergy & Asthma’s current OIT patients generally spend less than $300 for peanut protein capsules/flour and supplies before converting to roasted peanuts, Peanut M&Ms or peanut butter.

Aimmune Therapeutics is researching development of other OIT products such as tree nut and egg. Charleston Allergy & Asthma physicians have experience treating patients with OIT for tree nuts and wheat using sources currently available.

OIT, using Palforzia or another food source, helps food allergic patients reduce their risk of allergic reactions from unexpected or accidental ingestions. There are risks with any OIT protocol, including anaphylaxis, eosinophilic esophagitis, stomach aches and frustration with the daily dosing process. Dr. Moore includes, “There are very important precautions for patients on OIT regarding activity, exposure and illness that Charleston Allergy & Asthma physicians have experience educating patients about. Personalized OIT treatment also requires adjustments of dosing protocols for school trips, vacations, and day-to-day life that we understand and have the expertise to implement.”

Dr. Moore says, “For some patients, the benefit of having a ‘safety net’ brings freedom from fear of allergic reactions that is worth the risks and inconvenience. Some patients and families are more comfortable and skilled at avoiding their allergenic food and OIT is not the right path for them. Charleston Allergy & Asthma looks forward to partnering with patients and families to help determine which treatment options are best for you. Reach out today if you would like to learn more about our food allergy treatment plans.

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Girls eating lunch together at a table

Sesame: The New Peanut Allergy?

The United States has seen a rapid rise in the development of sesame allergy over the last 20 years.  Some experts consider sesame allergy to have “increased more than any other food allergy over the past 10 – 20 years” in the United States.  Increasing prevalence of sesame allergy has led to suggestions that our government issue regulations that require food labels to note the presence of sesame. Currently U.S. federal law does not require sesame contents in food packaging to be declared by food manufacturers.  These manufacturers are currently required to list the eight most common food allergens including milk, eggs, peanut, wheat, soy, tree nuts, fish, and shellfish.  

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Woman looking closely at a peanut

First Peanut Allergy Drug On Cusp of Approval

AR101 is an investigational biologic oral immunotherapy produced by Aimmune therapeutics.  If that sounds like a mouthful, it is, so let’s break down what that really means. AR101 will be a commercially available “drug” with a proposed trade name of Palforzia. As such, it requires approval by the Food and Drug Administration (FDA). It is currently considered “investigational” because it has not been approved by the FDA and is still under investigation. The term “biologic” refers to a product that is isolated from natural sources and not chemically manufactured. As explained by the American Academy of Allergy, Asthma & Immunology, “oral immunotherapy (OIT) refers to feeding an allergenic individual an increasing amount of allergen with the goal of increasing the threshold that triggers a reaction.”  In the case of AR101, the product is designed for peanut allergic patients and the treatment goal is to reduce the frequency and severity of allergic reactions due to accidental peanut exposure. 

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Top 9 Asthma Triggers

Asthma is an inflammatory condition of the airways in your lungs. It effects 8-10% of the population – that’s 24 million Americans! Asthma usually begins in childhood but can occur in adulthood and is the #1 cause of missed school and work. Asthma is triggered by a variety of exposures detailed below.

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Charleston Riverdogs facebook Peanut free night graphic

Peanut-Free Night!

It’s Peanut Free Night at the Joe!

Wednesday, May 15th 2019 at 6pm

We couldn’t be more excited to announce our 4th Annual Peanut Free Night! Come join us Wednesday, May 15th as the RiverDogs take on West Virginia Power (Pittsburgh Pirates affiliate). Gates open at 6:00pm and the game starts at 7:05pm.

Group of people at the Charleston Riverdogs game
This partnership with the RiverDogs allows families who are peanut allergic to come to the Joe and enjoy a fun night of baseball. Enjoying an evening of baseball at a stadium is a luxury that peanut allergic families often don’t feel comfortable doing. Since peanuts are a staple in America’s favorite past-time, those allergic often don’t feel safe attending this type of event. Fear of cross-contamination and exposure to peanuts means baseball stadiums are often avoided.

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Riverdogs peanut free night crop cover

Riverdogs Peanut Free Night is Here!

Come join us Tuesday, May 1st at the Joe when we celebrate our 3rd Peanut Free Night with the RiverDogs! We couldn’t be more excited for our annual event! The entire park will be cleaned of any peanut residue so peanut allergic families can come and enjoy America’s favorite past time. This is a big deal for many families who are unable to safely enjoy simple events. It’s scary and overwhelming when your children have a life-threatening allergy and we’re grateful for the RiverDogs for making this fun night possible!

“The RiverDogs will take the opportunity to celebrate cleanliness and friendliness on May 1st with the celebration of the World’s Cleanest Ballpark,” said Assistant General Manager, Ben Abzug. “In association with Charleston Asthma & Allergy on Peanut-Free Night, the RiverDogs will take every extra effort to ensure a spotless ballpark on that night,” Abzug added, “with a top-to-bottom cleaning prior to the game, inning-by-inning cleanings, and fun interactive games with fans to help keep The Joe beautiful!

There will be lots of fun eats and drinks, all peanut free, of course! Plus, fun games and giveaways all night long! Gates open at 6 p.m. with the RiverDogs taking on the Asheville Tourists at 7:05 p.m. Children 3 and under are free. You can purchase tickets for our special peanut free section here and use code nutfree18 for discounted tickets! “We invite everyone to stop by the peanut-free night at the world’s cleanest ballpark on May 1,” said Dr. Jeffrey Dietrich. “Just leave your peanuts at home!”

Use Group Discount Code "nutfree18"

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