Meet our Medical Advisor ...
Andrew M. Singer, M.D.
Board Certified Allergy & Immunology Specialist, Pediatrician.
Dr. Singer received his Bachelor of Science in Biology and his medical degree from Indiana University. He completed his residency at Children's Hospital Medical Center in Cincinnati, Ohio, and then completed his fellowship in allergy and immunology at the University of Michigan.
He joined Allergy & Asthma Affiliates in 2007, after serving as clinical instructor in the Division of Allergy & Immunology in the Department of Internal Medicine and in the Division of Pulmonology in the Department of Pediatrics at the University of Michigan in Ann Arbor, Michigan.
Areas of Special Expertise:
Anaphylaxis
Asthma
Eczema and Atopic Dermatitis
Food Allergy Hypersensitivity
Immune Deficiency
Sinus Infection/Sinusitis
After moving to Knoxville, Dr. Singer also cofounded Volunteers Educating for Food Allergies (VEFA), which is a Knoxville based food allergy advocacy group. VEFA then merged with FACET in 2012. He serves as our support group medical advisor as well as a member of FACET's Board of Directors and Advisory Council Chair.
Dr. Singer continues to update his knowledge with yearly professional meetings as well as independent reading.
Q & A with Dr. Singer:
if you have a question you'd like to submit to Dr. Singer or our Medical Advisory Council.
Question: Food allergies and eczema. What is the relation?
Answer:
Answer:
The answer is yes, no, and maybe. A few patterns emerge. There are clearly atopic dermatitis patients where food has no bearing on their eczema. They may notice worsening after ingestion or contact with acidic foods, but this represents irritation and not true allergy.
The next group are the ones where food clearly worsens the eczema. It is important in theses cases to understand what type of eczema however. In general the mild cases (a few small patches which can be treated with moisturizers or as needed uses of OTC strength topical steroids) are not usually related to foods.
The patients that need food allergy evaluation are the ones with moderate to severe eczema. In other words, moisturizers and OTC strength steroids do not help. Usually this onsets around the introduction of solid foods and continues to worsen. Face, trunk/body involvement and often secondary skin infections have happened. These children often itch until bleeding and nothing seems to help.
Sometimes a particular food trigger has been noted by a parent, but not always. In these cases, testing to foods they are eating can be helpful and help determine which foods to avoid. This has to be done cautiously however, as a food that triggers eczema one time, can trigger anaphylaxis several months down the road when reintroduced. It is also worth noting that even in the moderate to severe cases, food allergy is present in only 35-40% of cases.
The last group is the hardest to sort out. These are children with eczema and positive tests to foods, but food restriction does not help their skin. Often it's a trial and error approach based on skin/blood tests, only to determine the foods are not involved in the eczema.
In general eczema is triggered by many different exposures: temperatures, infections, soap, shampoo, foods and environmental allergens. Determining triggers, increasing moisturizer use, and careful use of topical steroids and antihistamines can help ease the skin condition.
Question: What is food allergy component testing?
Answer:
Answer:
When we have skin test or blood tests done and the results are positive, the results indicate that the patient has antibodies that recognize one or more proteins in that particular food. However it does not tell you which protein you are allergic to. Peanut for example has 5 separate proteins that can cause a test to be positive, but some proteins will cause anaphylaxis, some milder symptoms and some will only cause a positive test but no actual disease. Until the past few years we haven't been able to tease apart which of these proteins a patient is allergic to. But we have always seen patients with strongly positive tests to peanut but no reactions when they eat it.
Now however we can run a lab tests that will report out values for the separate proteins, and this can help sort out patients who are truly anaphylactic to peanut from those that have only a positive test and no allergy and the in between milder reactions. In peanut for example, one of the proteins is cross reactive with tree pollens. So if you are very allergic to trees, the lab and skin test for peanut will be positive but the patient does not react when they eat peanut.
This is very helpful and can help cut down on false positive peanut diagnosis. It can also help us figure out which patients we should challenge to peanut to confirm an allergy or which we don't need to challenge because the lab indicates 95% certainty of a reaction.
We can also test egg and milk this way, which can help us sort out which patients should try baked egg or baked milk.
This technology has also recently been approved for some tree nuts, and will likely be something that can be ordered by this fall.
Question: Do I really need a new Epipen when it’s past the expiration date? It’s still clear so we can still use it right?”
Answer:
Answer:
Truth or Dare…Epipen expiration dates.
This is understandable, especially given the expense of these (that is a topic for another day-are you listening Epipen?)
The truth of the matter is that the epinephrine does degrade over time. An expiration date states that if stored properly, on that date, there is still 100% of the dose of epinephrine available. The strength or dosage does begin a slow decline from that point. It does not turn into a pumpkin the next day like Cinderella’s carriage but it does decrease.
A study in the May 2000 Journal of Allergy and Clinical Immunology examined these devices anywhere from 1 month to 90 months after expiration. Not only did they confirm the decline in dose of epinephrine with age, they found that you cannot tell by looking at the color whether the drug has degraded. Several devices still had clear medicine but had lost epinephrine activity despite appearing “okay.”
And the devices where the epinephrine appeared cloudy or discolored did have reduced or little medicine left.
Let’s think of this in another way. An Epipen is like a fire extinguisher. It hangs around all the time, with the hope that you don’t need it. But when you need it, you need it to work.
If faced with using an expired Epipen, you should still use it. But you should always carry an in date device. Just because the medicine looks clear, does not mean it has the dose you need.
This is not a dare worth taking.
Question: I have heard that some kids who “outgrow” food allergies later develop Eosinophilic Esophagitis (EoE). Also, I understand that a small percentage of kids who participate in OIT (oral immunotherapy) later develop EoE. Can you shed some light on this?
Answer:
A very small group of patients may get EoE after a food allergy is outgrown. However, the prevailing feeling is that these children had EoE but didn’t manifest, as they weren’t eating the foods. Not something to worry about daily for children who have outgrown their food allergies. But if a food allergic patient has outgrown food allergies and gets stomach symptoms later (2-4 years per their study) I’d be more aggressive about a GI workup. (The only way to diagnose EoE)
And yes, 20% of patients can develop GI symptoms (mostly EoE) with oral desensitization. In all the fervor to promote this therapy it’s often buried under the “successfully desensitized” information but has been long recognized medically as a complication.
The study regarding EoE was from 2014.
Question: Do I need to worry about soy?
Answer:
Soy is a legume that is used as a primary food (soy milk, edamame) or a source for other food products such as soy oil or soy lecithin. Most patients with soy allergy have resolution of this by ages 3-5. It can last longer although rarely is lifelong.
In general there are two ways oils are produced: Hot pressed or cold/extruder pressed. Hot pressed oil is produced with bleaching, heating and other chemical treatments, which remove soy protein from it. This type of oil does not have allergen and does not trigger reactions (and may not be “specially” labeled on a processed food package). Cold pressed oils are less common and generally not used in processed foods but could be found in organic/health food areas to be used for food preparation at home. This can contain soy protein but has rarely been linked to causing a reaction.
Soy lecithin is another common soy sourced ingredient. It has a few uses in foods including as a release or non-sticking agent. It also functions to keep foods “together.” An example would keeping cocoa butter and cocoa from separating in a chocolate bar. The production of this removes most of the protein, and what is left is rarely enough to cause a reaction. (<5% of patients with soy allergy).
When I’m counseling patients about soy, I generally allow soy oil/soy lecithin unless there has been a history of a reaction to them. As always, individual cases vary, so check with your allergist before you or your child ingest it.
Here's a note from our Medical Advisor regarding a recent study and media reports about the risk of injury from administering epinephrine with an auto-injector ...
"By this time, many patients have been asking about the recent study showing injuries from epinephrine autoinjectors. Here is my take on the issue: Epinephrine the medication is safe when used to treat anaphylaxis. No debate here.
Intramuscular epinephrine is the preferred treatment. Giving this medication subcutaneously (under the skin rather than in the muscle) takes too long to work in an anaphylactic emergency. The study did show some injuries from the needle from an autoinjector. Understand this study has some limitations. They did not search actual ER visit records but searched social media sites and web message boards for reported injury, thus all details were not present.
The only thing to take away from this is that you should hold the leg still where the injection is given. This seems obvious but to those less familiar with injections acting in an emergency situation, it may not be first thing on their mind. Practice with the trainers. Add holding/securing the leg to the training of others.
My biggest issue with this article is how the press has added to it "life threatening injuries" to some of the headlines. The only thing life threatening about this article is patients not using epinephrine when it is needed. The injuries, although undoubtedly painful, will heal, maybe with a scar. But the scar from not using epinephrine when needed is much larger.
As always, discussing injector technique and device type with your physician is appropriate. Not giving epinephrine when needed is not."
"By this time, many patients have been asking about the recent study showing injuries from epinephrine autoinjectors. Here is my take on the issue: Epinephrine the medication is safe when used to treat anaphylaxis. No debate here.
Intramuscular epinephrine is the preferred treatment. Giving this medication subcutaneously (under the skin rather than in the muscle) takes too long to work in an anaphylactic emergency. The study did show some injuries from the needle from an autoinjector. Understand this study has some limitations. They did not search actual ER visit records but searched social media sites and web message boards for reported injury, thus all details were not present.
The only thing to take away from this is that you should hold the leg still where the injection is given. This seems obvious but to those less familiar with injections acting in an emergency situation, it may not be first thing on their mind. Practice with the trainers. Add holding/securing the leg to the training of others.
My biggest issue with this article is how the press has added to it "life threatening injuries" to some of the headlines. The only thing life threatening about this article is patients not using epinephrine when it is needed. The injuries, although undoubtedly painful, will heal, maybe with a scar. But the scar from not using epinephrine when needed is much larger.
As always, discussing injector technique and device type with your physician is appropriate. Not giving epinephrine when needed is not."
Question: Will it happen again?
Answer: One question we hear a lot is "what if we have another child...will he or she have food allergies too?" This has never been easy to answer, but a recent study has given us a better crystal ball.
The non scientific answer to this question is simple: probably not. (I already can heard everybody shouting at their screen saying "but it happened to us.") This study looked at two different issues. One was allergy, and the other sensitization. Allergy means there was a definite reaction to the food. Sensitization means there was a positive test to the food but no reaction when eaten (hence no allergy). For true allergy, Milk had 5.9% risk in second siblings, Egg, 4.4% and peanut 3.7% (lower than the prior studies showing about 7% for sibs with peanut allergy.) Sensitization rates (again, positive test but no reaction) were anywhere from 15 to 37% depending on the food. What does this mean for upcoming siblings? Most will not have food allergies. Most don't need to meet their friendly neighborhood allergist. But how do we know who should meet an allergist? If the next sibling has eczema or early respiratory issues (wheezing/asthma) they should be evaluated. And although this isn't specifically in the study, I think anyone very concerned about the next sibling should check in with an allergist. Limited food allergy testing and perhaps an oral challenge if deemed necessary can clear a child to eat a certain food and help reduce the stress of "not knowing.' This is where the sensitization piece comes in. There is the risk of a false positive allergy test. Generally with follow up testing and oral challenge we can sort this out safely. |
Question: Last summer, 13 year-old Natalie Giorgi died from anaphylaxis after accidental ingestion of peanut butter. Her physician-father followed common food allergy protocols for accidental ingestion: immediate administration of benadryl, observation, and an EpiPen once she started vomiting 20 minutes after ingestion. Actually, I am not sure how standard an EpiPen is for only ONE physical symptom -- vomiting.
I had understood we administer an EpiPen when two organ systems are involved. Please clarify the new emergency protocol.
I had understood we administer an EpiPen when two organ systems are involved. Please clarify the new emergency protocol.
Answer: One result of this tragedy is the recommendation to administer epi if allergen is ingested but no symptoms have started. This protocol is especially important for those with a history of more severe reactions in their past. In general however, rapidly spreading hives, (one organ system) would be indication for using epi, and any airway symptoms. Lip or tongue swelling included, as this could be an early indication of airway swelling. In general, I would only give Benadryl for a few local hives (where the allergen touched the hands for example) or belly pain with a few hives - anything beyond that, use epi immediatey.
Epinephrine is a safe medication to use (the only exception may be someone with a compromised cardiac status such as coronary vessel disease-in which case you may use a lower dose). The ER visit after using epinephrine is not because of side effects of the medicine, but to make sure the patient does not need a second dose of Epi and to get a dose of steroid to prevent a late phase reaction that can happen 2-10 hrs later. There is a misconception that Epi is dangerous and we wait to use it until a child cannot breathe, it should be used early! I am not sure of the specifics in the Giorgi case, only what I’ve seen in the press. It would be very unusual for vomiting to be the only symptom. |
Question: I understand that a notable cohort of children are developing eosinophilic esophagitis (EoE) after participating in peanut sensitization research trials. Is Dr. Singer aware of whether children with anaphylaxis to egg are at an increased risk of EoE if they start eating baked egg?
Answer: Great question! In the peanut desensitization trials, the patients ARE still having an immune reaction to peanut - the goal being to have their immune system recognize peanut and modulate itself into tolerating peanut, not reacting to it.
The baked egg is different. When egg is baked, the chemical structure of the proteins change and no longer resemble the egg protein a patient is allergic to. Therefore, they aren’t allergic to the baked form and won’t get EoE. 75% of egg allergic patients can tolerate the baked form because of this change. The other 25% (also less likely to outgrow the allergy) are allergic to egg proteins which do not change during the heating/baking process. |
Question: What is an Food Challenge and is it necessary for diagnosis?
Answer: This type of food allergy testing has long been called the 'gold standard' test for diagnosis or confirmation of food allergy and must be performed under the care and guidance of a physician.
Because there is a high rate of false positives with skin and blood testing, sometimes a food challenge is needed to... prove or disprove an allergy exists. There are 3 main types: 1. Open food challenge. This is the most commonly done, as it is the easiest to do. The patient and physician know what food is given. 2. Single blinded. The patient does not know the food (and it could be a placebo), but the physician does. 3. Double blind. Neither the physician nor the patient know what food is being used. Open challenge are what we use most commonly, outside of a research setting. Most of the difficulty is in 'blinding' the patient or hiding a food from them. Peanut butter has a characteristic smell, so preventing the patient from finding out it's peanut is very tricky (often they mix it with tuna oil - good luck getting a child to try that mixture!) Challenges often seem daunting and scary, especially for the patients. Most often they are done to confirm a patient has outgrown a specific food allergy. The goal is to ingest a "serving size" of a particular food. This varies on the food: one single egg or 2 tablespoons of peanut butter. The total dose is divided into 4-6 increasing portions, given 20-30 minutes apart. The patient has vital signs measured every 15-30 minutes and we advance the food provided no signs of reaction occur. Even though reactions can occur, we choose our patients for this carefully and keep all emergency medications on hand. Studies show however that challenges are safe to do in a physicians office provided they have experience with them. |
Question: Please explain allergy testing.
Answer: There are several types of allergy testing and often multiple types are needed to get the most accurate diagnosis.
Skin testing is the most common. Small amounts of allergen are introduced under the skin with a device (there are multiple different styles that all work effectively). After 15-20 minutes, the spots are measured to determine if a patient has allergy antibody to a certain allergen. A positive result is a bump 3mm larger than a control bump (done with salt water-no allergen). Redness often occurs but the bump (or wheal) size is what is most important. This testing is fast, least expensive and most sensitive (it will pick up an allergy if present). It can't be done if a patient is taking an antihistamine within one week of testing, or if there is an active skin rash. There is a small risk of reaction (<0.05%) due to the testing. Blood testing (RAST or more correctly Allergen Specific IgE) is also frequently used. Blood is drawn, the antibodies are filtered out. The separated antibodies are washed over a plate that contains the allergen. If you have allergy antibodies, it sticks to the allergen on the plate and is measured. This testing can be done without interference from medication. It can test to more specific proteins, in peanut for example, to give better risk assessment. Downside is the cost, up to 10x more per allergen than skin testing. Also it has a high rate of false positives (as does skin testing). It can miss allergies however. The technology is improving every year but up to 20% can be missed if blood testing alone is done. Remember though, a positive test (skin or blood) does not mean you necessarily are allergic to something. It is the history of a reaction consistent with an allergy and a positive test that implicates a food. An interesting statistic: 75% of patients with a positive blood test to peanut are not allergic to peanut. |
Question: What is the root cause of the increase in allergies?
Answer: There is no clear cause and there are many different influences.
We can associate the increase in allergic disease (not just food allergy but also hay fever, asthma, eczema as well) with increased use of antibiotics, vaccinations. Exposure to airborne pollution, raising carbon dioxide levels, have also been seen to correlate. With regard to food allergies, peanut allergy rates have correlated with increased consumption per person (doubled since 1950), use of dry roasted peanuts vs boiled, and the changes in way peanut butter is produced. On a most basic level, it appears that as our immune system has less today (because of vaccinations and antibiotics), it starts acting out and becoming poorly regulated. This causes it to react against things that are not threats but may have chemical features to things that do. For example, some evidence shows dust mite proteins resemble some bacterial proteins ... so the immune system mistakenly reacts to dust mite when it thinks it is protecting the body. As we have made great strides in improving quality of life with antibiotics, vaccines, mechanization, and Facebook, we have influenced the immune system toward a poorly regulated and allergic state. That said, I'll take hay fever over having polio and mumps. |
Question: If I am allergic to shellfish, should I also avoid iodine - especially with medical procedures?
Answer: There are medical reasons for iodine exposure, such as contrast for a CT scan or to treat thyroid disease. Seafood, and shellfish allergy in particular is often asked about before receiving iodine containing contrast or thyroid treatment. It turns out there is no higher risk of reaction due to shellfish allergy. This has become a bit of a medical myth that continues despite many studies showing there is no increased risk.
It should be noted however that anyone with a food allergy does have a slightly higher risk of a reaction to iodinated contrast. Again, each case should be discussed with your physician but shellfish allergy is not a reason to avoid iodine. |
Question: What is patch testing?
Answer: Patch testing is a less frequently used type of test originally found to be useful for patients with contact dermatitis due to chemicals, soap ingredients, metals like nickel and adhesives. It has been used to evaluate food allergy in children with gastrointestinal problems and in some cases severe eczema.
If food allergy has not been found with the other types of testing (skin or blood) this sometimes is offered. Small bits of food, mixed with saline or sometimes petroleum jelly are placed under small dime sized patches. They remain on the patient's back for 48 hours and are taken off and evaluated at 48 and sometimes 72 or 96 hours. They can be difficult to interpret but can help define delayed hypersensitivity. I do not recommend them for most food allergy patients, but when symptoms or gastrointestinal biopsies are saying "allergy" and conventional tests are not, this type of testing can be useful. |
Question: What about taking allergy medications before allergy testing? Would this interfere with the results?
Answer: There are several types of allergy testing available so we'll focus on medications with skin testing today. Skin testing relies on inducing a small allergic reaction in the skin. Histamine is released if the patient is allergic to a particular substance. When released, the histamine causes itching, a red area (because it brings more blood into the area) and swelling (because it prevents blood from leaving). This is a very common question - What type of medications can interfere with allergy testing?
Allergy Medications - *Most oral allergy medications are antihistamines, so they block this reaction from occurring during skin testing. One of the skin tests done is always with histamine itself. That way we know that all antihistamines are out of the patient's system and we can trust the skin tests (a negative is truly negative, not due to a medicine). *Other allergy medications like singulair (montelukast) or nasal steroid sprays (Flonase, Nasacort etc) do not block allergy skin tests and can be continued. *Nasal antihistamine sprays (Astelin and Patanase) should be stopped as they theoretically can interfere with testing. *Allergy eye drops could also interfere. Medications with Antihistamine Properties - There are other medications (not typically thought of as allergy medications) that can cause negative tests because they DO have antihistamine properties. For example, some antidepressants (imipramine, doxepin) also work as antihistamines and interfere with skin testing. Beta Blockers - These are usually blood pressure or migraine headache medicines. They block beta receptors on the heart and blood vessels. Epinephrine needs beta receptors "open" to work. If they are blocked, treating an allergic reaction (very rare from skin testing but can occur) can be more difficult. For most allergy medications, stopping them for one week before skin testing is adequate. Do not stop any other medication (beta blockers, antidepressants) without checking with the doctor who prescribed them. (Please note that the information provided above relates to the use of allergy medication prior to skin testing - this does not provide information about medications prior to blood testing.) |
Question: Asthma attacks and anaphylaxis: How to tell them apart?
Answer: A recent question asked how to tell asthma attacks and anaphylaxis apart, as they had heard that often you can’t.
An asthma attack is an acute spasm of the muscles around the airways causing shortness of breath, wheezing, coughing and distress if severe enough. Anaphylaxis is similar in that it also can cause acute spasm of the muscles around the airways causing shortness of breath, wheezing, coughing and distress if severe enough. At face value (and in the “heat of the moment”) these events are similar and can be confused. The concern has always been treating the respiratory symptoms with an inhaler, assuming it’s only an asthma episode and not seeing the big picture that it could be anaphylaxis and best treated with epinephrine. Anaphylaxis occurs when two or more organ systems are involved. For example itching/hives and wheezing (skin and respiratory) or hiving and vomiting (skin and gastrointestinal) or dizziness and wheezing (cardiovascular and respiratory), etc. These can be told apart, but often “in the heat of the moment” people focus on the more obvious breathing difficulty and miss the hives that are starting ... or don’t hear the patient say that they are nauseated and want to throw up. By the time it becomes more obvious that it IS anaphylaxis, a reaction is farther along and more difficult to treat. It’s probably best to think of an asthma attack as part of anaphylaxis, rather than indistinguishable. And a patient who has a history of asthma is at higher risk of severe anaphylaxis as their lungs are already inflamed and “twitchy” if you will. As far as treatment, epinephrine will help an asthma attack. We used to use injectable epinephrine to treat asthma and in fact the over the counter “Primatene Mist” was epinephrine inhaled. The problem with using epinephrine inhaled for asthma is that it does not last very long - a few minutes at best. Albuterol (which is a distant cousin of epinephrine) lasts for several hours. I hope this clarifies things a bit. |
Question: Why epinephrine first?
Answer: One of the more common questions I'm asked is: "It's okay just to give Benadryl and wait before I give epi, right?" As we understand more about anaphylaxis, we understand how quickly it can occur and the limitations of Benadryl.
During a reaction, the chemical histamine is released from mast cells. Those cells live in the skin, gut and respiratory tract (which are the main sites of symptoms of allergic reactions). Histamine has the obvious effect of causing itching. It also dilates blood vessels however, making them bigger so more blood can flow into the area. When this happens in the skin, you get swelling (or it can also happen in the airway). When enough histamine is released into the blood stream, it causes major blood vessels to dilate, reducing blood pressure. In the lungs, it causes wheezing and bronchospasm. Benadryl (diphenhydramine) works by blocking histamine receptors. So when histamine is released, it does not get to its target and its effects are blocked. BUT if a reaction is already occurring, histamine is already acting and its effects need to be reversed. Epinephrine does this: it constricts blood vessels to raise blood pressure and reduce the swelling. It also stops mast cells from releasing more histamine. And it increases the heart rate to help with blood pressure and relaxes the lung tissue to stop wheezing. Most importantly, it does this quickly - within a matter of seconds of injection it starts to work (Benadryl takes 20 minutes to begin to work). Many patients will say that they haven't needed to use epinephrine before. The severity of a reaction is unpredictable. Factors such as amount ingested, other medications taken and cofactors such as recent exercise or illness ALL have an impact. Also, our bodies release some epinephrine to counteract a reaction but it often is not enough. Understand your child's care plan and keep a copy at home. Keep your epinephrine injectors handy. |
Question: Anaphylactic to MSG?
Answer: A recent question was asked (on a FACETeer Forum) regarding anaphylaxis to MSG, or monosodium glutamate. MSG is a flavor enhancer used in many processed foods, including Chinese food. This causes a syndrome that mimics anaphylaxis with flushing, feeling faint, headache commonly, and often some nausea. There is some overlap in the symptoms of MSG sensitivity and anaphylaxis but this is caused by a different chemical reaction in the body than anaphylaxis. MS...G is acting like a drug in your system and that causes the symptoms, rather than the immune system reacting to something and releasing histamine. These reactions can get very uncomfortable but generally do not have the risks that anaphylaxis does. Epinephrine generally is not indicated in these reactions.
I would add that MSG reaction is a diagnosis of exclusions, meaning that you have other conditions like food allergy or mastocytosis ruled out before it's deemed that MSG is the cause of all the symptoms. |
Question: Why are there more reports of female teenagers having fatal anaphylactic reaction?
Answer: A recent question was asked regarding adolescent females and increased reports of anaphylactic fatalities in this population. In general, women do have high rates of anaphylaxis (not just fatal reaction). It's not known exactly why but hormonal changes seem to be part of this, and patients may react more severely during different points of time in their menstrual cycle.
Bigger than this though is the increased severity of reactions in teens/adolescents in general. The reason was thought to be increased risk taking behavior amongst this population. Just like not using seatbelts, or texting while driving, or substance experimentation. Teens take higher risks as they try to "fit in" or find their way in the world. A study of college students found this: "Potentially life-threatening anaphylactic reactions to foods are occurring on college campuses. Only 39.7% of students with food allergy avoided a self-identified food allergen, and more than three fourths did not maintain SIE. Such behaviors might place these students at increased risk for adverse events." At this age they aren't keeping their epi device with them, they aren't watching what they eat and they also (from another study) aren't telling their new friends/roommates etc. that they have allergies. Keep in mind that a lot of these studies are older (the one in quotes from 2008) and since then many college campuses have increased their efforts to recognize these students and provide more labeling and education in their cafeterias. There is more at play than just "typical teenage" behaviors though as there seems to be some physiologic changes that make reactions more severe in this age group (16-24). It hasn't all been teased out yet but we know from studies that is the highest risk age group. My advice (keep in mind this comes from someone who hasn't raised a teenager yet): Teach them at a young age, so avoidance just becomes part of them and automatic. Let them know it's okay for their friends to know. Make sure they are an active part of their doctor visits. |