Egg allergy

Egg allergy and the MMR – is it safe?

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Among the allergy community, there is a lot of doubt and uncertainty about the safety of the MMR vaccine in egg allergic children. This post sums up the latest research and recommendations.

What is the MMR?

The MMR Vaccine protects from measles, mumps and rubella. It is given around 12 month of age and again around 3 to 5 years of age. It is an active virus, consisting of weakened forms of the viruses.

Why is there a concern about giving the vaccine to egg allergic children?

The vaccine is cultured on embryo chick fibroblasts.

Though, it does not contain any hen’s egg protein. If traces of hen’s egg protein are detected, they are highly processed and their concentration is very low.

Recent studies:

MMR vaccination of children with egg allergy is safe:

a danish study published in 2013, investigating 32 children with egg allergy who had been referred to get their mmr vaccination (Priorix MMR) at hospital. None of the children had severe reactions

A review of a pediatric emergency department vaccination programme for patients at risk of allergy/anaphylaxis

Published in September last year, the authors claim their study being  “one of the largest studies looking at childhood vaccinations performed in a hospital setting for children who are ‘at risk’ of allergy, anaphylaxis or hypersensitivity”. A total of 374 patients (with a medical history of anaphylaxis, allergic reaction or strong suspicion of a severe adverse reaction against egg) contributed to the findings. All of the children received their vaccinations in a hospital setting. “Only six patients (1.3%) experienced an immediate reaction to a vaccination. All reactions were minor”. The authors conclude that “A significant number of referrals were unwarranted and the majority could have been safely managed in the community”.

Latest expert opinion (BSACI, 2007):

BSACI Recommendations for Combined Measles, Mumps and Rubella (MMR) Vaccination in Egg-Allergic children:

The MMR has an excellent safety-record and may be administered to all egg-allergic children in a primary care setting. As with any other immunisation, adrenaline should be readily available in case of rare and unpredictable anaphylaxis. MMR should be postponed if child is unwell. A hospital based application is necessary after a previous severe reaction to a vaccination (MMR or other) after a specialist assessment. It might be possible that the reaction occured due to an allergy to other components of the shot (gelatine (beef and lamb allergy) or antibiotics (neomycin or other)).

Other vaccinations and egg allergy:

Flu vaccine: updated every year, the content level of ovalbumin, varies every year, some jabs do not contain egg. A split dose (1/10 of single dose, than 9/10 of dose) of the vaccine might be an option. Consult your GP or specialist for up to date advise.

Yellow fever vaccine: unsuitable for children with egg allergy

So what is the verdict?

Latest research suggests that the likelihood for an egg-allergic child to react to the MMR vaccine is about the same as to any other non-egg containing vaccine. Reactions are rare but non predictable due to other substances like gelatine and antibiotics.

Even though the MMR seems to be a safe shot, it is always recommended to seek advise from your specialist if in any doubt. Every child reacts differently and the risk profile of your allergic child can be best assessed by your trusted allergist.

Sources: the anaphylaxis campaign, nhs choices, pubmed, bupa, bsaci

Please note that this post does not imply any medical advise. Please always consult your specialist.

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A as in Anaphylaxis

Finally here: first ever hEPI day!

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Every 10th of the month, we will take the opportunity to refresh the basics in case of an emerging anaphylactic reaction.

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So we got out our emergency kit, checked all bottles and pens, their expiry dates and contents. And, every family member had a go at demonstrating the others how they would administer the Epipen. All did a really good job:

“Blue to the Sky, orange to the thigh”: reminds you what part is the top and what is the bottom (containing needle):

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Take off the blue cap, form a fist around the pen, and apply the orange end which contains the needle firmly in the outer part of the upper thigh:

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Hold the pen tightly for 10 sec (one elefant, two elefants…, 10 elefants), remove the pen and rub the thigh.

If the patient is lying down, do not move him.

Call 999 and wait for the ambulance. If no improvement within 5-7 min, apply another epipen to the other thigh.

So, when will you give it a shot?

Stay hEPI!

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A as in Anaphylaxis

Introducing: THE Hepi DAY…

courtesy of evolve-trainingsolutions.co.uk

THE Hepi DAY:
Every 10th of the month, we will take out our trainer pen and practice, practice, practice! Plus, take the opportunity to look through your emergency kit for out of date products.
Let’s get this Epipen Training going! Studies show you have to constantly practice to be prepared and able to use your adrenaline pen correctly! Why the tenth? To remind us to leave the needle in for 10 seconds…
Stay hepi
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A as in Anaphylaxis, All About Allergies

Sooner rather than later…

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Maybe the most raised question in the allergy community: when is the right time to apply the epipen? No doubt it is the only drug able to break the vicious cycle, and its benefits outweight the risks. But actually when is the right time for it?

Even experts discuss the issue widely and have not come up with a formal consent. Based on experience, literature and recent incidents, this is one of the most sufficient answers I have encountered yet. So please take five minutes of your precious time and read this excellent advice by M.D. Phil Lieberman.

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A as in Anaphylaxis, All About Allergies, What allergybabe wants

Food allergies and emotions – a bumpy ride

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Bona fide of dealing with a food allergy

I have been sitting over this post for quite a while now.  Doing some proper thinking and finding the right arguments takes some time, and after completing the post, reality once more caught up with me, and had forced me to gradually adapt my wording, my thinking and my opinion.

This was supposed to be about how to deal with food allergies in a calm and rationale manner. It turned out to be quite different, as you may notice when reading further on. I was all convinced how stupid it is to get hysterical about foods allergybabe is allergic to, but, I admit, I adjusted my point of view. It is now a more complex approach I laid out and if you agree, I am happy. If not, I would love to hear about your views.

As a mum of an allergic child who had 6 anaphylactic reactions by the time he was 7 month old, not knowing what had caused his extreme reactions, I consider myself to completely understand the emotions and thoughts that constantly run in a parent’s head when taking care of an allergic child.

To any of you reading this from an outsider’s perspective (a friend of a friend with allergies, a care nursery teacher, a parent of a friend of an allergic child etc.) just let me try to explain why we are the way we are. Why we are so apprehensive about foods our children are allergic to, especially with peanuts.

The rationale behind the emotions involved in food allergy or: why we are entitled to occasionally freak out…

Anyone witnessing a proper anaphylactic reaction of his child will by any means avoid it to happen again. It is a very daunting and frightening experience.

Peanuts are one of the eight most common food allergens and are one of the foods that cause anaphylaxis, the most severe form of allergic reaction, which can lead to the individual’s death. And it does not matter how rare this event may be, if it could be your child.

Peanuts can hide every where, small amounts, invisible to the eye, can stick to a door handle, a toy at nursery, a food tray, a table cloth, a takeaway and can hide within an innocent looking biscuit. Tiny amounts can harm, and it is a natural reaction to be extra cautious about it.

Media and charity groups are covering the issue extensively, constantly reminding how lethal a tiny amount can be.

Twitter and other social media tools easily amplify and distribute an individual’s biased opinion.

As it is difficult to predict the likely severity of food-induced allergic reactions, parents and sufferers are on constant alert mode to avoid the allergen.

Statistics help to judge the likelihood of a reaction within a wider population, though they cannot predict an individual’s risk profile.

Is it in any way helpful to get hysterical over a legume?

Impartiality is the widely accepted approach to any medical issue.If doctors would panic, we would not get the appropriate care. That is why there are doctors, nurses and other professional medical staff. It is not the parent who has to act as a medical professional. But what to do if the parent happens to be a trained doctor? Who has had several encounters with life threatening situations, who quite routinely ran to a CPR when the telephone rang in that all to familiar high pitched sound, listening to a computer animated voice which told you where in the hospital the patient is about to depend on your skills and professionalism to get back to life? Doctors are trained to stay calm, not to emotionally get involved, to forecast what could happen next and decide how to proceed. As a professionally trained parent, you try to stay calm and still provide the emotional support for your child without overseeing best medical care.

Others may say as long as you do the right thing, nothing seriously can happen. And I believed it, too. And than, a young girl dies in a camp in California.  A young child who knew about her allergies, who did not take changes, who was very aware of the dangers.

Once I read a mother’s comparison of her child’s food allergies: Imagine a chef would prepare your meal, and just before doing so, he filled a rat trap with poison. He did not wash his hands afterwards, he used the same equipment, he used the very same plates etc. You would be horrified because there would be that real danger of getting severely poisoned.  See the picture. That is how we, the parents, see food allergies. We are on high alert. Always. Every single day. Because you just know, that one day, out of the blue, your child will have a reaction.

We all agree now that we have to avoid all contact with allergens. Do we have to avoid it by all means? I strongly believe in an individual’s right of freedom. Do not do anything for your own sake that involves restricting anyone else’s freedom. That is part of Germany’s Grundgesetz (German Constitution) and I am a strong believer in its profound value. How can it be applied to protecting food allergy sufferers? Where does individual safety and freedom end? Is society to be restricted for the sake of an individual’s health? Should the majority of people be denied to enjoy food because of a minority getting uncomfortable being surrounded by it? Where do we stop to demand and support from society? Is it ok to ban peanuts and other nuts from school halls and nurseries? Should the majority of people be denied to enjoy food because of a minority getting uncomfortable being surrounded by it? Do food allergic people have a right to ask for peanut free buffer zones on a plane? The questions do not stop here.

Can we allow grocery stores to sell peanuts? Is it ok to deny a child to feed the squirrels a handful of peanuts on the playground? Can we accept that other children will have a snack while playing on a common ground? Can a fellow tube rider have a guilt free snicker?

If you expect an answer, you are mistaken. I do not have an answer. But if you have ever witnessed a life threatening reaction, you will do anything to avoid it a second time.

You will do anything not to risk your child’s life ever again. Full stop.

I guess in the future, society will have to decide how high on a pedestal they put the individual’s needs and how much we are willing to limit freedom of the majority.

*This post was inspired by all the brave parents who care restlessly for their food allergic children and the following two articles:

http://www.princeton.edu/main/news/archive/S37/46/79G28/index.xml?section=topstories#top

http://www.sciencedirect.com/science/article/pii/S0277953613002657

This blog and its entire content is by no means intended to represent professional medical advice. Please contact your medical professional for any medical concerns you may have.

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RECIPES

Apple Cake – a sunday treat (GF*, EF, WF, DF, SF, NF, vegan)

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I remember when I was little, a sunday cake was not optional. It had to be made. So every saturday evening, when me and my brother have had our baths, we were tucked into our pyjamas and placed in front of the tele. There was always a nice family show on back in the 1980s, so a fun tv evening was guaranteed. While we enjoyed the games, jokes and songs of the time, my mum got busy in the kitchen. Depending on the season, she was about to be making a plum cake, a strawberry tart or, for special occasions, a schwarzwaelder kirschtorte. yes, with lots of cream, and ‘kirsch’…. . Once it came out of the oven, noone, not even my very very sweet toothed dad, was allowed to cut the cake. It was ment to be eaten for coffee and cake on sunday. That was the rule. And everybody obeyed. Most of the time… .

Nowadays, there are less strict rules in our house, and cake is made when we feel like making one. But whenever there is a round baked goody on our dining table, I remember my childhood and the distinctive smell on a saturday evening of a fresh, egg and butter loaden cake. Good times.

Here is the allergyfriendly version of a German classic: Apfelkuchen (apple cake)

For a 18cm diameter cake tin or 12 cupcakes you will need:

Ingredients:

35g  gluten free oat flour

165g gluten free bread flour (Doves farm)

1 1/2 tsp baking powder

90g caster sugar

1 tsp cinnamon

1/2 tsp bicarbonate

pinch of salt

50g pear sauce

100ml oat milk (*if made with rice drink#)

100ml sunflower oil

1/2 tsp vanilla extract

3 medium apples, peeled and sliced

Method:

– Preheat the oven to 180 degrees Centigrade/Gas mark 5

– Place liners in a cupcake tray or grease your round baking tin

– Sift the flours and salt into a bowl. Add the baking powder. Stir in the sugar.

– In a separate bowl, mix together the oat milk, bicarb, vanilla, pear sauce and oil.

– Pour the wet ingredients into the dry and mix. You cannot overdue gluten free batter, so combine well.

– using a large nozzle, pipe the dough into cupcake liners or a tin

– place the apple slices neatly on top of dough

– bake for approx. 32 minutes, until a knife comes out clean. Avoid overbaking (cake will get dry).

– Cool on a wire rack.

– dust with icing sugar.

Best enjoyed on the day it is made. But also nice on the day after, since the peaches keep the cake moist.

# please be aware that rice drink is not recommended for children under the age of 5 due its arsenic content

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