Episode transcript
Time stamps
0:00 Halloween and Allergy Risks
2:44 Importance of Allergy Awareness During Halloween
5:54 Teal Pumpkin Project and the Emotional Wellbeing of Patients
7:25 Advocating for Food Allergy Awareness in the Community
10:18 Testing with Allergen Components and Optimizing Diagnoses
13:21 Balancing Emotional Wellbeing and Physical Health of Patients with Food Allergies
Transcript:
Luke:
Did you know that on Halloween, according to a study in the Canadian Medical Association Journal, emergency department visits for peanut-triggered anaphylaxis jumps 85% on Halloween compared to the rest of the year?
Gary:
Yeah, but you know, Luke, it's not just peanuts or anaphylaxis that we need to be keeping in mind this time of year, but also the emotional well-being of pediatric patients with food allergies of all kinds.
Luke:
Get ready for an episode today that will equip you with the knowledge to not only keep your patients with food allergies safe this time of year, but also help to optimize their emotional health.
Gary:
Yeah, because no child wants to be left out of Halloween festivities.
Luke:
This is ImmunoCAST.
Announcer:
ImmunoCAST is brought to you by ImmunoCAP specific IGE testing and Phadia Laboratory Systems products of Thermo Fisher Scientific.
Gary:
I'm Gary Falcetano, a licensed and board-certified PA with over 12 years experience in allergy and immunology.
Luke:
And I'm Luke Lemons with over six years experience writing for healthcare providers and educating on allergies. You're listening to ImmunoCAST, your source for medically and scientifically backed allergy insights.
Halloween is around the corner and food allergies are always top of mind when it comes to those younger patients who may be excited to dress up and get some candy this time of year. In fact, as we had mentioned in the introduction, peanut-triggered anaphylaxis jumps about 85% on Halloween and for other nuts it's also 60% on Halloween. So we see a giant increase in anaphylaxis during this time of year.
Gary:
But it's not just patients with nut allergies that need to be considered this time of year. 1 in 13 children, or if you think about it, 2 children in the average classroom of 26 students will have a food allergy.
Luke:
When we think of Halloween, we often focus on preparing these patients for potential medical risks of accidental exposure. But it can be just as important to address the emotional well-being that comes with restrictions on participating in trick-or-treating or the occasional classroom Halloween party. Just because of their allergies, no child wants to or should experience feeling bullied, misunderstood, or isolated because of their allergies.
Gary:
Exactly. So that's why in this episode we're going to share some impactful information around the risks for both the medical and emotional well-being that patients with food allergies may be facing this time of year.
Luke:
So let's start with the anticipatory guidance that should be shared with patients in preparation to help prevent and manage accidental exposure. So what are a few things that providers should be reminding patients this time of year, Gary?
Gary:
Yeah, I mean some of this is really common sense, but I think it bears repeating. We need to remind patients, number one, to make sure if they have a diagnosed food allergy, that they bring their epinephrine autoinjectors with them when they're trick-or-treating or going to holiday parties. And then of course, the other side of it is they really need to not eat any of the trick-or-treating goodies that they pick up in the course of the evening until they get back home and really go over it with a fine-tooth comb.
Luke:
But even, and one thing worth noting that Gary and I actually out when we were researching this episode is that the miniature candies that patients may get from those giant variety bags of candies, the ingredients might actually be different than their full-size version. Which means that if a patient is normally eating a full-size version of a candy and it's safe to eat for them, the miniature version may not be. They're manufactured in different locations and they may have slightly different ingredients. And unfortunately, a lot of those bite-sized candies don't even list the food allergens on them because the food allergen information is on the greater bag. So just remind patients to be extra careful of those miniature candies.
Gary:
That was something I had no idea of. I knew about the allergen labeling information, but not the fact that they could actually contain different ingredients in different size versions.
Luke:
Again, it's important to remind patients of these things, but also you might want to check in on patients with food allergies to be sure that their diagnosis is correct or that they may have an additional diagnosis to work through based on a visit that they come in.
Gary:
And you know what? We'll talk more later about the ways that diagnostics can help later on in the episode.
Luke:
The biggest advice given is avoidance. If a patient is diagnosed with food allergy at this time of year, avoidance is often prescribed. But we need to think what that avoidance actually means because it may have an emotional impact. Halloween is the time of year where kids get to be kids, they get candy, they dress up, they can stay up past bedtime, and if they're eating the candy, they're definitely staying up past their bedtime. But not being able to partake in that experience may cause a child to feel othered or like an outsider, especially with how big Halloween is getting.
Gary:
Did you know over $10 billion is spent every year in the US on costumes, candy and decorations?
Luke:
It's huge and it's growing. And to not be a part of that big celebration in the fall, it may impact a child's emotional and their experience with community, which could have lasting disadvantages.
Gary:
So what can we do?
Luke:
I think really the question is what can we do to both assure their physical safety as well as optimize their emotional health? It's really a balance. So we want them safe, which comes with avoidance, but we also don't want them to feel like they're on the outside of an event.
Gary:
Exactly. So how do we normalize those with food allergies and the need to practice avoidance as well as use some anticipatory guidance to really keep them safe during this especially risky time of year?
Luke:
So when it comes to the emotional aspect of food allergies and Halloween, I think it starts with advocacy and normalizing that not everyone can eat everything. And Gary, why don't you talk a little bit about the Teal Pumpkin Project from FARE.
Gary:
So I love this initiative, Luke, it's been around for quite a few years now, and it's actually initiative, as you mentioned by FARE, the Food Allergy Resource and Education organization that really promotes inclusiveness around the Halloween holiday. So having available for trick-or-treaters, either allergens safer type foods, so foods that contain none of the top nine allergens or non-food alternatives, things like glow sticks or bracelets or necklaces, pens, pencils, crayons, et cetera. All these non-food items that can be given out to children with food allergy.
Luke:
And it's called the Teal Pumpkin Project because houses that are participating in this often put a sign with a teal pumpkin on it or have a teal pumpkin painted on their patio, it's kind of like a secret code for fellow food allergy safe people to know that, hey, I can go to this house and my child can get a food allergy safe treat. And we have an article with our partners on Allergy Insider all about the different treats that can be used this time of year if you want to participate in a Teal Pumpkin or tell your patients to participate. This is a great patient facing article that spreads a lot awareness. And it goes not just for parents of patients with food allergies, but also caretakers of any child who are coming into the office today, maybe mention, hey, you should consider having food allergy safe treats this year if you're going to be giving out candy. Because it's not just the food allergy families that would benefit from this, it's everybody. It's inclusivity. That's
Gary:
How we really advocate for our patients and being more inclusive and being able to really enjoy the holiday. But I think it's also important to actually get the diagnosis right. So many patients have been diagnosed in years past, either by history alone or by whole allergen testing alone and may have never had a confirmatory test to really prove that they have a food allergy. And I think we need to take a look at those patients and see is there anything we can do to either confirm their allergy and give them the knowledge they need to keep themselves safe or perhaps be able to refer them to our allergy colleagues to have an oral food challenge and potentially clear that food allergy diagnosis.
Luke:
I like how you set that up, Gary, because it's two patient types really, they're already diagnosed. So let's confirm the diagnosis and reiterate how important it is to avoid these types of foods and to make sure they have their epinephrine autoinjector when they go out. And I want to make it clear we're not just talking about peanuts here. We're talking about milk, egg, wheat, we're talking about all allergens on Halloween. There's a lot of hidden allergens out there. So these patients who are already diagnosed using specific IgE blood testing alone with a structured history can help them. And so looking at these patients who are already diagnosed, if they just got, let's say, a whole allergen specific IgE blood test, it's great for helping to rule in or rule out an allergy. But you may want to consider utilizing a component resolved diagnostic blood test to really understand exactly which protein or which molecule may be contributing to a reaction going to affect management and potentially help that patient.
Gary:
So for those patients that we are able to confirm their diagnosis, it's especially important, especially for adolescents. It's especially important for adolescents who may be out on their own to really give them the knowledge that you need to take your food allergy seriously. You need to carry your, and you really need to be cautious about potentially ingesting something you may be allergic to.
Luke:
And so the second patient then, so that's the first patient who's already been diagnosed and let's look at the patient who hasn't been diagnosed but maybe is presenting with new suspected adverse reactions.
Gary:
Yeah, I mean, so I think you mentioned this, right? The whole allergen testing is very sensitive. So it's great at potentially ruling out as suspected allergy. If we get an undetectable level of specific IgE antibodies, we can be pretty sure it's not that allergen that's causing the symptoms we test it for. But if we get a positive right, that can either be a significant positive where they're at risk for a true clinical allergy, or it may be an insignificant positive where they're at lesser risk of having a systemic reaction. And that's where the allergen components really come in. They help to give us some risk stratification and know which patients could potentially benefit from an allergy referral and an oral food challenge.
Luke:
And Gary, could you give me an example, I guess, of let's say peanuts specifically here, how component-resolved diagnostics may affect a child who has a peanut allergy, who is going trick or treating, they're all dressed up as a vampire and they're ready to go out?
Gary:
All right, so we know there's not a lot of allergens in blood, so the vampire should be safe from a trick-or-treating standpoint. But let's think about maybe that first patient, right? He's carried a diagnosis since childhood, maybe is an adolescent at this point. Had the diagnosis based upon a suspicion, but no true clinical reactions to peanut, had a whole allergen test, it was positive and they made the peanut diagnosis, which was very common 8, 9, 10 years ago. Now, does he truly have a peanut allergy? He's never ingested peanuts. Finding out on a molecular level is he sensitized to risky proteins that put him at much higher risk of a systemic reaction? Or is he sensitized to lower-risk proteins that may not cause any type of reaction? Finding that out and then referring him if he is at low risk for that food challenge that I mentioned could be life-changing. It could clear that diagnosis and allowing to lead a less-restricted life.
Luke:
Those are the two outcomes as well. They're sensitized to a high-risk protein and it's same as it ever was, avoidance the epinephrine auto-injector or they're sensitized to a low-risk protein. And like you said, Gary, referred to an allergist and potentially a candidate for an oral food challenge. But if that oral food challenge comes back and they can tolerate eating peanut, that could potentially be life-changing. The win is to know because that means that that child, in this example the little boy dressed up like a vampire, may be able to have that chocolate bar that says made in a factory that may have peanuts, knowing that they've passed that food challenge.
Gary:
And the flip side is if he is at high risk based upon his molecular profile, we know that too and we know to continue to take all the precautions as you mentioned.
Luke:
And hopefully in their neighborhood there's a lot of teal pumpkins out there to offer some safe alternatives. But this component testing isn't just for peanuts and we've talked about this before and on this episode's webpage with a link in the description of this episode, you'll find our other podcast episodes around components because there's component testing for milk, egg... Well, actually before I go, through pause this episode. Can you name the big nine allergens that are on food? So, pause. But it's milk, egg, peanut, tree nut, soy, sesame and wheat, shellfish and finned fish. We have component testing for those first seven. So milk, egg, peanut, tree nut, soy, sesame, and wheat.
Gary:
Yeah. Currently not in regular use in the US, shellfish or finned fish components. But speaking of that, we talked about lower allergen risk foods or candies, and I saw fish there, it reminded me of Swedish Fish.
Luke:
Oh yeah. Right. They are an allergy friendly option. And yeah, fun fact, they don't contain fish.
Gary:
Exactly. And you know what else they don't contain Luke? Alpha-gal, they don't contain any gelatin, so they're not risky for patients with Alpha-gal syndrome.
Luke:
Oh wow. That's interesting. Yeah, because usually with some of those gummies, you got to watch out for gelatin for those patients with Alpha-gal.
Gary:
Exactly.
Luke:
And we have interpretation guides, not for candy, but for components linked on this episode's page. If you ever wanted to look over maybe what it means to, if a patient is sensitized to a low-risk protein for let's say milk or a high-risk protein, but going back to Halloween and going back to these kids this time of year, it's really a balance. It's a balance of protecting them from having a severe reaction, but also keeping them included within the event in the community of trick-or-treating or classroom Halloween parties or what have you. It starts at knowing exactly what they may potentially be reacting to. And that will affect how we go about effective management.
Gary:
And we know Halloween is supposed to be scary, but it's really up to all of us to make it less frightening for our patients with food allergies by optimizing their both emotional well-being and their physical health. Getting to the right diagnosis, making sure they have the right diagnosis, preparing them if they are allergic, with the guidance around non-food alternatives, epinephrine, autoinjectors, et cetera and really being advocates in the community for a more inclusive experience around this time of year.
Luke:
And so remember, it's not just food allergy patients coming in, it's all maybe caretakers who are coming in. Just mentioning something to help make food allergy patients feel more included this time of year. And also test patients that may have a history of a reaction.
Gary:
Yeah, I would encourage providers that do reach out to their patients outside of the office through email campaigns or practice blogs to really talk about this issue, really advocate for their food allergy patients, link to the FARE Teal Pumpkin Project, or to the blog from our friends at Allergy Insider to really help patients, family members, and the community understand what it's like to be more inclusive for patients with food allergies during Halloween.
Luke:
Thank you for listening to ImmunoCAST and have a spooky Halloween season, but stay safe.
Gary:
Thanks so much. We'll see you next time.
Announcer:
ImmunoCAST is brought to you by Thermo Fisher Scientific, creators of ImmunoCAP™ Specific IgE diagnostics and Phadia™ Laboratory Systems.
For more information on allergies and specific IgE testing, please visit thermofisher.com/immunocast.
Specific IgE testing is an aid to healthcare providers in the diagnosis of allergy and cannot alone diagnose a clinical allergy. Clinical history alongside specific IgE testing is needed to diagnose a clinical allergy. The content of this podcast is not intended to be and should not be interpreted as or substitute professional medical advice, diagnosis, or treatment. Any medical questions pertaining to one's own health should be discussed with a healthcare provider.
