Cross-Contamination Concerns

The last couple of weeks, the peanut allergy message boards have been full of posts discussing companies' labeling policies.  One post that was concerning involved a teenager that had an anaphylactic reaction to Hershey's Rolo Caramels.  Someone responded to that post stating that she had spoken at length with a supervisor at Hershey's.  He told her that the majority of their products were manufactured on shared equipment with peanuts/nuts, and that the 1.5 oz Hershey bar was the only one made on a dedicated line.

The Hershey's allergen statement on their website reads as follows: "We take food allergies very seriously at Hershey and have strict procedures in place to prevent crossover of allergens into other products that do not contain the allergen. In instances where we have a concern about possible crossover by an allergen we take the added precaution of including an allergy information statement on the label."

Now my question is how many companies use shared manufacturing equipment, clean it and consider that they've removed all possibility of allergen cross-contamination??  It you believe Kashi's website information, it's impossible to remove all traces of peanut/tree nut..."Scientific evidence has shown that consumers with peanut and tree nut allergies can have a severe reaction to amounts that are below the current detectable limits based on existing technology."

I spent over 2 hours the other night searching the internet for some study or article that would validate either position, and didn't come up with much.  I did find the issue well stated in a 2008 study introduction published in the Journal of Food Protection, "Although allergen removal through cleaning of shared equipment or processing lines has been identified as one of the critical points for effective allergen control, there is little published information on the effectiveness of cleaning procedures for removing allergenic materials from processing equipment. There also is no consensus on how to validate or verify the efficacy of cleaning procedures."  Now, if I could only get access to the results of that study!

I found a ton of food industry articles on how to manage food allergens in the manufacturing processes as well as information on the type of tests available to test for allergen residue on equipment. A group from the University of Florida studied the effectiveness of commercial allergen test kits.  Their results were that the three common cleaning protocols regularly used in the food industry did not yield the same results. Some were better than others.  Does this mean that food allergy savvy parents need to ask what test kit a manufacturer uses to verify that there lines are clean and that there is no chance of cross-contamination?

In 2001, the Senior Health Policy Adviser for the Grocery Manufacturers Association offered testimony on the challenge of labeling food allergens. The speaker addresses the challenge of cleaning ingredients like peanut butter on manufacturing equipment.

Still in disbelief!

I'm getting lots of e-mails, Facebook postings, blog comments and excited greetings.  I can't thank you guys enough for your support.  Truth be told though, I'm still very much in disbelief and not quite sure how to express my feelings about the success of the food challenge.

Realistically, nothing changes. Abigail still takes her 8 drops a day, holds them under her tongue for 2 minutes and can't eat 15 minutes prior or 30 minutes after. She'll continue to do this daily for at least another 18 months until the end of her treatment.  We're to make absolutely no changes to our eating habits which means I'm still reading every label and our family will continue to avoid unsafe restaurants.  Abigail will still bring her own cake to birthday parties, we'll still ask friends and family to not have peanut products sitting out when we visit and I'll still meet with her next year's teachers and classmates and put the same protection policies in place at school. We're to always have her Epi Pen and Benadryl handy.  In other words, we continue to live day to day under the assumption that there's always a chance for accidental exposure.

I know that at some point her passing the food challenge with flying colors will set in.  I think that at some future time, even if I can't relax regarding what she eats, maybe I'll relax when it comes to social settings. Those situations that I currently give my o'kay, but worry about.  For example, lunch time in the cafeteria at school.  I worried about her sitting in the same spot that someone eating a peanut butter sandwich just vacated.  I worried at family functions when there was a safe dessert tray and an unsafe dessert tray.  I worried about friend's birthday parties, sleep-overs, church events and camp.  And, that list goes on and on.  You can't do that much worrying for 7 years and have it go away over-night.

It's really an emotional roll-coaster.  I'm sure it's confusing to Abigail as well.  She ate the equivalent of almost 10 peanuts.  Her doctor is smiling from ear-to-ear, she's getting hugs and treats, told how brave she is and then, by the way....you still can't eat anything with peanuts.

So, with some reserve, we're celebrating in the short term, but we're also still looking forward to the long-term.  There's quite a journey ahead with lots of unanswered questions.  Maybe a few more days of congratulations, and then I think we have to file this experience away until such time when we can truly celebrate.  I really think the best part of our food challenge experience is to know with confidence that we are getting the real stuff and not the placebo, that the SLIT methodolgy is working, that our time is not wasted and that we made the right decision to put Abigail through all of this.

Thanks again everyone for your support.  I attached a few pictures from our day at Duke.

It's 8:00 a.m. and Abigail is ready, although somewhat nervously, for her big day at Duke.











I've included these pictures so you can see the difference in her skin prick test between this week (1st picture) and her skin test in January.

I.V. is in and we're ready to start the food challenge.

Of course there were lots of treats.  Here we are enjoying a new DS game together.

This is it.  Last dose of the day.  She doesn't look any worse for wear does she?

A Successful Food Challenge!!

She did it!!  Abigail consumed all 9 doses of peanut flour today with no reaction!

I don't even know where to start.  There's so much to tell.  First though, I want to thank Dr. Kim and our RN's, Alice and Jan, for ensuring that Abigail's day was as pleasant as possible given the agenda.  I'd also really like to thank all of our family, friends and you guys, my readers, for keeping us in your prayers today.  God was listening!  I still can't believe it.  Depending on whether you use 240 or 300 milligrams as the average peanut size (there are mixed standards), Abigail ate the equivalent of 8 to 10 peanuts today.  Our family has much to be thankful for!

We started at 8:00 a.m. with the dreaded saliva test.  For whatever reason, Abigail hates spitting in that tube.  Next they did the skin prick test, and the results were better than 4 months ago.  With the use of numbing cream the insertion of the I.V. didn't hurt.  I wonder if Abigail has a future as a nurse because she always watches and even helps change the test tubes during the blood draw. With all of that out of the way, the Benadryl pre-measured and Epi Pens handy, she ate her first dose at a little after 9:00.

The first dose is just 5 milligrams.  Our doctor says it's uncanny and wonders if it's some sort of protective instinct, but the kids usually can taste even that minute amount.  She did, but said confidently that it was the oat flour. Ten minutes later, she ate the 2nd dose, 10 milligrams.  The doses continued, some met with a curled nose and followed by a drink of water, but she took them all without hesitation.  They were mixed with cinnamon applesauce and went from 5 milligrams to 15 milligrams, 50 mg, 100 mg, 250 mg, 500 mg and then 1000 mg.  By this time I had also smelled the mixture and hid my disgust.  Also, by this time, she had consumed the equivalent of 3 1/2 to 4 peanuts.  Dr. Kim was 99.9% sure that she was getting the peanut protein (remember it's double blinded and could have been the oat flour) so I was getting a little antsy.  Before each dose increase, they checked Abigail's breathing and skin for symptoms.  The next dose was 1500 mg and the final dose was 1580 mg.  Each of those doses were the equivalent to 2 1/2 to 3 peanuts each.  She coasted through.  I didn't allow myself to be super excited yet.  I didn't want to be disappointed if that did turn out to be the oat flour.

We had a 2 hour lunch break.  After Abigail had eaten her favorite, bagel with cream cheese, her stomach started to hurt a little.  It didn't stop her from eating her chocolate pudding or playing her Nintendo DS so that was a good sign.  Later that afternoon, I realized that she was still under the impression that she had eaten the oat flour which makes me wonder if it was a nervous stomach over the next challenge.

At 1:30, we started the process again.  For a change, the Dietitian mixed the flour with vanilla yogurt which worked well.  It was fun to watch Abigail's light bulb moment when she looked at the remaining 3 doses and then looked at the doses of Benadryl and exclaimed that she hadn't needed those.  You could see her realization that she was making it through with flying colors.  We finished those last 3 doses and by 3:00 were finished.  After final confirmation from the Dietitian that she had indeed had the peanut flour first and seeing the report that she was getting the real thing and not the placebo, there was some celebrating!  Abigail's was the 35th food challenge in the Peanut SLIT Clinical Trial.  She was one of 9 that was able to take all of the doses.

So, what's next.  We continue doing exactly what we've been doing the last year.  She'll take her drops daily, we'll continue to eat peanut and tree nut free and continue to avoid all chances of cross-contamination.  We go back in 3 months for a "check-in" visit and to get more drops.  At 6 months, we go in for labs, at 9 months we're back for another "check-in" visit, and at 12 months, another food challenge where they double the dosages she received today.

Again, thanks so much for all of your prayers and well wishes.  It has been a wonderful day!

Food Challenge Time

It's finally time. We've been participants in a Peanut Sublingual Immunotherapy Clinical Trial for over a year. May 18th marked our one year anniversary and June 23rd marks our first food challenge. Come 8:00 Wednesday morning, Abigail and I will be at the Duke Clinical Research Unit nervously and anxiously waiting to begin.

I've been quite excited waiting for this day to come.  Abigail has been more on the nervous side.  I've given her all the details I think she can handle.  I've clarified that they are not going to take her to the point of her having an anaphylaxic reaction, and it was evident that she was relieved.  Now, the day before, I'm getting a little anxious as well.  I just so badly want to see good results!

Here's what our day looks like. We start right off with testing.  Abigail will have to immediately get an I.V., then have blood drawn, have a skin prick test and spit in a tube for a saliva test.  Around 9:00 a.m. we'll start the 1st of 2 food challenges.  It's a blinded challenge so one will be peanut flour and the other oat flour.  The staff in the kitchen actually makes the call as to what comes first.  We're not supposed to know until after both challenges, but I hear it's pretty hard to not smell the peanut flour.  The flour will be mixed with applesauce.  I'm also bringing chocolate pudding, cinnamon applesauce and because she occasionally eats sunflower butter, I'm bringing sunflower butter and crackers to give her some variety.

There should be no issues with the first couple of doses.  If I'm reading my notes from our last Duke visit correctly, by the 4th dose, she'll be getting 100 milligrams, 5th dose, 250 milligrams, etc.  The 9th dose is the equivalent of 8 to 10 peanuts, over 1500 milligrams.  If she can tolerate it, they'll stop the challenge at the 9th dose.  There's a 2 hour break, and then the process is repeated with the second challenge.  It's going to be a long day.  We're expected to wrap up between 5 and 6 o'clock.

They'll be monitoring her the entire time.  Benadryl and Epi Pens will be right there, and of course, she'll have the I.V.  Every few minutes they'll check for a reaction.  Our doctor and a nurse will be there, with another nurse stopping in periodically with a new set of eyes.  We're looking for sinus issues, hives, stomach pains with possible vomiting.  Any of those symptoms will stop the challenge.  Her history of stomach aches adds a little complexity.  Her stomach hurts when she's nervous so we'll have to push through that.  That's also why they do a blinded challenge with both peanut and oat flour so they can rule out a psychological reaction.  According to her doctor, the biggest sign of a reaction is a change in behavior.  He says that the kids will be playing their Nintendo DS, watching a movie, reading a book, etc., and then all of a sudden, they stop and go lay down, kinda withdraw.  Small children will crawl in their mom's lap.

We're taking lots of movies, and I've got my bag of treats packed.  It's a big day for Abigail.  The good news is that they're seeing a clear difference in the study results between the children getting the peanut protein and the children getting the placebo.  At the end of the day, Abigail's file will be unlocked and we'll see what she's getting.  I'm 99% sure that we are getting the real thing, and I'll be embarrassed if we find out that she's been on a placebo all this time.  I really don't think so though.

According to our doctor, based on the 40 plus food challenges already completed, they know that the sublingual immunotherapy works, the question now is how to make it work better.  Keep us in your prayers on Wednesday that it works for us.  I'll post an update Wednesday night.

Generation Monsanto

We've had a very busy weekend celebrating my son's 3rd birthday and getting ready for Abigail's food challenge at Duke this week.  I'll post more on both topics tomorrow and Wednesday, but I wanted to pass on an e-mail update that I received last week from the Organic Consumers Association.  It's gives an excellent look at the current state of genetically modified foods and the impact on our children.  It's a call to require labeling of all GMO foods.  Here's the article, taken directly from the OCA e-mail and also found on Huffington Post.  It's definitely worth the read:

Generation Monsanto (GM) - Why We Need Labels on GM Foods Now

Gen-M, the first Monsanto Generation of humans force-fed genetically modified foods hasn't reached reproductive age yet (they were born in the late 1990s). But, if a critical mass of animal feeding studies are any indication, the millennial generation, reared on Food Inc.'s unlabeled "Frankenfoods" can look forward to a long-term epidemic of cancer, food allergies, learning disabilities, sterility, and birth defects.

Corn (85% of U.S. production is GM), soy (91% GM), cotton (88% GM), canola (85% GM) and sugar beets (95% GM) are all genetically engineered by Monsanto to withstand massive doses of the company's glyphosate herbicide RoundUp, or else to exude their own pesticide, Bacillus Thuriengensis (Bt). RoundUp, the favorite weedkiller poison of non-organic farmers and gardeners, causes brain, intestinal and heart defects in fetuses. And scientists warn that RoundUp, the most extensively used herbicide in the history of agriculture, "may have dire consequences for agriculture such as rendering soils infertile, crops non-productive, and plants less nutritious." In addition, hundreds of thousands of US dairy cows are injected with genetically engineered Bovine Growth Hormone (developed by Monsanto) in spite of studies linking BGH with cancer, and longstanding bans on the drug in the EU, Japan, Canada, and most industrialized nations.

With genetically modified foods and crops threatening public health and the environment, not to mention the next generation's reproductive capacity, why isn't there a massive consumer outcry to restrain Monsanto's biotech bullying and ban genetically engineered foods and agriculture?

The answer is disturbingly simple. Collusion between Monsanto and elected public officials (including the current Obama Administration) has obscured the fact that almost all non-organic foods in the US contain GMOs. Despite poll after poll indicating that 85-95% of US consumers want mandatory labels on foods containing GMOs, Congress has heretofore listened to Monsanto and corporate agribusiness, rather than their own constituents. In the European Union, Japan, or South Korea, where GM foods must be labeled, there are no GM foods on grocery story shelves (and little or none served in restaurants), since most consumers would not buy them and a significant number would complain if they saw GMO labels on products. Consequently there are very few GM crops being cultivated in the EU (mainly a small amount of corn in Spain for animal feed).

Most Americans simply do not understand that 80% of non-organic supermarket processed foods (basically every product containing soy, corn, canola, cottonseed oil, or sugar beet derivatives) are contaminated with GMOs. While nearly everyone in North America has eaten genetically modified foods, only 26% believe that they have.

People don't think they're eating genetically modified foods because they have no way of knowing whether they are or not. Genetically modified foods aren't labeled.

If we're going to save this generation from reproductive dysfunction and save our farmland from the ravages of RoundUp, we need to stop Monsanto.

The first step is to protect consumers' right to know whether their food is genetically modified.

We need genetically modified food labeled now!

Write your Congresspersons and 2010 candidates for the House and Senate. Tell them to support mandatory labeling of all genetically modified foods.

Cascadian Farms

I'm always on the look-out for organic products, especially peanut allergy safe organic products.  Even better is when I can find them reasonably priced and at one of the grocery stores I already shop at.  So, when I came across a few varieties of organic cereal for kids, competitively priced at $2.82 a box at Wal-mart, I was excited, and thought I would share my find.
 

I purchased the Cascadian Farms Cinnamon Crunch cereal, and the whole family liked it. I'm not sure we even ate it with milk. I think we finished the entire box just eating it by the handful for snacks. Of course, I contacted the company regarding their allergen labeling.  Here's what they had to say:

If one of our products contains any of the top 8 allergens (peanuts, tree nuts, dairy products, eggs, soy, wheat, crustaceans, and fish) or if it contains sesame, sunflower or mollusks, that ingredient is always listed in the ingredient panel, and also in bold letters just below the list of ingredients.  If a product is exposed to any of these allergens in the manufacturing facility the allergen will be listed in bold in the ′Contains Statement′ just below the list of ingredients.  This list is your ingredient assurance for that package.  It is not intended for other packaging of the same product.  Ingredients may vary from one package to another due to product reformulation.  If you have allergy concerns, please read each package ingredient panel.

I feel good about letting Abigail eat the Cascadian Farm products that do not have peanuts/tree nuts listed in the ingredients.  After reviewing their website and hearing back from their customer service, it appears, that Cascadian Farms is one of the few food manufacturers that are committed to protecting our health and the environment.

FYI - This post expresses my own opinions.  I was not asked by Cascadian Farms to review their products.

Last Day of School

Today was Abigail's last day of 1st grade. It's hard to believe another school year has come and gone

I would deem it a very successful year.  Abigail grew tremendously academically, emotionally and socially.  Also, just importantly, if not more so, we made it through the year without a single allergy mishap!! Yeah!!  Thanks to her great teachers, vigilant school staff and some wonderful friends, Abigail had a safe school year.

Just last weekend I was talking to a mom of one of Abigail's classmates. She said that she hadn't purchased peanut butter or peanut butter snacks the entire year. She said her daughter was super protective of her friend, Abigail, and wasn't going to take a peanut butter snack to school.  That almost brought tears to my eyes. This is a family with 4 children, 2 of them school aged, and they haven't had peanut butter sandwiches or crackers the whole year. How incredible is that??

The kids in her class learned to read labels.  They understood that products manufactured in the same plant or using the same equipment were also not safe.  If they brought a snack that wasn't safe, they moved to a different table to eat it. Abigail's teacher had a great idea.  She took all of the extra cupcakes (from Freed's Bakery which is nut free) left from the holiday parties, put them in baggies and stored them in the freezer in the teacher's lounge. That way Abigail had safe treats throughout the year.

Just recently, I read about some moms doing a PAL (Protect A Life) Hero session at the start of the school year.  They went into the class, talked about their son or daughter's food allergy, reviewed the steps to being a PAL and then handed out special certificates. I loved this idea and will definitely approach Abigail's teacher next year about doing something similar.  Knowing how great Abigail's classmates have been this year, I wanted to make sure they were properly thanked and wanted Abigail to do that herself.

Using the PAL Hero certificates from the FAAN website, I printed one for each member of the class.  I thought it would be nice if Abigail got up in front of the class, explain what the certificates were, tell the class thank you and then hand them out.  She freaked out when I told her my idea.  While she doesn't make a huge fuss about having a food allergy, this was obviously a sensitive issue and getting up in front of the class to discuss it was beyond her comfort level.  Again, her teacher came to the rescue.  She allowed Abigail to call 2 classmates over at a time to tell them thank you and to give them their certificate.  I asked Abigail what she said to them.  She said she told them thank you, said it was nice when they moved to a different table if they had an unsafe snack and then asked them if they wanted to hear more (I thought that was pretty cute). I had given her a "Be A Pal" brochure, again from the FAAN website, and she shared the 5 steps to being a PAL.  I was so proud of her. What a big girl thing to do!

FYI, the 5 steps are:
1. Never take food allergies lightly.
2. Don't share your food with friends who have food allergies.
3. Wash hands after eating.
4. Ask what your friends are allergic to and help them avoid it.
5. If a friend who has food allergies becomes ill, get help immediately.

And, here's a big thank you from me to everyone that made Abigail's 1st grade year one to remember...for all the right reasons!

Now at McDonalds - McFlurrys with Reese's Cups

My last 2 posts were about healthy living so now it's time to touch on a serious peanut issue or at least a very hot topic right now on the online allergy forums.  In it's 100 Days of Summer promotion, McDonald's has introduced a McFlurry with Reese's Peanut Butter Cup topping.  And, if the promotion goes well, restaurants can choose to make it a permanent menu item.

We don't eat at McDonald's often, but on occasion, as a treat, we'll let the kids get a Happy Meal or Hot Fudge Sundaes.  And, when traveling, it's often the only place to eat.  Obviously, the Sundaes are definitely out, but what about the cheeseburgers and french fries?

I stopped by my local McDonald's to check it out.  From a few of the horror stories I read online about people seeing Reese's Cup topping spilling out over the counter into other areas, including the floor, I wasn't sure what to expect.  The Reese's Cup topping was in a covered plastic container in the ice cream stand which is a free standing unit over by itself no where near the burger station or fries. Isn't that no different than when my daughter eats at one end of the cafeteria table and another child with a peanut butter sandwich sits at the other?

It was only 10:00 in the morning so it was probably the wrong time to visit.  Maybe I should stop by at the end of the day and see what the topping container looks like then.  Or, see what would happen if I ordered a McFlurry along with some fries, burger and a drink.  Would the cashier scoop the topping on the dessert getting residue on her hand, then go grab my fries and burger, take my money, pull out a drinking cup, press the button on the drink machine, handle the food tray and give me change?  So, now I'm seeing lots and lots of opportunities for cross-contamination.

Bottom line, if I won't serve my daughter food that has been processed in a plant or manufactured on the same equipment, then why would I risk eating at an establishment that presents the same or even greater risk.  At least a food manufacturer has strict standards.  Who's working with the hourly employees at McDonald's to explain the risks and teach them safe handling?

What's McDonald's saying?  Again, according to the message boards, McDonald's is sending the same form letter to everyone regardless of the type of inquiry.  Here's a summary....it contains one of the top 8 allergens....the safety and well-being of our customers is a priority...the decision to purchase a McFlurry is left to the consumers discretion....we look forward to serving you again under the Golden Arches.  Priceless!  So, if I had any doubts about my decision to not eat at McDonald's, at least during the promotion, they've been confirmed.

Just something else disappointing to have to tell my daughter.

2010 Sunscreen Guide

Just in time for summer, the Environmental Working Group (EWG) has released an in depth look at sunscreens.  Here are a few very surprising and note-worthy conclusions:

• Both the FDA and the International Agency for Research on Cancer agree that there is no evidence that sunscreen prevents cancer.  Hats, shirts and shade are the primary barriers.

• There is some evidence that sunscreens may actually increase the risk of skin cancer.  It's unclear why, but researchers speculate that it could be that sunscreen consumers stay out in the sun too long or that the sunscreen product is inferior.

• While there are more products than ever with a SPF higher than 50, there is no proof that they are better. In fact, they may encourage consumers to stay out in the sun too long.

• Vitamin A, a common sunscreen ingredient (in as many as 41% of sunscreens), may actually speed the development of cancer.  The FDA recently conducted a study of vitamin A’s photocarcinogenic properties, and there is a possibility that it results in cancerous tumors when used on skin exposed to sunlight.

You can read the full report in the EWG's 2010 Sunscreen Guide found on their website. It's a fantastic site. The EWG has included information on 1,400 sunscreens, lip balms and moisturizers. For those of us with allergy concerns they even point out ingredients that might be troublesome. They list their top picks and have a "Hall of Shame." There's a "Find Your Sunscreen" link so you can check what's on your shelf. They've even partnered with Amazon to create a store front where you can purchase some of the top brands.

Please take the time to check out the guide, read the dangers of some of the most common sunscreens on the store shelves and find out why the FDA has yet to wrap up sunscreen regulations that they started 32 years ago in 1978.

And, yes there is still a recommendation by the FDA to get 10 minutes of sunshine several times a week to help boost Vitamin D.  Happy Summer!  Enjoy the sun...just enjoy it wisely!