Living with the risk of anaphylaxis

 
Have you just found out that you are at risk of anaphylaxis or someone you may care for has told you of their recent diagnosis?

We encourage readers to consult their allergist or immunologist for personalised treatment and care. Regular follow-up is encouraged so that individuals can access up to date information on anaphylaxis. Never self-diagnose or rely on anecdotal information.

The information contained within this website is meant as a guide for individuals, parents and carers of those with anaphylaxis. Some individuals, parents and carers feel it is important or helpful to follow the strategies suggested to minimise the risk of allergic reactions but they may not be necessary for all children. If in doubt, discuss strategies with your treating doctor.

There is currently no cure for anaphylaxis. Treatment focuses on management and increasing community awareness of this potentially life-threatening condition.

Always remember this…………….

It is possible to lead a normal life. You are not alone. Often people feel overwhelmed, angry and anxious after a diagnosis of food allergy is made.

Knowledge is Power

The more information you know about your allergy the more confident you will be in managing it and educating those around you.

Don’t get caught up in chat rooms and make sure all information you rely on is from a credible source.

Remember that if you felt overwhelmed and frightened at the start, so will others when you first tell them. Give them small amounts of information to begin with and allow them time to digest and understand it. Most people want to help as best they can.

Educate your anaphylactic child and their siblings

• Educate your child and family at appropriate times regarding allergen avoidance, risk foods, cross contact and safe practise.
  
• Empower them to manage their anaphylaxis, as they grow older.
  
• Read our quarterly newsletter.

Effective management saves lives
People who have had an episode of anaphylaxis need to:

• recognise the early signs or symptoms of anaphylaxis
  
• know what to do if anaphylaxis occurs.

Patients who are at risk of anaphylaxis should:
Wear a Medic Alert bracelet or disc. This increases the likelihood that adrenaline will be administered in an emergency by doctors or ambulance officers.
Carry (and know how to use) self injectable adrenaline (EpiPen®). Adrenaline acts as a natural "antidote" to some of the chemicals released during severe allergic reactions. Adrenaline should be considered as First Aid for the treatment of anaphylaxis.

An Emergency Action Plan is essential
Since episodes of anaphylaxis are often unpredictable, a well thought-out "Action Plan" is an essential part of management and should be practiced. It requires you to recognise early warning symptoms and carry (and be trained how to use) medication such as adrenaline.

Download an Anaphylaxis Action Plan (requires Acrobat Reader)

Food Allergy Basics Fact Sheet

Food Hints  

LABELLING
Read all product labels every time you purchase a product. Labels and ingredient listings change without warning.

Become a LABEL DETECTIVE when you buy food for your family. REMEMBER TO CHECK LABELLING ON OUTER AND INNER PACKAGES!

• There is a risk of incorrect labelling of products with imported goods. Labelling requirements in some other countries are less stringent than Australian requirements and although imported goods still have to labelled according to Australian Food Standards, mistakes can occur during translation.
• There can be discrepancies on food ingredient labelling between the outer and inner packages in multi-packs.

Frequently Asked Questions about Food Lists and “May Contain” Statements

I have heard that lists of “safe” products are not recommended. Why not?
Relying on a list of "safe" products is not recommended because ingredients and recipes can change without warning, thus making it impossible to keep an up to date list. Ingredients can sometimes vary depending on the product size (i.e., regular and mini), or manufacturing location. The safest policy is to read the ingredient statement for all products every time you make a purchase.
Lists are left in drawers and they do not encourage the food allergic individual or their carers to always read the label.

Can products with “may contain statements” be consumed by those with food allergies?
It is not recommended as this statement is there because the food manufacturer feels there could be a risk of contamination. Cross contamination during food preparation, processing and packaging does occur and when a product is purchased the consumer has no real idea how great that risk may be. It is like “Russian Roulette”, maybe the package bought last week was fine but the product bought this week ‘May contain’ the specified allergen. It is safest to heed the warning on the product.

"May contain…." Can really contain.

Here is an example why AAI urge food allergic consumers to stay away from foods labelled with a “May contain….” statement as they can be real risk foods.
The examples below highlight this issue:
The ingredient label states it contains milk solids and then also has a WARNING statement that says it "May contain dairy........."
The WARNING Label directly below states it "May contain sesame" and it actually DOES DEFINITELY contain sesame – see second photograph!

Can products with “may contain” statements be consumed by non allergic children in preschools and schools but still be around the children with food allergies?
Severe reactions usually occur when an allergic individual has consumed the allergen. It is recommended that food allergic individuals totally avoid the food they are allergic to. It is reasonable for non allergic children to consume foods that “May contain…”around the allergic person as long as there is adult supervision and strategies are in place to minimise the risk of a reaction e.g. a no food sharing rule, hand washing after eating etc.

How can I find out if an allergen is present in a product, flavour or spice?
• Call the manufacturer and ask if allergen is present in the product, flavour/spice for
that product.
• If the manufacturer cannot answer your questions, you may have to avoid that product to be extra cautious about avoiding your allergen, particularly if there is a history of severe allergic reactions.

What should I do if I have a reaction occurs to a product that should not have caused a reaction?
Do not discard the product as it may be needed for analysis. Wrap up the product and secure it in a location where it won't be accidentally eaten again. If it is perishable, store it in the freezer. Record any identifying product code information, place of purchase, date of purchase etc
• Report the reaction to the manufacturer or the distributor if the product is made over seas. Report the reaction to the appropriate government agency.
• Report the reaction to AAI, email coordinator@allergyfacts.org.au or call 1300 728 000

How can I tell what a company's policy is regarding allergens?
• Call or write to the manufacturer.
• Some manufacturers list their policies regarding food allergen labelling on their websites.
• Be specific. Tell the manufacturer which foods you are allergic to.
• Phrase your questions so that they can be answered with a "yes" or a "no" (for example, "Does the flavouring in product X contain milk?")

PEANUT ALLERGIC
The following foods can cause problems for the peanut/nut allergic when eating out and should be avoided unless they can positively confirm that there is no peanut/nut protein present:

• Chinese and Thai dishes (even soup!)
• Baked goods (pastries, cakes, biscuits etc.)
• Sauces (eg chilli sauces)
• Desserts
• Toppings and gravy. Peanut sauce has also been used as a secret ingredient for marinating chicken.

AVOID ALL NUTS
If you have a peanut allergy it’s safer to avoid all nut products. Sometimes peanuts will be stored near other nuts in the production line or processed with other nuts and contamination may occur as a result of this practice. Tree nut allergic individuals should avoid peanuts for the same reasons.

HIDDEN MILK AND EGG PROTEIN
Always be aware of foods that have a shine to them. Egg and milk can be used to give food this glazed appearance, eg bakery items.

SOY ALLERGIC
Fish sauce can be used as a substitute for soy sauce.

FOOD ADDITIVE 322 – LECITHINS
Most commercial lecithin is obtained from soybeans. Other sources are egg yolks and leguminous seeds, including peanuts and maize.

BEWARE FRESH FOODS
Many butchers and fresh food outlets now have ready-to-cook products such as satay skewers or seasoned foods that contain egg and/or milk powder. These allergen-containing foods may very well be sitting next to the plain foods or prepared on the same surfaces etc. When purchasing these foods consider asking about the risk of contamination. Gloves may sometimes need to be changed if the shop assistant has served a food containing the allergen prior to serving your food.

TRYING A NEW MEDICATION OR FOOD
When giving a child a new medication or trying a new food, do so earlier in the day so that you can keep an eye on your child.

THE ALLERGEN IN THE HOUSE
It is much easier to manage life at home if the allergen is removed from your house however this is sometimes very difficult, especially in the case of egg and dairy for example.

If you do have the allergen in your home, wash contaminated kitchen utensils in hot soapy water or in the dishwasher. Use hot, soapy disposable paper towelling to wipe surfaces that have had the allergen on them. This allows removal of the allergen without contamination of the everyday sponge or washcloth.

Use a plastic basket in the fridge to contain allergic foods e.g. milk, eggs. So child knows not to touch the foods/products in the basket and can learn to recognize the products.

Use separate oil for cooking with risk foods.

PET FOOD
Fish food can trigger reactions in seafood allergic people. Some fish food contains shrimp meat and other seafood.

Canned/dry pet food does contain allergens. Check labelling of your pet food. (See Out and About for further information on animal feed)

HIDDEN INGREDIENTS
Casein maybe used as a binder in meat products and “restructured” salmon or imitation seafood.

Worcestershire sauce may contain anchovies and/or soy.

Beware of bakeries-no labelling so you cannot be sure of content. Bakeries pose a high risk of contamination due to open displays etc.

Out and About with Anaphylaxis

Consider pinning a badge or sticker on toddlers to indicate they should not be given food due to a life threatening food allergy. This is also a safeguard if the child gets lost, or comes into contact with people who do not know of his/her condition. (Often the first thing an adult will do to comfort a lost child is to offer him/her a lolly/ice cream etc.)

TAKE AWAY FOOD/RESTAURANTS

• Be aware of foods that are cooked in same oil as risk foods. (Eg. fish crumbed with egg cooked in the same deep fryer as chips)

B-B-Q SAFETY

• If you are having a BBQ away from home cook your child’s food on foil to be sure no other food comes in contact with it.
• Consider purchasing your own portable BBQ to ensure no allergen comes in contact with your child’s food during cooking.

PARTIES

• Keep suitable party cake slices individually wrapped and stored in the freezer. When you need to send the child to a party/special occasion/school celebrations etc. You can choose a piece from the freezer. Try to be prepared for the unexpected “special” occasion -keep frozen, labelled treats in freezer at home/school for treats/birthdays.

SPECIAL OCCASIONS AND CELEBRATIONS

• Special occasions and celebrations constitute increased risk for food anaphylactic individuals. There is an increase in food consumption and away from home activities. Be aware that with all the rush and excitement of social gatherings, others may forget about your special food needs.
• Be prepared to take extra precautions with checking foods offered or placed within reach of your child.
• Christmas/Easter presents may need to be double checked for that little packet of “goodies” that has no ingredient label.
• Consider agreeing to take turns caring for your child whilst at social occasions. This will help give both parents a chance to socialise and relax with friends and family, knowing that their child is safe.

VISITING FARMS/ANIMAL PARKS

• Always check the contents of animal feed for allergens, especially if your child is hand-feeding animals eg peanut has been found in cow feed and bird feed.
• Activities at farms may include collecting eggs and milking cows. If your child is milk or egg allergic try to organise a different fun activity.

INSECT STING ANAPHYLAXIS

• Always wear shoes outdoors.
  Be aware of clover and flowering plants (Grevillia, bottlebrush etc) as they attract stinging insects.
• Have lawns mowed and consider spraying clover yearly or when required.
• Consider removal of flowering plants from your home environment.
• Ideally, clothes that cover arms and legs are recommended out doors but this is difficult in Australia’s very hot summer climate.
• Gardening should be left to those who are NOT insect sting anaphylactic. (This includes lawn mowing!)

Miscellaneous Hints  

• Always inform doctors/dentists etc that your child has anaphylaxis. The knowledge that your child is highly sensitive is extremely important to doctors when prescribing drugs and in their medical treatment of your child.
• When out with your child slip a note stating your mobile phone number in their backpack or simply write number on their forearm in permanent ink.

AMBULANCE STATION EXCURSION

• Prepare your child emotionally for the possibility of an ambulance trip to the hospital. Take the time to visit your local ambulance station with your child. Give your child the opportunity to hop in the ambulance and become familiar with the vehicle and the paramedics. The trauma of emergency procedures may be lessened for children when they understand that paramedics are not “strangers in uniforms taking them away”.

BABYSITTERS

• Remind babysitter/grandparent etc. who will be minding your child, not to eat or handle the food allergen before arrival.

MEDICAL PLAY KITS

• Purchase a toy medical play kit for your child. Acting out doctor and patient routines helps give children a chance to familiarise and get comfortable with the idea of visiting doctors and medical equipment.
• Make certain that beanbags are filled with polystyrene. There was a case reported in the U.S. of a three year old peanut allergic child who had an allergic reaction after chewing on a bean bag which was filled with finely ground nut shells!

EMERGENCY PROCEDURE AT THE HOSPITAL

• State calmly:
  o That the individual is anaphylactic to “…..” (Peanuts/bee sting) and
  o The individual has ingested “….”
  o Note the medications which have been given i.e. EpiPen®, anithistamine,
  Ventolin® etc
  o Note approximate time given.
• The nursing and medical staff will need to be informed of all other medical conditions.
• Stay at the hospital for a minimum of 4 hours to cover for the possibility of a rebound reaction.
• Ask for a discharge summary/letter, which will detail management of treatment received, and medications administered which is to be given to G.P. and specialist.
• On discharge hospital doctor must prescribe an EpiPen® for replacement. If the individual is discharged without an EpiPen®, they are at risk of being unprepared for future reactions.
• If individual has had an anaphylactic reaction, an appointment needs to be made, to see their allergist for follow-up as soon as possible.
  

Travelling with food allergies   

• In response to your numerous questions regarding travel we have decided to put together some information that will help you plan your journeys.
• Travelling with food allergies is challenging but with careful planning it is possible.
• Whether travelling by air within Australia or overseas you will need to contact the airlines to receive their up to date policy regarding their rules for carrying medication. Do your research directly with the airlines and not through a travel agent.
• Most airlines recommend you carry some form of documentation or identification to support the need for your medication. A letter from your doctor/allergist and properly labelled medication is essential. Pack plenty of medication and always keep the medication and your emergency treatment plan with you at all times for easy access.
• We strongly recommend allergic passengers take their own food from home, keeping in mind there may be delays. This will minimize the risk of a reaction. Be sure to check on quarantine laws of your destination before departure as some countries have specific requirements.
• Most airlines have no food restriction policies. When making your enquiries ensure you get the name of the person who assists you and if possible ask for confirmation of your requests in writing. Keep this with you at all times.
• Try to book flights that are early in the day to minimize the serving of peanut snacks. However those allergic to milk and egg may need to book their flights later in the day. The allergic individual must communicate with the airline as to the flight time that poses the least risk for their particular allergy. Arrive early and allow yourself plenty of time to re-confirm your requests.
• When visiting food outlets or flying on an aircraft, check the tray/table for food particles/spills that have been overlooked by cleaning attendants. Whilst casual contact with food crumbs and smears is highly unlikely to cause severe allergic reaction, contamination of your safe food may be a problem.
• Remember to ask for assistance from your fellow passengers. You need their cooperation so work together to ensure a safe journey. On boarding, speak to the senior cabin crew member to alert them to the anaphylactic passenger’s status.
• Allergic reactions to food during travel have been documented. The most serious reactions are those where the allergen is eaten. The risk of serious allergic reactions from inhalation or touching of an allergen is considered to be extremely low. It is important to note that airborne particles can cause respiratory symptoms i.e. asthma, allergic rhinitis but several allergists and immunologists have stated that reactions to inhaled or touched allergens may cause localized symptoms and usually not general systemic, anaphylactic reactions. All individuals are advised to minimize the risk of any reaction.
  

Link:

New Aviation Security Measures for Carry-on Baggage at International Airports