I've been managing my children's life-threatening food allergies for over 13 years, since my youngest was 18 months old. On the one hand, this book was extremely informative; there's a lot of misinformation out there, so it's good to have a reliable go-to source. On the other hand, there are things I wish the book included, but didn't.
First, what I liked. The information was delivered very straightforwardly in question-and-answer format. The book was comprehensive, covering not just allergies but also other food-related conditions like intolerances and sensitivities.
The section on oral food challenges (p. 83-90) and all of chapter 4 on anaphylaxis and epinephrine (p. 98-130) were especially instructive and helpful. In particular, I appreciated that the book was very clear about treating anaphylaxis with epinephrine as the first line of defense, and how other medications (e.g., antihistamines, bronchodilators, and corticosteroids) are supplemental interventions. (p. 118-120)
Chapter 6 on "Mastering Allergen Avoidance" (p. 159-203) was also excellent. I wish EVERYBODY - teachers, parents, family members, employers, all medical professionals - could read this chapter!!
Importantly, when discussing oral immunotherapy (OIT), the book stated unambiguously that "the primary benefit is to increase the threshold of reactions" (p. 268) and "this is a treatment, not a cure." (p. 272) I was relieved to see this information so clearly presented because in my experience, it is very common for people to misunderstand OIT and believe it is a full-fledged cure.
Now, what I wish the book had included. Everything below is going to sound nit-picky, but if there's one thing managing allergies has taught me, it's the importance of being thorough!
For the most part, the Q-and-A format helped make the book approachable. Occasionally, though, I think it broke up a topic unnecessarily. A person skimming the book might read one answer and think it was complete, not realizing additional information is presented under another question. For example, this question and answer appeared on page 32: "If I am allergic to one nut, do I need to avoid all nuts? A person may be allergic to one or two or many nuts. Avoiding all nuts when there is an allergy to just one or two is a personal decision." Reading just this excerpt, a reader might think that the decision is a simple matter of personal preference. It's not until later on the same page that the nuances were described. A separate question asked: "What considerations are important in deciding whether to eat some types of nuts when there are allergies to other types?" The paragraph-long answer to this question pointed out, "Because nuts are often processed together it is difficult to find ones that are not at risk for cross-contact." So, it turns out, the decision involves a deeper understanding of nut manufacturing processes and also a personal risk assessment. Because of this tendency for details regarding a specific issue to be broken up among several questions, I wish some questions were grouped together, with a "main question" serving as a section header, and related questions listed underneath, maybe as bullet points.
Along the same lines, I didn't understand why small pieces of information were separated out in the "Delving Deeper" section on pages 157-158. This section consisted of just 3 paragraphs, one each for addressing questions related to FPIES, eosinophilic esophagitis, and atopic dermatitis. Each topic had a whole section earlier in the same chapter, so why weren't these paragraphs just included in their respective sections?
I was disappointed that the brief section on allergic-like reactions to alcoholic beverages (p. 45-46) did not at all mention the "Asian flush", which was only alluded to in passing under an earlier question about alcohol intolerance. (p. 5) Asians having allergic-like reactions to alcohol is not a true allergy, but it is a well-known issue caused by a deficiency of the enzyme aldehyde dehydrogenase 2 (ALDH2), a condition similar to lactose intolerance, which was examined more closely. (p. 3-5)
Chapter 3, "All about Allergy Tests," was extensive, yet still managed to omit one of my most pressing questions: Can both the skin test and blood tests be positive even when there is no allergy? I actually found it odd that this question was not posed, since the opposite question was asked and answered: "Can both the skin test and blood tests be negative even when there is an allergy?" (p. 77)
I also wish the section on antihistamines (p. 116-119) was more thorough. On page 117, different types/brands were mentioned, e.g. diphenhydramine (Benadryl), cetirizine (Zyrtec), and fexofenadine (Allegra), but loratadine (Claritin) was noticeably absent; why? This section mostly discussed antihistamines as a group, but there's a whole bunch of questions regarding the different types/brands that I frequently see debated, and they were not addressed at all: What's the difference among these options? Does it matter which one you take? Why would a doctor prescribe one over another? Can a person build up tolerance to one type/brand, thereby requiring a switch to another type/brand? Is any particular type/brand recommended for acute allergic reactions vs. on-going maintenance of seasonal/environmental allergies? If one type/brand of antihistamine is routinely used daily for maintenance, will the same type/brand still be effective for an acute reaction? Is it better to use the same type/brand for an acute reaction, or a different type/brand? Is it possible to exceed an allowable daily dose limit if taking a specific type/brand of antihistamine for an acute reaction when the daily maintenance dose of the same medication has already been taken, and if so, is that okay?
On page 189, a question asked, "How does one know when a student is capable of carrying emergency medication?" I especially appreciated that a specific age was NOT given (it really depends on the child), but I was disappointed to see "self-carry" conflated with "self-administer", as the first item on the list said, "They express a desire to carry and self-administer epinephrine." But there are grown adults with a fear of needles who don't "desire" to self-administer! My children were responsible enough to self-carry (they knew EpiPens were not toys and were only to be taken out and used by a parent, teacher, or other supervising adult) years before they were confident or capable enough to self-administer. In fact, on the following page, the answer to a related question about self-treating says, "If your school allows your child to self-carry, be sure to emphasize that this situation does not mitigate the need for an adult to take full responsibility for administering the medication in the event of an emergency" (p. 190); so a child CAN self-carry even if they aren't expected to self-administer, and I wish that distinction was made clearer. Also, parents of newly diagnosed young children might appreciate a few suggestions - perhaps by being directed to "see chapter 11" (see next paragraph) - on HOW epinephrine autoinjectors can be self-carried (e.g., in a SPIbelt or small cross-body bag), as well as tips on how to keep the autoinjectors within the acceptable temperature range (e.g., use an insulated bag for extended time in excessively hot/cold conditions).
Chapter 11 "Accessing Help and Information to Manage Food Allergies" was surprisingly short. I excitedly flipped to this chapter early when the author advised, "Chocolate may be better purchased from specialty manufacturers that cater to people with food allergies (see the resources in chapter 11)" (p. 27), expecting to see a list of allergen-free chocolatiers. Alas, there was none; the singular reference to "Foods Allergen-free specialty manufacturers; local allergy-friendly restaurants and bakeries; cookbooks; recipes" (p. 291) was almost comically unhelpful. I understand why the author would want to avoid any appearance of supporting a for-profit company, but maybe just a little more direction in how to go about finding some of those resources might have been nice. For example, someone dealing with a new diagnosis might appreciate knowing that nut-free ice cream shops, multi-allergen-free bakeries, and nut butters free from cross-contamination by other tree nuts do exist.
Okay, that's it. I know the "what I wish the book said" list is longer than the "what I liked" list, but the book certainly did not have any misinformation, and in terms of volume of information and value added, it was definitely worth the read.
