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Back in May 2013, I began attending the Anaphylaxis Campaign’s Manchester Allergy Support Group.

The group is run by Michelle Byrne and meetings take place:

  • On the first Monday of every month.
  • From 7pm to 8.30pm.
  • At St John’s Church, Irlam Road, Flixton, Manchester, M41 6AP.

The meetings often include a talk by a guest speaker, who might be, for example, a specialist in allergy or immunology, or an expert in asthma, eczema, nutrition or first aid.

For:

I will also post details of forthcoming meetings on the Nutmums events page, with links to the group’s posters giving details of the individual talks, where available.

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The documentary “Living with an Allergy”, directed by Nina Whitehouse, features four families from the Manchester Allergy Support Group, each discussing how allergies have affected their lives.

From parenting children with severe food allergies to discovering a life threatening wasp venom allergy in adulthood, the programme looks at:

  • How the allergies were discovered.
  • How food allergy changes how you shop for food.
  • The challenges faced when eating out, such as ensuring restaurants are aware of cross contamination risks.
  • The emergency medication (and other safeguards, such as translation cards) that you need to always have to hand.

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Children’s parties can be daunting events for parents of food allergic children. You might get lucky and have a trustworthy, clued up host, who happily agrees to make sure everything is safe for your child. Or you might have to prepare a replica party tea, minus allergens, for your child to take along. And if the worst comes to the worst, you can give the food part a miss altogether. But surely, when it’s YOUR child’s party, you can feel more relaxed, safe in the knowledge that you are in control of the food? Well, maybe not, if you are hiring a venue…

I read a blog post by a fellow allergy mum recently, which left me feeling terribly vexed. In short, she was investigating party venues for her son’s 3rd birthday. She asked a local museum, who offered children’s party packages, whether she could hire the space but provide her own party food. The museum’s response was that she would need “£2 million public liability insurance as well as references for 2 previous grade 1 listed venues that [she had] provided catering for”. Given this was clearly impossible, she provided the venue with some suggestions for safe foods for her child, and was met with the response that the museum could not provide catering on this occasion. (For the full story, see the post No dairy – no party? part 1 on the AllergyBabe blog.)

As well as feeling indignant at the injustice of a food allergic 3-year-old being denied a birthday party, I also wonder whether such policies could be discriminatory and open to legal challenge?

I’ve blogged in the past about whether it is possible to claim disability discrimination for a nut allergy. In short, the Equality Act 2010 (EA 2010) protects people from discrimination on the basis of certain “characteristics”, one of which is “disability”. In Wheeldon v Marstons, an employment tribunal, at a preliminary hearing, held that a chef’s severe allergy to nuts was a “disability” under the EA 2010. If this becomes settled law, businesses (as goods, facilities and service providers) could then also have a responsibility not to discriminate against someone with a severe nut allergy. In my view, this could force restaurants to “reasonably accommodate” nut allergy sufferers by providing at least one safe menu option and also, for example, make nightclubs reconsider their “no EpiPens” policies.

If a children’s party venue refuses to cater for a food allergic child, isn’t that also an example of disability discrimination? If you are “open for business”, don’t you have to be open for business to ALL? Take the example of the Christian B&B owners who turned a gay couple away from their guesthouse: if you are running a business you can’t apply discriminatory policies to pick and choose who you serve. In my view:

  • IF severe allergy is a legal “disability” under the EA 2010, then
  • A party venue that refuses to cater for a child on account of their allergies (or imposes impossible to meet criteria, having the same effect) amounts to disability discrimination.

Hopefully at some point someone will bring a test case against a restaurant/nightclub/party venue/similar and this point will be clarified for the food allergic community, so people will know the level of service they are legally entitled to expect.

I’m about to start researching venues for the Manchester Allergy Support Group children’s social event (more details to follow in the New Year). I will certainly report back as to any obstacles I come up against. However, if anyone else has encountered similar issues when trying to book a children’s party, do post a comment below – I would love to hear from you!

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The prospect of school is looming.  I cannot ignore it any longer. Next September, D moves out of the protective bubble of nursery and into the big wide world of primary school. The application forms need to be in by mid January.

I’m guessing that (given a choice) parents might ordinarily choose a school on the basis of things like proximity to their home, or the OFSTED rating. And those factors are important to me too. However, the deciding vote will be in favour of the school that seems the most clued up about protecting a child with food allergies. So I have embarked on a tour of our local primary schools, both to have a look around and to broach the subject of D’s peanut allergy with the staff.

Once the appointments were in the diary, I realised that I needed to:

  • Compile a list of questions to ask the school. However, in order to do this, I first needed to know what measures UK schools typically put in place for allergic children.
  • Think about the things I could be doing behind the scenes, both before and after term starts, to make things safer for D (and therefore less stressful for me).

Although I’m still feeling like a novice on the schools front, I thought I would share some of:

  • The excellent advice I’ve been given by Nutmums.com readers who have school age children.
  • The handy tips I picked up at at a recent Manchester Allergy Support Group meeting on “Food allergy in schools”.
  • Links to the other useful resources I’ve found on this topic.

If you’ve already been through starting school with a nut allergy, and have any advice or tactics that may help me and other readers with pre-school children, do post a comment below – I would love to hear from you!

What measures do primary schools put in place for an allergic child?

It seems the starting point is the EAACI position paper from 2010: The management of the allergic child at school. This sets out the following “rights of the allergic child”:

“1. To be educated in a safe and healthy environment, with as few provoking allergens and irritants as possible and to breathe clean air in schools.

2. Not to be stigmatized as a result of their condition.

3. To be able to participate in all educational and recreational school activities to the same extent as their peers.

4. To have access to medication and other measures to relieve symptoms.

5. To have access to trained personnel who are able to treat acute reactions.

6. To have their education adapted to their condition if necessary (e.g. physical education).”

The position paper talks about a “co-operative partnership” between doctors, community and school nurses, parents, the school and the child. It sets out action points for the various parties. So, as parents, for example, we need to:

  • Tell the school about D’s allergies and provide the school with a written allergy management plan (obtained from the hospital).
  • Provide the school with a set of D’s emergency medication (and keep track of the expiry dates, so I can provide replacement adrenaline auto-injectors when needed).

In turn, the school’s responsibilities include:

  • Adopting the written emergency treatment plan.
  • Making sure all staff (1) can identify children with allergies and (2) are aware of the location of the children’s (individually labelled) emergency medicine kits.
  • Ensuring all staff are trained in allergen avoidance, recognition and treatment of anaphylaxis (with annual refresher training).

For more information on allergy management plans, see Anaphylaxis Campaign, Setting up a management plan, which links to plan templates on the BSACI website.

Will the school be “nut free”?

Selfishly: I would like D’s school to be “nut free”.

Rationally: I know that children have allergies to all sorts of foods, and I can see how making a school milk, egg, soya, wheat etc etc free would be unworkable.

There is also the argument that, by making a school nut free, you create a false sense of security and don’t prepare the nut allergic child for life in the outside world. Although I can see the sense in this, I think there’s something to be said for erring on the side of over-protection for a young child of four or five, compared to a child of, say, ten, who has a completely different level of awareness.

Of the three schools I have visited so far, two have been “nut free”, to the point where they ask parents not to include peanut- or nut-containing foods in packed lunches. The third school said they hadn’t needed to impose a “nut ban”, as it hadn’t yet been an issue: their pupils hadn’t yet brought in peanut butter sandwiches.

Is there a school nurse?

From talking to our local primary schools, it seems that in our area (East Cheshire) each school nurse works for several schools. So, the school nurse isn’t based full time at any one particular school. However, of the three schools I have visited, all aim to make sure that ALL staff (so teachers, teaching assistants, administrative staff, dinner ladies etc) know which children have allergies (and to what allergens), how to recognise an allergic reaction, where the child’s medication is kept and how to administer an adrenaline auto-injector. Music to my ears, to say the least.

What’s safer: school dinners or packed lunches?

In September, the Government announced that all infant school pupils in England will get free school lunches from September 2014 (see the BBC report and the Anaphylaxis Campaign’s response). My first thought was “we’ll stick to packed lunches, thanks all the same”. Then I started wondering: would it be safer for me to put my trust in the school dinner provider, and have D sitting amongst children eating the same food, or send him in with a packed lunch that I knew was safe, but then live in fear of cross-contamination from the child next to him eating a peanut butter sandwich or nutty granola bar?

My fears on this have been allayed somewhat after talking to the various schools. All three had ladies who prepared the school dinners on site, and one said that I could come into school, before D started, to talk to their cook about D’s dietary requirements. The schools also had a “no swaps” rule and had extra staff on hand at lunchtimes to police this.

When I attended the Manchester Allergy Support Group back in October, Judy Stafford (from the Royal Manchester Children’s Hospital) gave an extremely informative talk on “Food allergy in school”. On the school dinners vs packed lunch debate, she suggested thinking about who it was who wanted packed lunches. Was this mum, thinking it was safer? Or actually something the child wanted (maybe for reasons unrelated to allergies)? Could mum’s fears be overcome, if the nut allergic child ate at a “nut free table”? Or, might it even be sufficient for the nut allergic child to have a seat at the end of a table, where it would be easier for the staff to keep an eye out for spills or attempted swaps?

The schools I have visited do not have separate nut free tables. At one of the schools, children could sit wherever they pleased: there was no segregation of those having school dinners and those with packed lunches. I think I will talk to the cook at whichever school we end up, and make a call on this nearer to the time.

Ideas for working with the school

A recurrent theme running through both the position paper and the support group talk is the need to work WITH the school. One Nutmums.com reader told me that she worked with her son’s school to put together a risk assessment, which set out all the steps that his school would take to minimise the risk of an allergic reaction. Her son was diagnosed as peanut and tree nut allergic during the summer holidays before starting Year 4 (ages 8-9). The measures the school put in place (and which I will be using as a guide!) included:

  • All staff trained on use of Jext pens.
  • Son to take in packed lunch and own snack for playtime.
  • Lunchtime staff to be able to identify son, and also ensure his table is wiped down before he sits down to eat at lunchtime (he was taken into the kitchen on the first day of school to say hello to all the dinner ladies!).
  • Son’s emergency allergy kit to be placed in office, clearly labelled as his and with his photograph on it (I put together a tupperware containing his Jexts, antihistamines, ‘blue’ inhaler and clear instructions for use plus lots of copies).
  • Procedure established for staff to go and get the allergy kit immediately in case of emergency.
  • Emergency plan laminated with son’s photograph on it and placed in an obvious place in every classroom and the school kitchen and staffroom (my youngest son told me he has a peep at his big brother’s photo every morning in his classroom before the register is taken!). The emergency plan states … what my son is allergic to, where his emergency kit is kept, how to recognise a reaction and what to do if a reaction occurs. It also sets out a vast array of emergency contact numbers from myself, my husband, grandparents and local auntie and uncle!
  • School implementing a “no nut” policy so parents are advised via school newsletter not to include nuts, nut products, peanut butter, nutella etc etc in packed lunches and snacks – this is a massive relief, and has been probably the main factor in allowing me to relax during the day. Parents are to be re-reminded about this at the start of every new term.
  • We are to send in bag of allergy friendly snacks so that when other children are handing out treats on birthdays etc, there’s a stash of goodies that my son can have so he doesn’t feel left out.
  • We are to be informed in advance of party days/class treats so can liaise with teacher to see what food is going to be provided and send in suitable alternatives if needs be.
  • I have to be a ‘parent helper’ on school trips wherever possible.
  • Children are also encouraged to wash hands before and after eating.

One other suggestion (from a teacher who herself has allergies), is to provide the teacher with a list of acceptable foods. The teacher would need to check the food label each time, but a “safe list” would give them a starting point if they wanted to do treats.

Feeling daunted? You betcha…

At the moment, if we take D out with his scooter, we have to walk on the outer edge of the pavement and steer him back towards the hedge when he starts veering towards the road. The speed is there, the control isn’t, and neither is there any proper conception of the danger of the oncoming traffic. When I look at older children zipping along on scooters by themselves, it’s difficult to picture D doing the same. I know it will happen. It just seems a long way off.

In the same way, I struggle to picture D saying “no thank you” to a child in a playground who offers him a chocolate biscuit. D knows that nuts will make him poorly (“because I hab allergy”), that we need to check ingredients labels (“check label! no nuts!”) and that he has special medicine if he is ever unwell. But is he at the stage where he would say “no” to a food? I don’t think we’re there yet. But we need to be at that point, in ten months time.

What can we do at home to prepare and plan ahead?

Two key rules…

A reader told me that every morning, she makes her son repeat the following two key rules:

“1 – don’t eat anything that someone else gives him

2 – tell the teacher if he feels any sign of a reaction at all”

I think this is a tactic I will be copying wholesale!

Another suggestion is to build up your child’s allergy awareness generally, for example by talking to your child about checking food labels when supermarket shopping, or by explaining what’s happening at a restaurant (when you are reading a menu and checking the position on allergens with the staff).

Anticipating risk areas

What things at school pose a particular risk for the nut allergic child? And, crucially, what can you do to prepare for them and make them safer?

A key piece of advice which stuck in my mind following Judy Stafford’s support group talk was to always ask “what are the options?”, always looking at the situation from the perspective of what your child CAN do (inclusion) rather than what they CAN’T (exclusion). So, say there is a school party coming up where food is going to be served: what are your options? Well, firstly, you could talk to the school about the party food, as it may be that everything is already nut free. If not, you could:

  • Keep your child home that day, so they miss the party altogether.
  • Provide a packed lunch for your child to eat, whilst all the other children eat party food.
  • Find out what party food will be served, and provide a packed lunch with nut free versions of those foods (as far as possible).
  • Offer to do the shopping for the party, so that all of the food is safe for your child and they can dig in and pile food onto their plate like everyone else.

Other common risk areas for food allergic children at school include:

Birthdays. The birthday boy or girl might bring in treats to share with the class. Events such as Halloween and Easter pose a similar risk. One nut mum I know has instilled into her child that Haribos are safe, but anything else is off limits. The position paper suggests that “Food-allergic children may benefit from an individually labelled box, containing allergen-free ‘treat’ foods for class celebrations or rewards”, so it’s worth talking to the school about a treats box and to agree that you will be given a heads up on any impending food-related events.

The home corner. It seems common for infants school classes to have a “home corner”, where children can play house or play shop. Empty food packets are often used as props. One nut mum I know has been very pleased with the comprehensive way in which her sons’ school and nursery have dealt with their allergies, however the school has recently taken to using empty boxes of Crunchy Nut cornflakes as home corner props. Fortunately, her son (aged 5) can recognise the packaging and knows not to play with that particular box. However, I guess if your child was less aware, it would be a case of talking to the teacher and maybe offering to provide alternative props.

Water fountains. Rather than use the water fountain, could your child have bottled water on hand instead?

Sporting events and school trips. For any events where the child is going to be taken out of school (for example, for swimming lessons, to play football against another school, on a school trip), parents need to talk to the teacher in charge beforehand, to check:

  • On arrangements for food.
  • That both your child’s emergency meds and a person trained to administer them will be on hand.

(see the Anaphylaxis Campaign’s advice on Out-of-school activities).

At the support group talk, Judy Stafford mentioned that you could consider volunteering to be a parent helper, however you need to bear in mind your child’s age, as this can be socially awkward for the child as they get older. Judy also suggested that, if you know there is a residential trip coming up in year 6, you could do some groundwork beforehand, for example:

  • Going on school day trips.
  • Have sleepovers at grandparents’ or a friend’s house.

At the support group talk, it was suggested that someone could also test your child by offering a peanut-containing snack. (Although that sounds a good idea, when D gets a bit older I think a potential flaw might be if he then holds a grudge against the “tester” as having been trying to poison him!)

Christmas party. See above – you might, for example, send in safe food for your child or get involved in organising the food for everyone.

Cookery lessons. Home economics classes (or whatever they are called now!) sound like a potential food allergy minefield. However, it seems that a food allergic child need not necessarily be excluded from cookery classes or clubs, but there will need to be some discussion with the teacher beforehand as to how things can be made safe. Recipes could be adapted to be nut free. The child with allergies could use their own designated work space and utensils, for example with baking tins which can be easily differentiated (for example, a different shape or colour).

My list of questions for the initial appointment

It has been a relief that all of the schools I have visited so far have had experience of allergic children and already had systems in place to care for pupils with allergies. However, I still have more to visit, and, in case they are less forthcoming, these are the questions I will ask:

  • Do you have experience of other children with allergies?
  • If D joins your school, will we put together an action plan? What would you like me to provide?
  • Can all staff identify those children with allergies? (Do you have their photos on a wall?) Where are their emergency medicines kept?
  • Do you have a school nurse? Do all staff know how to use an EpiPen / Jext pen?
  • Is the school “nut free”?
  • What are the arrangements at lunchtime? Is there a nut free table? Are swaps forbidden?
  • As regards school dinners, would it be possible to come in to talk to the cook about D’s dietary requirements?

Further information

 

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Today’s guest post is by Michelle Byrne, who runs the Manchester Allergy Support Group. Since my son’s peanut allergy diagnosis, we have so far holidayed in Britain. When I began attending the support group in May 2013, one of the things I wanted some advice on was how to go about holidaying abroad, in the least stressful way possible. Michelle had spoken about this to the support group back in January and had lots of information about what you can do (particularly before departure) to reduce the risks. I’m delighted that Michelle has kindly agreed to share with Nutmums.com her tips on how to travel safely with allergies (and eczema and asthma). The message? Preparation is key! Louise

Holiday preparations

by Michelle Byrne (see Biography below).

It is possible to have an enjoyable holiday if you have allergies – it just takes careful planning. You need to think carefully when choosing your destination, which time of year to travel, your accommodation and mode of transport. There are also various things you can do before departure and items you can pack, which will minimise your risks.

Destination

Climate:

  • Extremes of climate are often detrimental to those with asthma.
  • Colder or more temperate climates tend to be preferable for those with insect allergy and eczema.

Native Language:

  • Unless you (or a travelling companion) are fluent in a foreign language, then English-speaking countries are preferable.
  • Check whether a translation product has been produced for the country you are visiting. Allergy UK and Allergy Action provide translation cards.

(Louise’s note Jan 2014: a reader has also recommended Dietary Card).

(Louise’s note Jan 2015: when holidaying in Turkey, one nut mum discovered that most restaurant staff were Russian! Her recommendation would be to also take Russian translation cards to Turkey).

Standard of Local Healthcare Provision:

  • Third-world countries are unable to provide a standard of healthcare comparable to that in westernised places.
  • Some destinations may be remote, making access to healthcare difficult.

Availability of Replacement Medication:

A report in 2003 found that adrenaline auto-injectors were:

  • Readily available in most European countries as well as North America, Australia, Israel and South Africa.
  • Not available in many other popular travel destinations including Turkey, Egypt, Thailand, Malaysia or Indonesia.

The current situation can be clarified through contacting the embassies of the intended destination(s).

Availability of Food:

  • Check whether there is, for example, a supermarket in the locality where you can purchase allergy safe food.

Time of Year

When choosing a time of year to travel, check:

  • Your destination’s climate.
  • (If relevant to you) when plants/vegetation will be pollinating/flowering.

Accommodation

Camping Holidays:

  • Camping holidays can be an issue for those who have pollen and insect allergies.
  • Consider cotton-lined sleeping bags if you have a skin condition.

Residential Breaks:

  • Self-catering holidays are usually preferable for those with food allergy.
  • If you have a dust mite allergy, think twice about staying in olde worlde destinations, carpeted and exuberantly furnished hotel rooms or highly ornate places.
  • Those with allergy to animals must avoid staying in accommodation that permits dogs/cats.

Means of Travel

To Destination:

  • Flying can be problematic for those with nut allergies.
  • Different airlines have different/no nut allergy policies. Here are links to various airlines’ nut allergy pages:  British Airways, Aer Lingus, Alitalia, American Airlines, United Airlines, Virgin Atlantic. Always check as the policies can change. It is always advisable to contact the airline BEFORE booking and outline any specific concerns.
  • Keep in mind that just because an airline does not serve peanut snacks, it does not mean it is peanut-free. The airline may include peanut ingredients in its meals, or other passengers may carry peanuts on the plane with them.
  • A nut-free meal can be requested, but cannot be guaranteed to have been produced in a nut-free environment and may therefore contain traces of nuts.  It is prudent for those with nut allergy to take their own food onboard flights.
  • Surfaces of cabin furniture may possibly have traces of nuts.  Such exposure can be minimised through wiping surfaces that you are to come into contact with.
  • Changes in air pressure within an aircraft may be problematic for those with long-standing breathing problems.  Consult your GP/chest physician prior to booking a flight.
  • Fumes from steam trains/narrow boats etc can exacerbate asthma.

Around Destination:

  • Open-air modes of transport expose one to insects/pollen/fumes/dust, all of which potentially exacerbate allergic disease conditions.
  • Those with asthma should avoid animals as fur can exacerbate the condition.
  • Those with insect allergy should also remember that animals attract insects.

Health Insurance

European Health Insurance:

  • UK residents should take a (free) European Health Insurance Card (EHIC) (formerly form E111) to obtain medical treatment if visiting a European Union country, Iceland, Liechtenstein, Norway or Switzerland.

Travel Insurance:

  • Those seeking cover for potential anaphylaxis should not have to pay an additional premium when travelling within Europe, as anaphylaxis is an emergency and covered by the EHIC.
  • Mainstream insurers do provide cover for those with severe allergies, though this may require medical screening and payment of an extra premium.  Should difficulties be encountered, contact the Anaphylaxis Campaign Helpline (01252 542029).
  • It may be cheaper to purchase annual travel insurance as opposed to travel insurance for each individual holiday.
  • Avoid holiday health insurance policies that exclude treatment of any “pre-existing health condition” (as this could include allergies).

Prior to Travelling

Important Telephone Calls:

Call:

  • The airline to check their current (1) Peanut Policy as it can change and (2) rules for carrying medication. Request written confirmation from the airline. Such documentation may help if flights are rescheduled en route.
  • Your GP to request written confirmation for the necessity to carry adrenaline auto-injectors.  Some GPs may charge a fee (around £10-£15) for providing such documentation.
  • Your chest physician (if you have a chronic chest condition), as investigations may be necessary to ascertain if one can withstand the changes in pressure inside the aircraft whilst in flight.
  • The Anaphylaxis Campaign (01252 542029) for any further queries, and also information on equivalent support organisations in the country you are visiting.
  • The Embassy and/or Tourist Office of the countries to be visited, for advice on:
    • emergency numbers in that country (for example, 911 in North America, 112 in Europe,  000 in Australia, 111 in New Zealand,  119 in parts of Asia);
    • the ambulance provision at your destination.  For instance, in France it is the fire service that provides an ambulance service;
    • the local food specialities and their likely ingredients; and
    • whether the medications you plan to pack are actually permitted in the destination country (it illegal to possess some medications in certain countries).
  • The proprietor at your destination to discuss, for example:
    • if the food prepared on the premises is suitable for your food allergies; and
    • the bedding (can feather pillows be substituted with synthetic? do you need to bring your own?)

ICE:

  • Store your next of kin’s telephone number in your mobile phone’s contact list under ICE (In Case of Emergency). Emergency services look for this when assisting unconscious patients. Obviously, make sure the contact list is accessible without a password.

Packing

Medication:

  • Discuss travel intentions with GP reception staff when requesting more medication than usual (or an earlier repeat prescription), to avoid GP rejecting requests.
  • Order and pack more medication than is required – in case there are journey delays or spillages.
  • Ensure all medication (1) is comprehensively labelled (2) complies with fluid restrictions enforced by airline (3) will remain in date throughout the duration of the planned trip.
  • Pack a copy of the repeat prescription request form/current medication list (using non-proprietary/generic terminology) for reference in an emergency.
  • Ensure that you and your companions know how and when medication (especially adrenaline auto-injectors) should be administered.
  • Give your travelling companion a spare adrenaline auto-injector to carry, so that if your bag goes missing, you will have a back-up.
  • Obtain a doctor’s letter explaining necessity to carry adrenaline auto-injector. 

Sun Creams:

Patch test sun tan lotion prior to travelling. For advice, see The National Eczema Society’s factsheets “Eczema and the Sun” and “Sun Screens and Ingredients: What to Look For”. Generally aim for at least SPF 15 with both UVA and UVB protection. Sunscreen to be applied about every two hours (and after swimming).

Insect Repellents:

This will deter biting insects, but not venomous insects. Check you can tolerate the product before travelling. Consider that asthma may be exacerbated through use of vaporised/aerosol products.

Medical Pendants:

Consider wearing a pendant which details emergency medical information. For example, Medicalert or SOS Talisman.

Apps:

  • St John Ambulance First Aid App (free) Guidance for first aid responders to emergencies, including how to administer CPR (Cardio-Pulmonary Resuscitation).
  • Anaphylaxis Coventry University Medical (free) Personalised anaphylaxis management plan, including your allergens, emergency contacts, medications and emergency procedures (including video explaining how to inject epinephrine). Users can also set reminders for auto-injector expiry dates.

Translation Card:

  • A translation card containing allergy information and what should be done in an emergency should be obtained (see above).
  • Translation cards can be hand-written by someone who knows the native language. For a school trip, members of the language department could provide invaluable advice/assistance.
  • Obviously a more foolproof means of conveying information about allergies is to be able to communicate in the native language (or travel with someone who can).
  • If you have internet access on your phone, Google can be used to provide on-the-spot translations.

Medication Carry-Cases:

If you carry all medication in one pouch/case, this makes accessing them easier in an emergency. It is advantageous to use a purpose-made carrier as they:

  • Are frequently brightly coloured and thus highly visible to/easily found by medical personnel/others for use in emergencies.
  • Provide protection to the medication from extremes of temperature and mechanical damage through knocks/bumps.

[Louise’s note – for details of the online stockists I have come across, see EpiPen accessories.]

Plug Adaptors:

  • Many countries have different plug sockets to the UK.  An adaptor must be packed in order to use a nebuliser in certain destinations.

Clothing:

  • Cotton clothing is best for those with skin conditions as it is cooler and less irritating.
  • Avoid bright colours if allergic to insect stings.
  • Shoes are preferable to open footwear for those with insect sting allergy and skin conditions.

Sterile Wipes:

  • Important for those with food allergies, to wipe surfaces off which food is to be eaten, to ensure any contamination by possible allergens has been removed.

Perfumes:

  • Should be avoided by those with asthma/eczema/insect venom allergy (insects are attracted to perfumes).

Food:

  • Pack some safe non-perishable snacks.  Some of which should be taken in hand luggage on flights for consumption during the journey.

Bedding:

  • Consider taking one’s own bedding, especially if one has a marked allergy to dust mite or synthetic coverings.

Cash:

  • It is prudent to carry some cash (say, at least £100) in the local currency when abroad as some medical establishments refuse to treat patients without a cash payment in advance.

On Arrival

Clarify Local Healthcare Provision:

Make sure you know:

  • The location of the nearest hospital (and whether it is state-run or private)
  • The location of the nearest pharmacy.
  • Whether your hotel has an in-house doctor.
  • Contact details of local taxi firms.
  • All of the phone numbers one is likely to need in an emergency.

Medication:

  • Medication must be carried at all times.

Food:

  • Choose plain simple foods without sauces or dressings.
  • Do not eat foods, the constituents of which are not known.
  • Ensure those preparing food are aware of your specific allergies.  For non-English speaking countries, provide a written translation detailing your allergy and what to do in an emergency.
  • Be aware of international culinary differences and methods of food preparation.  For instance, Spanish chefs frequently use ground almonds in place of flour in cakes, French bakers often use lupin flour in bakery products (this can evoke reactions in those allergic to nuts).
  • “Standard” items on chain restaurant menus are cooked with different ingredients from region to region, so it is possible that one’s “usual” from the UK may not be suitable abroad.  Contact the International Customer Helplines of the chain restaurant prior to travelling.

Water Sports:

  • Chlorine in swimming pools can exacerbate both asthma and eczema. (Use medication/creams prophylactically if chlorine has provoked exacerbations on previous occasions).
  • Sand/salt in seawater often exacerbates pre-existing skin conditions.  Avoid direct contact with the skin through wearing of adequate clothing/footwear and use of appropriate creams.

Biography

michelle_byrneMichelle Byrne is allergic to nuts and various other foods and is also asthmatic. Although she had a reaction to nuts aged 3, it was not until she was 19 that, whilst training to be a doctor, she realised she could have a severe allergy and need to carry an EpiPen. In February 2012, Michelle set up the Manchester Allergy Support Group, which meets 7.00-8.30pm on the first Monday of the month in Flixton, Manchester.

The group is supported and endorsed by the Anaphylaxis Campaign and regularly has guest speakers including, for example, specialist allergy doctors and nurses and representatives from the National Eczema Society.

For more information, see the group poster (which includes Michelle’s contact details) and a list of the group’s discussion topics for 2013. 

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In my previous post, I talked about the world’s biggest food allergy study (the iFAAM study) and how the professor leading the study, Professor Clare Mills, will be talking at the next Manchester Allergy Support Group meeting on Monday 1 July 2013.

Professor Mills is also involved in the TRACE study, which is being led by Dr Andrew Clark, allergy consultant at Cambridge University Hospitals. Commissioned by the Food Standards Agency, the TRACE study will investigate how much peanut will cause an allergic reaction and whether exercise and stress make people more likely to react. The study results will be published in summer 2016.

UK food allergen labelling laws govern ingredients which have been intentionally added to a food’s recipe. They do not cover accidental cross-contamination, for example where a product is contaminated from peanut residue left on shared manufacturing machinery. Where there is a risk of such cross-contamination, food manufacturers put advisory warnings on the packet such as “May contain peanut” or “Produced in a facility that also processes nuts”. At present, there is no way for the consumer to assess the level of risk behind these warnings.

By discovering what amount of accidental peanut contamination is safe (even after people have exercised or are stressed), the TRACE study should help improve “may contain” labelling, by limiting warnings to foods where the peanut levels are likely to be above the threshold.

Dr Clark, together with experts from Imperial College, London, are looking for peanut allergic men and women, aged 18-45, to participate over a 12 month period. For more information on the TRACE study, including details of how to get involved, see http://www.tracestudy.com/.

Source: Manchester University, Pioneering study to investigate factors affecting how much peanut is safe to eat.

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On Monday 1 July 2013, Professor Clare Mills (from the Allergy and Respiratory Centre at the University of Manchester) will be attending a Manchester Allergy Support Group meeting. She will be talking to the group about the iFAAM study, which launched in March 2013 and is the world’s biggest ever study of allergies.

What’s the iFAAM study about?

iFAAM, which stands for “Integrated Approaches to Food Allergen and Allergy Risk Management”, is being led by the University of Manchester and will bring together food allergy experts from the UK, Europe, Australia and US. The study is expected to take three years to complete.

Professor Mills (who is heading up the project) said:

“This is a massive research project which will have far reaching consequences for consumers and food producers. The evidence base and tools that result from this will support more transparent precautionary “may contain” labelling of allergens in foods which will make life easier for allergy sufferers as they try to avoid problem foods.”

At present, if a prepacked food or alcoholic drink contains one of the top 14 food allergens (or an ingredient made from one of them), this must be declared on the food label. The 14 allergens include both peanuts and nuts. From December 2014, the Food Information for Consumers Regulation 1169/2011 (EU FIC) will extend the allergen labelling requirement to foods sold non-prepacked and foods prepacked for direct sale. However, both the existing law and EU FIC only regulate those ingredients intentionally added to the food. They do not cover allergens which are added accidentally, for example due to a manufacturer using the same equipment for, say, both plain and nutty biscuits. For more information, see Deciphering UK food allergen labelling law.

The iFAAM study will build new risk models to support allergen management in factories, which, in turn, will minimise the use of “may contain” labelling.

In addition to producing a standardised management process for food manufacturers, the iFAAM study will:

  • Develop tools to measure allergens in food, which will allow the validation and monitoring of manufacturer’s allergen management plans.
  • Develop safe allergen thresholds, which would give the food industry guidelines to work within and should reduce the use of “may contain” labelling.
  • Try to predict which allergy sufferers are likely to suffer a severe reaction.
  • Look at whether early introduction of allergenic foods and other nutritional factors may protect against developing allergies. This would then inform the nutritional advice for pregnant women, babies and allergy sufferers.

For more information on the iFAAM study, see:

(See also my related blog post on the TRACE study).

Manchester Allergy Support Group

As mentioned above, on Monday 1 July, Professor Clare Mills together with Debbie Hughes (Allergy Nurse Specialist, University Hospital of South Manchester) will be attending a meeting of the Anaphylaxis Campaign’s Manchester Allergy Support Group. Professor Mills will be talking to the group about the iFAAM study.

For more information on:

  • The support group meeting on 1 July 2013 with Professor Mills, see the Manchester Allergy Support Group”s July poster.
  • The topics to be discussed at the Manchester Allergy Support Group throughout 2013, see the group’s list of discussion topics.
  • The group generally, with leader Michelle Byrne’s contact details, see the group poster.

Update (September 2013)

Please see the Events page for details of the Manchester Allergy Support Group’s forthcoming meetings.

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I mentioned back in February that, following my toddler’s anaphylactic reaction to peanuts, I was keen to meet other people in the same boat, for example by joining an allergy support group, or a playgroup for children with food allergies.

On Monday 6 May, I did just that. I attended a meeting of the Manchester Allergy Support Group, which is run by Michelle Byrne and supported and endorsed by the Anaphylaxis Campaign.

The Manchester Allergy Support Group meets on the first Monday of the month. As the May meeting fell on Bank Holiday Monday, it took the form of an informal group discussion. I found this really useful and am definitely planning to be a regular attendee.

The group often has guest speakers, including, for example, allergy specialists from hospitals in and around Manchester and the National Eczema Society. The next meeting, on Monday 3 June, will be a first aid session led by Laura Grewer of St John Ambulance.

For more information (and Michelle’s contact details), see:

For details of allergy support groups across the country, see the Anaphylaxis Campaign website.

Update (September 2013)

Please see the Events page for details of the Manchester Allergy Support Group’s forthcoming meetings.

Update (December 2013)

For more details of the speakers for 2014, see Manchester Allergy Support Group 2014.

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I recently read a blog post by a mum whose 4 ½ -year-old son had an anaphylactic reaction to sheep’s milk feta cheese. Thankfully, he was okay. However, his mum had described, two weeks on, how the family are dealing with the experience and some of the things they have learned.

Much of the article rang true for me, particularly the need for parents to give themselves time to recover emotionally and physically from an anaphylactic episode. My son, D, was 20 months old when he suffered anaphylaxis after eating a peanut butter cookie (for more details, see Who am I? Where am I? Why do I feel this way?). At that time, D was only at the stage of speaking in single words (save for the phrase “bye bye baby”, which he had taken to muttering repeatedly since his little sister’s arrival the previous month!). So we didn’t experience the problem of trying to get him to talk about what had happened, as you might with an older child. However, the article got me thinking about some of the issues we faced, which I imagine might be common for toddlers who have been hospitalised. Continue Reading