Saturday, October 31, 2015

Allergy-Free Halloween Candy Round-Up 2015

By Kelley Lindberg

Go Teal! The teal pumpkin means we
have non-food treats available!
Every year I hit the stores looking for Halloween candy, and I share a list of common candies and the allergens they list. This year, I have been burning the candle at both ends and in the middle and haven’t had a chance to do that. But I’m going to post last year’s list, because I don’t usually see much variation year to year, so last year’s list will at least give you a starting point as you help your little trick-or-treaters sort through their candy loot.

If you still need to find candies free from all of the Top 8 allergens or free from corn, Target had a large supply of YumEarth Gummy Bears, Gummy Worms, and Lollipops yesterday when I was there (each $3.14 bag contains 10 individually wrapped packets). Dollar Tree always has a surprising amount of safe “icky” choices, like gummy skeletons and lollipops shaped like skulls, so if you’re looking for something fun and gross to put on top of cupcakes, for example, try Dollar Tree. They also carry the best peanut-free and tree nut-free candy corn I’ve found, from Crystal Bay. (I think Crystal Bay candy corn tastes better than Brach’s, anyway!)


Large companies use multiple factories. That means the same candy may be produced in different places, with different allergens present. So CHECK LABELS on every single piece of candy. Wonka is one of the worst companies for producing the same candy in different packages containing different allergen warnings, but they are one of the best at individually labeling their candies so you can verify its safety before every bite. A few candies may have changed their ingredients and moved to other places in my list from last year -- a good reminder to check old favorites. When in doubt, call the manufacturer for clarification (most list a phone number right on their package).

First I’ll list candies that don’t list corn as an ingredient (because there aren’t very many of them). Then I’ll list the candies and treats that do contain corn, but are free from some or all of the Top 8 allergens (peanuts, tree nuts, milk, egg, soy, wheat, fish, shellfish).

By the way, EVERYTHING on this entire list is nut-free and peanut-free. That's where I started, then I broke them down by the other allergens. I hope it helps simplify your Halloween!

Corn-free as well as free from Top 8:
YumEarth is at Target, and
this year they're even cheaper!
  • Bob’s Sweet Stripes Soft Mint Candies (red & white peppermints) (Sam’s Club)
  • Cotton Candy (Parade brand, Sam’s Club, 8 tubs per package)
  • Cotton Candy in Candy Corn and Boo-Berry flavors (Dollar Tree)
  • Cotton Candy, Hello Kitty (Dollar Tree)
  • YumEarth Gummy Bears and Gummy Worms (in Target!)
  • YumEarth Organic Pops (in Target!)

Everything from here on down contains corn ingredients:

Free from Top 8 (Wheat, Peanut, Tree Nut, Milk, Egg, Soy, Fish, Shellfish):
  • Baby Bottle Pops (Sam’s Club)
  • Betty Crocker Halloween Fruit Snacks
  • Bubble Babies Gum Balls (contains coconut, Dollar Tree)
  • Candy Jewelry (Dollar Tree)
  • Dots
  • Dum-Dums
  • Giant Lollipop (Dollar Tree)
  • Grave Gummies (contains coconut) (Dollar Tree)
  • Gummy Body Parts (contains coconut oil) (Dollar Tree – coffins and bags) [Note: 2 years ago, 
  • Walmart sold Frankford Candy Body Parts that contained peanuts, nuts, milk, soy, beef, and corn, so read company name and ingredients carefully]
  • Gummy Turtle Power Candy Pizza (contains beef gelatin, Dollar Tree)
  • Halloween Pops (contain gelatin, Dollar Tree)
  • Haribo Gummy Bears (contains coconut)
  • Hello Kitty Family Favorites Candy Mix (Dollar Tree)
  • Hot Tamales
  • Hubba Bubba bubble gum
  • Jelly Belly trick-or-treat-sized packets of jelly beans (Target)
  • Jolly Rancher
  • Life Savers
  • Life Savers Lollipops
  • Life Savers Gummies (contains gelatin, possibly pork-derived, although I can’t verify)
  • Market Pantry Spooky Shapes fruit snacks (Target – contains pork gelatin)
  • Mike & Ike
  • Pixy Stix, regular and giant (Sam’s Club carries a package of 50 Giant Pixy Stix)
  • Push Pops
  • Ring Pops
  • Skittles
  • Skulls & Bones Hard Candy (Dollar Tree)
  • Smarties
  • Sour Patch Kids (but be careful—the Sour Patch Twists contain wheat, so read labels carefully)
  • Spiderman Villains Candy Sticks (contains beef gelatin) (Dollar Tree)
  • Spongebob Gummy Krabby Patties (beef gelatin) (Dollar Tree)
  • Spooky Lollipop Rings (Dollar Tree)
  • Starbursts
  • Swedish Fish
  • Tic Tacs
  • Trolli Sour Brite Crawlers (gummi worms) (Sam’s Club – contains gelatin)

Contains Soy or Soy Warning (but free from other 7 top allergens):
  • Bon Bon Boom Lollipops (Dollard Tree)
  • Cry Baby Extra Sour Bubble Gum (Dollar Tree)
  • Hubba Bubba Bubble Tape
  • Jolly Rancher Crunch ‘n’ Chew (last year, these had soy listed, but I didn’t find any this year, so I can’t verify ingredients. Call the company at 800-468-1714)
  • Jolly Rancher Fruit Chews (last year, these had soy listed, but I didn’t find any this year, so I can’t verify ingredients. Call the company at 800-468-1714)
  • Jolly Rancher Lollipops (last year, these had soy listed, but I didn’t find any this year, so I can’t verify ingredients. Call the company at 800-468-1714)
  • Laffy Taffy
  • Laffy Taffy Ropes (Sam’s Club)
  • Lollipop Skulls (Dollar Tree)
  • Market Pantry Candy Corn Flavored Kettle-Cooked Popcorn (Target)
  • Scary Eyeballs Bubble Gum (Dollar Tree)
  • SweeTarts Chews (check every individual Wonka candy label because ingredients vary by assortment, and SweeTarts GUMMIES contain a warning for peanuts, tree nuts, milk, soy, and wheat!!!)
  • Gum: Dentyne, Trident, Orbit, Eclipse, Wrigley’s (Doublemint, Winterfresh, Big Red, Juicy Fruit, Spearmint, etc.)

Contains Wheat or Wheat warning (but free from other 7 top allergens):
  • Red Vines
  • Scooby-Doo Sour Straws (beef) (Dollar Tree)
  • Sour Punch Twists
  • Twizzler’s Pull ‘n’ Peel (these don’t list soy, although regular Twizzlers do, so read carefully)
  • Twizzler’s Strawberry Twists (these don’t list soy, although regular Twizzlers do, so read carefully)
  • Twizzler’s Rainbow Twists (these don’t list soy, although regular Twizzlers do, so read carefully)

Contains Milk or Milk warning (but free from other 7 top allergens):
  • Pop Rocks
  • Popping Candy (Dollar Tree)
  • Pumpkin Face Bubble Gum in Jar (Target)

Contains Egg or Egg warning (but free from other 7 top allergens):
  • Bottlecaps (check every individual Wonka candy label because ingredients vary by assortment – some have wheat warning)
  • Gobstoppers (check every individual Wonka candy label because ingredients vary by assortment)
  • Nerds (check every individual Wonka candy label because ingredients vary by assortment – some have wheat warning)
  • Nerds Ropes(check every individual Wonka candy label because ingredients vary by assortment)
  • Spree (check every individual Wonka candy label because ingredients vary by assortment)
  • SweeTarts (check every individual Wonka candy label because ingredients vary by assortment, and SweeTarts GUMMIES contain a warning for peanuts, tree nuts, milk, soy, and wheat!!!)
  • SweeTarts Mini (check every individual Wonka candy label because ingredients vary by assortment, and SweeTarts GUMMIES contain a warning for peanuts, tree nuts, milk, soy, and wheat!!!)
  • SweeTart Twists (check every individual Wonka candy label because ingredients vary by assortment, and SweeTarts GUMMIES contain a warning for peanuts, tree nuts, milk, soy, and wheat!!!)

Contains Soy and Wheat or warnings (but free from other 6 top allergens):
  • Airheads
  • Twizzlers

Contains Milk and Soy or warnings (but free from other 6 top allergens):
  • Charms Blow Pops
  • Double Bubble gum (check every individual Double Bubble candy label because ingredients vary by assortment and store)
  • Hershey’s Chocolate bars, the 1.55 ounce size ONLY (the S’mores size) (all other sizes contain nut warnings)
  • Kraft Caramels
  • Sixlets candy-coated chocolate drops
  • Tootsie Pops
  • Tootsie Rolls
  • Tootsie Fruit Rolls

Contains Wheat and Egg or warnings (but free from other 6 top allergens):
  • Bottlecaps (check every individual Wonka candy label because ingredients vary by assortment – some don’t have wheat warning)
  • Nerds (check every individual Wonka candy label because ingredients vary by assortment – some don’t have wheat warning)
  • Nerds Ropes (Sam’s Club)
  • Shockers (check every individual Wonka candy label because ingredients vary) (Sam’s Club)
  • SweeTarts (check every individual Wonka candy label because ingredients vary by assortment – some don’t have wheat warning)

Contains Wheat and Milk or warnings (but free from other 6 top allergens):
  • Utz Halloween Pretzel Treats (contains sesame warning, too)

Contains Soy, Milk, and Egg or warnings (but free from other 5 top allergens):
  • Sugar Daddies (Dollar Tree)

Non-Candy Ideas (can find packs of individual serving sizes at warehouse stores like Sam’s Club):
  • Boom Chicka Pop Sea Salt Popcorn (Target – 16 individual bags per container)
  • Chex Mix (contains wheat, soy, and corn)
  • David’s Sunflower seeds
  • Funyuns Onion Flavored Rings (contains milk, soy, and corn)
  • Jack Link’s beef jerky (contains beef, free from Top 8)
  • Keebler Crème-Filled Sugar Wafer Cookies (contains soy, wheat, and cornstarch)
  • Lay’s Potato Chips (free from Top 8)
  • Nabisco Lorna Doone cookies (contains wheat, corn, and soy)
  • Oberto Beef Jerky (contains beef, free from the Top 8)
  • Oreos (contains soy, wheat, and corn)
  • Slim Jim Meat Sticks (contains beef, chicken, soy, wheat, and corn)
  • Zoo Animals crackers (Sam’s Club, contains wheat, corn, soy, milk)
  • Drinks, like Kool-Aid Jammers or Capri Suns, or sodas in mini-cans – check ingredients

Watch Out for These:
  • The following candies may land in your child’s trick-or-treat bags, and they may not have ingredients labels, so watch out for them:
  • Bazooka Gum-Filled Pops – lists only corn, but comes in an assortment listing all allergens in a factory warning
  • Banana Splits (sold at Sam’s Club in an assortment. Contains soy and egg, and has factory warning for peanuts, tree nuts, and milk)
  • Brachs – everything this manufacturer seems to make has peanut and nut warnings, plus some of the other allergens, depending on the product.
  • Columbina candies – all have a factory warning for peanuts, egg, tree nuts, soy, milk, and wheat
  • Goetze’s Caramel Creams (sold at Sam’s Club in an assortment. Contains wheat, milk, and soy.)
  • Hershey’s: All mini and fun-sized Hershey’s chocolates contain nut warnings and should be avoided. Plain milk-chocolate and dark-chocolate Hershey’s kisses are nut-free, but contain milk. Most flavored Hershey’s kisses (caramel, cherry-filled, etc.) list nut contamination. The only nut-free size of Hershey bars is the 1.55 ounce size (the type commonly sold alongside graham crackers and marshmallows for S’Mores.)
  • IBC Root Beer Barrels (sold at Sam’s Club in an assortment. Has factory warning for peanuts, tree nuts, milk, soy)
  • Jawbreakers contain only sucrose, but packaged in an assortment that lists all the allergens in a factory warning
  • Lemonheads contain only corn, but are usually found in assortment bags that include warnings for all the allergens on the overall packaging
  • Mary Janes (sold at Sam’s Club in an assortment. Contains peanuts and soy, and has factory warning for tree nuts, wheat, milk, and egg)
  • Slo Poke (sold at Sam’s Club in an assortment. Contains soy and milk, and has factory warning for peanuts, tree nuts, and milk)
  • Taffy: For the first time this year, there are 2 taffy brands that are nut free. One is made by Taffy Town, and local company, but theirs do contain eggs, milk, and soy. The other is by an online store called Sweet Pete’s , which advertises that their taffy is made in a nut-free, dairy-free, and gluten-free facility. Other than those two sources, I have not found any other taffy that is nut-free, so assume most taffy in your child’s trick-or-treat bucket contains nut contamination.
  • Tiger Pops – packaging lists all allergens
  • Warheads – various packaging lists some or all Top 8 allergens in factory warnings

Monday, August 24, 2015

Back to School with Food Allergies

by Kelley Lindberg

About this time every year I post my back-to-school tips. So I’ll repeat them again this year, in the hopes that they help smooth the way for other parents over the next few weeks. Good luck, and here’s looking forward to a successful and safe year at school!

(For those of you tuning in to see how my son did this week with his OIT, he did great. No reactions, and he’s now at 10 mg of peanut flour, which contains 4.1 mg of peanut protein, in a liquid solution. This week’s Kool-Aid flavor: grape!)

Now, back to school. Remember, there are links to several school-related resources on the Utah Food Allergy Network's website, so be sure to check those out. And last year I posted my Back-To-School Food Allergy Shopping List, so you might want to look at that, as well.
  1. Ask the principal if there are other food-allergic kids in the same grade, and if they can be assigned to the same teacher. That makes it easier for the parents of the allergic kids to trade off field-trip and party chaperone duties, reminds the teacher to keep the classroom allergen-free for multiple kids, and gives you some backup in food issues. (It's nice to NOT be the only one.) Statistically, about one in twenty kids has a food allergy, so chances are good there will be several food-allergic kids in your school.
  2. Make several copies of your Food Allergy Action Plan (available on FARE’s website) and ask to hang one in the office, the cafeteria kitchen, and the classroom, so that your child's photo and "What to do in case of a reaction" instructions are handy no matter where he is.
  3. Practice with your child what he should do if he "feels funny." Role-play and pretend you're the teacher, and have him come up and tell you what's wrong. Often our kids are too shy about asking for help, so have him practice with you, and with the teacher if possible. Not only does that give your child words to use if something happens, but it helps impress upon the teacher how important it is. If he or she has a friend in class that can help, ask them to role-play, too. Our boys have a friend who was very vocal in supporting and helping speak up for them when they were shy. (Girls are especially awesome as allies!)
  4. I get on my principal's staff meeting agenda at the first of the year and give a 15-minute talk about allergies and demonstrate the EpiPen or Auvi-Q. When my son was in elementary school, I also gave a presentation to my son's class and all the teachers and aides he comes into contact with. If you're not comfortable doing this, ask if there are other allergic parents that you can contact. Talk to them about ways to teach the teachers -- maybe another mom would be willing to give the presentation if you make the photocopies. It's easier when there are two of you involved! There are also DVDs made for elementary school presentations, so you can let the DVD do the talking! “Binky Goes Nuts” is an Arthur cartoon from PBS. “Alexander the Elephant Who Couldn’t Eat Peanuts Goes to School” used to be available from FAAN before they became FARE, but now I can only find used copies on places like Amazon.
  5. Remember, In Utah, your child can legally carry his EpiPen or Auvi-Q. But he probably is not capable of administering it to himself in an emergency, so make sure the teachers and everyone else know where it is and how to use it. Because both EpiPen and Auvi-Q are available right now for $0 copay, get a pair for the school office, and a second pair to keep with the child (in his backpack or lunch bag, usually). You might also attach a luggage tag with his photo on it to his backpack, so the teacher can tell which backpack is his quickly.
  6. If he's going to be having lunch at school, talk to the Lunch Lady and cafeteria monitor. Introduce your child, tell her what your child is allergic to, and let your child know that the Lunch Lady is a friend that will help keep him safe. Then remember the Lunch Lady and the cafeteria monitor on holidays with little thank you cards or gifts to show you appreciate them. Few people do that. But it will help keep your child's food issues fresh in their mind, and they'll get to know him well.
  7. Ask about setting up a food table just for allergic kids. All that’s required is a table with a sign that says allergies only, and the cafeteria monitors clean it with a separate marked bucket and cloth. Don’t let them make your child eat in a separate room or the principal’s office. He shouldn’t be punished or isolated just because he’s allergic to some foods! Ask the principal to mention the allergy table in a newsletter or other information that goes home with kids at the beginning of the year. You may find other kids with allergies expressing an interest in sitting at the table if they know it’s available.
  8. Ask the parents of your child’s friends to send safe lunches with them every once in a while, so they can eat with your child. Make it a fun place to be!
  9. Most peanut-allergic kids don’t react to the smell of peanut butter in the air, but a few do. If you are worried if your child will react to the air in the cafeteria, ask to take him in for a “practice run.” Sit in the cafeteria for half an hour and see if he reacts. If he doesn’t, cross that worry off your list.
  10. Eat lunch with him for the first few days. That will reassure both of you that you can both handle this!
  11. Talk to the teacher about which cafeteria door your child should use to avoid peanut butter contact (usually the one furthest from the playground), where to put his lunch bag after lunch, and where his EpiPens will be.
  12. Remind your child NOT to throw away his lunch trash. Tell him to bring it home in his lunch bag, so that he can avoid using the trash can. If another kid slam-dunks a half-full milk carton in the trash can, you don’t want your milk-allergic child to get splashed.
  13. Medical alert jewelry can help remind teachers and other staff about your child’s allergy. Lots of companies now provide medical alert jewelry in styles ranging from classic metal bracelets to fashionable plastic jewelry or even cool fabric sports bands (like at American Medical ID). Use your favorite search engine to find a style your child will enjoy wearing.
  14. If your schedule allows, volunteer a lot, so the staff knows you and counts on you (not just for allergy issues). If the only time they see you is when there's a food allergy issue, then you may start feeling like they're whispering "Oh no, here she comes again." But if they see you as a "Gosh, what would we do without her" kind of volunteer, then the occasional food issue will be coming from a great mom who's making a reasonable request.
  15. If someone else is already the class mom, or you can't volunteer for that position, tell the teacher you really need to attend all parties and field trips because of the food allergy. The teacher may want to let the other parents know that you'll be selected for all the special events because of the food allergy, so that they don't think the teacher is playing favorites.
  16. Volunteer to shop for all the snacks or food materials for classroom parties or food educational units (like making noodle necklaces or gingerbread houses, etc.). Tell the teacher if she'll collect money donations, you'll go buy all the ingredients. They're usually delighted to get out of having to shop, and it lets you ensure the ingredients are safe.
  17. Be aware and be prepared, but don't panic! School is going to be a lot of fun, and your child will do just fine. And believe it or not, so will you!

Monday, August 17, 2015

6 Reasons Why I Almost Didn’t Pursue OIT for My Son’s Food Allergies

By Kelley Lindberg

Because of some discussions that took place on FaceBook after my first OIT post, today I will share the concerns I had going into this new treatment for my son’s food allergies.

My first post two weeks ago about my son’s journey with Oral Immunotherapy (OIT) for his food allergy to peanuts sparked a lot of interest (“Searching for a Food Allergy Treatment—Our OIT Journey Begins.”) Of course people are interested—this is a new therapy for food allergy that might represent a possible way to reduce a person’s reactions to a food allergen. Since experts estimate that 1 out of every 12-20 kids in American has a severe food allergy, a treatment that would lessen or eliminate the threat of a life-endangering reaction to food would benefit millions of people.

So, as I mentioned in that first post, I’ve been watching medical studies for years. As my son approaches his college years, I’ve been hoping one of the many possible therapies currently being developed makes it through trials and gets far enough along in its progress to offer me some hope for him before he’s off on his own, eating in college dorms and living with roommates. So when my allergist began offering OIT in his office, I was interested.

I was not, however, quick to jump on the bandwagon. In fact, even though I’d been begging our allergist for years to keep my son in mind if he ever began implementing a treatment protocol, when he finally approached me, I said “No, thank you.” I felt that the treatment was still too new and that there were too many unanswered questions and risks.

Now more than a year has passed, and although I still have questions and worries, my son and I decided enough data is being accumulated and enough patients have been through the process nationwide that we were willing to consider it.

I want to share my concerns, however. My goal with blogging about our journey is NOT to become an evangelist for OIT. It is to share our unique experience, adding our personal observations, successes, setbacks, worries, and other personal views to the growing body of information out there, so that others who are interested can see one more perspective.

To start with, I thought I should share my concerns, which explain why we waited over a year before we signed up for OIT.

I am very cautious when it comes to my son’s life. (Go figure, right?) While peanuts and tree nuts represent life-threatening dangers to him, we’ve also become REALLY good at managing those allergies by strict avoidance. In 16 years, he has had only 2 minor reactions as a toddler (which were how we discovered his allergies) and one minor reaction on an airplane two years ago. We’ve never had to use an emergency epinephrine auto-injector (EpiPen). We’ve been far more vigilant than some might think is necessary, but it’s worked for us almost perfectly. We’ve avoided foods with “made in a factory with” warnings. We’ve talked to every teacher, soccer coach, and friend. We carry EpiPens everywhere we go. We’ve used an abundance of caution, and we’ve been very lucky so far.
Of course, accidents happen, and while the temptation to say “We’ve been doing fine so far, why change things” is strong, I know a big change is on our horizon—college. When he goes to college, I won’t be there to remind him, cook for him, or notice those first signs of a reaction that only moms can see. So “the way we’ve always done it” is going to change, and I won’t have any control over that.

So I want reassurance that my son’s life will be safe when I’m not around. But that doesn’t mean I’m convinced OIT will be the answer. I’m hopeful, but not blindly so.

The first caution to note is that OIT is currently not recommended by official medical associations. A growing number of individual physicians are offering this treatment in their offices, but make no mistake—it is NOT an officially sanctioned treatment. That carries a lot of weight. I had to do my own research to reassure myself that enough doctors are doing this now, and have been doing it long enough to show documented success, that I feel comfortable with the practice. Medical associations will take a much longer time and require even more well-documented and tightly managed studies before they approve of it. I had to be comfortable with moving forward without that reassurance, and let me tell you, that’s WAAAAAYYYY out of my comfort zone.

Next, this treatment doesn’t prove successful for everyone. Our allergist and others like him who are sharing information and protocols with each other are claiming a success rate of 85 – 90%. That’s very encouraging, but it still means 10 – 15% of the people who try it won’t make it to the end of the treatment cycle and therefore won’t be protected from their food allergen. That’s a lot of time, effort, and money to risk on a gamble, even with pretty good odds.

A third big hurdle for me was a study that linked OIT to the development of possible eosinophilic esophagitis (EoE) disorders. EoE disorders are a different type of allergic reaction in the esophagus and digestive tract that can cause significant health issues. I didn’t want to trade my son’s known allergies, which we know how to manage, for a potentially worse disease. But I also learned about a study that shows a small percentage of kids who naturally outgrow their food allergies can develop EoE to that same food years later. (See the article “Those Who Outgrow Food Allergy Can Risk EoE” on Allergic Living magazine’s website.) The study’s researchers speculate that the kids who develop EoE (10-15% of the kids who outgrew their allergies) may have had EoE to begin with, and the disease was hidden because they were avoiding the food. When they outgrew the allergy and began to eat it again, perhaps that’s when the EoE symptoms were triggered. So even if my son outgrew his peanut and tree nut allergies on his own, he might still run the risk of developing EoE. Also, my allergist explained that in talking with other allergists about these possible links between OIT and EoE, the allergist are occasionally seeing EoE symptoms begin to emerge, but they immediately stop the OIT treatment and the EoE symptoms disappear. As he explained it to me, their observations show that when they stop the OIT, the patient reverts to their original allergies, and the EoE symptoms go away and do NOT progress into full-blown EoE disease. So the patient is ultimately no worse, albeit no better, than when they started. However, this is only anecdotal experience, and only large-scale, long-term studies will definitively illuminate the link between eliminating food allergies (whether through OIT, SLIT, a future treatment we don’t even know about yet, or by naturally out-growing them) and EoE. Those studies may be on the horizon, but they’re not here yet. So we’re flying a little bit in the dark as far as this risk goes.

Fourth, OIT is an expensive and lengthy process. We have to realize going in that we’ll be committed to this process for a minimum of 6 months of weekly appointments, probably more. And the dosing is twice a day, every day. We are very fortunate that our allergist is in our health insurance network, so we pay the specialist co-pay for every weekly appointment, plus additional fees for the peanut solution and any other tests or expenses we incur. Many people aren’t so lucky. Either they don’t have health insurance at all, or their chosen allergist is out-of-network, meaning they must pay a higher percentage of their medical bills for the weekly appointments. We’re talking thousands of dollars here for some folks. And that doesn’t include the costs some people incur when they live far from their allergist and choose to either relocate or fly or drive round-trip to their appointments every week.

Fifth, the treatment process requires us to adhere to a very regimented schedule. We’re not a highly regimented family. We like to be spontaneous. Dinnertime can be anywhere from 5:30 to 9:00, depending on what we’ve got going on that day. And my son is right in the middle of that social whirlwind called “the teenage years.” As part of the treatment, he must be dosed with peanut solution after breakfast and after dinner every day. And he must refrain from physical activity that can raise his body temperature (which increases his risk of a reaction) for 30 minutes before and 2 hours after those doses. That means he can’t inhale his breakfast and rush off to the swimming pool to clown around with friends. He can’t wolf down dinner, then immediately long-board with friends to the skatepark. And last weekend, only a week-and-a-half into his treatment program, he had to miss out on a weekend with his best friends at a lake cabin because I need to make sure he’s dosing at the right times and that he’s close to emergency medical help if he needs it. He’s having to confine his physical activity to the middle-of-the-day hours and curtail some of his social activities, and that’s hard.

Sixth, after we go through the 6+ months of treatment, we’re not finished. We’ll never be finished. Right now, patients who complete OIT are committed to having to eat a “maintenance” dose of their food allergen every day for, potentially, the rest of their lives. So while for some of us, having to eat a handful of peanut M&Ms every day for the rest of our lives doesn’t seem like a bad thing, what if he hates peanuts? Being told you have to eat a food you hate every day for the rest of your life, just so you don’t run the risk of becoming allergic again and having a life-threatening reaction, can seem like a cure that’s nearly as bad as the disease, right? Maybe someday there will be new data that shows OIT conveys longer-term protection than it now appears, or maybe a new treatment will cure these patients once and for all of their allergies, but until then, my son will be eating a handful of peanuts (or peanut butter) every day, whether he likes it or not. And currently, the recommendation is that these “cured” patients continue to carry EpiPens, “just in case.”

So, was this an easy decision for us? No, definitely not. So why did we choose to do OIT despite all of these hefty concerns?

Because we made the decision as a family—and my son had ultimate veto power—that the risks and inconveniences were worth the possible outcome. To live his life unafraid of that accidental exposure, to be able to kiss a girl without interrogating her about her last 2 meals, to be able to go with friends to a Mexican or Chinese restaurant without being left home, to go on a vacation without worrying about how many hours away he’ll be from medical help if he goes into anaphylaxis… all of those are goals we decided are worth pursuing.

Only time will tell if we made the right decision. But it feels right for us, for now.

And for those of you following along on our OIT journey, we had a wonderfully uneventful week, with no reactions at all after his up-dosing last week (now at 5 mg of peanut flour, which contains 2 mg of actual peanut protein). And the question I know is on everyone’s mind? This week’s Kool-Aid flavor for the peanut solution is Fruit Punch!

Wednesday, August 12, 2015

OIT Food Allergy Treatment, Step 1: Yep, He’s Drinking the Kool-Aid

By Kelley Lindberg

My son swallows his first dose of
peanut flour mixed in Kool-Aid. This dose
equals about 1/100,000th of a peanut.

Last week I announced that my teenage son will be undergoing a new treatment for food allergies, called Oral Immunotherapy (OIT). (See “Searching for a Food Allergy Treatment—Our OIT Journey Begins.”) While not yet recommended by official medical associations in the U.S., I feel like OIT has also progressed beyond the purely experimental stage, with a small but growing number of allergists in the country providing this treatment. While the temptation to embrace this treatment as the miracle cure I’ve been hoping for is strong, there are many significant reasons to be cautious, or even downright wary.

However, I know many of you want to know how my son is doing after his first two weeks of treatment, so this week I’ll focus on telling you how the first two weeks of treatment have gone. Next week I’ll step back and talk about the concerns I had (and still have) going into this treatment, because I want the information I post to be as fair and balanced as I can make it. Otherwise, it’s of little use to anyone, in my opinion. Deal? Deal! (And I promise all my posts won’t be this long, but there’s so much to share in these first couple of posts. Sorry!)

Day 1, July 27:

Today was our information kick-off meeting. We met with the allergist and his staff, and we went over all the details, such as the dosing schedule and what to do if he has a reaction to the dosing. Highlights:
  • We’ll spend two days introducing tiny amounts of peanut in a liquid solution, every 15 minutes over a period of 3 or 4 hours, gradually increasing the dose until he reaches the level just below where average patients begin to show reactions. (Or they will stop sooner if he reacts sooner.)
  • After 2 days of this in-office treatment, we’ll take home a bottle of the solution, and we’ll administer it to him twice a day at home, every day, until next Thursday when we return for our regular “up-dosing” appointment. Assuming he got through the week without any major reactions, the office will administer an increased dose to him and watch him for reactions for an hour before sending us home with a bottle of that increased dose. We’ll dose him at home twice daily with that until the next Thursday. We’ll repeat this cycle of returning to the office to increase the dose (“up-dosing”) every week at the same time.
  • If he has a small reaction, such as a few hives in a localized spot, we can treat with liquid Zantac, liquid Zyrtec or Allegra, and if necessary, a liquid steroid. For larger reactions, we should call the doctor immediately and be prepared to administer epinephrine. Larger reactions, including anaphylaxis are less common, but they do occur.
  • He must take the peanut dose on a fairly set schedule—once after breakfast, and once after dinner, but not later than 9:00pm (so that he has a good two hours of being awake and alert before going to bed, because those two hours are the most likely time to have a reaction, and they don’t want him falling asleep during that time). The doses should be between 9 and 15 hours apart, so there is some flexibility, which is good for our family.
  • He must refrain from physical activities that might raise his body temperature for 30 minutes before and 2 hours after each dose. For an active teenager, this could be inconvenient.
  • He will start on a liquid peanut solution, then after a few weeks graduate to peanut flour mixed into a soft food (like pudding or applesauce), then finally graduate to actual whole peanuts. At every step, the peanut proteins are carefully measured and controlled. You definitely can’t do this at home (unless you have a measuring cup that can accurately measure 1/100,000th of a peanut!).
  • To enhance the treatment, the doctor recommends taking a probiotic daily. Some studies indicate that food allergies may be linked to the reduction of beneficial bacteria in the gut due to antibiotic use, so our allergist includes probiotic use in his protocol.

After hearing all of this information, my son and I went home to talk about it.

And my son balked.

He had been the one who first wanted to do this, for the obvious reasons: he wanted to be free from the danger of accidental exposure, and he wanted to stop worrying about peanuts everywhere he went. I hadn’t been sure about it in the beginning, but because he wanted to do it, I was now on-board.

But now that the treatment was only hours away, he suddenly realized it’s scary. He’s never had to use an EpiPen, and now the doctor was telling him he might have to BECAUSE of the treatment. Plus, he fixated on the “no physical activity for 2 hours after dosing” rule, and he became very upset about that. Never mind that he no longer plays soccer or runs track, and he primarily spends his time on the computer, playing his guitar, or watching movies with his girlfriend. In his mind, this was a sudden, insurmountable problem that no one warned him about.

He went to his room, I started texting my friend Kim for advice, and we each stewed for an hour. Then I went to his room, shoved the pile of clean laundry off onto the floor so I could sit beside him (See? We’re just like every other family!), and started to talk to him. I talked about the reasons we had originally looked into this process, and the ultimate goals that he longed for. We talked honestly about pros and cons. Finally, I realized I was talking myself into quitting the process. But much to my surprise, he had talked himself back into it! When he calmed down from his initial panic, he realized that his goals to become as peanut-worry-free as possible outweighed his concerns. Then he just had to talk me back into it.

Finally, we both agreed to go ahead and start the OIT procedures the next day, as planned.

It was a mentally exhausting discussion, but one I think we both needed to work through in order to feel good about what we are doing.

Day 2, July 28:

8:30am: We get to the doctor’s office bright and early, ready to start (despite yesterday’s hiccup).

8:45am: Our allergist meets with us privately to answer last-minute questions and brief us again on what to expect. We ask about probiotic brands and dosages, but otherwise we are as ready as we are going to be.

9:00am: We’re taken to the Food Allergy waiting room, where other patients and parents are gathered. There are 5 patients starting this OIT cycle with us: three teens (my son is the oldest at 16) and two younger kids (the youngest is 4). My son has brought his laptop and I’ve brought a book to read.

It looks like a syringe, but the solution is not
injected--it's squirted into the mouth and
swallowed. The syringe is an accurate way
to measure and deliver the liquid orally.
9:20am: First dose! The nurse gives my son an oral syringe filled with 5 mcg of peanut flour mixed in a liquid, which he squirted into his mouth. Then he has to “swish and swallow” with water to make sure none of the solution gets stuck in his mouth, and that he swallows all of it. (Spoiler alert: The “secret liquid ingredient” into which the peanut protein is mixed is cherry Kool-Aid!) He breathes deeply a few times, and again every few minutes, to “test” himself for any reaction. He wasn’t told to do this, so I know he’s just nervous and worried that he’s going to start wheezing. He doesn’t.

9:35am: Second dose, same quantity (5 mcg).

9:50am: The dose is doubled, so this time he ingests 10 mcg. After a few minutes, I think his face starts to look faintly reddish, but after a few seconds, it fades and I can’t decide if it’s my imagination or not. I ask the nurse, but by then his color looks normal and she doesn’t see anything either. He doesn’t feel anything, and he continues working on his laptop. I have a hard time focusing on my book.

10:05am: Same dose again (10 mcg). People in the waiting room are starting to talk to each other and share “when did you find out he/she was allergic” stories. Everyone’s nerves are starting to calm down a little.

10:20am: Increased dose—now he’s at 25 mcg.

10:45am: Increased dose again—now he’s at 50 mcg. Again, I think maybe he seems a tiny bit flushed, but it only lasts a few seconds, and then it’s gone again. It could be my imagination. I am so worried that something wrong is going to happen, I know I’m conjuring up demons. But he says he feels totally normal, he’s stopped taking deep breaths, and he’s totally relaxed about the whole thing. I’m trying to relax. Honest.

11:05am: Same dose (50 mcg).

11:20am: Increase to 100 mcg. All is good. No flushing.

11:35am: Last dose of the morning, and it’s 100 mcg again.

11:45am: The doctor comes in and gives us a refresher talk about dosing at home and what to do if he gets sick. Then the nurse gives us an oral syringe filled with a single dose (half of the amount in the last dose he just took, so 50 mcg of peanut flour), which he will take at home after dinner tonight.

7:40pm: We finish dinner, then give my son his evening dose of 50 mcg.

9:00pm: My son is annoyed with me because he just asked if he could go long-boarding with his friends. I told him he needed to stay home so I can watch him for reactions. Maybe eventually I will be more comfortable with him going out in the evenings, but for the immediate future, I need him nearby.

A hive!!!! (On his lower cheek.)
Despite my initial maternal panic, it
went away after we treated him with
oral antihistamines.
9:15pm: We’re watching TV, and my son says “Mom, I have three hives.” WHAT??? Sure enough, he has one on his cheek, and a couple on his right side. I grab the paper that says what to do in a reaction, and I line up the 3 liquid medications I’m supposed to give him. My son calmly says, “Really? All three?” Suddenly I’m questioning myself. Did the doctor say to give all 3? Or one at a time? Or…? Crap, I don’t know! I dial the phone number on the “home dosing instructions” sheet and the doctor answers. I tell him what’s going on, and he calms me down and says to administer Zantac and Allegra, but to hold off on the steroid. He says if the reaction gets worse to call him back. I make my son hang up his phone (for some reason he thinks a girlfriend conversation is more important, but I insist) and I give him the 2 medications. The hives disappear in a few minutes. Yes, I watch my son like a hawk for the next several hours. No, he doesn’t get any other hives. No, he doesn’t ask about going long-boarding again. I can’t help making one snarky little “See why I wouldn’t let you go long-boarding tonight?” comment, but prevent myself from repeating it ad nauseam. I’m proud of my restraint. I’m not sure he appreciates it, though.

Midnight: It’s been 3 hours, drama-free. We each head for bed peacefully, our first day over and our first crisis minimal and handled. Whew. I can do this, right?

Day 3, July 29:

8:30am: We arrive at the office and get checked in.

Graphic found on
Bruno Thadeus’s Hypersensitivity Slideshow
9:00am: The allergist comes to talk with us privately to see how we’re doing. My son is fine. I’m still nervous and a little embarrassed about calling the doc last night. He assures me that’s normal, then says from now on, when there’s a small reaction like that, we should hold off and watch it for a few minutes to give the body a chance to resolve it on its own. He admits that this is exactly the opposite of how we’ve been trained to act all along, but because these are minute quantities and his reaction last night was so small and immediately cleared up with the medication, we want to give the process time to work on building up his immunity. He also spent some time explaining the science of what we're doing. In overly simplified terms (which I am probably explaining poorly), a reaction happens when a single allergen protein molecule lands on two IgE receptors on a mast cell at the same time. If an allergen protein molecule only lands on one IgE receptor, there’s no reaction. It has to connect two receptors for a reaction to happen. So what we’re trying to do by introducing minute amounts of the allergen protein (in this case, peanut protein) is slowly saturate individual mast cell receptors with their own protein molecules until all the receptors are eventually “occupied” by a single peanut protein molecule, so that there aren’t any lonely IgE receptors hanging out trying to make a pesky threesome. (Okay, I’m positive that’s not how the doc explained it, but you get the idea.) {Photo from } The doctor also said that the OIT process may also increase the IgG4 in the body, and if the amount of IgG4 eventually dominates over the amount of IgE, that may add additional protection against allergic reactions. Yeah, I’m going to need to do some more research before I fully understand all of that.

9:30am: First dose of the day. Because my son had a minor reaction after last night’s dose, we dropped back to a lower dose this morning. So while the other patients began with a higher dose of peanut (1 mg, I think), my son started back at 25 mcg. The doc recommended being conservative today, which frankly makes me happy! This means we may extend his treatment by a few weeks overall, but I’m okay with that.

9:43am: I think my son looks faintly reddish again, but it goes away quickly.

9:45am: The red is gone, and he is given the next dose with no problems. This dose is 50 mcg.

10:00am: 50 mcg. No red color, no problems at all.

10:15 and 10:30am: These two doses are at 100 mcg, which is the dose we finished at yesterday in the office. There are a lot of people in the Food Allergy waiting room today—the same people who started this cycle with us yesterday, and additional patients who are farther along in their treatment and are coming in for their weekly “up-dosing” appointment. Several chat with us about how happy they are with their treatment so far.

10:45 and 11:00am: Both of these doses are 250 mcg each! This is the highest he’s done so far. No problems.

11:15 and 11:30am: 500 mcg… still going strong!

11:45 and 12:00: His last two doses for the morning are both 1000 mcg each (1 mg)! This is where the rest of the kids started this morning, but like I said, I’m okay with being conservative and taking it slow. We will go home with a bottle of the Kool-Aid solution. He will take a half-dose tonight (500 mcg), then starting tomorrow morning he will take a full dose (1 mg) twice a day until we return next week. The other patients are doing doses of 5 mg now, so my son is behind their level, but I still feel good about taking it a little slower.

Midnight: It's been an uneventful evening, which is just the way I like it! No hives, no worries after his evening dose.

Day 6, Aug 2:

My son finds an itchy bump on his torso about three hours after his morning dose. It doesn’t really look like a hive, and it could be a bug bite. Hmmm. We watch it for a half-hour, and it doesn’t get any worse and no others pop up. We don’t administer any medication, and eventually it starts to fade and finally goes away on its own.

Day 10, Aug 6:

This is the bottle of peanut solution
we use at home. Grape Kool-Aid. Mmmm!
(My son says he'll never be able to
drink Kool-Aid again without chasing it
with water for the "swish and swallow" step.)
Today is our first “up-dosing” appointment. We tell the doctor about the one mystery hive/bug-bite/bump last Sunday, and he says it probably wasn’t a hive since it happened so long after the dosing, and says we did the right thing to watch it. My son is given a single dose of the new increased amount (2.5 mg), then we sit in the waiting room for an hour to make sure he has no reaction. This time, the peanut flour is mixed in grape Kool-Aid, and for the first time, we can actually see the peanut flour floating in the solution. It’s strange to know that he’s ingesting this, on purpose, after so many years of strict avoidance. Life is weird.

Day 16, Aug 12:

I am finally getting all these notes written up for my blog. He’s been doing great all week—no reactions, no hives, no problems. Tomorrow is our next up-dosing day.

If you’re still reading, I’m sorry this was so long, but I hope this has been informative. Next week, I’ll post about some of the concerns/cautions related to OIT. (Plus, I’ll provide an update on how he does after tomorrow’s up-dose, of course!) See you then!