The Science of Anaphylaxis – An Allergic Storm

posted February 12, 2013
02/12
2013

“Education leads to enlightenment.  Enlightenment opens the way to empathy.  Empathy foreshadows reform.”  -  Derrick A. Bell

The death of Ammaria Johnson is heart-wrenching for all of us.  An innocent 7 year old dies at school from peanut-induced anaphylaxis because her life-saving medication, epinephrine, was not available to her.  This is a grim reminder of the life-threatening nature of food-induced anaphylaxis and a very serious reminder of the critical need for massive food allergy education.

So, here’s what I am going to do.  I am going to teach you what happens in your body during an allergic reaction.  I want to do this for two main reasons:

1.  TO EMPOWER YOU.  Science is power.  It’s the proof.  And because food allergy is a term used relatively loosely, food allergy families and friends often find themselves feeling like they have something to prove. If you can use the words “mast cell” and “histamine” when you are describing food allergy to someone, they will have less opportunity to question you, to doubt you.

2.  TO HELP YOU EDUCATE OTHERS. If you have a clear understanding of how food allergy works and why epinephrine will save the life of someone who is experiencing anaphylaxis then you can be a better and more confident educator.  You will become an authority on food allergy.  You’ll have the facts in your back pocket.  People will listen because science is power.

I was at a kindergarten social for Sal and two fathers asked me why Gino and Milo didn’t go to the same school as my older son.  I explained that for preschool we hired a teacher for the boys because they have life-threatening food allergies and we didn’t think they were ready for a traditional food-filled preschool setting.  They just looked at me.  I felt doubt.  I felt judgment.  I felt misunderstood.  So instead of continuing with the normal, “So, anyway, I grew up in Bourbonnais.  What about you?” conversation, I thought I would give something else a try.  I asked them if they would mind if I took a few minutes to explain, scientifically, what happens during an allergic reaction.  They agreed, mostly to humor me.  (How could I blame them?  It was a pretty nerdy opening line.) As I spoke, the way they looked at me changed.  Their body language shifted from cross-armed and distant to relaxed with their body’s leaning in toward mine.  They were shifting from doubt to empathy before my eyes.  They were engaged.  As I was teaching them, they had no choice but to learn.  It was a powerful moment for me and later, I found out, for them too.  I am going to tell you what I told them.

The human immune system has an extraordinary eloquence and precision.  Nothing man-made can compete with its beauty and power. With that being said, this is a greatly simplified version of what happens during an allergic reaction but I think it is all you need to become an empowered educator.  Okay, friends, are you ready?

There are two main allergic cells in your body, the mast cell and the basophil.  These cells contain within them pockets (or granules, seen in red in image below) filled with chemicals that mediate allergic disease.  Mast cells are found docked in tissues whereas basophils are floating around in the blood.   Both of these types of cells have receptors on their surface.  Some of these receptors have IgE (immunoglobulin type E) antibodies attached to them. Think of the IgE antibody as a hand that projects out from the cell (seen in dark blue, shaped like a “Y” in image below).  Each of the hands will only grab onto specific food proteins.  They have a favorite food, so to speak.

Those are the main cellular players.  Now here’s what they do.  An individual eats a food to which he or she is allergic.  Let’s say it is a peanut but it could be virtually any food.  The peanut enters the gastrointestinal (GI) tract, whether it is peanut residue that cannot even be seen or an actual piece of a peanut.  At some point, the tiny allergenic peanut protein passes thru an insecure barrier in the wall of the GI tract.  The peanut protein then finds its way, through a series of events, to the blood stream and tissues.  Here is where the peanut protein finds the mast cells and basophils.

Now, there are those “Y”-shaped IgE antibodies (the hands) on these mast cells and basophils, remember?  The hands on some of the cells of a peanut-allergic person are looking for peanut protein.   When these hands make contact with the peanut protein, they grab onto it and in turn, the cell becomes “excited”.

The pockets of chemicals (granules) found within the cells quickly move to the edge of the cell and pour their chemical contents out into the bloodstream or tissues (degranulation). The chemicals spewing from these cells (seen in red in image below) include histamine and tryptase, among others. This process of degranulation can occur very rapidly and does not just occur in a few cells but instead in many cells all over the body.  This process occurs even if there was only a miniscule amount of peanut protein that originally started the reaction, even if the blood test showed a low number for peanut, even if all of the past reactions were minor.  If this process were not deadly, I would say that the efficiency and rapidity of the reaction borders on fantastic.

Histamine, tryptase and the other chemicals that are now swirling in the blood and the tissues start to wreak immediate havoc and the signs and symptoms of anaphylaxis are quickly evident.  Anaphylaxis hits as sudden as a summer storm.  The damage is frightening and widespread.  Histamine causes many changes to occur in the body.  Some of these effects are more considerable than others.  Histamine causes smooth muscles to contract leading to abdominal pain, cramping, nausea, vomiting and diarrhea.  It can lead to wheezing (like asthma) from airway constriction that can ultimately lead to respiratory distress, respiratory arrest and death.  Histamine also causes vasodilatation.  This is when blood vessels get bigger and have less ability to contract to get blood back to the heart.  This can cause a decrease in blood pressure that can lead to dizziness, feeling faint, shock and death.  Histamine also induces microvascular leakage.  This means that both cells and fluid that are supposed to stay in the blood vessels are able to leak out of the blood vessels.  This can lead to hives, itching, and swelling of the throat leading to suffocation.  If enough fluid leaks out of the blood vessels, there can be accompanying decrease in blood pressure leading to shock and death.  Histamine can also cause marked mucosal edema and mucus secretion.  It can cause the airways to become swollen and filled with mucus making it difficult for oxygen to get from the air we breathe into the blood that circulates around our body.

Now we are in the midst of anaphylaxis, WE MUST STOP IT.  YOU MUST USE INJECTABLE EPINEPHRINE.  How does epinephrine work to stop an allergic reaction?  You need to know this.  You need to understand WHY you must carry this everywhere you go.  You need to know WHY you must use this medication when your son or daughter, parent, grandchild, student, or friend is having a serious allergic reaction.  I told you how fast these reactions occur (and many of you have seen the speed of a reaction first hand) so there is no time to waste. If someone is experiencing anaphylaxis, injectable epinephrine must be given immediately.  Be a hero. Save a life. Don’t be afraid. Once you give the injectable epinephrine as instructed, here is what it does…

Epinephrine constricts blood vessels.  This is important because it curbs that microvascular leaking that leads to decreased blood volume and plummeting blood pressure, potentially leading to shock and death.  Epinephrine relaxes airways.  So while histamine is trying to make the airways tight, epinephrine tries to relax them in order to allow air to pass more easily.  Epinephrine helps to decrease swelling in the upper airway so that air is not obstructed from getting to the lungs.  It decreases cramping of the GI tract.  It helps to block the hives and itching that accompany an allergic reaction.  Epinephrine can help to stop anaphylaxis from progressing to death if given early and appropriately.   It is the only thing that can.  Antihistamines can relieve some of the skin symptoms (hives, itch) but they do not have the ability to save a life from anaphylaxis.

To summarize:  The food that one is allergic to enters the body.  It finds its way to allergic cells (mast cells and basophils) that recognize only certain foods through their IgE antibodies.  Once the allergic food protein binds to that IgE, the cell pours out chemicals (histamine and tryptase) that cause swelling, itching, decreased blood pressure, and can ultimately lead to death.  Epinephrine counteracts these effects.  It decreases swelling, increases your blood pressure, makes your heart pump better and helps to prevent a fatal reaction.

That is anaphylaxis in a nutshell, so to speak.   This is why it can be deadly and this is why epinephrine can save a life.  Please share this post with your friends, families, teachers, administrators, school nurses, physicians, and anyone else you can think of.  I know it is a long post but it is so very important.  If we do not push to educate others, I’m afraid that we are going to continue to lose our sweet and innocent food allergic children to anaphylaxis.  We simply cannot stand for this and, if I know anything about families who have children with food allergies, I know we won’t stand for this.  There is too much at stake.

Sarah | 110 Comments | Permalink
Anaphylaxis, Observations, Science

If You Wish You Could Do More… You Can!

posted December 3, 2012
12/03
2012

Hello friends,

As a parent of children with food allergies, I frequently feel like I’m not doing enough to change the course of my children’s disease.  We are great allergen avoiders but I want to be proactive.  I want to play a role in effecting a change.

Isn’t there something I can treat them with to increase their chances of losing their allergic sensitization?  Isn’t there some sort of intervention that may help?  Isn’t there anything I can do to help bring about a cure or a treatment for food allergies?

Fortunately, for all of us…there is.  One of the most effective and efficient ways to support a cure for food allergies is to support research at Lurie Children’s in Chicago.

Research, both clinical and basic science, is where the answer is.  There is no way to unlock the mystery of food allergies without research and there is no research without financial funding.

For those of you not familiar with Lurie Children’s, they are the Midwest leader in specialty care devoted exclusively to children. Staffed with 1,100 pediatric specialists focusing on 70 specialties, they care for more than 149,000 children every year. With an array of progressive support programs and features, backed by the latest medical technology, Lurie Children’s is making critical strides to the advance the care provided to children who suffer from food allergies.

Will you consider joining my husband and I in supporting Lurie Children’s allergy research with a special gift before December 31st?

The Division of Allergy and Immunology, where I completed my fellowship training as an allergist, cares for more children with allergies and asthma than any other healthcare provider in the Midwest.  Dr. Jacqueline Pongracic and her team at the Lurie Children’s Bunning Allergy Institute, actively seek to improve the lives of children and families affected by food allergy through a commitment to clinical excellence and research.

Never before has there been a better opportunity to impact the lives of so many children through medical research.  

Last year, Food Allergy Initiative and its partners introduced the “Roadmap to a Cure,” a strategic plan that will lead to the development of a safe, effective FDA-approved treatment potentially offering protection to the majority of food allergy sufferers. Oral immunotherapy, or OIT, has shown tremendous results and is now ready for FDA Phase 3 trials.  Lurie Children’s faculty members, Melanie Makhija, MD, and Rachel G. Robison, MD, are currently gathering data in order to take a lead role in these life-changing OIT research studies.

Hosting medical trials unfortunately takes money.  The harsh reality of the current research funding environment is that federal support for research has slowed alarmingly at a time when the opportunities for progress are the greatest.  As more cases of life threatening allergy are identified each year, more children are counting on us to help fund life-changing and potentially life-saving research than ever before.

At this important time of year, I want to invite you to join me in helping the Division of Allergy and Immunology of Lurie Children’s acquire the tools they seek to better care for our children.  To do this, we have set a goal to raise $20,000 by December 31.  Funds raised will ensure that important clinical trials are launched in 2013 and researchers can continue to explore new treatments for our children.

By giving a monetary donation to support food allergy research, you will be a part of the answer.  Regardless of the size of your gift, 100% of your donation will go toward research that will directly benefit you or a loved one with food allergy.

You can make your gift to today by visiting Lurie Children’s website at heroesforlife.org/allergymom.  

As a special thank you, all donors of $100 or more will receive a special apron from The Allergist Mom and Lurie Children’s to wear while making your allergen-free treats this holiday season!  You might also consider making a gift in honor of a loved one with food allergy.  If you do, Lurie Children’s will send a special thank you packet to your special someone.  Other fun gifts are also available- see our full list of benefits at heroesforlife.org/allergymom.

I have presented this fundraising opportunity to you because I truly believe that research is the only road to a treatment or a cure for food allergies.  And if you are anything like me, that is all you really want!

Thank you, friends, for considering our request.

A very special thank you to our Corporate Sponsors, Nutphree’s Cupcakes and Enjoy Life Foods!

P.S.  A few months ago, I was interviewed for the Eric and Kathy’s 36 hour Radiothon to benefit Ann & Robert H. Lurie Children’s Hospital of Chicago.  In the interview I spoke about the serious nature of food allergies, how they have significantly impacted my family, and the singular importance of research in this field.  If you didn’t hear this segment during the Radiothon and would like to, please click on this link!   01 Eric and Kathy Radiothon

Sarah | 8 Comments | Permalink
Lurie Children's

Top 8 Allergen-Free Thanksgiving Stuffing

posted November 20, 2012
11/20
2012

Last year I decided to try to transform my Gramma Boudreau’s stuffing recipe into one that would be safe for my family, meaning that I had to make it top 8 allergen-free plus some.  The flavor of this stuffing tells of my childhood Thanksgivings and I wanted desperately to share that with my children.  So many traditions have been changed for us because of food allergies.  We can’t use real Easter eggs, we don’t build gingerbread houses (yet… I’m working on that one!), we can’t eat creamed corn or cranberry sauce so I was determined to make this stuffing and to make it taste like Thanksgivings of old.  Well, I did it and I wanted to share it with you!

The tell-all behind this recipe will be found in my newest article in the Winter issue of Allergic Living magazine!  They so kindly let me share this recipe with you before it hits the shelves next week in honor of Thanksgiving.  If you want to subscribe to Allergic Living, here is the link: https://allergicliving.com/index.php/subscriptions-renewals/.

You might even recognize someone on the cover…

Have a wonderful Thanksgiving, friends.  I am very thankful to have each one of you on this journey with me.

 Gramma Boudreau’s Stuffing

For Croutons 

2 loaves of gluten-free, allergen-free bread

olive oil

sage

black pepper

parsley

onion and garlic salts

Lawry’s seasoned salt

 

For Meat Filling  

olive oil

1 1/3 cup celery, chopped

2 cups white onion, chopped

1¼ lbs ground pork

1¼ lbs ground beef

2 cups mushrooms, chopped

sage

pepper, salt

1/3 cup of water

6 cups chicken broth or beef broth (check ingredients on these in particular or make your own)

Method

1. To make the bread cubes, cut up the 2 loaves into small crouton-sized cubes and place on a parchment-lined cookie sheet. Leave the bread to dry out for about 4 hours.

2. Heat the oven to 325° F. Spray the cubes with olive oil, then sprinkle with sage, black pepper, parsley, onion salt, garlic salt and seasoned salt. (You will need more than you think for gluten-free bread to retain the flavor of a traditional crouton.)

3. Place in the oven to bake. After 15 minutes, turn the cubes, spraying again with oil and repeat seasonings. Bake another 15 minutes or until the croutons are crunchy. Remove from oven and set aside. (The croutons are good for a salad, too.)

4. To make the meat filling, heat a small amount of olive oil in a frying pan over medium  heat. Add the celery and onion, and cook until they are nearly transparent.

5.  Now add the ground pork and beef (I use sirloin). As the meats begin to cook together, add the mushrooms.

6. Once the meat is browning, add 3 shakes of sage, 2 shakes of parsley, and salt and pepper to taste. When the meat is cooked through, drain any remaining fat then stir in 1/3 cup water.

7.  Preheat the oven to 350° F. Place the bread cubes in a large bowl, and add the meat mixture.  Pour in chicken broth (read ingredient labels carefully for allergens or make your own broth). Add 3-4 more shakes of sage.

8. Using a large spoon, fold the mixture by lifting and mixing in the croutons, just be careful not to overmix and make the cubes mushy.

9. Put this mixture into an oiled baking dish and place in the oven for 1-2 hours. Time will depend on depth of the dish.

Enjoy!!

SAFETY NOTE:  Although this recipe is meant to be top eight (cow’s milk, egg, soy, wheat, peanut, tree nuts, fish and shellfish) allergen-free, I cannot guarantee that all of the products that I have used will remain top eight allergen-free.  I encourage you to always read food labels thoroughly each and every time you use a product as ingredients and manufacturing practices may change without warning. Please omit and/or substitute any ingredients that are unsafe for you or your family members for ingredients that are safe.  If you need help finding substitutions, please let me know and I will do my best to help.  If you have questions about whether a particular food is safe for you or your family members, please contact your physician.
Sarah | 11 Comments | Permalink
Holidays, Recipes

Food Allergy Death Talk

posted October 15, 2012
10/15
2012

It was a gorgeous fall day for the Food Allergy and Anaphylaxis (FAAN) walk in Chicago.  The kids were busy collecting allergen-friendly food samples and coloring pages.  There was music playing and the kids packed the stage to dance together.  They felt a common bond with the other children there.  There was excitement; they felt special in their sameness.  Then the music stopped only to have this afternoon punctuated by a story they will never forget.  This fun-filled day was put to an abrupt end as a mother was about to share the very painful and tragic story of her daughter’s death from anaphylaxis.  Her daughter had eaten cow’s milk contaminated french fries from the school cafeteria and had a significant delay in the administration of injectable epinephrine.  This mother was articulate and overflowing with a strength that most mothers could not possibly possess after the death of a child.  She is a warrior against food allergy related morbidity and mortality and she has helped to shape and fashion a much safer world for children with food allergies.  This post is in no way meant to detract from her story, from her daughter’s story, but instead it is meant to highlight what her words meant to my children, and what they may have meant to your children, whether you think they heard them or not. Chances are they actually did hear her heartbreaking words and they took them deep into their ever-maturing but tender young minds and they tried to process what this little girl’s story meant for them.

The night following the walk, as I sat on the edge of Milo’s bed, he said, “I had a nice day but I didn’t like that story of the little girl who died from her food allergy.  It was the only bad part.  It was too sad.”  I was surprised he had listened.  When I heard the mother begin to tell her story, I tried to distract my 6 and 7 year-old children.  I encouraged them to open their Enjoy Life cookies or look through their bag of goodies but obviously that hadn’t worked and their little ears heard it all.  I agreed with him that it was a very sad story but I told him that he didn’t have anything to worry about.  He fell asleep while I rubbed his head, reassuring him that everything would be okay.  And I hoped that this would be the last of the food allergy death talk.

The Monday morning after the walk marched on as usual.  The house was hectic and my husband and I took turns begging the boys to get dressed, find their shoes, and brush their teeth.  When I showed up at school during the lunch hour, I overheard Milo telling some friends at his table about the walk and how there was a very sad story about a girl who died from her food allergy.  This is at a table of children with food allergies.  I swept in and reminded everyone that they all make good, safe choices about the food they eat and they have their medications with them all the time and that nothing bad is going to happen to them.  They looked at me like they believed me or at least like they wanted to believe me.  And I hoped that now this would be the end of the food allergy death talk.

A few minutes later, a second grader with food allergy who walked with us that Sunday, came in the cafeteria.  He walked right up to me, no smile in sight, and said, “Dr. Romano, that was a sad story about that girl yesterday.”  I called his mom right away to share what he said and what I told him in reply.  She told me that after the walk he couldn’t stop talking about how happy he was that didn’t eat food from the school cafeteria and how worried he was about peanuts getting into his safe food.  This story had hit too close to home for these young children and their minds weren’t mature enough to process all of this.  These kids felt like they knew her.  She was in school, just like them.  She was allergic to milk, just like them.  She loved french fries, just like them. They too may die then, just like her.  My friend and I both hoped that this would be the last of the food allergy death talk.

In the car, after picking the kids up from school, Gino told me that Milo wrote about the girl who died at Writer’s Workshop and then shared the story with his class.  He also shared that they sent bubbles up to this little girl in heaven, in her memory.  He was dealing with this as though we had taken him to another child’s funeral. Gino told me that the teachers looked sad, even demonstrating how one of them turned her lower lip outward in a frown.  Milo then stated confidently, “Mom, I will not die from my food allergies.”  I quickly and fiercely agreed with him.  Then I looked in the rearview mirror and made eye contact with Gino.  He looked at me with his huge brown eyes that were clearly holding back tears and said, “But I could die of my food allergies though, right mom?”  I answered the same way as I would answer if he asked me if he was going to get hit by a car while crossing the street and die.  “There is no way you are going to die from your food allergies, Gino.  There is just no way.”  To which he sighed in relief.

My oldest son, Sal, shared with me that he had been feeling worried that his brothers would die from food allergy but that he was trying not to worry because he and everyone in our family know how to use the EpiPen.  Sal then suggested that he redo second grade to be in the same class with his brothers next year so that he could be sure they would be safe at school.  I felt overwhelmed and honestly, a little angry that we had to have this conversation. This wasn’t my plan to teach them about the realities of dying from food allergy in first grade.  I felt regret that when the story started that beautiful Sunday afternoon that I didn’t follow my gut and walk away with them.  I felt I had let them down, that I didn’t protect them from a truth that they were too young to hear, to young to understand.  Then two-year-old Lucy yelled over the boys that it was her turn to talk.  We all quieted so she could participate in the drive-home-from-school talk.  She said through an enormous grin, “My blallet teachah died fom eating a chocit bah”.  For some strange reason, the car erupted in awkward but necessary laughter and then we all changed the subject.

I have never hidden the seriousness of food allergy from my children.  If they ask, could I go to the hospital because of my food allergy? I say yes. If they ask, if I eat a food that I’m allergic to could I get really, really sick? I say yes.  If they ask, if I have an allergic reaction and forget my EpiPen, could it be bad?  I say yes.  They have overheard the terms life-threatening.  They have heard people in a hush ask me if my children could die from peanuts or milk.  They know.  They’ve heard about it.  They’ve been sick.  They’ve been to the ER.  They know how bad it can be.  I have never told them directly that they could die from their food allergy.  I didn’t want to yet.  Literature has shown that this age of children do not have the ability to truly understand the concept of death.  They are not dying, so I didn’t feel that this was an imperative discussion yet.

As they approach their teenage years, when children inevitably engage in more risk-taking behaviors and when they have a more mature level of understanding of the concept of death is when we planned to have the talk.  In the meantime, I have chosen to teach them about how to keep safe from an allergic reaction in the same way I teach them to cross the street safely.  To safely cross the street, I tell the children to stop at every alley and street, to look both ways for cars, to make eye contact with the driver before they cross in front of the car, and to continue to look around as they walk through the crosswalk.  I tell them to do all of these things to keep them safe and to avoid getting hit by a car.  I don’t follow up this conversation with saying “And if you do everything I have taught you, you still won’t be safe enough.  There is still a chance that some drunken maniac will careen through the red light up onto the curb and plow you over and you could die.”

I teach food allergy safety the same way.  I teach them to wash their hands before they eat.  I tell them to only eat food that I have prepared or that a family member who knows about their food allergy says is okay.  I make sure that they don’t try food if they aren’t sure what is in it.  They carry their injectable epinephrine everywhere they go. They and the adults and teachers and nurses at the school know exactly how and when to use the medication.  They know to call 911.  What I don’t ever do is follow this conversation up with this, “And if you do everything right, know what you are allergic to, ask an adult to help you make a good decision about the safety of your food, and have your EpiPen with you, something could still go terribly wrong and you could die from food allergy.”

What I am saying is that I prepare my children the best I can in life to make safe choices, like I am sure you all do.  But I don’t want to instill in them a paralyzing fear that no matter what, even if they make great choices, death is only a moment away.  As an adult, I know that that is true.  It is much easier to die than to stay alive.  But I can rationalize this, I can make a bit of sense out of this.  School age children cannot and now I have proof.  They didn’t see the series of errors that led to this little girl’s demise.  What they did hear was that she did everything right that day.  She knew what she was allergic to, she asked a trusted adult if her food allergen was in her lunch, she told her teacher when she was not feeling well but still she died.  That is such a powerless and scary story for us as parents but can you imagine how you would feel if you were the child with food allergies?

So before you use the words “death”, “die”, or “life-threatening”, in an attempt to sway someone into believing how severe and scary your child’s food allergy can be (all of which I have definitely done), or before you are in the company of someone who is presenting food allergy in a way that you are not comfortable with, stop and look around.  Can your children hear you?  Are they suddenly old enough to understand what you are saying? Do you want them to hear this conversation?  Are you ready for them to hear it?   Are they ready to hear it?  Because I’m pretty sure at ages 6 and 7 that mine weren’t ready.  If they are present during these conversations and they are old enough not only to hear you, but also to really listen to you, please do not assume they didn’t get it.  Talk to them.  My boys luckily shared some of their feelings with me but not all children will do that without being prompted.  In fact, if Milo hadn’t opened the door for the discussion, Gino probably would still have been wrestling with his fears alone.  You just may need to ask if they have any questions about anything that they heard at the walk or about their food allergies in general.

For four days following the walk, when leaving lunch, Milo had been rushing up to me before I left and making me pinky swear that I will see him at 3.  He had been persistent and emphatic about this.  As I started to walk out of the school on the second day, it hit me.  The reason he was doing this was because the mother at the FAAN walk said that she dropped her daughter off at school and never saw her alive again.  He was making me promise I would see him again.  A first grader should be worrying about play dates and baseball and his math homework.  He should not be worrying about whether or not, when his mom drops him off at school, he will ever get to see her again. So, listen, my sweet little boys, let me do this kind of worrying, in my own, very personal, sacred place where mothers worry about these kinds of things. I will carry this fear, all of your fears, for now.  And I promise, with not just a pinky swear, but with all my heart and soul, I will see you at 3.  I guarantee.

———-

Most of the readers of this post understood my point of view, regardless of what they choose to do in their home. For those of you who took it as though I do not teach my children to take food allergy seriously or do not think teaching the severity of food allergy is of utmost importance, I wrote this to clarify: As I said in the post, my children absolutely know the severity of their food allergies. As an allergist and a mother, I don’t think anyone should make light of the seriousness of allergic reactions. One of my children has had anaphylaxis to over 10 different foods in 5 years. I don’t think there is a single iota of his being that doesn’t realize the seriousness of this. I am in no way saying to hide the seriousness of food allergy. I am only saying that you should consider your child’s age, developmental stage, and personality before you have the conversation about dying from your food allergy. We are all out to do the same thing: keep our children safe and the way that we do that is based on our children’s needs and experiences, and our own experiences and is up to us as individuals. Some of you mention that you didn’t see the problem. For me, the problem was that the first story my children heard about a child actually really dying from their food allergy was a story in which the child that DID EVERYTHING RIGHT. She knew her allergens, she asked a trusted adult, she told her teachers she was sick and she didn’t get treated in time. This is a devastating, hopeless story. What can a five-year-old learn from this particular story? That no one really knows for sure if the food you’re eating is contaminated with the food you are allergic to? If you get really sick, the adults around you may not realize they need to help you? So all of the teaching and training and explaining and all of the discussions about the potential to die from your food allergy, how would that have helped Sabrina? That was the problem for me, for us. The children know what to do to keep themselves as safe as possible. Their first food allergy death story didn’t not have to be an absolute worst case scenario in which the child did nothing wrong but trust adults to save her life. How terrifying for them. I heard Sabrina’s beautiful mother speak at an adult FAI event several years ago. Her words made a deep impression on the adults at the event. They turned from doubters to believers. It made my friends comment that they would never hesitate to give the epipen to my children or other children they thought were having an allergic reaction. It is an imperative story for school staff, parents, restaurant workers, chefs, daycare providers, etc. This post isn’t about good parenting or bad parenting. It is not about hiding or shielding children from the truth. This post is about timing and empowerment over hopelessness. Thank you for taking the time to read the post and whether you agree or not, I hope that it gave us all something to think about.

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Sarah | 68 Comments | Permalink
Anaphylaxis, Family, Observations

Who Needs Nuggets When You Can Have Tortas?

posted October 8, 2012
10/08
2012

Many of the top 8 allergen-free chicken nuggets that you can buy in the frozen food section are made with corn, which Gino is allergic to.  So, of course, we have to make our own but I wanted to put a little twist on it.  With the help of my dear friend, Letty, we came up with Chicken Tortas.  I catch myself taste testing them so much that the kids are lucky if there are any left for them.

 Letty’s Chicken Tortas

3 boneless skinless chicken breast halves

2 garlic cloves

4 TBSP gluten-free flour

2 tsp olive oil

1/4 white onion, chopped finely

1/4 cup rice drink

1/2 tsp garlic salt

1/4 tsp black pepper

1/4 tsp kosher salt

First, I clean 3 boneless, skinless chicken breast halves and then boil them in water for 40 minutes or until completely cooked.  I usually add 2 whole garlic cloves, a slice of onion, salt and pepper to the water to flavor the chicken.  In this photo, I added a tomato but this is optional.  It also looks like I doubled the recipe here… that’s a lot of chicken!

When the chicken is cooked thoroughly, I remove them from the water.  Once they are cooled slightly, I cut the breasts into fours, tear the chicken into very small pieces and place it in a bowl.  Add 1/4 finely chopped onion, 4 TBSP gluten-free flour mix, 2 tsp olive oil, and 1/4 cup rice drink to the bowl and mix by hand.  Then sprinkle 1/2 tsp garlic salt, 1/4 tsp black pepper and 1/4 tsp kosher salt onto this mixture and mix again.

Gino doesn’t like the onion to be crunchy and because the meat is already cooked, they don’t need to be fried for too long.  This means that the onion often remains a little crunchy.  If your children have a texture issue, you can blend the chopped onion with the rice drink.  This eliminates the crunchiness of the onion.  Problem solved.

When all of the ingredients are mixed together, form into small patties.  I use about 1/2 cup of canola oil in the skillet and when this is hot, I add the patties, frying them for about 1 minutes on each side or until they are easily able to be flipped.  You can also brush them with oil on both sides and bake them to avoid the extra oil involved in frying.  The chicken is already cooked so bake them to your desired doneness.

When you take the tortas out of the pan, set on a paper towel to drain the remaining oil.

I usually serve these up with crinkle cut fries, ketchup and a bowl of fruit on the side. These can also be frozen, so double the recipe and you will be able to pull a few out at a time for a quick lunch or dinner.

Hope your family enjoys them as much as we do.  I love the idea of eating non-processed chicken, don’t you?

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SAFETY NOTE:  Although this recipe is meant to be top eight (cow’s milk, egg, soy, wheat, peanut, tree nuts, fish and shellfish) allergen-free, I cannot guarantee that all of the products that I have used will remain top eight allergen-free.  I encourage you to always read food labels thoroughly each and every time you use a product as ingredients and manufacturing practices may change without warning. Please omit and/or substitute any ingredients that are unsafe for you or your family members for ingredients that are safe.  If you need help finding substitutions, please let me know and I will do my best to help.  If you have questions about whether a particular food is safe for you or your family members, please contact your physician.

Sarah | 23 Comments | Permalink
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