Food Dependent, Exercise-Induced Anaphylaxis 

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Being a young adult with allergies, I have grown up learning all the ins-and- outs of my allergies and how to manage them.  Since the age of one, I have been identified as being allergic to wheat, eggs, nuts, and have also had other allergies that I’ve been fortunate enough to grow out of. Like others who have grown up with allergies, I became proficient in knowing what each of my allergic reactions were like, the severity of each reaction, and what works for managing and staying safe with my allergies.  Over the years, I have become quite comfortable with my abilities to manage avoiding food allergens. And, while I’ve had the occasional reaction to wheat or eggs, I have been fortunate never to come in contact with nuts—which put me at risk for anaphylaxis. That being said, I recently had a different kind of allergic reaction which I was unprepared for, and knew very little about.  This allergic reaction is something known as ‘food dependent, exercise induced anaphylaxis’ or FDEIA.    Some of us may be aware of the ability of exercise to exacerbate medical conditions such as asthma; but this can also be true for food allergens or foods we are not even normally allergic to.  FDEIA is defined as a rare, unpredictable syndrome characterized by anaphylaxis associated with the ingestion of a food and the occurrence of exercise.

I won’t go too in depth. But I want to share part of my experiences with an exacerbated allergic reaction related to exercise.  Currently I go to school and live in Kingston.  My living arrangements involve housing with a great group of girls who have all been extremely accommodating towards my allergies.  My one housemate had done some baking one afternoon and was kind enough to make her baking ‘allergy friendly’ for me.  She had finished making her goods before I was about to go for a run. And, being assured it was free of my allergens, I indulged in her baking before starting my exercise.  Briefly into my run, I noticed a slight ‘tickle in my throat’ and the idea crossed my mind that my body could be mildly reacting to something.  I then made the poor decision to keep going (thinking that the tickle in my throat couldn’t really be a reaction).  I then noticed my breathing was becoming a bit more labored and uncomfortable.  I again made a poor judgment call and attributed this to just being a normal shortness of breath from the progression of my run.  I can’t stress enough how things quickly escalated from there.  My breathing became extremely labored, my eyes started swelling, and my body became extremely itchy on its extremities.  I also began experiencing a variety of uncomfortable GI symptoms and started to become progressively light headed—which was,  likely, from my blood pressure dropping.  This was an extremely dangerous situation to be in.  I had always been a very confident and regular runner and, in this situation, had no medicine or phone with me. I will admit that, at that point, carrying an auto-injector was never part of my usual running routine.   In this case, I still marvel at how fortunate I was that, while this was occurring, I was able to get help and receive medical attention.

What was extremely eye opening to me in this situation, and what I really want to share, was how long it took me to fully recognize that I was actually experiencing a severe life threatening allergic reaction.  With my allergies, on a day-to-day basis, I felt quite confident in my ability to identify allergy risks and when a reaction was starting. In this situation, however, I didn’t identify the progression of this reaction early enough.  It never crossed my mind that I was at risk for experiencing a severe allergy attack until it had progressed to such that level.  It was only after I was treated for this reaction that I was told about Food Dependent, Exercise Induced Anaphylaxis that things really became clear.  It was found my personal reaction was triggered by spelt (as species of wheat which my housemate thought was gluten free but in fact was not).  While having spelt would cause me to have an allergic reaction, it normally would never have caused such the severe reaction I subsequently experienced that day.  Exercise itself has also been found to be capable of inducing anaphylaxis (known as Exercise-induced Anaphylaxis) or ,with FDEIA, it can be related to a combination of food consumption and exercising.  As mentioned earlier, with FDEA, it has been found that both foods someone is aware they are allergic to, and sometimes even foods that don’t normally cause an allergic reaction, can trigger FDEA.  Research has been done on these topics and, while there is still a need for more, it is an interesting subject to look into and educate yourself about. It is important, as individuals who have managed our allergies for some time, to still be aware of different reactions and risks with allergies that can occur, and to always work to stay educated and safe.

Caitlyn 

Explaining Allergies to Your Roommates

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For the better part of the last eight years, like many of us, I’ve lived with roommates. As someone at risk for anaphylaxis, stemming from allergies to various nuts, I am very careful about both choosing my roommates and about being very forward when it comes to explaining my allergies and the precautions that need to be taken to ensure that I feel safe in my own home. The following will detail some measures I have taken to stay safe over the years.

I have been fortunate to live with roommates who have been both long-time friends and family over the years. These individuals are familiar with my allergies and have been in various situations with me (at restaurants and traveling for hockey and vacationing abroad). Nonetheless, one must be particularly careful to not have a false sense of security simply because those you live with are familiar with your allergies and the precautions required for you to stay safe. Put simply, all it takes is one mistake on your part or the part of a roommate. I find that a simple chat when you first move into a new place, and some friendly reminders as time goes on, goes a long way.

Cooking and doing dishes when you have roommates can be a challenge at the best of times. I’ve found that having all my own personal pots, pans, utensils, and plates and bowls to be very smart way to ensure that no cross-contamination occurs. Additionally, while I’ve had dishwashers at every place I have lived, I hand-wash every one of my dishes. That is to say, not all dishwashers are equally effective when it comes to cleaning your dishes. Nor can you always count on your roommates to avoid consuming food products that have even “may contain” warnings on the labels. At the end of the day, it is your responsibility to look out for your own safety. And I’ve found that following these courses of action to take stressing about cross-contamination out of the equation.

Something as simple as brushing your teeth, if you share a bathroom, can be a potentially dangerous situation. But, again, if you stick to a safe method, it can make a world of difference. I’ve found that keeping my toothbrush, toothpaste, and mouthwash in my own kit, a travel kit to be specific, prevents me from worrying about my toothbrush touching those of my roommates, worrying about someone using my toothpaste or worrying about someone using my mouthwash (guests included). Additionally, always make sure your roommates and guests know where your auto-injector are at all times.

While no method can completely overcome simple human error, on your part of the part of your roommates, these have been the methods that have works for me over the years. What methods have worked for you and what additional methods might you suggest? 

Aaron S. 

Dating and Allergies – A Practical Approach

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In two weeks, my partner and I will be celebrating our 3 year anniversary! Being in a serious, long-term relationship, I no longer worry as much about my allergies when I am with him. When we go out to the restaurant, he’s also watching the kitchen staff and wondering whether or not the waiter/waitress truly understands how serious my allergies are. He’s always got my back! When we are planning “date night,” we call restaurants ahead of time or make plans that don’t revolve around eating out.

Dating with food allergies can seem terrifying for many people. When I was a teenager, I outright refused to date because I was too scared of trusting a boy with my life. I felt that waiting until I met someone I thought I could trust, and who completely understood the severity of my allergies, was the right thing for me to do. I always took out my auto-injector on the first date and explained how it worked, when I would need it, etcetera. Doing this made me feel safer. Having said that, everyone is different. Dating is supposed to be fun and you should therefore do things you feel safe doing.

Talking about food allergies and the auto-injector:

Explaining your allergies, the severity of them, and showing dates how to use your (epinephrine) auto-injector is very important. It is ultimately up to you as to when you want to talk to them about it and show someone you are dating your injector. Personally I feel that, because food allergies are life-threatening, it is extremely important that others know right away what “the deal” is. This is not intended to scare them; but it is intended to show them that you are confident with your allergies, know how to manage them, and that you know what to do if something were to happen. Most people will feel better knowing what to do if something were to happen (especially if you reassure them that you take extra precautions and know how to manage them).

What to do on a date:

If you have food allergies, or perhaps your girlfriend or boyfriend has food allergies, you might be wondering what to do on a date. How do you make the date safe? Here are a few ideas. Not included below is the obvious food date (breakfast, lunch or dinner). If you are going to meet for food, then make sure you go to a place you feel safe. If you feel like trying a new place, call them ahead of time and make sure you feel safe with their menu and their precautions with your allergies.

  • Picnic – Bring safe food and spend the afternoon at the park, by the lake, or on the beach
  • Tea/coffee- Tea/coffee dates are always fun. Try new cafes in the area!
  • Mini-Golf – Who doesn’t like mini-golf! J
  • Go-karts – Speed! And no food! Or you could always bring your own snacks.
  • Wine tasting – Another fun one. You could always bring a few safe snacks for yourself.
  • Bike rides – You could even head for a picnic! Or go for a nice ride together. Maybe even rent a tandem bike for fun!
  • Aquariums, Museums, Art Galleries.

There are so many things you could do without even going to a restaurant or getting food. Get creative. Rent a canoe or a paddle board and get out on the water! There are a lot of safe choices out there! Don’t let your allergies impact the fun you have on your dates! If he/she really likes you, your food allergies won’t stand in the way of that! Be yourself. Make the date a safe one so you don’t have to stress about having a reaction and can relax and enjoy the time with your date.

Erika

Allergies and Reasonable Expectations for Airlines

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My sister is currently employed as a flight attendant with a Canadian-based airline company. I recently made a point of sitting with her and discussing what expectations are reasonable for both airline staff and passengers when it comes to allergies in the air.

On more than one occasion, passengers with food allergies have put my sister in an awkward position. For example, a parent informs her of her child’s allergies and attempts to take the meal that is being offered. My sister reiterates that she does not know whether or not the flight meals have come into contact with allergens as they are prepared by a different service on the ground. Here are some reasonable expectations that crew and airline staff have of those travelling with allergies:

1)  Bring Your Own Food/Snacks- As much as we would like to be accommodated and included in the airline meal service, bringing your own food is always the safest bet.

2)  Carry Your Medication- Some airlines may have their own epinephrine on the flight; but you should always be responsible and carry your auto-injector with you at all times.

3)  Stock Up on Disinfectant- Wanting to wipe down the armrests, food trays and any other surfaces of the airline is totally reasonable. Despite the cleaning crews’ diligent work, germs are still present. Most airline staff are very understanding of this; however, most do not have any type of disinfectant wipes / sanitizer present. B.Y.O.S- Bring your own sanitizer.

4)  Be Understanding and Polite- Most airline staff will do what they can to help you. It is important to be understanding of their limitations too! The more patient and polite you are to them, the more likely it is that they will provide you with amazing service.

As for airlines in general, most of their duties are regulated and the policies change from company to company. However, here are some things that I think would be reasonable to expect of airline staff when travelling.

1)  Aware- I would appreciate it if staff had some form of familiarity with allergies. They don’t have to be an expert on the topic; but it would be nice if the staff were at least competent enough to assist a passenger allergies.

2)  Announcement– I think it is a pretty reasonable request for airline staff to make an announcement informing passengers to refrain from eating your allergen.  Although it is hard to expect that everyone on board will abide by the request; but it definitely helps raise awareness among the aircraft passengers and reduces the chances of you coming into contact with your allergens.

3)  Understanding- Airline staff should understand where allergic-folk are coming from. No I’m not a flight risk. And I’m really not trying to be difficult! I am just trying to ensure that I’m safe in my sparingly small space at 40,000 feet in the air! Reassuring an allergic passenger is always a plus.

4)  Offer- We know that you don’t have a restaurant on-board; but if the menu options are a ‘no-go’ for us, we do appreciate an offer for an alternative. Chances are, we have our own food packed. But it does mean a lot to hear airline staff make safe suggestions.

What have your experiences with Airlines and your allergies been like? Comment below!

Nicole

Changing Ingredients and the Importance of Checking Even Your Daily Staples

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It’s hard for me to pinpoint the age that I started to read. All I remember is that I was a swift reader upon entering the first grade. I do equate this to the fact that I had probably been reading ingredient labels well before your average fairytale (although I read those too)!

This act is as normal to me as opening a package. Whenever I eat, cook, or do anything involving a food item, a glance at the ingredients list  is just a part of the process. I am glad this has become a habit.

I remember one day when I was totally craving a fix of chocolate! I grabbed one of my favourite candy bars and, while waiting in line, took a look at the ingredients list. I questioned: “May contain traces of tree nuts and peanuts!?! Since when!?”

I remember having this incredibly bitter inner dialogue before reluctantly placing it back onto the shelf. A part of me was extremely disappointed, but another part  of me was relieved. If I hadn’t  checked the label, who knows what could have happened! I am lucky that the act of reading ingredients has become such an ingrained habit.

After reiterating the importance of checking labels, I must admit that there have been times that I have forgotten. I made a grave mistake once but I was very lucky with how the events played out. My most serious allergic reaction to date happened after eating a food before reading the ingredients. It was a food that I had eaten numerous times before. However, the “Holiday” version of this snack contained hazelnuts. I had wrongfully assumed the food was safe and landed myself in the hospital and on an IV on Christmas morning. The whole situation could have easily been avoided had I done the simple task of reading the label.

It is very important to always check the label. It doesn’t matter how many years you’ve eaten that food, how much you trust the company, or whether or not it is an item that is unlikely to have come in contact with your allergen.

Please, check the label every single time. Have any of you had similar experiences with ingredients lists? Please comment below!

Nicole

Allergies as Disability: The Pros and Cons

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Often, when people find out I am allergic to peanuts, they say: “How do you live without peanut butter?!”  My response is:  “Well, it’s kind of a life-threatening allergy. So…”

Allergies are more of a win than a burden for me. Yes, it can be an annoyance to manage my allergies when I am going to eat out, go to people’s houses for dinner or have business lunches and dinners. That being said, I am pretty satisfied with the idea that I am always endlessly conscious of what I am eating.

I am used to reading labels, asking about ingredients and knowing everything that is in my food. In efforts towards choosing healthy lifestyle options, this is an easy cross-over for me. I have no new habits to form when reviewing foods. Along the same lines, one of the cons in having allergies means having to put out the extra cash for specific foods because of the foods I can or cannot eat.

The idea of labelling people with allergies as having a disability has been brought up in various sectors of society. I feel this would be an interesting concept. I am not sure how that would change lifestyles or benefits (medical) for people with allergies; but it would be nice to have a similar qualification for a tax deduction based on the extra costs that can be associated with purchasing allergen free foods, for example. Another pro of having people with allergies be labeled with “a disability” is the potential for it to create more black and white legislation towards issues like dealing with allergies on airplanes and allergen free areas at sporting venues (to name but a few possibilities).

There are some potential conflations that may come with being labeled with a “disability.” Unfortunately, people may have a hard time identifying something as a disability when it sits outside more traditional physical or mental issues. Allergies are comprised of neither of those, at least in a straightforward sense. So I can understand the frustrations people with allergies might have if others were to equate their disability with having a physical or mental rather than as a stand alone category. As a person with allergies, I have to manage my allergies daily so I do not consume things that will put my life at risk. So I remain unsure how having myself recognized as a person with an allergic disability versus person with allergies would change daily management.

Personally, I am okay with having allergies. Would life be easier without them? Yes. But I have them and, if there are ways that we can lessen the burden financially and socially for people with allergies, I am personally all for that.

Joanna

Part 2 – Allergies in Film and Television: Myths versus Realities

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Howard Wolowitz, a character from the brilliantly funny TV show The Big Bang Theory, has a peanut allergy. In season 1, episode 16, Howard has an intentional allergic reaction. Without spoiling too much about the plot, Howard is trying to stall as much time as possible to keep his friend, Leonard, from going home early to a surprise birthday party. In order to stall, he initially fakes an allergic reaction; but the nurses at the hospital catch on to his ploy and send him away. Desperate to stall, Howard does the unthinkable and eats a food with peanuts in it. This short clip is what follows:

https://www.youtube.com/watch?v=QuOpWSAsKnc

There isn’t much myth in this clip; however, there is plenty to learn from it. 1) Never intentionally eat your allergen to stall time for a surprise birthday party. Nothing is worth risking your life in this way! 2) If you’re having a reaction, a Hospital is where you need to go. So, in that sense, Howard was in the right setting to have a reaction. We never saw an auto-injector used, but having nurses and hospital staff at-hand is even better. 3) The swelling of Howard’s face, extremities, and tongue are very possible symptoms of an allergic reaction (as we also saw with Hitch from my previous post).

In the second season of a Canadian ‘school teacher comedy’ called Mr. D, one of the teachers, Bobbi, has just donated blood to show another teacher, Simon, that giving blood isn’t so scary. After her successful donation, and his not-so-successful donation (I won’t spoil the reason why), the two are relaxing on lounge chairs. The school librarian, Wayne, then brings them each a cookie. Bobbi is allergic to peanuts and asks: “Are there any nuts in these cookies?” Wayne responds with a “No.” So Bobbi takes a bite of her cookie. Wayne then says: “There are peanuts.” Bobbi spits out her cookie, starts to panic, and tells them that she’s super allergic to peanuts. Wayne and Simon then exchange dialogue about the difference between a nut and a legume and how Bobbi should know the difference. She sits back in her chair and tells them she needs her EpiPen. A few things can be learned here: 1) Although Wayne is a ‘smart aleck’, and should have told Bobbi there were peanuts in the cookie from the beginning, the fact that peanuts are considered legumes and not nuts is an accurate fact. 2) Her response of spitting out the cookie and calling for her auto-injector was smart. 3) She says she needs to go to the hospital because her throat is closing up. This is also a smart decision (9-1-1 should additionally be contacted when an allergic reaction arises).

Lastly, Ross Geller, one of the main characters on the TV show, Friends, is allergic to lobster, peanuts, and kiwi. In the following clip, Ross eats a Kiwi-Lime pie that he mistook for a Key-Lime pie that his sister, Monica, made for him.

https://www.youtube.com/watch?v=unmfG892KgQ

From the clip, the allergic reaction is very easy to notice. His throat and tongue swelling up are a few of the many possible signs that a life-threatening allergic reaction is taking place. So, in this sense, the clip is quite accurate. However, Ross never suggests the use of an auto-injector. He is afraid of needles and this may be the reason he does not suggest using one; but even his sister never mentions it. The decision to go straight to the hospital could be seen as a good decision (although it would have been wiser to call 9-1-1 and let help come to them). They live in the heart of New York City. So getting to a hospital before the reaction gets very bad, especially without the use of an auto-injector, is not very likely. The decision is ultimately very risky for Ross (he says in the clip that he can die from Kiwi).

Hopefully you learned a thing or two by reading through this two-part blog! Remember to always be critical of how food allergies are portrayed on the big screen. Sometimes clips and scenes are quite accurate, while others are completely wrong or misinformed. Just because we see food allergy management on the big screen, or on our favourite TV show, the management not necessarily accurate or advisable. Some of the clips reviewed here were simply used to cause audiences to laugh; but, when you or someone you know is faced with a severe allergic reaction, it is no laughing matter and proper care should be taken. Thanks for the read. If you have any more clips, scenes or stories to share, please comment here and we can spark a conversation!

 

Dylan

By Food Allergy Canada