Cross-Contact vs. Cross-Contamination

Uggg. I wish I could turn this side of my brain off, but I can’t. These two terms have been spinning in my head for the better part of this week now. I have wanted so badly to define them and talk about them, and it seems like this is the best place for that. So, cozy up. Here’s what’s on my mind. What a sexy Saturday night this is! Atleast HBO is on. And I have ice cream. mmmmmm.

What is cross-contact?

Cross-contact happens when one food comes into contact with another food and their proteins mix. As a result, each food then contains small amounts of the other food. These amounts are so small that they usually can’t be seen. Even this tiny amount of food protein has caused reactions in people with food allergies! The term “cross-contact” is fairly new. Some people may call this “cross-contamination.”

Types of cross-contact:

Direct: Allergen was applied then removed.

  • Peeling cheese off a cheeseburger to make it a hamburger
  • Removing shrimp from a salad
  • Scraping peanut butter off a piece of bread and using it to make a different sandwich

Indirect: Cross-Contact (allergen was not directly applied)

  • Using the same spatula that flipped a cheeseburger to flip a hamburger
  •  Not washing hands after handling shrimp before making the next salad
  •  Wiping off—not properly cleaning—a knife used to spread peanut butter before using it to spread jelly

Why don’t we use the term cross-contamination?

Cross-contamination usually refers to bacteria or viruses that get on food and make it unsafe to eat. In cross-contamination, cooking the food will lower the chance of a person getting sick. This is not the same with food allergies and cross-contact. Cooking does not remove an allergen from a food! The only way to stop you from having a reaction is to avoid the food and carefully clean anything that came in contact with it using soap and water.

How to stop cross-contact?

  1. Your cutting boards + never use a wooden cutting board
  2. Wash your hands, especially if recently handling the allergen
  3. Wash your sink out
    1. (SPLASH ZONES!!! – if you have a peanut butter and jelly sandwich, then wash the peanut butter knife in your sink, your sink now contains peanut protein. If you’re thinking about serving fresh fruit for snack time to share, and rinse your fruit in this sink, your fruit has now been exposed to the peanut protein unless you wash your sink out first. Everything must be sanitized after the allergen has been present.
    2. Clean all surfaces + cooking utensils

How to clean:

Use hot, soapy water with a clean cloth or paper towel to wipe kitchen surfaces and counters. Wash cloths used for cleaning in the hot cycle of your washing machine often (when was the last time you did that?). You can sanitize sponges with a quick zap in the microwave or dishwasher, but you should still replace them often since they harbor bacteria.

Also, scrub down counters and dishes every time you prep a food and before moving on to the next item. One high-power solution is a mix of 1 tablespoon of unscented, liquid chlorine bleach with 1 gallon of water. Use that to sanitize surfaces and utensils.

—-all of this information is from the CDC + Foodnetwork.com + FoodAllergy.com (FARE)

So, as you can see, it’s pretty easy for cross contact to happen. There are many places for this to occur. This is why we have to be vigilant and why us allergy parents can seem crazy when we’re figuring out what to serve our kids!

Whew. Well, glad that’s unloaded and off my brain. Time to go snuggle my little bunny. Maybe tomorrow I’ll have something less serious and more delicious to write about.

Nut-free Vacation Planning

Pre-kids, my husband and I had grand expectations of worldly travels with kids in tow eating baby crêpes in Paris and schnitzel in Stuttgart, and Bangers and Mash with a few pints in the UK. Then, reality set in.

Colicy baby, an entire vacation cancelled last minute due to whooping cough. Eventually a nut allergy diagnosis. Bad colds, never ending sick kids. Ear infections on top of ear infections and exhausted parents. We quickly learned that our dreams of extravagant travel were pretty far off in the distance. If we wanted to actually enjoy it, anyway.

When life hands you lemons, make lemonade, or something.

We have adapted over the past 6 years and have found things that work for us that we consider”fun” travel.

  1. Low key trips “up north” Wisconsin
  2. Visit family 
  3. Kid friendly states; Tennessee + Colorado
  4. Museums and aquariums
  5. State parks
  6. And Disney, for when you’re missing the world and want to feel “fancy”

So that brings me to #6. This year marks our third time to Disney in 6 years. Partly, we love Disney. Mostly, we have severe food allergies, and Disney has it handled, like a boss. 

Today, we logged on to My Disney Experience and selected a few activities, and meal reservations. After choosing the time, restaurant and guests, we were prompted to add food allergy information. We can also view all food menus and allergy information way before we get into the park. Disney also has first aide stations clearly marked incase we come in contact with our allergy. Not to worry, we generally pack 3 twin packs and loads of benadryl.

Today’s post is me tooting Disney’s horn for being over the top excellent about handling our precious children and their various dietary needs. Thank you, Disney, for making this trip the most stress free trip we will take all year. From the Magical Express airport pick up, luggage handling, kid camps, spas and delicious dining, it’s all covered so we can enjoy 100% family time. 

Non-safe Snack Update

Hostess recently made a change to their HoHo’s. They have added Peanut Flour. Peanut Flour has been in the news lately, many processed food manufacturers have decided to go this route for whatever reason. It’s a huge deal for us in the allergy world because we get used to buying certain snack items. This is just another reason to always check the labels, don’t get too comfortable with your favorite snack items!

Rold Gold Pretzels, Zingers and DingDongs are also in this same manufacturing facility. Out of an abundance of caution, we’re no longer including these snack items on our safe list. So summarize we’re removing these items from our “safe list”:

  1. Rold Gold Prezels, snack size or regular
  2. Hostess HoHos
  3. Hostess Zingers
  4. Hostess DingDongs

First Independent Play Date

When you have a child with life-threatening food allergies, leaving your child alone, for any amount of time, is anxiety provoking. Luckily for us, Chloe’s friends and their families have all been amazing and over the top careful about her food allergies. Here’s what we did to prepare for this HUGE step of independence for her:

  1.  We decided to invite her new friend over to our home first. This allowed us to talk as a family with her friend and her family about our serious food allergies. This conversation was a great ice breaker and allowed us to talk openly about many things parents have concerns about.
  2. After the first play date at our home, Chloe had her first play date at her friends house.

It was a beautiful Friday afternoon. Chloe was over the moon excited. I was trying to stay optimistic the entire time – she was so happy to see her friend. Suddenly, I remembered the conversation that I had wanted to have with her before we left regarding nuts. She had NO IDEA what nuts actually looked like – she definitely knew the names of the nuts that she’s allergic to, but she’d never actually seen a walnut, pistachio, shelled peanut, cashew. We jumped online and saw a few pictures together before packing her purse with a safe snack, EpiPen and Benadryl.

Once I dropped her off, I didn’t go home. I couldn’t. It felt to far. Instead, I opted to do some grocery shopping nearby and check my phone every 5 minutes. It’s hard. It’s hard knowing your child has this life-threatening allergy and leave them in the care of someone else, even though I trust them immensely. I have seen my daughter have two episodes of anaphylaxis. We know for a fact that her allergies are serious. Life-threatening. She swells up and is unable to breathe if she comes in contact with these foods.

Cross-contamination happens so easily and if you’re not “in it” — in the allergy world, reading all the labels, communicating with the manufacturers, realizing that not all labels are created equal and peanut free does not mean nut free, just knowing all these silly allergy rules! I’d much rather spend my time reading ANYTHING other than damn food labels and websites! But for now, my daughter depends on me to know these things in order to keep her safe. And I will. Forever, even when she’s grown, help her understand her allergy and manage it as safely and effectively as possible.

She rocked her first independent play date, like I knew she would. She had fun with her friend, and that’s what mattered.

Safe Buns at Metro Market

Good Morning!

Bakery items are almost always a no-go in our house. Unless we can get a 100% confirmation from the manufacturer on cross contamination, we do not buy it.

How do we find out about these details? Emails and phone calls, and keeping in touch with our nut community of friends which we share lots of information! We average about 3 calls/emails a month in our house, so not too bad. Holiday time , it will be about 3 calls per day!!!🎄⛄🎁

Here is a sample email that my husband wrote this morning while he was at the grocery store picking up supplies:

Hello,

My daughter has allergy to nuts.  Are nuts used on your line that makes the sliced French rolls?

Thanks and kind regards,

Doug 
——

Doug,

Our production plant where the French rolls are made is a nut-free facility. There are no nuts allowed in the building at all at this time.

Please let us know if you have any further questions. Thank you.

Tim Lotesto
Alpha Baking Company, Inc.

The baking company returned our email within one hour, Doug was able to buy the rolls for our slow cooker dinner.

If you’re looking for a great tasting French roll, check out Alpha Baking Co!

Enjoy your weekend. Fall is right out our window. Loving the colors!🎃



My New Louboutins, OH I MEAN EPI PENS!

The EPI PEN that we kept at my daughter’s school last May SAVED HER LIFE. Wait. Let me say that again.

SAVED HER LIFE!

Yes. Our 5 year-old daughter suffers from life- threatening nut allergies where she has an anaphylactic response to any nut that she happens to eat. This allergy is not a choice. She was born with this very severe allergy.  Because it’s so severe, we keep epi pens:

  1. at home
  2. at school/backpack
  3. in mom’s purse
  4. at Grandmas house

That is a total of 4 epi pens at the current rate of $608.61 = $2,434.44 yearly. Epi pens expire every single year. This isn’t a one time purchase.

Yes, my husband is a physician, so automatically you’d think we have amazing, affordable insurance. Our insurance is good; however, we pay a very high premium.

Our prescription drug coverage on an epi pen with Physicians Plus Insurance is 80%, so we are paying $800 each year on EPI PENS alone. During the three years we have had to use EPI, we’ve spent $800 x 3 = $2,400 JUST TO KEEP HER SAFE. This is what is recommended by her physician and specialist. I am sure my math here is working out to be much better than most. Many people do not carry this many EpiPens because of cost.

Just to keep this real or completely unreal, that’s about 4 pairs of the designer Christian Louboutin shoes. You know, the red soles? What else could we do with this insane amount of money spent on an injector that I hopefully wont have to use and put into a garbage can when the expiration date comes up?  How about 16 weeks worth of groceries? Eighty trips to the gas station to fill your car completely. A very nice vacation to an all-inclusive resort?  A super nice holiday for the kids? I could go on and on as to how to use that money.

Do you see where I’m going here? With the soaring costs of this medication to keep my daughter safe, we are making sacrifices, and by WE, I mean the entire nut-allergic community.

Why put extra costs on an already costly allergy? Did you know that SoyNut butter is between $5 and $7 per jar? What about all these nut-free items made in nut-free facilities? Those aren’t cheap. Asthma, eczma and allergies are all lumped together and in many cases if you have one, say asthma, you likely have either eczema or allergies, or all three. We are lucky to have allergies to food, and asthma (of which our special inhaler is NOT covered by insurance, so add another $50 each month for daily inhaler).

Our family’s story is hardly a sad one. I’m grateful for the coverage we get. Last week I read a blog post about a family with two kids with life threatening allergies who give up all luxury items, no summer vacations, no new school supplies, no dining out, no new school clothes, nothing. They scrape by because their insurance covers a minimum amount of this medication and they have two kids with life threatening allergies. Can you imagine?  They both work, have jobs, have insurance, live in a decent home, doing the best that they can, but because of these medications and the increase in price, they can’t afford to do anything else?! What kind of life is that?! Trapped by your prescription drug costs to stay ALIVE?!

The argument noted in the CBS news article yesterday stated, “this price increase should not be a big deal since 90% of Americans are insured.” I assure you this is a HUGE deal since having insurance does not mean that you are going to have your drugs covered.

I found a study published by the US National Laboratory of Medicine, NIH on the demographics of people needing epinephrine for severe allergies.

***

Abstract

BACKGROUND:

The epidemiology of anaphylaxis is uncertain, especially its geographic distribution.

OBJECTIVE:

To address this deficit, we examined regional rates of EpiPen prescriptions in the United States.

METHODS:

EpiPen prescriptions in 2004 were obtained for all 50 states and Washington, DC, from NDCHealth, Pharmaceutical Audit Suite (Alpharetta, Ga). Data included the number of total filled prescriptions, including refills, and the actual number of EpiPens prescribed. Several data sets were used to obtain state-specific populations, as well as multiple demographic, health, and weather characteristics. State population was used to calculate the average number of prescriptions written per person.

RESULTS:

Overall, there were 1,511,534 EpiPen prescriptions filled during 2004. These prescriptions accounted for 2,495,188 EpiPens. On average, there were 5.71 EpiPens prescribed per 1000 persons. Massachusetts had the highest number of prescriptions per 1000 persons (11.8), whereas Hawaii had the lowest (2.7). In addition to state-to-state variation, there was an obvious regional difference: New England (Connecticut, Rhode Island, Massachusetts, Vermont, New Hampshire, Maine) had the highest values, with 8 to 12 EpiPen prescriptions per 1000 persons, whereas the southern states (between and including California and Mississippi) had only 3 prescriptions per 1000 persons. The New England finding persisted even when controlling for all available factors (eg, population demographic characteristics, number of health care providers, prescriptions for other medications).

CONCLUSION:

A strong north-south gradient was observed for the prescription of EpiPens in the United States, with the highest rates found in New England.

CLINICAL IMPLICATIONS:

The regional differences in EpiPen prescribing may provide important etiologic clues (vitamin D status) and merit further investigation.

 

***

I highlighted the total number EpiPens so you could clearly see the total number of pens prescribed. That’s a pretty big number to profit from at $600 per pen. The price increase boils down to this: GREED.

Mylan knows there is a demand for these life-saving medications. We’re not going to stop buying the medication because of a price increase. That would literally mean death. Thus, the rate increase because they know we’ll keep paying, whatever they dictate, to keep our families safe. This is literally a life or death choice for most of us carrying EpiPens. How can you put a price on that?  “Ho, Hum, staying alive this year will be…..ONE MILLION DOLLARS.”  That’s how crazy this all is. Especially with a drug that has been around for so long with no new changes or improvements. How can a $100 drug SOAR to $600 in a matter of a few months?

My note to the CEO of Mylan, the manufacturer of our EpiPens: Take your golden parachute and leave! It’s awful that I must patronize your company, and contribute to your gross salary at all. BOOOOOOO.

 

Normal blogging will resume as usual. Just HAD to get that off my chest today. It’s infuriating.  To sign the petition, check my facebook page for the link.

Happy Wednesday!

BTS Nut-Free Check List

Now that it’s August 1, our back to school countdown has officially begun. We have 24 days to get ready. Going back to school is exciting, even more so with food allergies.

This school year we are promoting a more positive and proactive nut-free lifestyle. We have done this by empowering Chloe to make smart, independent decisions for meals and activities. This will help her when she is faced with different choices at school.

Is it OK for me to share a lunch with my friend?

Is it OK to just sample this cookie?

Is it OK for me not to wash my hands this ONE time before lunch?

Is it OK for me to accept a birthday brownie from my friend on her birthday?

The answer to all of these questions is no.
These are just a few of the scenarios we are preparing Chloe for as she begins a new school year.

In order to ensure a nut-free school day, we have worked as a family to include a few simple things in Chloe’s day.

  1. A new backpack that has a special pouch for epi-pen to access easily.
  2. An Aller-mates purse/Fanny pack to always carry at school to her computer lab, art class, gym, etc.
  3. A custom treat box. This box comes as a HUGE lesson learned from last year (thank you, Stacy for the idea). We will always, 100% of the time, use this treat box to minimize any uncertainty of labels, etc. for snacks at school.
  4. Bento box from last year with nut-allergic stickers on it.
  5. Aller-mates bracelet to wear on her wrist and attach to backpack. We just ordered these from Amazon.

Some things that I have done as a parent to help her prepare for a new school:

  • Speak with the school administration and know the nut policy of the school.
  • Discuss an action plan and have it on file with the school and nurse.
  • Speak with her teachers directly.
  • Talk with the school bus company (if applicable).
  • Learn where school epi-pen are kept.
  • Learn the lunch process and how they minimize cross contamination risks.
  • Be available and offer my time and information.

With all of these preparations under way, I’m confident we are going to have a wonderful year at a fantastic new school. Enjoy the remainder of summer. t his is a very bitter sweet summer as it is the last “free” summer before both kids are in school and we have busier schedules.