June-July 2012 Food Allergy News

INSIDE2Message from FAAN Leadership

3FAAN Advocates for Safer SchoolsCelebrating 20 Years of Service

4Development Pathways in Food Allergy

6Mariel C. Furlong Awards for Making a DifferenceIngredient Notices

7Allergy-Free Recipes

8A Mother’s JourneyLegislative and Advocacy UpdateDelta Airlines revises peanut allergy policy, landmark legislation in New York

9Ask the ExpertWhat are the criteria for doing an oral food challenge? How best to handle treats for non-allergic sibling when the family is out and about?

10Is Coconut a Tree Nut?

11Research UpdateIncreasing the accuracy of peanut allergy diagnosis by using Ara h 2

News from FAAN’s Research Grant Program

June-July 2012Volume 21 Number 5

FAAN Visits Capitol HillOn May 16, during the 15th Annual Food Allergy Awareness Week, FAAN representatives visited with elected officials in Washington, D.C., to urge passage of landmark legislation. Read more on page 3.

Left to right: Deborah Zeller, president of the Virginia Association of School Nurses; John Lehr; Brian Hom; Janet Atwater; House Majority Leader Eric Cantor (R-VA); Laura and Sheryl Pendleton; Norma Bergey, immediate past president of the Virginia Association of School Nurses; Eleanor Garrow

FAAN representatives pose with House Minority Leader

Nancy Pelosi (D-CA)

Senate Assistant Majority Leader Dick Durbin (D-IL) accepts an award from FAAN Board of Directors Chair Janet Atwater for his dedication and commitment to our cause.

Congressman Steny Hoyer (D-MD), pictured left, and Congressman Phil Roe, M.D. (R-TN) address attendees at a Congressional briefing to discuss the School Access to Emergency Epinephrine Act.

2 June-July 2012 Food Allergy News

FAANTM (800) 929-4040 www.foodallergy.org

Maria L. Acebal, Publisher

Mary Jo Strobel, Managing Editor

Nancy Gregory, Media Relations & Associate Editor

Julie Fanning, Creative & Production Manager

Hugh A. Sampson, M.D., Medical Editor

Sally Noone, R.N., M.S., Medical Editor

Maria L. Acebal, President & CEOChris Fanning, Chief Financial OfficerEleanor Garrow, V.P. of Education & OutreachChris Weiss, V.P. of Advocacy & Government Relations Gina Clowes, V.P. of Member Relations

OperationsNancy Ammann, Wayne Atkins, Heather Busicchia, DeLois Blevins, Veronica Braun, Debbie Copan, Jacqueline Dominguez, Cindy Durant, Sarah Flores, Julie Forrest, Pascale Nouama, Michelle Rambajan, Kendal Rauh, Beverly Ryan, Rachel Wissinger

Medical Advisory BoardS. Allan Bock, M.D., Boulder, Colo.A. Wesley Burks, M.D., Chapel Hill, N.C.Glenn T. Furuta, M.D., Aurora, Colo.John M. James, M.D., Fort Collins, Colo.Stacie Jones, M.D., Little Rock, Ark.Todd Mahr, M.D., LaCrosse, Wis.Hugh A. Sampson, M.D., New YorkWayne G. Shreffler, M.D., Ph.D., Boston, MAScott H. Sicherer, M.D., New YorkF. Estelle R. Simons, M.D., Winnipeg, CanadaSteve Taylor, Ph.D., Lincoln, Neb.Robert A. Wood, M.D., Baltimore, Md.Robert S. Zeiger, M.D., Ph.D., San Diego, Calif.

©2012. The material in Food Allergy News is not intended to take the place of your doctor. Food Allergy News or the Food Allergy & Anaphylaxis Network will not be held responsible for any action taken by readers as a result of their interpretation of an article from this newsletter. If you have any questions or concerns, ask your physician. Never change your child’s diet without the advice or help of a physician and registered dietitian. Food Allergy News is published 6 times a year by the Food Allergy & Anaphylaxis Network, Inc., 11781 Lee Jackson Hwy., Suite 160, Fairfax, VA 22033-3309. ISSN #1075-4318. Periodicals postage rate paid at Fairfax, Va. POSTMASTER: Send address changes to Food Allergy News, 11781 Lee Jackson Hwy., Suite 160, Fairfax, VA 22033-3309. Our office is open Mon.-Thurs. 9:00 a.m. to 5:30 p.m., and Fri. 9:00 to noon ET. If you have any questions, please call 703-691-3179. To order a subscription, send $29 in check or money order to the Food Allergy & Anaphylaxis Network. Mastercard, Visa, and American Express are also accepted. All rights reserved. This material may not be duplicated without the expressed written permission of the publisher.

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May has been about celebrating our accomplishments and looking forward to new beginnings. Within the same week, we celebrated FAAN’s 20 years of service to the food allergy community and announced our intent to merge with the Food Allergy Initiative (FAI), a sister organization based in New York. As the parent of a child with food allergies, emotions have been running high. At our anniversary event, we all cried with Amarria Johnson’s mother, Laura Pendleton, about the tragic passing of her daughter at school from an anaphylactic reaction. We stood on our feet to applaud Anne and Terry Furlong, founders of FAAN, to express our immense gratitude. We laughed with Congressmen Roe (TN) and Hoyer (MD) as they recounted family anecdotes with warmth and humor. And, throughout the evening, we savored the delicious allergen-friendly

meal created by honoree and celebrity chef Art Smith, as well as the spirit of camaraderie that inevitably results when we gather with others who also love someone with food allergies. And now, standing at the cusp of FAAN’s merger with FAI, I am filled with hope for the future, hope for our kids that one day the burden of food allergies will be lifted from their shoulders. The path forward will not always be smooth, but I am confident that by walking together, the journey will be more successful. At this time, I am pleased to introduce and welcome John Lehr to our leadership team. John will serve as CEO of the merged organization; we are so fortunate to have his extensive talents at work for us. I look forward to working with John and our new team from FAI as we continue to make life safer and easier for all families managing food allergies.

Message from FAAN LeadershipBy Maria L. Acebal, J.D.

This is such an important time for the food allergy community. The merger between FAAN and FAI will unite the nation’s two leading food allergy organizations to advance a cure and promote education for food allergy. Combining FAAN’s expertise as the most trusted source of information, programs, and resources related to food allergy and anaphylaxis with FAI’s leadership as the world’s largest private source of funding for food allergy research, the unified organization will become a much stronger champion for the families we serve, and will drive important advances in research. I had the privilege of attending FAAN’s 20th anniversary celebration in Washington, DC in May, where I met FAAN’s founder, Anne Muñoz-Furlong. Her vision and tireless work has led to immeasurable advances in food allergy education, advocacy, research, and awareness. We look forward to building upon that success in the years to come on behalf of the

nearly 15 million Americans with food allergies. I also look forward to working with the current executive leaders of FAAN and FAI, Maria Acebal and Mary Jane Marchisotto, respectively. Both of them bring to the table incredible talent and a vast amount of knowledge, and they will continue to serve in executive leadership roles in the merged organization. In the meantime, I value your opinions, ideas, and feedback as I get acclimated in my new role. Please feel free to contact either the FAAN office ([email protected]) or FAI’s office ([email protected]). u

By John Lehr

John Lehr, Maria Acebal and Mary Jane Marchisotto

3Food Allergy News June-July 2012

Awareness Advocacy Education Research

FAAN Advocates for Safer SchoolsFAAN representatives, along with Laura Pendleton, whose daughter Amarria suffered a fatal anaphylactic reaction at school earlier this year, and Brian Hom, a father who lost his 18-year-old son, BJ, four years ago to a fatal food allergy reaction, spoke out in support of the School Access to Emergency Epinephrine Act (S. 1884/H.R. 3627), proposed legislation that encourages states to ensure that epinephrine is readily accessible in schools for the treatment of potentially fatal anaphylactic reactions. The bill was introduced in the Senate by Sens. Dick Durbin (D-IL) and Mark Kirk (R-IL). U.S. Representatives Phil Roe, M.D., (R-TN) and Steny Hoyer (D-MD), who introduced the legislation last fall in the House, hosted a Congressional briefing in the Cannon House Office Building on May 16 to discuss the legislation. Other speakers at the briefing included Hemant Sharma, M.D., director of the Food Allergy Program at Children’s National Medical Center in Washington, DC; Deborah Zeller, President of the Virginia Association of School Nurses; and Kenton Duty, age 17, one of the stars of Disney’s television show “Shake It Up.” Kenton has a food allergy and is one of FAAN’s Celebrity Ambassadors Who Care.

awareness to this important cause.” “Ensuring that students have access to potentially life-saving epinephrine in the event of an allergic reaction is not just good public policy – it is simple common sense,” Hoyer said. As of press time, the bill has more than 25 co-sponsors in the Senate and 60 co-sponsors in the House. For information on how you can help get this important legislation passed, visit www.foodallergy.org. u

Celebrating 20 Years of Service

After a productive day on Capitol Hill, FAAN staff and guests attended a 20th Anniversary Celebration at the Liaison Capitol Hill Hotel in Washington, DC, honoring FAAN founder Anne Muñoz-Furlong, country music star Trace Adkins and his wife Rhonda Adkins, Chef Art Smith, Washington Capitals hockey player Tom Poti, Walmart’s VP of Food Safety Frank Yiannas, Senators Dick Durbin (D-IL) and Mark Kirk (R-IL), and Congressmen Steny Hoyer (D-MD), and Phil Roe (R-TN). Your generosity helped us to raise more than $250,000 – thank you!

From left to right, Kenton Duty, Laura Pendleton, Brian Hom, and FAAN CEO Maria Acebal prepare to address attendees at the Congressional hearing.

Senator Barbara Boxer (D-CA) meets with Kenton Duty, Brian Hom, and John Lehr to learn more about the importance of the proposed bill.

Representative Joe Pitts (R-PA), chair of the Health Subcommittee of the House Committee that will consider HR 3627, center, meets with John Lehr and Janet Atwater.

“Passage of the School Access to Emergency Epinephrine Act is so important because it could save a life. A systemic allergic reaction is fatal and can kill within minutes. To prevent a fatal outcome, we need to make epinephrine pens available in our schools for sudden emergencies,” Roe said. “I want to thank FAAN for their hard work in bringing

Disney star Kenton Duty

with Rep. Hoyer and his daughter

Anne and granddaughter

Alexa.

Chef Art and FAAN’s Board Chair

Janet Atwater

Rep. Roe addresses attendees

Anne Muñoz-Furlong accepts honors



project gave great advances to research in this area, and several disease-specific measures were developed to assess quality of life in children and teens, including a series of food allergy quality of life questionnaires. When the questionnaires were completed and analyzed, we found a strong impact of food allergy on the quality of life in children’s everyday lives. Although the life-threatening nature of anaphylaxis makes prevention the cornerstone of therapy, it also impacts the quality of life of food-allergic patients. In the initial focus groups conducted, parents suggested that the anxiety associated with the risk of a potential reaction has more profound effects on emotional and social aspects of a child’s everyday life than having a food-allergic reaction. Children were also found to be generally anxious according to parents, even in situations where food was not involved. Findings in the EuroPrevall birth cohort study demonstrate that the impact of a diagnosis of food allergy begins early and can be detected over the course of one year. Researchers in Iceland, U.K., Germany, Spain, Netherlands, and Italy administered a questionnaire before the infant was diagnosed with food allergy by food challenge, and again 12 months later. A similar pattern of responses across countries shows that even at this very young age, it appears that children are reluctant or afraid to try new foods, and have a lack of variety in their diets. Children’s ability to participate fully in social events is also adversely impacted. We found similar results using the same questionnaire in the U.S., Singapore, and Japan. While health related quality of life instruments such as these questionnaires capture the impact of food allergy, the manner in which food allergy is experienced and managed every day must also

Developmental Pathways in Food Allergy

By Audrey Dunn Galvin Ph.D., Reg. Psychol. Ps.S.I.

In order to gain a truly meaningful picture of the impact of a disease on a

patient’s everyday life, health professionals must understand the patient perspective. The term used to measure these perspectives is called health related quality of life (HRQL). How a patient may perceive their quality of life may depend on many factors, such as age, gender, context, and culture. Therefore, patients with the same clinical criteria often have dramatically different responses. To give an example, two patients with the same prognosis following an operation for a heart bypass can have two very different perspectives on how their lives have changed. For one, it may be an opportunity, for another, it may be perceived as a catastrophic

event that changes how they see themselves, how they interact with others, and how they perceive the overall quality of their everyday lives. In turn, this can impact how well they follow medical advice for their future health. It has become increasingly important, therefore, for researchers and healthcare professionals to understand how the perceptions, experience, and impact of a chronic disease might influence a patient’s interpretation and response to it, so that we can respond more appropriately. Although a growing number of families must live and cope with food allergy on a daily basis, it is only in recent years that the social and emotional impact of food allergy has been researched in depth. The EuroPrevall

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Middle childhood is an important transition point when children begin to gain autonomy and self-belief in their ability to control events in their lives.



be evaluated. Experience and coping in any chronic disease is an intricate pattern of facts and feelings interwoven into a child’s developmental pathway from birth to adulthood. Patient and parental perceptions of risk may seem irrational to some clinicians, but have their own logic and validity from the perspective of those living and coping with food allergy. In order to create a developmental framework, we interviewed 120 children/teenagers aged 6-18 years in 15 age-appropriate focus groups. Parents were also interviewed. Our findings indicated that experience and coping in food allergy is complex and dynamic, and involves a series of factors such as age, gender, and the type of disease. Because they were diagnosed when infants, young children feel that they are the same as other children, and parents help them to feel normal and protected in their everyday lives. As children become more aware of the rules and see them as restrictive, together with a growing awareness of difference and uncertainty, the search for normality becomes stronger, and children evolve strategies in order to cope. By adolescence, these coping strategies become more defined, and in some cases more rigid, and an expanding social world further drives their search for normality. Subsequently, we also analyzed data from focus groups and interviews held in Australia, the U.K., Italy, Singapore, and the U.S. The themes that emerged from other countries were strikingly similar to our previous research including the impact of living with uncertainty, with difference, with rules and the coping strategies used. “Living with uncertainty” is a central theme when living with food allergy. Allergic reactions are unpredictable – sometimes they are mild, sometimes severe, and

sometimes they happen when least expected, even if the individual is vigilant. This is not only because of the uncertain nature of reactions in food allergy, but also because of confusion and lack of transparency

and specificity in food labeling; inconsistency around guidelines for use and prescription of epinephrine; and lack of awareness and understanding among some schools, restaurants, and the general public. Children and teens can respond to these conditions by experiencing a loss of control over their condition, and, therefore, in some cases, becoming very anxious and avoidant in their emotions and behaviors, or in contrast, becoming frustrated, or angry, and taking risks with their safety. Trust in safety of food labeling and confusion about thresholds (how much allergen is required to cause a reaction, and how severe this reaction might be) is a significant source of uncertainty and stress for children, teens, and parents. In many cases, teens and

young adults felt reading ingredient labels was pointless and frustrating, and therefore took deliberate risks. This attitude was often formed during the middle childhood years. Transition points are a

source of stress and uncertainty, particularly for parents of food-allergic children. The start of elementary school is a new anxiety trigger, because the parent must hand over responsibility and control to a third party. As children grow and become more aware of differences, and as their social world expands, parents worry that children may take risks in order to “fit in” with other children. Going to secondary school is a transition point that tests parents’ resources, increases their uncertainty, and intensifies their anxiety. Since parents can transmit these feelings to their child, allaying parental anxiety reduces the child’s and creates a positive feedback loop, which ultimately benefits both.

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Greater support and clear information is important at time of diagnosis and at the different transition points along the developmental pathway.

Development continued on page 10



Mariel C. Furlong Awards for Making a Difference

Congratulations to the winners of FAAN’s 16th Annual Mariel C. Furlong

Awards for Making a Difference, the Fourth Annual Grandparent Awards and the Youth Special Achievement Awards. Each recipient showed an extraordinary commitment to food allergy awareness.

Community Service – Support Group • Thanita Glancey – Ashburn, Va. • Sherée Godwin – Madison, Wis. • Wendy Wessel – Brooklyn Park, Minn.

Community Service – Other• Denise Mitchell –Lincoln, Neb. • Michael and Janet Schwartz – Massapequa, NY

Food Industry• Red Robin – Rockaway, NJ • Via 45 – Red Bank, NJ

School Principal • Cheryl Damato – Morgan Hill, Calif.

School Nurse• Rita Molloy – Medford, NY.

School (Other)• Brenda White – Milwaukee, Wis. • Inly School – Scituate, Mass.

Grandparent Awards• Jeanne Feldman – Pittsford, NY • Brenda Statzer – Martinsville, Ind. • Rita Wilson – Clearwater, Fla.

Youth Special Achievement Awards• Jennifer and Rachel Braun – Napersville, Ill. • Lauren Maunus – Palm City, Fla. • Brett Nasuti – Upton, Mass. • Corey Shive – Lansdale, Pa.

The annual Mariel C. Furlong Awards for Making a Difference were created in 1996 to honor

individuals and corporations who have gone above and beyond the call of duty to make a difference in the lives of individuals with food allergies. The awards are named after Mariel Christine Furlong, daughter of Anne Muñoz-Furlong, the founder of FAAN, and were presented at FAAN’s 19th Annual Food Allergy Conferences. u

Ingredient Notices

Mars Chocolate North America Mars Chocolate North America would like you to know that Milky Way® Simply Caramel Bar is changing its allergen advisory statement from “May Contain Egg” to “May Contain Peanut and Egg.” The reason for the change is because new size varieties will be available that are made on shared equipment with peanut containing products. During the transition, which could take several months, there may be products on store shelves with different allergen advisory statements. As always, Mars Chocolate North America urges you to read all labels for the most accurate allergen information. For more information, contact Mars Chocolate North America Consumer Care at (800) 551-9985.

Kellogg Company Kellogg Company would like you to know that as of May, its Kellogg’s FiberPlus®

Antioxidants Caramel Pecan Crunch cereal and all three of its Kellogg’s® Crunchy Nut™ cereal varieties are being reformulated with a natural flavor that contains pecan, walnut, and almond ingredients. All of the ingredient and allergen statements for these products will be updated to state that they contain peanut, wheat, pecan, walnut, and almond ingredients, and may contain other tree nuts. Because product formulations may change from time to time, consumers are strongly encouraged to read the package label prior to every purchase. For more information, call the company at (800) 962-1413 or visit www.kelloggs.com.

Kashi FoodsKashi Foods would like you to know that as of May, the allergen statement for all three varieties of Kashi® Cookies will indicate that these products contain almonds. The allergen statement will state “Contains

wheat, soy, almond, egg, milk, peanut, and walnut ingredients. May contain other tree nuts.” Additionally, Kashi® Banana Chocolate Chip Soft n’ Chewy Bars are reformulated to contain walnuts and will state “Contains wheat, milk, soy, walnut, peanut, almond, and egg ingredients. May contain other tree nuts.” Because product formulations may change from time to time, consumers are strongly encouraged to read the package label prior to every purchase. For more information, call the company at (877) 747-2467 or visit www.kashi.com.

Maria Acebal and MCF award winner Wendy Wessel


FAANTM | (800) 929-4040 | www.foodallergy.org

M – Milk-free E – Egg-free W – Wheat-free P – Peanut-free S – Soy-free N – Nut-freeNote: Recipes calling for margarine will be coded as containing soy, although milk- and soy-free margarine is available at some grocers.

Allergy-Free RecipesIn this issue, we are including tried and true recipes that highlight the wonderful flavors

that summer has to offer! These dishes are perfect for a backyard picnic. Enjoy!

Easy Grilled KebabsM, E, W, P, S, N

Marinade:u1/2 cup olive oil u1/2 cup red wine vinegar u1/2 T. coarse black pepper u3 cloves garlic, peeled and finely

choppedu1 tsp. salt

Kebabs:u1 1/2 lbs top sirloin steak, cut into

1 1/2-inch cubesu1 large green bell pepper, cut into

1 1/2-inch chunksuPineapple chunksu1 medium red onions, peeled, quartered

and separatedu1/2 lb. button mushroomsuSkewers*

Sprinkle salt and pepper over steak cubes and place into plastic zip-top bag. To prepare marinade, whisk together marinade ingredients in a small bowl. Pour into plastic bag, coating the meat. Refrigerate 3 hours. Preheat grill. Assemble kebabs by alternately threading meat, green pepper, pineapple chunks, onion, and mushrooms onto skewers. Grill about 8 minutes. Turn, and grill about 8 minutes more or until meat is cooked and vegetables are tender.

* If using wooden skewers, soak in water for a half hour before threading with food and grilling.

Chocolate-Chip BrowniesM, E, P, N

u1/2 c. milk-free shorteningu1 c. sugaru1/2 c. silken tofuu1 tsp. vanillau2/3 c. unbleached all purpose flouru1/2 c. cocoau1/2 tsp. baking powderu1/4 tsp. saltu1/2 c. milk-free mini chocolate chips

Preheat oven to 350 degrees and spray an 8 inch square baking dish coated with milk free baking spray. In the bowl of a mixer fitted with the paddle attachment, combine shortening, sugar, tofu and vanilla thoroughly. In a separate bowl combine flour, cocoa, baking powder and salt with a wire whisk. Add to the shortening mixture and mix until just combined. Stir in chocolate chips with a rubber spatula. Spread batter into prepared baking pan and bake 30 minutes or until cake tester comes out clean. Cool completely and dust with confectioner’s sugar, if desired.

Recipe adapted with permission from The Food Allergy Mama’s Baking Book by Kelly Rudnicki. Copyright (c) 2009. To order a copy, visit FAAN’s website.

Key to Symbols: Stir mixture into orzo. Season with salt and pepper. Serve warm or cold.

Note: If you are avoiding eggs and/or wheat, substitute hot, cooked rice for the orzo.

Strawberry-Banana SorbetM, E, W, P, S, N

u1 1/2 cups diced fresh strawberries u2 very ripe bananasu1/2 cup cold wateru1/2 cup sugaruJuice from 1 medium lemon

Place all ingredients in a food processor or blender, and process until smooth. Pour into a freezer-safe container, cover tightly, and freeze about 2 hours, stirring mixture occasionally, until thick and firm.

Orzo-Asparagus SaladM, P, S, N

u1 1/2 cup hot, cooked orzou1/2 tsp. salt u1 T. olive oilu3 tsp. minced garlicu12 asparagus spears, cut into 1-inch

piecesu1 cup packed fresh spinachuSalt and pepper, to taste

Place hot, cooked orzo in a medium bowl. Set aside. In a small pan over medium to medium-low heat, heat olive oil and garlic, stirring often. Add in asparagus. Sauté for 3-4 minutes. Stir in spinach. Cook until asparagus is tender and spinach is wilted.

For more easy, great-tasting recipes, be sure to check out our recipe database on www.foodallergy.org. Let us know if you have a favorite to share!



A Mother’s JourneyBy Rhonda Lubin

In 1991, my 1-year-old daughter, Julie, became violently ill after taking her first sip of cow’s milk

and subsequently was diagnosed with a life-threatening allergy to all milk products. She was too young to understand, but my life turned upside down. There was so much to understand and learn and so many restrictions to her diet. I was afraid to leave her in the care of anyone. Even her grandparents were not, in my mind, completely trustworthy. Whenever I was not with her, the fear that she would die from eating something wrong was overwhelming. Today, Julie is 22 and is about to graduate college. She still has to be cautious about every morsel of food that she puts into her mouth. The journey continues for both of us. Of course, it is much more challenging for her than for me; but as any parent knows, we never stop worrying about our children, no matter what age they are. Throughout the years, we have dealt with so many issues that most of you encounter as well, including:l severe and surprising food

restrictions (the prevalence of and/or cross-contact with milk in so many foods we never expected)

l the sadness in her eyes when she was told she could not eat birthday cake at friends’ parties or share snacks at school

l the emotional fallout of feeling “different” from other kids and receiving unwanted attention when just wanting to “blend in,” particularly through the teen years

l the effect on other family members who feel “guilty” eating unsafe foods

l the trials and tribulations of traveling – finding “safe” places to eat; dealing with allergic reactions when far from home

l having to convince people (including

restaurant staff) that a milk allergy is, in fact, life-threatening and not simply lactose intolerance

l ending up in emergency rooms, where I had to tell the medical staff how to treat a severe allergic reaction

The list goes on and on. Food allergies are, unfortunately, on the rise in young children. Thanks to awareness and education efforts, most people no longer roll their eyes when you tell them you could die from eating something to which you are allergic. Restaurants are much more careful and accommodating. Schools and camps have protocol for dealing with allergic kids and the proper use of epinephrine auto-injectors. Laws requiring that food labels clearly indicate the presence

of allergens have transformed food shopping for people with allergies. Some states now require that epinephrine be available on ambulances. And, of course, there is the ongoing commitment to research and finding a cure. I think of Julie as a “pioneer,” who had to deal with challenges when people simply didn’t understand what all the fuss was about. But thanks to FAAN (and the wonderful care of Dr. Hugh Sampson from the Mount Sinai School of Medicine), Julie has successfully navigated through school, camp, travel, and even a semester abroad in Italy. Julie says that dealing with food allergies has made her stronger, more mature, and certainly more responsible. Until there’s a cure, I will never stop worrying about her. But I will always be extremely proud of her. u

Rhonda Lubin has been a FAAN member since 1991. She is a freelance editor and lives in Westchester County, NY.

Delta Airlines Revises Peanut Policy

Effective June 1, Delta will institute a new policy for travelers with peanut allergy. The new policy states that if the airline is notified at least 48 hours in advance that you are flying with a peanut allergy, it will not serve any peanuts or products that contain peanuts on your flight. Previously, the airline would create a 3-row buffer zone for passengers with peanut allergy.

Teacher Certification Bill in New YorkLandmark legislation is also being considered in New York (Assembly Bill 8977 and Senate Bill 5458) that would require people in that state applying for a certificate or license to be a classroom teacher, teaching assistant, pupil personnel service professional, or school administrator supervisor or school superintendent to complete a training course on the use of an epinephrine auto-injector. If you live in any of these states mentioned above, please contact your local legislators and ask them to support these bills. u

Legislative and Advocacy Update



Ask the Expert

What are the criteria for doing an oral food challenge? We’ve been to two allergists and they do a skin test because they say an oral challenge is too risky.

The criteria for doing an oral food challenge are based on a combination of allergy test results, usually both skin and blood tests, and the reaction history. For example, if someone just recently reacted to a food, or has an extremely high IgE level to that food, a challenge would not be worth the risk. The decision also differs for each food and each patient, so the decision is really made on an individual basis.

Robert A. Wood, M.D., is a professor of pediatrics and international health and director of Pediatric Allergy and Immunology at Johns Hopkins University School of Medicine in

Baltimore, MD. He is also a member of FAAN’s Medical Advisory Board.

One of my children has a severe nut allergy while the other does not. When we are out and about and come across a bakery or ice cream parlor, our non-allergic child asks for these treats. It is too risky for my allergic child to have these things. In this scenario, we wonder which child to deny. We don’t want our non-allergic child to never have the pleasure of indulging in these treats when we are out, just because her sister can’t. Is there a clear answer?

I have seen families manage this issue many different ways successfully, but I admit that I have a bias toward finding ways

to include the allergic child in activities with her immediate family—especially when the child is very young. If you’re planning an outing where you’ll allow a treat, why not plan to enjoy something that is safe for both children? For example, simply explain that you are going to have snow cones instead of ice cream cones because it’s something the whole family can enjoy – just as you might choose a G-rated movie if you have a 4-year-old, even though your 9-year-old might want to see a PG-rated movie. At times, we do what’s best for the whole family. As your children age, you might allow different treats. For example, when we’re on vacation, I’ll let my older son have a milkshake, but we’ll make sure we find a milk-free slushee or Popsicle® for my younger (food-allergic) son.

Keep in mind that when we restrict what a child can have, he or she is inclined to want it even more. You might also consider taking each child on an outing alone. For your non-allergic child, it can be a “peanut date” where he or she may enjoy any peanut or nut-filled treat of choice. Even better is to make these outings a weekly or bi-weekly ritual. I don’t think you are at risk of not preparing your daughter for the real world when you sometimes make the choice to keep treats inclusive. When a family member, especially a child, has a special need, we might expect that one’s immediate family would be more accommodating than the outside world. For example, for a deaf child, all family members may choose to learn sign language. One could argue that “This is not real life,” as the whole world isn’t going to learn sign language, or you could view this as the support of a loving family. u

Gina Clowes, FAAN’s Vice President of Member Relations, is a well-known advocate and coach, and is the Founder of AllergyMoms.com. Her advice and parenting tips have

appeared in numerous print, radio and television features including CNN, People, and ABC World News Tonight.

Do you have questions about food allergies? If so, our experts have the answers! Each month online, as an exclusive FAAN member service, we publish a question-and-answer session with leading

experts on a wide range of topics – from diagnostics, to research, to food allergy management in everyday life. To access the Ask the Expert section and read an archive of questions and answers, login to foodallergy.org, and in the top right corner, you will see a link to the Members Area. To ask a question, send an e-mail to [email protected].

Dr. F. Estelle R. Simons Receives Distinguished Clinician Award

Congratulations to Dr. Estelle Simons, who was named recipient of the Distinguished Clinician Award at the 2012 Annual Meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI). Dr. Simons is a Professor in the Department of Pediatrics and Child Health at the University of Manitoba, Canada, and founder of its Division of Allergy and Clinical Immunology. She is also a member of FAAN’s Medical Advisory Board. She was recognized for “significant contributions toward an improved understanding of the clinical pharmacology of medications used to treat allergic disorders.” Dr. Simons’ research has defined the clinical pharmacology of many medications used to treat asthma, allergic rhinitis, hives, and anaphylaxis. She is pictured here, accepting her award from the 2011 AAAAI President, Dennis Ledford, M.D. Please join us in congratulating Dr. Simons on this prestigious award.



The coconut palm (Cocos mufifera) is a member of the Arecaceae family, and

is abundant throughout tropical regions. The coconut fruit is sometimes considered a tree nut because it is a hard-shelled fruit that grows on a tree. However, in botanical terms, the coconut is not a tree, but rather

is a palm. The coconut palm is genetically different from trees that produce the typical tree nuts such as walnut, pecan, hazelnut, almond, etc. In 2006, the U.S. Food & Drug Administration added coconut to the list of tree nuts that manufacturers are required to label under the mandate of the Food Allergen Labeling and Consumer Protection Act (FALCPA), which requires manufacturers to label, in plain language, major food allergens (milk, eggs, fish, crustacean shellfish, peanuts, tree nuts, wheat, and soy). Shortly after the law took effect, the U.S. Food & Drug Administration, which is charged with enforcing FALCPA,

Is Coconut a Tree Nut?By Steve Taylor, Ph.D.; Joseph L. Baumert, Ph.D.; and Jamie L. Kabourek, M.S., R.D.

clarified the law by defining the terms that would indicate tree nuts, and coconut, which had not previously been considered commonly allergenic, appeared on this list. So, do those with allergies to other tree nuts need to avoid coconut as well? Not necessarily. Very little evidence exists to suggest that individuals allergic to other more commonly allergenic tree nuts (e.g., walnut, cashew, almond, pecan, Brazil nut, hazelnut, macadamia nut, pistachio, pine nut) will also be allergic to coconut. The vast majority of cases of coconut allergy appear to involve just coconut, with no evidence of allergy to other tree nuts. Although the prevalence of coconut allergy is low, medical literature does report a handful of cases, and reactions to coconut can be severe. Therefore, if you are allergic to tree nuts, talk to your doctor about whether or not coconut should be restricted from your diet. u

Steve Taylor, Ph.D., is a professor in the Department of Food Science and Technology and co-director of the Food Allergy Research and Resource Program (FARRP) of the University of Nebraska-Lincoln. He is also a member of FAAN’s Medical Advisory Board. Joseph L. Baumert, Ph.D., is assistant professor in the Department of Food Science and Technology and co-Director of FARRP, and Jamie L. Kabourek, M.S., R.D., is a registered dietitian and resource manager for FARRP.

The vast majority of cases of coconut allergy appear to involve just coconut, with no evidence of allergy to other tree nuts.

Middle childhood is an important transition point when children begin to gain autonomy and self-belief in their ability to control events in their lives. We find increased levels of anxiety or risk-taking behavior follows this point, resulting from the negative impact of attempting to cope every day with challenges that are above and beyond those faced by most children in this age group, who do not have food allergy. Adolescence is yet another important transition point with increased stresses related to age-specific challenges, in addition to the burden of food allergy. Parents also experience high levels of stress and anxiety due to constant vigilance and feelings of guilt. Some of this worry is maladaptive (e.g., overprotection), preventing normal social development, and therefore may have a long-term impact on health related quality of life and positive coping ability. Greater support and clear information is important at the time of diagnosis and at the different transition points along the developmental pathway. Specifically, parents have suggested that greater emphasis is needed on the social and emotional aspects of food allergy, on knowing what to expect, and on enhancing self-management skills that both children and their families can draw on, and that generalize to both everyday and non-typical situations. To address and attempt to alleviate food allergy related stressors, research suggests that reducing uncertainty should be a major goal for health professionals working with children, teens and families. u

Audrey DunnGalvin, Ph.D. is a registered psychologist and a biostatistician in the department of Paediatrics and Child Health at Cork University Hospital in Cork, Ireland.

Development, continued



Research UpdateIncreasing the accuracy of peanut

allergy diagnosis by using Ara h 2 A recently published study focusing on peanut allergy diagnostics shows that blood tests for Ara h 2 (the major peanut allergen) are more accurate in determining peanut allergy than whole peanut-specific IgE blood tests or peanut skin prick tests alone. Researchers concluded that the sensitivity of Ara h 2 sIgE testing is 60% compared with 26% with whole peanut sIgE. “These findings might have profound clinical implications because they allow for increased peanut allergy diagnosis and reduce the number of patients requiring referral to specialist services for confirmation of food allergy by using [oral food challenges],” the study’s authors wrote. To reach these findings, researchers used a cohort of 200 infants (median age, 12 and 14 months) in Australia. Half of the subjects had a clinical peanut allergy, 58 were peanut-sensitized, and 42 were non-peanut-sensitized and used as negative controls. Of the 100 infants with peanut allergy, 57% had skin prick test results that could qualify for a peanut allergy diagnosis and 35% had skin prick tests results that would require an oral food challenge to confirm a clinical peanut allergy. Looking at the same infants’ test results for peanut sIgE, 65% had levels that would require an oral food challenge. Researchers reported that using current thresholds for oral food challenges, 95 infants with whole peanut sIgE measurements, 50 infants with skin prick test measurements and 44 infants with Ara h 2 sIgE measurements would require an oral food challenge. Using the Ara h 2 sIgE testing in

combination with whole peanut sIgE tests would reduce the number of oral food challenges by almost two-thirds, according to the study. Another aspect of the study involved looking into whether Ara h 2 sIgE levels could predict the severity of the allergic reaction, but that data showed that the levels did not identify the four patients with peanut allergy who experienced an anaphylactic reaction during their oral food challenge.

The study’s authors noted that the participants’ age (approximately 1 year) could mean that the results may not generalize to other ages. They also noted that while Ara h 2 has been identified as the pre-dominant peanut allergen in many countries, the use of this testing may not apply to some countries, e.g. Spain, where Ara h 9 is reported to be the dominant allergen. u

Dang TD, Tang M, Choo S, Licciardi PV, Koplin JK, Martin PE, Tan T, Gurrin LC, Ponsonby A-L, Tey D, Robinson M, Dharmage SC, Allen KJ. J. Allergy Clin Immunol. Doi:10.1016/j.jaci.2012.01.056.

News from FAAN’s Research Grant ProgramWhy do some children develop a peanut allergy and others don’t? Researchers trying to answer this crucial question in order to learn how to prevent this life-threatening food allergy believe that being exposed to peanuts through skin early in life could be a determining factor. These findings were published in the March issue of Allergy, the European Journal of Allergy and Clinical Immunology.1 The study was funded in part by the Food Allergy & Anaphylaxis Network’s competitive Research Grant Program, which has awarded more than $5 million since 2004 to scientists advancing research in the field of food allergy. Researchers at the Guy’s and St. Thomas’ NHS Foundation Trust, St. Thomas’ Hospital in London, looked at the blood cells of children with peanut allergy and compared them to children who are not allergic to peanuts. They keyed in on the immune cells that respond to the peanut allergen, and learned that these lymphocytes appear to carry a surface marker – an “address” offering clues about where the peanut allergen was first encountered. They found different markers depending on whether the exposure occurred through the skin (environmental exposure) or through the gut, and learned that the marker for skin was associated with a peanut allergy diagnosis. “FAAN played a crucial role in supporting this novel research study, which is consistent with the hypothesis that the route of exposure affects whether peanut allergy develops,” said Gideon Lack, M.D., professor of pediatric allergy at King’s College London and one of the authors of the study. “Skin exposure may be linked to peanut allergy, while eating peanuts early may protect from peanut allergy. This study supports a growing body of work on preventing peanut allergy and is in line with the hypothesis of the LEAP study, the outcome of which may influence strategies to prevent peanut allergy.” Lack is principal investigator of the ongoing Learning Early About Peanut Allergy (LEAP) study, which is looking into the question of whether eating peanuts in infancy makes the immune system tolerant or sensitive to peanuts later in life. u

1 Chan SM, Turcanu V, Stephens AC, Fox AT, Grieve AP, Lack G. Cutaneous lymphocyte antigen and a4b7 T-lymphocyte responses are associated with peanut allergy and tolerance in children. Allergy, Vol. 67, Issue 3, pages 336-342, March 2012.

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