Anyone with an EpiPen prescription can get a maximum of $100 off their insurance co-pay fee when purchasing an EpiPen or EpiPen Jr. 2-Pak.

To take advantage of the offer, simply request the card from your doctor’s office or by calling 1-800-395-3376. See more details at the website epipen.com. Bring the co-pay card to your pharmacist along with your EpiPen prescription.

The co-pay card may be used on up to three 2-Paks per prescription, or may be applied to an unlimited number of prescriptions. The promotion ends at the end of 2013.

The co-pay card is available to most insured patients, with the exception of those insured by federal or state health-care plans. The offer is not available outside the United States.

Epinephrine works best when injected directly into muscle, as opposed to fat, as it absorbs into the bloodstream faster this way. Using ultrasound results, researchers from the U.K. measured the distance between the surface of the thigh and the inner muscle of 93 children. It was discovered that this distance was greater than the length of the auto-injector’s needle in 82 percent of the obese children studied.

At three-quarters down the thigh, the distance was reduced so that only 17 percent still had their muscle out of reach.  This suggests that the lower thigh could be a more effective location for giving an epinephrine shot to any obese individual.

Heights, weights, waistline measurements and body mass index data were gathered in order to determine which children would be considered obese.

See more news from the AAAAI 2013 conference here.

Allergic Living asked Dr. Phil Lieberman, clinical professor of medicine and pediatrics at the University of Tennessee’s College of Medicine (and father and grandfather to food-allergic children), for answers to nine food allergy questions you’ve been wondering about but haven’t had a chance to ask.

1. What are the typical hallmarks of severe allergic reaction?

Reactions that involve the respiratory tract system (upper and lower areas) and the cardiovascular system. For example, coughing, wheezing, shortness of breath, inability to breathe because of upper airway swelling, cardiac arrhythmias, fall in blood pressure with shock, and even a heart attack typify a severe allergic reaction.

2. What do the new food allergy guidelines produced by the National Institute of Health/National Institute of Allergy and Infectious Diseases say constitutes an anaphylactic reaction to food?

If any two of the following body organ systems (skin, GI tract, cardiovascular, airway or central nervous) are affected, this automatically requires the use of an auto-injector of epinephrine. If a known allergen is ingested and there is a single manifestation of any reaction in any of those bodily systems, this also automatically requires use epinephrine. For a deeper explanation, the National Institute of Allergy and Infectious Diseases has patient guidelines that can be downloaded for free.

3. What is the best course of action in the event of an anaphylactic reaction?

Immediately inject epinephrine and then call 911.  A second dose should be available and it should be administered in 10 minutes if there has been no improvement and/or if an emergency medical facility has not been reached. To prevent threatening falls in blood pressure, you can lie down and elevate your legs as well, if this posture does not make it difficult to breathe.

4. What exactly is epinephrine and how does it work in the body? What does it do to a severe reaction?

Epinephrine is a hormone the body makes itself: the “fight or flight” hormone. It is designed to increase blood flow to muscles, strengthen contractions of the heart and increase alertness. Its other name is adrenaline because it is manufactured in the adrenal gland.

5. Are there any side effects or risks of using an autoinjector of epinephrine?

In general, there are no severe side effects from the administration of epinephrine. Because it is the “fight or flight” hormone, it can make you jittery, raise your blood pressure and in some patients, cause tremors. In a healthy individual, this is uncomfortable but is not a threat. In some patients who have high blood pressure or heart disease, more severe side effects can occur.  Still, in a case of anaphylaxis, the risk/benefit ratio favors the administration of the drug since anaphylaxis is a life-threatening condition.

Next page: “Is there a difference between different manufacturers of epinephrine?”

Drumroll, please!

The winner of the grand prize in The Allergic Living May Awareness Contest is:

Wendy Antosiewicz of Hamilton, New Jersey.

Wendy tells Allergic Living that she greatly looks forward to receiving the state-of-the-art KitchenAid^® Architect Series Stand Mixer in Cocoa Silver. (Retail value approximately $500.) As the mom of a daughter with allergies to milk, eggs and tree nuts, Wendy says she “bakes all the time” to accommodate her daughter’s diet. So the mixer will be a very welcome addition to her kitchen.

This KitchenAid mixer features 10 speeds; 2 polished stainless steel bowls (5 qt. and 3 qt.); durable direct drive transmission and 325 watts of power.

See below for the 2nd Prize winners.

2nd Prize: Sloane Miller’s new book Allergic Girl: Adventures in Living Well With Food Allergies.

The Winners of the two autographed copies of the book are:

- Khadija Farah of Mississauga, Ontario

- J. Burcke of Dover, New Hampshire

Congratulations to our winners. And thanks to everyone who took part in the contest and who supported May Awareness Month.

It is usually only post-appointment, and on your own, that you begin to think through the ramifications of “avoiding that allergen” and that an allergenic food might turn up unexpectedly in the ingredients of packaged foods, or deep fryers, or personal care products. And what about school? Will my allergic child feel safe among all the allergen-eaters and the many sets of grubby little hands?

Suddenly the allergist’s pronouncement to “avoid all traces of the allergen” feels like the weight of the world. At Allergic Living, many of us have food allergies too, and we know the anxieties, especially at first. But like the many allergy experts and health journalists who contribute to our magazine, we also know this to be a fact: food allergies are manageable.

You have to be smart about it and organized, since a life with food allergies means planning because, well, we eat every day of our lives. As families or individuals living with allergies, what we don’t get to be is as spontaneous as others. But we can live safely, fully and well.

Get Organized

Managing your allergies starts with organization. If you have an allergy, avoidance of your trigger becomes second nature. You’ll become the person who always has the treat and auto-injector in her bag, not to mention wipes and a cell phone with 911 on speed dial.

There is a learning curve before you can start to feel comfortable with the new dietary restrictions and anaphylaxis precautions, and that takes time.

Importance of hygiene: The first step to managing a food allergy involves basic hygiene. Wash your hands – a lot. Residues from foods you are allergic to (for instance nuts) can be transferred from one person’s hands onto surfaces like bus or subway poles, and then onto your hands. This won’t be a problem as long as you always wash your hands before eating or touching your mouth, nose or utensils.

Warm, soapy water is the best way to wash your hands but hand sanitizer is better than nothing. Baby wipes are also a good idea and it is more likely that the proteins can transfer to the disposable wipe. They can also be used to clean tables and chairs which is especially useful during travel (e.g. airplane).

Cross-Contamination: The second step involves learning and teaching others about cross-contamination. Also called cross-contact, this occurs when a food that you are allergic to comes in contact with something that you were going to eat. The allergen contamination may happen directly or may occur indirectly through shared use of utensils.

For an example of the latter, say there are two soups on the stove, one with cream and one that is safe for a dairy allergic individual. It’s essential to make sure that the same spoon isn’t used to stir both soups. It will be important to educate friends and relatives about cross-contamination when you go to their homes.

Grocery Shopping: Buying packaged food at the grocery store can be particularly challenging, especially at first. That’s because you’ll need to get used to reading the label on everything you buy, and often more than once. This includes foods like crackers, breads, cookies, sauces, ice cream, candies and chocolate. Be sure to read the ingredient list, as well as any precautionary statements (ie: This product may contain peanuts).

When you’re reading the ingredient list, look for a direct mention of the food you’re avoiding (ie: soy) and any hidden words or names. For example, the word casein is sometimes used instead of milk, and an allergen like mustard may be hidden in the word “spices”.

In Canada, new regulations became law in 2012 that require manufacturers to list priority allergens in plain language, and list ingredients of ingredients if they contain a priority allergen. For example, if the starch in a cracker is derived from wheat, this would have to be indicated.

In the United States, labeling rules have been in place since 2006 that require manufacturers to use plain language when listing priority allergens, and to declare all priority allergens. (Note that priority allergens in the U.S. do not include sesame and mustard, as they do in Canada.)

Keep in mind that an easier, safer option is often to prepare food from scratch. Shop for meats, fruits and vegetables that are safe for you to eat and create delicious snacks and meals at home. That way, you’ll know for certain what’s in your food.

In Allergic Living.com’s recipe section we have plenty of appetizing recipes free from top allergens.

Next: Eating Out, Being Your Own Advocate

See an allergist. If you don’t already have an allergist, go to your family doctor and ask to be referred to one; a good allergist is like a private investigator who can usually single out the culprit in no time. When it comes to food allergies, an accurate diagnosis is key, or else you risk giving the boot to foods that are just fine, and keeping the trouble-makers around.

Keep a journal. As soon as you suspect a food allergy, keep a careful journal of everything you eat, your activities, and any symptoms you experience. You may suspect that a particular food is causing your reactions, but it could be a different offender altogether – and your journal will help you and your allergist arrive at an accurate diagnosis. (Allergists consider the “reaction history” a key part of the process.)

Take the test. When you see your allergist, he or she will likely want to perform one or more tests to pinpoint your allergy. The following are the types of tests available.

1. The Skin-Prick Test

This is by far the most common allergy test, and is usually performed in the allergist’s office. A drop of a serum that contains the allergen is placed onto the patient’s forearm or back, and is then pricked with a small needle so the allergen goes slightly under the skin’s surface. (This is not at all the same sensation as getting an injection or blood test; it’s more like a small pin prick.)

If you are sensitized to an allergen and it is put under the skin, antibodies attack and create a small red bump called a hive – so if a hive forms where the serum was placed, it indicates a possible allergy.

It is important to note, however, that if a hive does form, it does not necessarily mean you will react when you eat the food. In fact, some studies have shown that only half of the people who have positive skin tests are actually allergic to the food, so a positive test is only one indicator of a possible allergy.

But the bigger the hive that forms, the more likely it is the person will react when he or she eats the food. (False negatives are also possible, but are uncommon.)

Need to Know

• It is important that you avoid taking antihistamines for at least 48 hours before the prick test, or the results may be inaccurate.

• Serious systemic reactions to the skin-prick test are possible – but extremely unusual. So skin-prick tests are considered a simple and safe tool in allergy diagnosis.

The skin-prick test replaced the traditional “scratch test”, in which a drop of serum was put on the skin and then scratched with a pin, because the scratch test put more allergen under the skin and came with a greater risk of a serious reaction.

2. Specific IgE Blood Test (RAST, UniCAP, ImmunoCAP)

Blood tests are a less common method of diagnosing allergy, because they are much more expensive and not necessarily more accurate – but they are sometimes used when a patient has a skin condition that makes prick testing difficult, when a serious allergy is suspected.

They are also often used to help confirm the results of a prick test.

For this test, a blood sample is taken then sent to a laboratory for testing. At the lab, the blood is put in contact with an allergen in a dish; if the patient is sensitized to that allergen, the antibodies in the blood will attach themselves to it.

A substance that recognizes those allergen-attached (IgE) antibodies is added, and then they are counted. The higher the number of those allergen-attached antibodies, the greater the likelihood the patient will react when exposed to that substance.

The downsides of the test are that they are considered less accurate, and they lead to more false negatives. In fact, if the test is negative, the patient still has a 15-20 per cent chance of being allergic to that substance.

Like the skin-prick tests, a positive test does not necessarily mean you’ll react when you eat the food. However, if a test comes back with a very high number of allergen-attached antibodies, there’s a greater likelihood a reaction will occur when the food is eaten.

3. Intradermal Test

An intradermal test is similar to a skin-prick test in that a small amount of an allergen is introduced to the skin, and if a hive forms, the test is considered positive. The main differences are that the serum is more diluted, and it is put more deeply under the skin’s surface, where it is more likely to react.

Intradermal tests aren’t used as often as they once were, because they can result in more serious reactions, and are usually only administered after a prick test has come back negative. They are most commonly used to test insect venoms and drugs, starting at very low concentrations, then working up slowly. They are rarely used for food testing.

This type of test is more sensitive, so can give clearer results – but they also tend to lead to more false positives. On the upside, there are fewer false negatives.

Anaphylaxis Note: It’s important to note that none of these tests (prick, intradermal, blood) can predict whether or not a person will go into anaphylaxis, the most serious form of allergic reaction. Some people assume that the more severe the reaction on the skin or in the blood, the greater the chance of anaphylaxis – but this is not statistically true.

1. Never eat without your auto-injector, period.

2. If you’re a child, never eat food that one of your parents hasn’t approved. If you’re an adult, don’t even think about that mystery food.

3. Read labels. Always. Know the ingredients of every food that enters your (or your child’s) mouth.

4. Learn to cook – well. No. 3 isn’t difficult if you do No. 4. And you’ll enjoy your food more knowing it’s safe.

5. Organize and Plan. Think through what’s to eat whenever you or your child will be eating away from home.

6. Always carry a safe snack. That way, you’re never stuck without anything to eat.

7. Speak up about your allergies. Always discuss menu items with waiters or chefs. Tell that guy you started dating that even a nutty kiss can have unintended consequences.

8. Parents: Teach your allergic children to manage their own allergies. Prepare them, but don’t scare them about peanut butter as a “loaded weapon”.

9. Don’t dwell upon what you can’t have; focus on what you can.

10. Manage food allergies, don’t allow them to run your life.

You may be wide-eyed at the task ahead, but with a little preparation (OK, a lot at first), and maybe a few new tools, you’ll soon be able to make safe, nutritious meals for you and your family.

Yes, you’ve got to read through all those ingredients on food labels. Start with the help of a friend: have one person read the label while the other person checks the list of items to watch for with your allergen. You’ll get the hang of it with a little practice.

Consider too, whether an item may have become contaminated by another item. Did someone use a knife smeared with peanut butter to dig into the jam? It’s not worth it to keep 35 cents worth of jam if there’s a chance of a reaction. Face it, you will throw away food.

Will you keep some allergens in your home for those who don’t have the particular allergy? This is a personal decision that is based in part on necessity, part preference. Can the nutritional requirements of all family members be met on a diet restrictive of all allergens?

Since being prone to allergies in general runs in families, but you don’t inherit specific allergies, some families find that several members have different allergies. To accommodate all, they need to keep some allergens in the home.

If this is the case, special care must be taken to ensure there is no accidental exposure. You can employ:

- Special drink; special cup – Kids love to have their own special items. Having a cup for each child means they won’t drink from the wrong cup by mistake.

- Be alert when handling dangerous foods! Some parents have been known to implement rules such as: “No white liquids when Mommy is tired.” Keeping foods in different looking containers is helpful. If you purchase your soy milk by the carton, consider buying milk by the bag.

- Color code – This is great for the young child who can’t read but has mastered colors. A system of green (OK) and red (not OK) dot stickers works well. They can quickly find a safe snack by themselves and you have a built in system for recognizing which food is safe for whom.

- Label – Storing foods side-by-side can increase the risk of contamination by spills. A plastic container kept in the fridge and labeled with the individual’s name is a handy way of avoiding this issue. Babysitters will appreciate a container full of safe snacks in the cupboard that can be given out. Keep some safe foods at levels the children can reach and store allergens up out of reach.

Next: Safe Kitchen Gear

Does your child refuse to eat a certain food, or complain that it makes his “tongue hurt”? These could be signs of a food allergy, and should be taken seriously.

It is common for the symptoms of food allergy to vary by individual – and from reaction to reaction in the same person. Not everyone will get all the symptoms, which range greatly in severity from mild to severe (and even fatal): your throat may feel tight on one exposure to your allergen or you may get itchy hives on your skin and vomiting with the next.

The Range of Symptoms

-Tingling in the mouth
-Swelling of the tongue and throat / feeling of throat tightness
-Itchy skin, hives or skin redness
-Abdominal cramps
-Vomiting or diarrhea
-Breathing difficulty, wheezing
-Faintness due to a sudden drop in blood pressure

Anaphylaxis

Anaphylaxis is the severe form of allergic reaction. It involves one or more of the body’s symptoms; for example, the gastrointestinal tract, the respiratory tract, the skin and the cardiovascular system. A person experiencing anaphylaxis often has difficulty breathing, and the person could lose consciousness. Anaphylaxis puts a person at risk of death.

Anaphylactic reactions can come on quickly, and it’s impossible to know when a reaction will become severe. It’s important that people with food allergies are prepared for a reaction by always carrying an epinephrine auto-injector (either EpiPen or Twinject).

Experts recommend using epinephrine early if a person known to be at risk of anaphylaxis begins to show signs of allergy symptoms – don’t wait until the symptoms worsen, as it may become to difficult put a halt to the reaction once it’s in progress.

Symptoms reviewed by Dr. Susan Waserman

When a family member has an allergy, reading is protection.

Reading the ingredients on every packaged food label becomes a way of life when you have food allergies and are at risk of anaphylaxis. Labels have to be carefully before a food is sampled by the allergic family member. While labels are supposed to by law be written in plain English, look for hidden sources of allergens and other less obvious names for allergens (such as “casein” or “whey” for milk).

Also be on the lookout for precautionary statements. These are statements that indicate an allergen may be in the food, due to cross-contamination during production. Examples of precautionary statements include: “May contain wheat” and “Manufactured in a facility that also processes tree nuts.”

Allergists generally advise people with allergies to avoid all products that show such statements about their allergen(s) – dubbed “may contains” – because they often “do contain” the allergen.

If you are ever uncertain about whether a food product is safe for you, call the manufacturer to confirm. When in doubt, don’t eat it.

In Canada, new regulations come into effect in August, 2012 that would require food manufacturers list priority allergens in plain language on packaging, rather than using alternate names (ie: arachidic acid, for peanuts). The ingredients within listed ingredients that are priority allergens would also have to be shown. For example, manufacturers couldn’t simply list “flavouring” if the source of the flavouring is a priority allergen, such as mustard.

More on Canada’s New Food Allergen Regulations.

In the United States, the Food Allergen Labeling and Consumer Protection Act went into effect in 2006. FALCPA requires manufacturers to use plain language when listing priority allergens, and to declare all allergens either in the ingredient list, or in a “Contains:” statement at the end of the list.

The allergens included in this regulation are milk, eggs, fish, shellfish, tree nuts, wheat peanuts and soybeans. These regulations do not include sesame and mustard, unlike the new Canadian regulations.

Separate legislation requires companies to declare sulfites if they are present at more than 10 parts per million, or if they had a technical or functional effect in the food.

Both Canada and the United States are studying ways to regulate the precautionary statements used on packaged food labels.