FSIS Issues Public Health Alert for Weis Markets’ Ready-To-Eat General Tso Chicken Meals Due to Misbranding and Undeclared Allergens

For Immediate Release

May 13, 2022

Contact Information

Weis Markets
(866) 999-9347, option 5

Company Announcement

WASHINGTON, May 13, 2022 – The U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) is issuing a public health alert due to concerns that Weis Markets’ ready-to-eat (RTE) General Tso Chicken meals may contain milk, a known allergen, which is not declared on the store’s finished product label. FSIS is issuing this public health alert to ensure that consumers with an allergy to milk are aware that these products should not be consumed.

The RTE General Tso Chicken meals were prepared, labeled and sold in the Deli area at Weis Markets stores between April 13, 2022, and May 11, 2022. The products have sell by dates of April 13, 2022 through May 15, 2022. The following products are subject to this public health alert [view labels]:

• Deli compartment containers containing “Weis GENERAL TSO CHICKEN FAMILY MEAL Serving Size 1 cup Calories 500.”
• Deli compartment containers containing “Weis GENERAL TSO CHICKEN SMALL MEAL Serving Size 1 cup Calories 500.”
• Deli compartment containers containing “Weis GENERAL TSO MEAL Serving Size 1 each Calories 910.”

These items were sold at Weis Markets’ retail delis in Delaware, Maryland, New Jersey, New York, Pennsylvania, Virginia, and West Virginia.                             

The problem was discovered when Weis Markets in Sunbury, Pa. reported that they had been using correctly labeled, USDA inspected and passed chicken products containing milk ingredients but did not update their in-store labels for General Tso Chicken meals to include milk as an ingredient.

There have been no confirmed reports of adverse reactions due to consumption of these products. Anyone concerned about an injury or illness should contact a healthcare provider.

FSIS has verified the affected products are no longer available for sale but is concerned that some product may be in consumers’ refrigerators. Consumers who have purchased these products are urged not to consume them. These products should be thrown away or returned to the place of purchase.

Consumers and members of the media with questions about the public health alert can contact Weis Markets at (866) 999-9347, option 5, Mon-Fri, 8 a.m. to 5 p.m. ET.

Consumers with food safety questions can call the toll-free USDA Meat and Poultry Hotline at 888-MPHotline (888-674-6854) or live chat via Ask USDA from 10 a.m. to 6 p.m. (Eastern Time) Monday through Friday. Consumers can also browse food safety messages at Ask USDA or send a question via email to MPHotline@usda.gov. For consumers that need to report a problem with a meat, poultry, or egg product, the online Electronic Consumer Complaint Monitoring System can be accessed 24 hours a day at https://foodcomplaint.fsis.usda.gov/eCCF/.

Mrs Miller’s Homemade Jams Issues Voluntary Recall Due to an Undeclared Soy Allergen

For Immediate Release

May 13, 2022

Contact Information

Brent Miller
330-674-1165
info@millershomemadejams.com

Company Announcement

Fredericksburg, OH (May 09, 2022) Mrs Miller’s Homemade Jams in Fredericksburg OH is voluntarily recalling its Smokey BBQ Bacon Jam and Spicy Chili Bacon Jam, packaged in 9 oz glass jars. The recall is due to an undeclared soy allergen found in the Worchestire Sauce and Hickory Smoke ingredients used in these jams. This recall has been initiated due to the ingredient label not stating a soy allergen.

Products were available for sale from 04/01/2019 - 05/09/2022 online and at the following retailers & distributors:

Ashery Country Store 8922 State Route 241, Fredericksburg, OH 44627
Mrs Miller's Homemade Noodles 9140 CR 192 Fredericksburg, OH 44627
Cracklin Pig Rosters Roasters PO Box 450 Berlin OH 44610
Hillside Orchard PO Box 281 Hinckley, OH 44233
Kountry Kin Crafts 902 Planing Mill St Caldwell OH 43724
German Village PO Box 223 Berlin, OH 44610
Amish Originals 8 N State St Westerville, OH 43081-2114
Country Hills Market 8229 County Road 201 Fredericksburg, OH 44627
Amish Door Market PO Box 215 Wilmot, OH 44689
Hershberger's Farm Market 5452 St Rt 557 Millersburg, OH 44654
Bunker Hill Cheese 6005 CR 77 Millersburg, OH 44654
Chuck Lager 4500 New Linden Hall Rd Pike Creek, DE 19808 609-351-4617
Steiner's Furniture LLC 10722 NW Grand Ave Sun City, AZ 85351 602 568 1149
Doak Distributing LLC Elmira MI
Maria Sobas 2461 Timbers Edge Ln Columbus OH 43235 9375376163
Bork Farms 537 Neal Rd. Homer City Pa. 15748
Anne's Mercantile 3825 N Cramer St Shorewood, WI 53211 7196472224
Burton Farms General Store 425 Conover Blvd W Conover, NC 28613 704 530 4372
Marie Bakers Gift Shop PO Box 75 Longville, MN 56655
Kidd’s Quality Merchandise 849 Midway Road Alum creek, WV 25003 Orchard Farm Stand 3350 NE Catawba Rd, Port Clinton, OH 43452
Mountain Witch Tea Company 40641 Big Bear Blvd Big Bear Lake, CA 93215
The Pantry 2122 US 92 Auburndale, FL 33823 863 206 3646
Garden Market 4660 Hwy 119 Montevallo, AL 35115
Floyd’s on 60 5830 Davis Creek Rd, Barboursville, WV 25504
Nagel Farm Stand 39491 Parson's Rd Grafton, OH 44044
Farmers Meats & Deli 304 552 6643 Cambridge True Value 115 North Ashland St Cambridge, MN 55008
New Creation Farm 12126 Clark Rd Chardon, OH 44024
J&J Sales 5770 Spring Grove Dr Solon, OH 44139
Streb's General Store 4369 OH-39, Millersburg, OH 44654
B & S Meat Packaging 1007 Heber Springs Rd Batesville AR 72501
Amish & Sofa City Outlet 3383 Hickory Blvd, Hudson NC 28638
Bay 15 115 N Ashland St Cambridge MN 55008
Bargain Depot USA Florida
Stirgwolt & Associates 2439 Coltsbridge Dr Lewis Center, OH 43035 Beekers General Store 226 E. Front St PO Box 273 Pemberville, OH 43450
Mountainside Exchange 1325 Washington St Clarkesville, GA 30523 706 389 8441
Jabella's Roadside Market PO Box 133 Wilmot, OH 44689
Nana’s Crackers & Pretzels Louisiana
Walnut Creek Foods PO Box 240 Walnut Creek, OH 44687
Miller's Farm Market 7396 US HWY 97 Peshastin , Wa. 98847 509-669-1585
Quiet Harmony Ranch 10684 Morrison Mikesell Rd New Paris, OH 45347

The issue was discovered during a routine inspection conducted by the Ohio Department of Agriculture. There have been no reports of illness involving the product addressed in this recall. However people who have an allergy or severe sensitivity to soy could run the risk of a serious or life-threatening allergic reaction if they consume this product. Individuals exhibiting signs or symptoms of food borne illness or allergies should contact a physician immediately.

Customers with a soy allergy or sensitivity who have purchased the affected product should dispose of it and contact Mrs Miller’s Homemade Jams for a replacement jar. Consumers with questions regarding this recall can contact Brent Miller at info@millershomemadejams.com or 330 674 1165.

HP Hood LLC Issues Allergy Alert on Undeclared Peanuts in Planet Oat Non-Dairy Frozen Dessert (Updated: Additional Locations)

For Immediate Release

May 12, 2022

Contact Information

Consumer Affairs
1-800-242-2423

Company Announcement

HP Hood LLC – Lynnfield, MA, is recalling 4,481 cases of Planet Oat Chocolate Chip Cookie Dough and Planet Oat Chocolate Peanut Butter Swirl Non-Dairy Frozen Dessert with a Best By date of 12/17/22, because it may contain undeclared peanuts. People who have an allergy or severe sensitivity to peanuts run the risk of serious or life-threatening allergic reaction if they consume these products.

Product was distributed nationally to retail stores in the Continental United States. Product was also distributed to retail stores in Alaska, Hawaii, Puerto Rico, St. Maarten, and Cayman Islands.

This recall is limited to the following products:

This recall does not apply to any other UPC codes, “Best By” dates, or varieties of Planet Oat frozen dessert products.

No illnesses have been reported to date.

The recall was initiated after it was discovered that some Chocolate Peanut Butter Swirl product, which contains peanuts, was packaged in a Chocolate Chip Cookie Dough container, which does not contain the peanut allergen statement. The issue was discovered by a retail customer, which contacted Hood.

All retail customers that received the recalled products are being instructed to remove such products from their shelves. All distribution centers are being instructed check inventory, cease distribution, and notify retail customers.

Consumers who purchased the product may return it to the retail location where the purchase was made for a full refund or exchange. Consumers with questions may contact consumer affairs at 1-800-242-2423 Monday through Friday, 9 AM to 4 PM EST.

Below are images of the Chocolate Peanut Butter Swirl and the Chocolate Chip Cookie Dough frozen desserts and the affected “Best By” date:

On May 20, 2022, the Food and Drug Administration (FDA) approved Dupixent® (dupilumab) for people 12 and older with eosinophilic [EE-oh-sin-oh-FILL-ick] esophagitis [uh-sof-uh-JIE-tis], also known as EoE. In the clinical trial, Dupixent greatly improved EoE symptoms. This is the first FDA-approved medicine available in the U.S. to treat EoE.

What Is Eosinophilic Esophagitis (EoE)?

EoE is an allergic, progressive condition that causes swelling in your esophagus (swallowing tube). The esophagus is in an upper part of the gastrointestinal (GI) tract (gut). It is the tube that moves food from your mouth to your stomach when you swallow. EoE happens when certain white blood cells called eosinophils [EE-oh-sin-oh-FILLS] migrate to and build up in the lining of the esophagus. This buildup can damage the esophagus and make it harder to swallow. For people with EoE, swallowing even the smallest amount of food can be painful and lead to choking. This can lead to significant anxiety, frustration, and poor quality of life. In addition, this disease can cause narrowing of the esophagus, which may need to be dilated by a gastroenterologist.

There are about 160,000 people in the U.S. living with EoE who are being treated medically. Of these, treatments have failed for around 48,000. Many children and adults with EoE respond well to changes in their diet, such as specific food elimination diets (e.g., milk, egg, wheat, and soy). Certain medicines, such as proton pump inhibitors (PPIs) typically used to treat gastroesophageal reflux and swallowed corticosteroids, may also help manage and reduce symptoms. But these treatments may not give full relief because they don’t adequately combat or reverse the buildup of eosinophils in the esophagus – the underlying cause of the disease.

What Is Dupixent?

Dupixent is a type of treatment called a biologic, or monoclonal antibody therapy. In general, biologics target specific cells (pathways that are part of your immune system) to block inflammation and swelling. They are typically prescribed when conditions do not respond to other treatments. Biologics are not steroids. Several specific biologic therapies have been developed to use in the management of difficult-to-control conditions such as atopic dermatitis, asthma, and chronic rhinosinusitis with nasal polyps (CRSwNP).

Dupixent is currently approved by the FDA for the treatment of moderate-to-severe asthma and atopic dermatitis (eczema) for people ages 6 and older. It is also approved for CRSwNP for people ages 18 and older. It is an injection you can give yourself at home every few weeks (children will need help or supervision). It comes in two options – a prefilled syringe or prefilled auto-injector.

What Should People With EoE Know About Dupixent ?

Clinical trials looked at how safe and effective the treatment (Dupixent) is compared to other treatments already available. The first study of the trial showed positive results for EoE when participants took 300mg of Dupixent once a week for 24 weeks compared to a similar group of patients not taking Dupixent (i.e., placebo group).

The second part of the Phase 3 trial enrolled 159 people. Eighty people in the trial were in the treatment group that received Dupixent. Researchers reviewed their symptoms, such as swelling in the esophagus and trouble swallowing. After 24 weeks, the people who got Dupixent showed the following improvements compared to the placebo group not receiving Dupixent:

• Reduced eosinophils in the esophagus
• Reduced swelling in the esophagus
• Reduced EoE symptoms, such as trouble swallowing

Overall, the people who took Dupixent saw significantly larger improvements than the people who did not take Dupixent (placebo group). Dupixent is the first biologic to show such positive results in EoE patients.

What Happens Next?

The FDA approved this treatment for adults or children ages 12 years or older who weigh at least 88 pounds. Talk with your doctor (allergist or gastroenterologist) to find out if this new treatment may be an option for your child (or you, if you have EoE).

Read more about the study and the FDA announcement.

Medical Review: May 2022 by John M. James, MD

White Cane Sockeye Salmon LLC Issues Allergy Alert on Undeclared Wheat and Soy in Wild Alaskan Cooked and Smoked Salmon

For Immediate Release

May 19, 2022

Contact Information

Randy Houghton
208- 661-7927
WCSockeye@yahoo.com

Company Announcement

White Cane Sockeye Smoked Salmon LLC of Coeurd-Alene, ID is recalling Wild Alaskan Cooked and Smoked Salmon because it contains undeclared Wheat and Soy. People who have an allergy or severe sensitivity to wheat or soy run the risk of serious or life-threatening allergic reaction if they consume this product.

The affected Wild Alaskan Cooked and Smoked Salmon has been sold at farmer’s markets Green Valley, Udall Park, Oro Valley, and Rillito Park in Arizona. The affected product was last sold on 5/15/2022.

The affected Wild Alaskan Cooked and Smoked Salmon is packaged in vacuum bag, sold frozen, and there is no lot code or best by date on a package. Enclosed is the label of the affected product.

No illnesses have been reported to date.

The recall was initiated after it was discovered that product containing wheat and soy in Teriyaki Sauce, but it was distributed in packaging that did not reveal the presence of wheat and soy.

This recall is being made with the knowledge of the U.S. Food and Drug Administration.

Customers with wheat or soy allergy or sensitivity and have purchased the affected product are urged not to consume the product and dispose of it or return it to their place of purchase for a full refund.

Consumers with questions may contact Randy Houghton at 208- 661-7927, Monday-Friday, 8am-4pm GMT or send email to WCSockeye@yahoo.com

Van Leeuwen Issues Voluntary Recall on Undeclared Tree Nuts (Cashew and Pistachio) in Frozen Dessert Product

For Immediate Release

May 10, 2022

Contact Information

Kate Alberswerth
(718)-701-1630
kate@vanleeuwenicecream.com

Company Announcement

BROOKLYN, N.Y., May 10, 2022 -- Van Leeuwen Ice Cream of Brooklyn, NY is voluntarily recalling 2,185 frozen 14 oz pints of its non-dairy frozen dessert product "Oat Milk Brown Sugar Chunk” because it may contain undeclared specific trace of allergens (tree nuts – cashews and pistachios). People who have an allergy or severe sensitivity to specific types of allergen (e.g., peanuts, tree nuts {chestnuts, brazil nuts, walnuts, hazelnuts, pecans, pine nuts, cashews}, eggs, and sulfites) run the risk of serious or life-threatening allergic reaction if they consume these products.

The recalled products are distributed nationally in retail stores. The product comes in a 14 ounce white package with orange lettering and an orange lid. The product is marked with lot #21V194 and a best by date of 1/13/2023 which are both displayed on the bottom of the pint. The recall does not apply to any other lot marking, best by date, or varieties of Van Leeuwen Ice Cream products.

The recall was voluntarily initiated after it was discovered due to a customer complaint, who experienced a reaction, that the lot contains the undeclared tree nuts and was distributed in packaging that did not reveal the presence of the allergen. The cause of the contamination is being investigated.

Retailers who are in possession of the product are urged to, in this order, stop sales and distribution immediately, contain and isolate the lot, and contact Van Leeuwen Ice Cream immediately for verification and disposal instructions. Consumers who have purchased the impacted lot should return them to the place of purchase for a full refund.

Any questions or concerns should be directed to Kate Alberswerth, kate@vanleeuwenicecream.com or 718.701.1630 between the hours of 9:00 – 5:00 EST.

Advocating for children with food allergies and asthma is a great way to spread awareness during National Asthma and Allergy Awareness Month. We invite you to help us take action on Advocacy Action Day!

When creating policies, Congress needs to consider what families managing food allergies and asthma need to live full, healthy lives. Around 5.6 million children and 26 million adults in the U.S. have food allergies.^1,2 About 25 million people have asthma.³ And because these are related conditions, many children may have both.

These numbers show us how many people in the U.S. are managing food allergies and asthma. But they don’t show the impact these diseases have on families, their quality of life, and their communities.

We need more than just health care policies. We need Congress to consider the health of children with food allergies and asthma in all policies. They need the following to live healthy and full lives:

• Safe food
• Affordable, accessible, quality health care
• Clean air
• Healthy homes
• Financial stability
• Education

One way you can take action today is by asking Congress to support the Medical Nutrition Equity Act of 2021 (MNEA). MNEA is a bill that would require public and private insurance to cover medical foods, vitamins, and individual amino acids.

Medical foods are nutrition products (usually formulas) that are made to manage a disease or condition. They are prescribed and used under medical supervision. They are not the same as foods recommended by a doctor as part of a diet to manage symptoms. These products are sometimes needed to give complete or added nutrition. Children need proper nutrition for growth, mental development, and immune system development.

Help us expand coverage of medical foods by acting now! Use our tool below to send an email to your senators and representatives. You can also choose to post your message on Twitter. Then sign up to receive Advocacy Action Alerts so you can continue to help us advocate for people with asthma and allergies throughout the year.

References
1. Gupta, R. S., Warren, C. M., Smith, B. M., Jiang, J., Blumenstock, J. A., Davis, M. M., Schleimer, R. P., & Nadeau, K. C. (2019). Prevalence and Severity of Food Allergies Among US Adults. JAMA Network Open, 2(1), e185630. https://doi.org/10.1001/jamanetworkopen.2018.5630
2. Gupta, R. S., Warren, C. M., Smith, B. M., Blumenstock, J. A., Jiang, J., Davis, M. M., & Nadeau, K. C. (2018). The Public Health Impact of Parent-Reported Childhood Food Allergies in the United States. Pediatrics, 142(6). https://doi.org/10.1542/peds.2018-1235
3. Centers for Disease Control and Prevention. (2020). 2019 National Health Interview Survey Data. U.S. Department of Health & Human Services. https://www.cdc.gov/asthma/nhis/2019/data.htm

If you have a child with food allergies, how do you decide when they are ready to carry epinephrine and/or use that epinephrine themselves if they are having a severe allergic reaction?

Epinephrine is the only treatment for severe allergic reactions, known as anaphylaxis [anna-fih-LACK-sis]. It gets injected into the outer thigh. It comes in a device that helps you give the injection. Epinephrine must be given quickly when symptoms begin. For this reason, it’s important to always have epinephrine nearby. People (of any age) who are at risk of severe allergic reactions should carry their epinephrine with them wherever they go.

How Do You Know When a Child Is Ready to Carry Their Own Epinephrine?

Every child develops on their own schedule. There is no specific age when a child must start to self-carry or administer. So how do you know when your child is ready to be responsible for carrying their epinephrine devices? The answer to this question depends on your child.

Here are some factors to keep in mind:

• Is your child comfortable carrying epinephrine at all times in a waist belt, backpack, purse, medicine bag, or other carrier?
• Does your child show they are able to remember their medicine bag or backpack and not lose it?
• Does your child show that they know not to play with the epinephrine?
  
  

How Do You Know When a Child Is Ready to Use Their Epinephrine and Inject Themselves?

There are no formal guidelines for when a child is ready to give themselves epinephrine. Many kids are ready to carry their epinephrine sooner than they are ready to self-inject. Many pediatric allergists agree that by age 9 to 11, a child should know:

• The symptoms of a severe allergic reaction
• The need to use epinephrine
• How to show the use of self-injectable epinephrine¹
  
  

By age 12 to 14, most allergists expect children to self-carry and self-administer epinephrine.

When your child is ready to self-inject depends on their maturity level, their needs, and their abilities. Here are some factors that will help assess if your child is ready to self-inject:

• Can your child use a training device to show they know how to use the device correctly?
• Can they recognize the symptoms of anaphylaxis?
• Do they express confidence they can self-inject in an emergency?
• Does your child have developmental delay, autism, attention-deficit/hyperactivity disorder (ADHD), depression, etc. that may impact their decision-making skills?
• Does your child have a history of anaphylaxis?
  
  

Keep in mind that an allergic reaction may be so severe that your child may not be able to self-inject, no matter their age or knowledge. Because of this, federal guidelines for schools call for a trained staff member to give epinephrine in case a school nurse is not available.

If your child has recently had a severe reaction and someone else gave them epinephrine, talk about how they might handle a future emergency when there is no adult around.

Talk with your child and your allergist if you think your child is ready to have more responsibility self-managing their food allergy.

It’s important to think about these issues when your child is younger. This will make it easier to teach them how to manage their food allergy as they grow and it will create a foundation for good food allergy management as they become teenagers and young adults.

Medical Review: May 2022 by Michael Pistiner, MD, MMSc

References
1. Children Assume Responsibility for Anaphylaxis Treatment | AAAAI. (2020, September 28). Aaaai.org. https://www.aaaai.org/Tools-fo...children-epinephrine

Dr. John James, a board-certified allergist, about some common questions people have about food allergies, anaphylaxis, and epinephrine.

Question: My child has food allergies. How can I tell if they are having a severe allergic reaction (anaphylaxis)?

Dr: James: Anaphylaxis [anna-fih-LACK-sis] is a serious allergic reaction that happens fast and can be life-threatening. Signs and symptoms usually start within 5 to 30 minutes after exposure to the relevant food allergen (such as, but not limited to, peanut, tree nuts, egg, and cow’s milk). Some of the most common symptoms that should raise your suspicion are:

• Generalized hives and/or swelling of the face, throat, and body
• Repeated vomiting with or without diarrhea
• Trouble swallowing or talking (hoarseness, changes in voice), trouble breathing, shortness of breath, repeated coughing, wheezing
• Dizziness, fainting
• Feeling or sensation that something very bad is happening

Note that these symptoms can occur alone or several at the same time.

An Anaphylaxis Action Plan can help you identify symptoms.

Question: I’m afraid to give my child epinephrine. Will epinephrine hurt my child if I give it to them if they aren’t having an allergic reaction or I give it too soon?

Dr. James: This is an excellent and common question that parents often ask when they have an infant or child with food allergies. Epinephrine is used to treat severe allergic reactions, including those triggered by food allergies. It is the only medicine that can stop severe allergic reactions.

You give epinephrine by injection. It comes in devices that help you do the injection. The most common options are auto-injectors. These devices are pre-filled with the medicine, and upon pressing them against the outer thigh, they will inject the medicine for you. For two of the epinephrine auto-injector options available in the U.S., you never see the needle. The needle pulls back into the device instantly when you are done injecting.

If you need to use epinephrine, have your child lie down. Hold their leg firmly, but not roughly, just to help them hold still. Inject the medicine into the middle of the outer thigh.

If you are feeling nervous or afraid, be sure to practice before an emergency occurs. When or if an emergency does happen, keep yourself calm as you give the epinephrine so you can help your child feel as comfortable as possible.

An epinephrine auto-injector is always safe and appropriate to give to your infant or child if they are having a severe allergic reaction. This is the most effective, rapid, and life-saving treatment for these reactions. Even if you give epinephrine too soon or if you are not sure if they are having anaphylaxis, you should still give them this medicine because it will help stop an allergic reaction and it will not do any harm or cause any major side effects.

Epinephrine may cause some noticeable symptoms including shakiness, dizziness, increased heart rate, headache, anxiety, and sweating. These are not severe and typically go away quickly and on their own. The benefit of injecting epinephrine always outweighs potential risks. In summary, this medicine can be lifesaving. If you suspect your child is having anaphylaxis, give epinephrine immediately and as directed.

Question: If my child has an allergic reaction to a food, when should I give them epinephrine? Should I give BENADRYL® first?

Dr. James: If you suspect your child is having a serious allergic reaction after they eat their food allergen, your first step should always be to give epinephrine immediately. Then call 911. Only epinephrine can stop anaphylaxis. This is your child’s first line of defense when this type of reaction occurs.

Antihistamines like BENADRYL® and ZYRTEC® cannot stop anaphylaxis, so you should never use these medicines in place of epinephrine. Antihistamines are not appropriate for treating anaphylaxis and are not proper substitutes for epinephrine during a severe allergic reaction. Antihistamines do not reverse swelling of the airways or raise low blood pressure. They can help relieve some allergy symptoms but work slowly and do not adequately manage anaphylaxis symptoms. You certainly can give antihistamines after giving epinephrine to help in the overall management of allergy symptoms. There are no adverse interactions between these two medicines.

Question: Should I give my child epinephrine if they accidently ate their food allergen but aren't having symptoms of an allergic reaction?

Dr. James: This is an excellent question that should be decided on for your child between you and your doctor. Your child’s history of prior serious allergic reactions to foods, such as peanuts, tree nuts, eggs, and cow’s milk, is critical here. In some instances, it may be very helpful to treat with epinephrine even if anaphylaxis is not yet occurring, such as when anaphylaxis is likely to develop after an exposure or when it may be hard to tell by the observer (such as a school nurse, health aide, etc.).

A food allergy Anaphylaxis Action Plan has options that your doctor can choose to address these possibilities. There may be times when your doctor may recommend that you give epinephrine immediately after a definite food allergen ingestion before symptoms occur because severe reactions can occur suddenly without major warning signs.

For example, if your child has a history of a very severe anaphylaxis, such as respiratory distress, hypoxia (low oxygen in the blood), low blood pressure, or neurologic compromise after exposure to specific food allergens, your doctor may recommend that you give epinephrine immediately after your child accidentally eats their food allergen before symptoms develop because severe reactions can progress rapidly.

Other examples would include a child who has a history of repeated anaphylaxis with exposure to a specific food allergen or a child with a history of major reactions to very small amounts to a food allergen. All these issues need to be considered when writing an Anaphylaxis Action Plan for family, other caregivers, school personnel, and others.

Question: What is the best way to inject epinephrine? Do I inject it into the arm or thigh?

Dr. James: Below are instructions for using most epinephrine auto-injector devices. Instructions may vary depending on the brand.

1. Take the epinephrine auto-injector out of its package/carrier.
   
   
2. Remove the safety cap.
   
   
3. Hold the auto-injector in your fist. Do not hold your hand or thumb over the ends of the device. This could lead to an accidental needle stick.
   
   
4. Hold the leg of a young child firmly in place before and during the injection.
   
   
5. Push the end with the needle firmly against the outer side of your child's thigh, about halfway between the hip and knee. After you feel or hear a click from the auto-injector, hold it in place for 3 seconds.
   
   
6. You can give the injection through clothes or on bare skin.
   
   
7. A protective shield will cover the needle when it is pulled out of the thigh.
   
   
8. Call 911. The child treated with epinephrine should be taken to a hospital emergency room for further observation and treatment.
   
   
9. Give the used auto-injector to the EMS or hospital staff for disposal.
   
   

Question: Do I need to take my child to the emergency room after I give them epinephrine? Why? Is it because of the epinephrine or the allergic reaction?

Dr. James: Severe allergic reactions (anaphylaxis) should receive emergency medical treatment. This starts with using your epinephrine immediately and then getting medical care (e.g., call 911). It is generally recommended that if someone experiences anaphylaxis, they go to a hospital emergency room for observation and treatment for several hours. This is not because of the epinephrine, but because the allergic reaction requires further monitoring. Many people need more than one dose of epinephrine or other emergency treatments.

There can be delayed allergic reactions (a second wave of serious symptoms called a “biphasic reaction”) several hours after the first symptoms. These symptoms can be appropriately managed in an emergency room.

John M. James, MD, is a board-certified allergist. He is a medical specialist and spokesperson for the Asthma and Allergy Foundation of America. He is also President of Food Allergy Consulting and Education Services, LLC. He has worked as a medical specialist in the field of allergy, asthma, and immunology for over 30 years. Dr. James received his bachelor’s degree from the University of Arkansas and his Doctor of Medicine degree from the University of Tennessee. Dr. James completed his allergy and immunology fellowship at Johns Hopkins Hospital in Baltimore, Maryland, and he is board certified by the American Board of Allergy and Immunology.