The Costco Perspective

Sometimes I like to take a step back from the daily grind and focus on the "big picture."  It only seems appropriate that my trip to an uber-sized warehouse store could help with this "big picture" endeavor.  As the New Year has come and gone, it's good to periodically put things in perspective and reflect - how far we have come, where we are now, what may lie ahead in this allergy journey.

The start of the allergy journey was a bit like my arrival at Costco -

I make sure I've got my shopping bags, hop out of the car, turn to press the button on the remote to lock the doors, and begin my stroll to the store entrance.  I clear the back end of my car, and... holy bleepety, bleep, bleep, bleep.  I almost get bowled over by the white Suburban with fancy silver rims on a mission to get that coveted parking spot next to the store entrance.  Geesh.  I didn't see that one coming.  An inocuous day like every other can completely change things (thankfully I didn't get run over).  The day that my son had his first anaphylactic reaction certainly changed life in ways I couldn't have imagined.

As the rush of adrenaline subsides, I show my membership card to the petite, smiling gray-haired lady only to be greeted by this:

Holiday ode to theobromine

Molecule of theobromine

When holiday times start getting you down… theobromine.

Pick yourself up with a quick fix… theobromine.

You might just fall in love with this season… theobromine.

Against all odds and all reason… theobromine.

Its botanical origins discovered by our friends to the south… theobromine.

Well before the first Christmas ever existed… theobromine.

Why on earth do we consume such a bitter magical potion… theobromine.

It’s elementary, my dear Crick and dear Watson…

Theobromine, theobromine.  Your magical, mystical powers make my heart sing.  You make me feel good and give my mind focus.  You suppress coughs, relax airways, and tame inflammation. Your pharmacology truly works wonders for me… but only in small doses, you see.

Cocoa beans - Image source:  http://cocoa-beans.org/

Who on earth figured out how to get it?!… theobromine.

The beans of cacao – we collect it, ferment it; we dry it and roast it… theobromine.

But, it’s still not ready for consumption after all that… theobromine.

We grind it and press it, then send it off to make chocolate… theobromine.

Our friends in Europe perfected a most laborious art… theobromine.

Some like it dark, some like it light, some raise a glass for a toast… theobromine.

Give it some sweetness, give it some flavor… theobromine.

The possible culinary combinations seem endless… theobromine.

A final chocolate product.  Darker chocolate = more theobromine.  Image source:  http://en.wikipedia.org/wiki/File:Chocolate.jpg

Theobromine, theobromine.  Your magical, mystical powers make my heart sing.  You make me feel good and give my mind focus.  You suppress coughs, relax airways, and tame inflammation. Your pharmacology truly works wonders for me… but only in small doses, you see.

So holiday times getting you down just a bit?

Endless cooking, and cleaning, and holiday shopping draining your spirit?

Take a short moment, a deep breath, along with two, maybe more, pieces of chocolate.

Close your eyes, soak it in, and thank the Lord for this blessing… theobromine.

• Pronounced \thē-ə-ˈbrō-mēn\

• My favorite allergy-friendly theobromine sources – EnjoyLife, Vermont Nut-Free chocolates, and Hershey’s cocoa powder to make my own concoctions.
• A nice series on the origins and processing of chocolate from Cadbury

If food allergy deaths in food-allergic individuals are rare, do we change our ways?

This is a follow up post to 1 reason I despise science headlines.  It is in response to the recent press-coverage of Incidence of fatal food anaphylaxis in people with food allergy: a systematic review and meta-analysis  published in the journal Clinical and Experimental Allergy.

After a week of thought, I am content that a group of researchers attempted such a risk assessment given the existing literature, i.e. what is the risk to a population of food allergic individuals dying from an allergic reaction to food.  There is a real need for good, hard statistics to put things into perspective.  What I am unsure of is whether this study warranted the press coverage that it has received.  As discussed in my first post, there is a huge range of error surrounding their identified risk of death - 1.81 deaths per million food allergic individuals per year (with a statistical error that gives a 95% chance that the true value falls between 0.94 and 3.45 deaths per million assuming no bias).  However, there are real issues of possible bias, which includes but is not limited to possible medical coding errors surrounding death due to anaphylaxis and pinning down the true prevalence of food allergy.  This at least is a first attempt at systematic review/meta-analysis and certainly warrants more powerful studies to hone in on the true value with better accuracy and precision.  The bottom line is that even with obvious known flaws in their acquired value, it is very unlikely that the risk of food allergic individuals across the food allergic population dying from their food allergy will trump the risk we all face from accidental death.  The number of U.S. deaths due to accidental death is reported as 391 per million per year, according to the CDC.  The study authors certainly have noble intentions of this study reducing the anxiety faced by food allergic individuals or their caregivers.  Senior author, Dr. Robert J. Boyle, a pediatric allergy specialist at Imperial College London is quoted in a New York Times blog, “It’s a matter of not letting food allergy rule your or your child’s life.  The risk is surprisingly low. You still have to take precautions, but I think it’s important to see it in context.”
What I've been grappling with personally is - does this study reduce my anxiety level?  

1 reason I despise science headlines

For a week now, I've been pondering an article I came across in ScienceDaily - Dying from Food Allergy Less Likely Than Being Murdered.  As all good headlines should do, they grab the reader's attention and make you want to read more... MORE!  As a parent of a severely food allergic child, this headline certainly grabbed my attention and elicited a most visceral response - how dare they minimize our daily struggle and fear to prevent a life-threatening reaction (anaphylaxis) by comparing it to something completely unrelated (like murder?!)!  After an eye roll so large that I thought my eyeballs would permanently cramp at the top of their sockets, I opted to let the emotion settle a bit and break this down further.  Clearly, I'm biased, but I needed time to analyze this while recognizing my own biases to see if there is indeed merit to the article and the original peer-reviewed article it is based upon.

Bone marrow transplants to cure food allergies?

Let me get this out of the way from the get-go, bone marrow transplants (BMTs) to cure food allergies are not really a question up for debate - this is NOT a good treatment option for your typical food allergic individual. There I've said it - the disappointing part. More on WHY I say this further in the post where I will discuss exactly what a BMT is. Let's just say the potential life-threatening risks of a BMT (among a few other factors, such as cost) far outweigh the potential benefits of a food allergy cure - even for those of us dealing with the risk of life-threatening anaphylaxis.

So where did this business of BMTs curing food allergies even come from? This week, clinicians presented a case-study at the annual #ACAAI (American College of Asthma Allergy and Immunology) scientific meeting, that a 10-year-old boy with both leukemia and a life-threatening peanut allergy was likely cured of his peanut allergy following a BMT to treat his leukemia (Link to press coverage of the case study) [1]. First off, I cannot even imagine dealing with a life-threatening food allergy and then discovering cancer on top it. Needless to say, this family has endured a lot. The really good news is that as far as I can read in the scientific abstract from the meeting, the boy is cancer-free and peanut-allergy free! Below I am giving you the details that are given in the abstract, which inquiring minds may want to know (Meeting abstracts are published in the 2013 November Supplement to the Annals of Allergy, Asthma and Immunology).