Holidays with Food Allergies (Recording)

This webinar was recorded on November 14, 2023

Anxiety around managing food allergies is a year-round concern, but it can increase as we approach the winter holidays. Learn how to navigate the holiday season safely with food allergies.

Speaker:

Michael Pistiner, MD, MSC

Michael Pistiner, MD, MSc is Director of Food Allergy Advocacy, Education and Prevention for the Mass General Hospital for Children, Food Allergy Center. He has a special interest in food allergy and anaphylaxis education and advocacy, infant food allergy management, healthcare provider education, facilitating collaborations between the medical home and school health, and maintaining quality of life in children (and their families) with food allergies.

Dr. Pistiner is a fellow in the American Academy of Pediatrics (AAP), where he is a member of the Section on Allergy and Immunology Executive Committee, Council on School Health and the Massachusetts Chapter of the AAP. He is also a member of the American Academy of Allergy Asthma & Immunology and the American College of Allergy, Asthma and Immunology.

Additionally, he serves on the medical advisory board of Asthma & Allergy Foundation of America, New England Chapter and is a voluntary consultant for the Massachusetts Department of Public Health School Health Service Unit. He is author of “Everyday Cool With Food Allergies”, co-author of the “Living Confidently With Food Allergy” handbook, and co-founder and content creator of AllergyHome.org.

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Transcript: While this transcript is believed to be accurate, errors sometimes occur. It remains your responsibility to evaluate the accuracy and completeness of the information in this transcript. This transcript is not intended to substitute for professional medical advice.

Lynda Mitchell: hi, everyone. Thanks for joining us. We are getting started in just a few minutes. We are going to allow people to filter in to the Zoom webinar. We will go ahead and get started. Thank you for joining us this afternoon. Hello. I’m Lynda Mitchell, CEO of asthma and allergy network. We are here with a real treat today with Dr. Michael Pistiner as today’s presenter. Dr. Mike and I have worked together in the past on allergy-related topics. I’m a food allergy mom myself, so I’m looking forward to this. This should be fun as well as educational. We have a few housekeeping items before we get started today. First, all participants will be unmute for the webinar. We will be recording today’s webinar. It is actually already recording, and we will post the link to the recording on our website within a few days. You will find all our recorded webinars on our website. Just scroll down on the bottom of the homepage and you will see a list of current and most recent webinars along with a link to prior recordings. This webinar will be one hour in length, and that includes time for questions, so keep adding your questions so we can answer them as we go along. We will take those questions, but you can put them in at any time. The Q&A box is at the bottom of your screen. We have someone monitoring the chat at the Q&A, so if you need help, just let us know and we will get to as many questions as we can before we conclude today’s webinar. We will not be offering continuing education credits for this webinar, but a few days after the webinar, you will receive information from us with supplemental information as well as a link to download certificates for your records. We will also try adding a link to the certificate in the chat today. Sometimes it works, sometimes it does not. So let’s get started. Today’s topic is Holidays with Food Allergies. Anxieties about food allergies is a year-round concern, but it can increase as we approach the holidays. Learn how to navigate this holiday season safely. We hope this will help you find the safest and lowest stress options to navigate these sometimes stressful situations, if you are a caregiver of someone with food allergies, a patient who has food allergies, school nurse, or other health care professional. Tis is my pleasure to introduce today’s speaker, Dr. Mike Pi stiner, director of food allergy, education, and prevention. He is a fellow at the American Academy of pediatrics and member of the American Academy of allergy, asthma, and immunology and the American College of allergy, asthma, and immunology. Dr. Mike is also the author of “everyday cool with food allergies,” a children’s book and cofounder of the website allergyhome.org. Thank you, Dr. Mike, for being here today. Let’s get started.

Dr. Pistiner: Thanks for having me.

Lynda: You bet. You want to take this one on food allergy management? I know this is your thing about prevention and emergency preparedness.

Dr. Pistiner: In thinking about any circumstance we want to prepare for, we need to have food allergy management strategies when we are taking care of a kid our — or ourselves at all times and in all circumstances. Holidays are one of those times and circumstances, and food allergy management is two pillars, the pillars of prevention and emergency preparedness. For prevention, we are going to want to ACT to prevent accidental exposures — avoid, communicate, and teach. In order to avoid, we read labels. We understand and prevent cross contact. We communicate with the child who has food allergies, people who are serving them, people they are interacting with. In the case of the holidays, many times It is friends, family, host. We teach. We teach our children, and we wind up teaching the people who sometimes will be serving us food, hosting us, or coming in our homes. As far as the pillar of emergency preparedness, we want to be prepared to R.E.Act, recognize a severe reaction, recognize anaphylaxis, know how and when to administer epinephrine, and to be able to contact 911. We want to have this plan, these food allergy pillars, and take them with us on our holiday vacations and/or when we have our family and friends join us. You are muted, Lynda.

Lynda: Sorry about that. You and I have talked a lot about age appropriate education for children and getting them involved in self-management. Would you like to talk about this and review handouts the American Academy has published recently regarding this?

Dr. Pistiner: Yeah. The participation of our kids in their own food allergy management is going to be an important thing in any of these settings. In the holiday setting, this is going to be where things are a little different than they usually are, when our kids know what their roles are in school or in our own homes. This is standard. This is traditional. Often times on the holidays, things get shaken up a little bit, and we may be at other people’s turf, and the kids are going to have different ability to have different responsibilities, ranging from a little child who is exploring their hands or the environment with their hands and their mounts and putting objects in their mouth 80 times an hour — with their hands and their mouths, and putting objects in their mouth to a teenager who is going to be able to come indicate with people serving them and be able to self manage sometimes even better than us parents can do for them.

Lynda: OK, great. For those of you who might be interested in having access to these handouts, they are free. They are available on the website, but the easiest way to get to it is just type into a Google browser, food allergy ages and stages handouts, and you will find them. They are wonderful little handouts that I encourage you to take a look at and are available in Spanish.

Dr. Pistiner: They will reinforce those pillars. They get at the prevention and emergency preparedness and will be targeted for the age group of the child who you have, and so, hopefully, those will be really helpful.

Lynda: They will be good for school nurses, too, don’t you think?

Dr. Pistiner: certainly, yeah.

Lynda: OK, we can move to the next slide. Now we are going to talk about different things we can do to keep children safe or yourselves — or ourselves safe. Cross contact is a big issue. What exactly is cross contact, and how can we be careful about cross contact?

Dr. Pistiner: Cross contact is when unexpected allergy makes it into the food that should not have the allergen in it. This could be something that happens with transfer from an object, so if a serving spoon was in the mashed potatoes, and the mashed potatoes have dairy in them, and then that serving spoon goes into the cauliflower, now the cauliflower may have some dairy in it. That is an example of some cross contact. A peanut butter knife that goes in the jelly jar. Those are physical. Those are utensils that ultimately have allergen on the. Other sources of cross contact also can be splatter. If food is prepared and splatters on food next to it, if multiple dishes are put in the oven to heat up and something drizzled on something else. Those could be examples of cross contact. Hands and saliva could also have cross contact. If I am preparing something, and I have dairy in my hands or some sort of nut product, and then I just wipe them off and move onto the next thing, I may also have allergen and transfer it that way. Saliva can also have it. This is going to come into play when we have children visiting other children and lots of little kids who are putting lots of things like Sophie the giraffe in their mouth and then another little kid goes and puts the same object in their mouth. If they just ate allergen, that is something that can cause cross contact. The phase — buffets, which sometimes are quite popular at the holiday tables. This is where one utensil used in one dish goes to the next and can transfer allergen. Each family is going to have different issues when we are celebrating our holidays, and every family has kind of different styles of serving and preparing food, and so we were talking a little bit about this in the past. What have you done when you have an hosted — been posted as far as trying to prevent cross contact?

Lynda: I try to bring some safe dishes so I know someone can eat something in case the rest of it was not safe. Also, I have them go first on the buffet line so everything is untouched and he can get his safe meal and he went on to eat while everyone else went on through the line. That is how I try to avoid cross contact. The other thing I will add is cross contact can happen in manufacture and production lines. Do you want to talk about that?

Dr. Pistiner: That pulls us back a little bit to label reading. With label reading, when we see those cautionary statements, those cautionary statements, each family will be a little different the way they roll as far as if they include or exclude. That will be something that the allergist and/or a health care team will work through with the family. There’s going to be some kids who can eat baked-in egg, and they will have different things that they need to include or exclude, but the cautionary statements we see on a label, which then imply that there could be in a manufacturing potential allergen that gets in that. Some studies have been done, and one specific to nuts show that there was a 7% chance that when there was a cautionary statement for peanut, that there was detectable peanut. In some of the cases, it was not necessarily high enough to cause an allergic reaction. In sum, it was. Ultimately, if there is uncertainty of if the person you are serving or if a person with an allergy needs to avoid cautionary statement for that food entirely, if there is a cautionary statement, avoiding is the safest thing to do. The language has also been looked at, so it does not seem to with it bring actual risk in different language. For example, if it says “may contain traces of,” it did not necessarily have prior testable quantities than the ones that said “produced in a facility” because the FDA does not regulate the use of this terminology. Currently, as things stand, you cannot necessarily look at that thing and determine if once you have a cautionary statement it is risky or not.

Lynda: Thank you for that. It is more complicated than before when we used to say avoid everything, but now it is more nuanced. Wendy mentioned shared drinks. People drinking out of the same cups or straws. That’s a really good thing to keep in mind. I know we will talk about this later with pets, but do you want to mention the pet food thing?

Dr. Pistiner: There’s also if a pet eats food like a peanut treat and then switches the kid, that kid may have skin contact and also oral exposure if they are looking right in the kid’s face, so be careful about some of those things that a child with a food allergy may come in contact with. And if we have infants and toddlers who may eat directly from the pet’s bowl, they may be eating the pet food themselves, so not only is it gross, but it can cause an allergic reaction. They say that in about 40% of dog food, those are things to keep in mind. Pet food can have fish, so these are things to be somewhat cognizant and thinking about. Other things to think about cross contact would be — you know, everybody likes a good kazoo. Musical instruments are sometimes some time — something to crack down on the holidays. Once your kids are passing around — I’m forgetting the name of the thing that causes horrible noises. Any blowing type musical instrument would be something you would want to be thinking about if your kid is one of many and everybody just ate.

Lynda: Lastly, you brought up the dog kissing a kid, but how about grandma or aunt so-and-so kissing a child after having consumed food with allergens in it?

Dr. Pistiner: Skin does a good job keeping allergen out, so getting a kiss on the cheek could cause local rash or hives if you get a good amount of allergen on their in 30% or 40% of the time. The issue then would be if the kid rubs it off and puts their hand in their mouth. The issue also is that if grandma open mouth kisses the kid, we are going to have many problems, but skin does a good job, so if a kid gets a kiss on the cheek, they can wipe it off.

Lynda: Thank you. OK, let’s move onto the next slide. Reading food labels. You touched on that, but I would like to take it from here to go over to — go over the top nine food allergens and label laws.

Dr. Pistiner: Relatively recently, Sesame was added. We went from the top eight to the top nine. Peanuts, tree nuts, wheat, dairy, fish, eggs, shellfish, soy, sesame are the major food allergens. On a label, when one of these allergens is included in an item , if it is in flavoring or spices, it has to be in plain language and it has to be on the label. This is new for Sesame. One thing that happened when Sesame was added was some manufacturers started adding genuine Sesame to new items that never had Sesame before. So anybody who is going to be reading labels for Sesame is going to need to be cognizant of this. If it says Sesame on the label, then these days, that means business, so you are going to want to avoid it, just like you would with any other major eight. For all the other major nine, if you see the allergen on the label, taking it seriously and avoiding it is the way to go. Adding labels is going to be the key to label reading. When you are being hosted by others, sometimes you may not have access to the labels. I would then advise avoiding items that you did not get to know were read by somebody that knows how to read labels. Label reading is not the easiest thing. If you have relatives or friends who are willing to learn, being able to train them how to read a label, you can rely on that, especially if you know that they know what they are doing. Sometimes when we visit others, we have to be going to other homes where they have a kid with a food allergy, and label reading is something they are good at. Sometimes when we visit others, they don’t have time to necessarily know. They may ask you questions that let you know that they may not really be familiar with what is going on, and then you are not going to want to rely on them. Being able to get the label yourself is going to be important, but then as Lynda and I talked about, if the food was already plated, cross contact is still something that could have happened, so being able to actually get to the item when it comes straight out of the package is going to be really helpful, and being able to potentially be part of choosing, purchasing, serving is going to be the safest.

Lynda: OK, great. There’s a lot of convenience options where you can get a hold Thanksgiving dinner — and hold Thanksgiving dinner from an Italian gourmet shop or even just a grocery store — you can get a whole Thanksgiving dinner. Talk about labeling laws and how that does or does not impact what you will find in that.

Dr. Pistiner: It is important to be able to know that the label of each of the ingredients is accessible. If someone were to cook a dish that has six things that go in that dish, we will need to have access to or the chef will need to know that each of those dishes that go into the larger dish, all labels will ultimately need to be looked at in order to know that whatever the kid is eating does not have allergen in it. This is potentially tough if someone else is preparing the food. Oftentimes, especially if — and this is going to come up later — if the food allergy is not necessarily discussed at the time of food prep. It can be really challenging to make sure that each of those micro ingredients is safe and that no cross contact occurred while putting them together and preparing the food. This is where farming it out from another place can be tricky . Sometimes if someone were to go to a grocery store that has some of the buffets that then have the labeling, that you still can have the issue of cross contact, and sometimes it is hard to keep those labels accurate.

Lynda: Also, the labeling law does not apply to meals ready-to-eat and take-out food. Stores might put the labels, the ingredients on them, but they may not, and that is not a violation of the law. There’s loopholes in the labeling law. It has certainly improved from what it used to be, but be cautious about stuff like that as well. Let’s see. I think we had a question. Let me back up for just a minute. Let’s see. Going back to the previous slide , is there a determined timeframe where the allergen remains in saliva?

Dr. Pistiner: There was a cool study done looking specifically at peanut. They did different things to try to decrease the amount of salivary peanut. Grown-ups eight peanut product and then did testing to see if there was detectable peanut in the saliva after they did several things like toothbrushing, mouth washing. Toothbrushing did not take it down to undetectable. Mouth washing did not take it down to undetectable. Reading several hours later and having a peanut-free meal did. That has been the recommendation and guidance that people have been given.

Lynda: Thank you very much. We are going to move on to dealing with relatives, well-meaning relatives who don’t understand food allergies or have traditions that they don’t want to change because of food allergies. Can you talk about that?

Dr. Pistiner: Yeah, so the well-meaning and enthusiastic. Sometimes people put a lot of love in their food, and sometimes it can also include allergens. Even if somebody tries really hard, if they don’t know what they are doing, it may not be safe, and sometimes some people can take offense, and some people really like it when kids really enjoy eating their muffins or cookies or what have you. So this is where having some conversations, especially in the older kids who kind of are starting to have an awareness — this will be conversations with many different people, one of which being the kid. And understanding that, you know, someone is trying really hard, that they really care about them, but at the same time, giving the child the opportunity to say no, thank you. While everybody wants to be a pleaser, you cannot be a pleaser when it comes to food when you have a food allergy. So practicing saying no, thank you, and also letting the kids know which of the grown-ups are OK to give food to the child to eat, and so in some circumstances, especially, like, some folks on the holidays where you have two dozen people there and lots of relatives all over the place, and having the point people for the people who can say which food is OK and which food is not OK — I would probably actually say which food is OK, so this way, no one is going to eat something otherwise without it truly being vetted, but if aunt Millie comes at a kid with a muffin, than the kid should know that mom and dad and grandpa Joe — they are the only people who can tell me that this is OK or not. So I’m going to bring them over and have a conversation with Aunt Millie. That is going to be where you don’t want to take a chance. After some understanding or some teaching, I think that most of us have relatives and friends that would be reasonable enough not to take offense.

Lynda: Yeah, that’s true. There’s certain cultural situations where they are going to get hurt feelings no matter what. How do you navigate that? I know you’ve got to stay firm.

Dr. Pistiner: Explaining that it’s nothing personal. Explaining that these are the rules we always follow and we need to have a label. Thank you so much for doing this for us, and I’ll eat it, but not my kid, and so there may be all different ways to kind of approach it. Maybe the sibling without a food allergy could get a double serving. These would be ways you want to navigate that with your own family. Throw in some humor, making it not personal, and certainly being careful not to be snippy or express disappointment, especially if they tried and then got it wrong. I have been in situations where hosts have tried so hard, and then there’s just one slip up that made that meal something that could not be eaten, and, man, as much as it is tough on the kid, it is really tough on the host who now feels terrible, so being able to be gracious about that, and this also builds a little bit of resilience in our kids and being able to kind of figure out and problem solve and find stuff that they can eat. And if there is not much that they can, then reward them for their patience and amazingness later.

Lynda: Exactly. Bringing along something as a backup plan can always be an option so you are not completely relying on the host. That can take some pressure off of the situation. OK. I think we can move onto the next slide. Thank you. Working with your host. I have had great success working with hosts over the years where I have gone to stay at my sister’s house and she understands the severity of the situation but also does not feel 100% comfortable cooking. So I am able to get together with her ahead of time and say we want to use this kind of chicken stock, this brand, this kind of something, this kind of something, and so I guide her into what ingredients to buy, and usually I get there and help her prepare it. That is kind of how I have been working at all these years. Why don’t we hear what you had to say about it in terms of ideas for how to approach it?

Dr. Pistiner: A little different based on the relative over the host that we are visiting. In some cases, them actually creating and serving and preparing all of the food works out. I have been in some circumstances where they have tried to make all of the food allergen-free. I have also been in circumstances where we brought the food that my son was going to consume and then we put it in a particular place where it would not have any cross contact with any of the other food. Then we participated in getting the utensils to serve the food, so this way we knew that the food would be safe for him, but we brought it ourselves and then actually would heat it up at the host’s house, so this way, it was essentially freshly served and not all that boring.

Lynda: I think your point about having a contingency plan is a good one. I think that kind — I think I referenced that about bringing something along just in case. Do you want to comment on that a little bit?

Dr. Pistiner: Beyond the holidays, and I think we will get into some of this, especially around traveling with the holidays, but having backup food if you are going to be in a situation or circumstance for a while and not have access to food that you know is OK, then being totally hangry is no fun, so having something that troubles easily with you, like beef jerky, like rice cakes, like potato chips. Those will be things that can be useful to hold you over if you are stuck in the airport, if you wind up at that host’s house and they truly have nothing because the walnut stuffing touched everything. Having some backup can be really useful. Agreed. OK, any other thoughts about this? I guess we are going to go over to pets. What about a host’s pets? There’s pet allergies, but also the pet food we kind of touched on. Do you want to talk a little bit about that?

Dr. Pistiner: As far as the food allergen in pet food, we got the peanut treats that dogs munch on, egg, sometimes dairy in some of the food animals will be eating. Potentially fish in some of the food animals eat, too. This picture actually has a nice demo of one of the things we need to be thinking about, which is if the pet just ate that food and some are just, now we have skin exposure — if the pet just ate that food and smooches the kid, now we have skin exposure. In younger kids who are crawling around on the floor and happen upon the dog food and eat it, then that is going to obviously be an issue if it has allergen in it. Another thing is that many of the people who have food allergies also have environmental allergies, including pet allergies. If you are crashing at your relatives’ house, and they have cats or dogs, and someone in your family is allergic to cats or dogs, that can be tricky. In those cases, bringing your own pillow is nice. Bringing an inflatable mattress. Not having the kid lay down on the mattress that the dog or the cat likes to hang out on — those will all be really useful. The allergist may work with you or your primary care doctor may work with you for certain antihistamines or medication you can use prior to visiting, so this way, you can visit and have a good time. There are some kids who are exquisitely allergic and may have asthma exacerbations if they sleep over. In that case, making sure you have a hotel room that is close enough to hang over and have fun and then get out and taking asthma medicines and staying on the maintenance medicine and having the reliever medicine available if needed.

Lynda: Great. OK. I guess we can move on to the next slide. Here you are — be the host. That is another alternative for holidays. Do you want to talk about that? I can talk about my experience.

Dr. Pistiner: Yeah, I mean, you have control. That way, when you are the host, you really can prepare any of the dishes that would be the routine for serving the child with a food allergy. You also can invite other people to bring food, so now is it’s almost the flip. If other people are serving or preparing food outside of your house, you don’t necessarily know that that dish is going to be safe, so you at least have all of the safe dishes, including the primary ingredients so you can whip something up for anybody in your own home, and then if you want your guests to supplement, they can. Just again, remember and be cognizant of cross contact. Many of you, when you are going to host other people and you are bringing their food, your kid or your family, who is used to just sticking the spoon in whatever cannot do that if you are going to allow the outside food in, so it will still be safe, but you will have to be thinking about cross contact and again, label reading, if you are allowing other people to bring food in.

Lynda: Yeah. Agree with that. My son is 33 now and still anaphylactic to milk, even small amounts. A long time ago, I said I will just make Thanksgiving, so I can make a completely milk-free Thanksgiving, including pumpkin pie, but my family likes to bring something, so I tell them to bring a dessert. I put that milk free pumpkin pie on the counter first and let him take his piece of pumpkin pie, and then the rest of the desserts come out and everybody goes to town on whatever else is left. That way, anybody who wants to bring something can still bring something, but it is at the end of the meal and they can bring out whatever they brought after my son has what he has that is safe for him. I kind of do it where you can have your cake and eat it, too, so to speak. I had it that way. Nobody in my family knows that everything is milk-free. You cannot tell.

Dr. Pistiner: They stop coming.

Lynda: Free meal at my house? My family will be there. That is how I have handled it all these years. You can accumulate some really wonderful recipes that are free of the allergens that you need to avoid for the most part, and so just keep an eye out for those and use safe substitutes in order to make what you need to, and sometimes you just need to create new traditions with food so that if the foods that you traditionally brought and served for a holiday just need to be retired and something else that is safe that your whole family can enjoy and replace it. That is sort of how I have navigated that all these years. It seems to have worked out well. They are all going to show up next week again for me to cook everything for them.

Dr. Pistiner: What I also like is especially if someone is coming and they have dietary restrictions, we can shower them with care, and it is nice to be able to take care of somebody like you want to be taken care of. That is one of the cool things I also like about hosting.

Lynda: Yeah, that’s true, and we get the whole food allergy cross contact thing, so I also have to make something free of another allergen because of the guests coming to my house, I know how to do that. I have to look around for safe substitutes for, say, egg or something, but I can do that. I know how to do that, so it all works out. But you’re right, it is kind of safe haven for someone who has food allergies.

Dr. Pistiner: What’s interesting is it also gives me perspective when that happens. When I have someone visiting my home who has an allergy different from my kids, it makes me — I feel a little nervous. I want to make sure I’m not going to make a mistake. I make sure I’m not just for getting and grabbing the same thing I would normally, and it would be really poor form if you come to a pediatric allergist’s house, and he gives you cross contact with allergen. It is like a high-stakes game if I’m posting somebody with an allergy. I cannot get it wrong.

Lynda: The pressure would be on you.

Dr. Pistiner: Oh, it’s intense.

Lynda: I remember I was invited to someone’s house when my son was maybe 15 or so, and she said please bring your son. I will do this. She spent excessive care getting everything milk-free for him, but afterwards, she said I don’t think I’m going to have your son over anymore because it was just too stressful. And I can understand that. It would be stressful, like you said, if you were to have someone over to your home, and it would be a little bit for me, too. I know I could do it, but I would have to really stay focused so that I did not slip, like you were saying.

Dr. Pistiner: There’s also levels of hosting. The level I’m talking about is me totally making a dish for someone with an allergy visiting my home that is not one of the ones that we deal with, right? I could do it, and my training and my skills — like most parents of kids with food allergies — make it so I can do it safely. My level of stress might be a little higher because it’s not something I’m used to. The next phase might be something like simpler dishes, like I know how to boil pasta. I’m pretty good at it. And we can make an easy dish that has simple ingredients, and that makes it even easier. The easiest thing I can do is purchase premade food that is sealed with a label and serve that to my guest or if they could bring their own, but any level of this type of ability to host someone could and should be appreciated by the person with the food allergy. I think one of the things we have not had a chance yet to talk about is with holidays naturally comes emphasis on food, but one of the things I think is really helpful is deemphasizing food and really emphasizing family, runs, togetherness, experiences. So these are things where what we were talking about before was traveling with your backup food. You just have to be able to keep your calories up so you can have all the fun you can. It is not a big focus on the food. Being able to make it so there is going to be that comfort and that one is ultimately what I think is a great goal, as opposed to a fabulous, yummy holiday dinner. That would be really cool, but sometimes that’s not going to happen.

Lynda: That’s a really good point. Deemphasize the food. OK, go to the next slide. It kind of is a good lead-in for this slide. Is it OK to create new traditions? Why don’t you take that one.

Dr. Pistiner: I think that springboard off of what we were talking about. One family might like to make gingerbread houses with frosting that seals the corners together. You may be able to and you can figure out new, non-food-driven experiences that can celebrate the holiday and celebrate with your family but not necessarily focus on the food or the eating part.

Lynda: Yeah, and sometimes that takes some creativity and thinking, but there’s a lot of suggestions out there now. Yeah, just getting out of the house, doing something else.

Dr. Pistiner: Family walk.

Lynda: Yeah. Yeah. All kinds of things. Great. Thank you very much. Let’s go to the next slide. Finding safe food during holiday travel. You want to talk about airplanes, grocery stores in strange locations, hotels with kitchens, and travel coolers?

Dr. Pistiner: As far as holidays, just brings us back to travel in general also and back to those pillars of food allergy management, prevention, and emergency preparedness. Wherever you are, you will need these. If you are on that car ride, in the airport, on the airplane. This is going to be where having some backup food and food that you will be able to know you can eat when you are in your transition of your travel. For example, you go to get on the highway. You are driving to a relative way out west. There is a gas station. You guys got stuck in traffic, and now everybody is starving. A bag of chips may be something that can be pulled off. Getting that hot dog that was sitting on the roasting thing that was just sitting there for three years and there’s no label would be a bad idea, so being able to think about what you would do, but that’s where preparedness comes in super handy, and I think that, Lynda, you were telling me in your past experiences, you would sometimes have cooler and have stuff for travel.

Lynda: Yeah, used to carry a little cooler with all kinds of snacks. I made it kind of a conversation with my son. “What would you like to take on the plane?” So he was OK with the fact that that was how he would eat. This was way back when they used to serve food on airplanes and meals and things like that. It made him have some choices so that he felt comfortable about what he would bring. I remember one time I had an eight-hour drive across the state of Pennsylvania, and I was looking for a place, and certain parts inside the state are pretty rural. I did not find any place to stop that I was comfortable at, so I ended up driving eight hours, getting in the house and then having to cook dinner because there was just no safe options for him. But I did not take any chances because it wasn’t worth it.

Dr. Pistiner: That’s where some preplanning is nice, especially with the holidays. Some Thanksgiving traffic can be brutal and you can get trapped in the car for a long time. That’s where having a little bit of car food can go a long way. Then if you are already late for the dinner and your kid is hangry and you show up at your relatives’ and screening food to make sure it is safe, that is the perfect storm. That is where being repaired — and if you are trapped in the car, you might as well have that conversation before you arrive. I’m hoping that you are having that conversation well before you have arrived, even when the purchasing of ingredients is happening, but this way, coming out of the car hangry, that would be the most challenging circumstance. By the way, if you are then finding hotels or Airbnb’s near relatives or wherever you are traveling to, sometimes finding some of the places that actually have a kitchen or nice — are nice. If your kid has multiple allergies, then you are able to actually not necessarily have to rely on restaurants other than your host for all the other meals and being able to have your own food to prepare or serve is nice. But then, just getting a refrigerator will also then allow you to bring perishable items and be able to have that in the morning or whatever.

Lynda: Yeah, I used to stay at residence Inns and places that have a kitchen. It was lower stress at times. One thing I want to mention about grocery stores is that if you go, especially from the East Coast to the West Coast, different manufacturing plants might be producing the food and even though it looks like the same brand and the same product, you should really check the labels because they may be made slightly differently in a production facility that is in a different part of the country. Again, label reading is something you do every time. I just want to reinforce that, especially if you are going outside your local area where the labeling might be a little different because of the food being produced in a different manufacturing facility. Do you want to comment on that at all?

Dr. Pistiner: Yes. Agreed. International travel is going to make getting to know the labeling and labeling laws even more important.

Lynda: Yeah, absolutely. Travel coolers are great. You can plug them in and they keep things cool for quite a while, so I use those as well. So, good. I think we are close to the end. Going to try the next slide. You want to talk about school celebrations?

Dr. Pistiner: Yeah, so lots of celebrations anywhere, not just school, have been traditionally food-centered. The easiest thing in a school, especially for the school nurses out there, is to try to encourage celebrations to be non-food. That makes it really easy — pencils, stickers, activity books, fun, games, songs. These are all really going to probably take the stress out of the classroom, out of the teacher, and be able to not have to worry about allergens, but traditionally, people have used food for celebrations, and so if that is going to happen, fresh fruits may be a great way to celebrate if you have to have food, and then items with labels, and if there is going to be some sort of — especially if it is going to be any activity, avoiding food-related activities that are part of the curriculum or part of any learning is going to be really important because that could exclude a child with a food allergy from something that will be considered a learning experience in school. If possible, avoiding the allergen during the celebration is a nice way to be inclusive, and again, as I was mentioning, food-free celebrations are really what I would recommend. And then also, just in general, a nice, healthy way to approach, because there are many potential celebrations in the school year, and there’s a lot of unhealthy treats and snacks fed to the children, so, you know, this is a good way to also support healthy habits.

Lynda: That’s great. We did have one question. Is there any kind of certain cleaners or whatever that can be used to clean off surfaces in the classroom or in the home so the allergen can be removed? Can you also comment on hand sanitizers?

Dr. Pistiner: There was a study looking at different methods of cleaning for allergen. Standard soap and water with a white — white — with a wipe work. You don’t need bleach. You don’t need Lysol. Those are great things to kill viruses and bacteria, but just like Purell. Hand sanitizer designates and drives. A really good at killing viruses and bacteria, but if you just take your alcohol and put it on allergen, it will still be there. You are going to need something that is going to mechanically move it away, so that is where wet wipes, soap and water with a dishrag, not to be used again after cleaning the allergen, disposable wipes — careful with sponges because if you clean something with a sponge and then you go and clean another plate after you just cleaned up the milk, that is going to transfer milk protein, so this is going to be where using disposable things is going to be important if you are going to then be cleaning allergen.

Lynda: Very true. I don’t know if this is completely in the lane, but stickers, do they still have gluten in them?

Dr. Pistiner: I have not heard of gluten being in stickers. I hope that when we give stickers to children, they are old enough developmentally that they are not eating the stickers, licking the stickers, or putting the stickers in their mouth. I have not heard of a problem with stickers. I have seen small babies put stickers in their mouth, and that is a Choque risk, but from a gluten perspective, that has not been something that I’m aware of.

Lynda: Is there anything else we need to do in terms of school celebrations? My son was a light younger. I mean, like, inclusion right now, people are so much more compassionate about inclusion and making sure children are not left out. I’m sure with regard to food allergies that there is still a long way to go, but I just remember my son saying I have always had — my son’s teacher saying I have always had an ice cream soda party at the end of the year, and I’m not going to stop because of your son.

Dr. Pistiner: Spring boarding off of what you were just saying, a final thought would be where — you know, I’m talking about non-food calibration. That’s the easiest and the best. Sometimes, some school nurses are going to be in a school where there is a policy that you don’t necessarily have the opportunity to change, and if food is being served, then what you can do is give the family of the kid with a food allergy a heads up. They will always appreciate it. Nobody likes hearing or getting a letter sent home with the kid that today there was a celebration and they did not have anything to eat or they just wanted to give you a heads up. If you can preemptively say holiday celebration is coming up in two weeks, can you please bring items that your child can eat, let’s also talk about it. This way it gives the family a little time to prepare. Obviously, it is it’s best if there will not be that situation or if there has to be and you have no control, then I would say giving the family a heads up and working with them to plan.

Lynda: Great. There’s about three minutes left. I’m going to ask one more question and if you could just answer quickly and we will move on. Do allergens stay on hand washed and air dried dishes or dishes washed in the dishwasher?

Dr. Pistiner: The mechanical movement of allergen away is going to be very effective. Let’s pretend you take a plate, and it’s got, like, those grime and old crusty food on it. Not only is that disgusting, but that’s possibly allergen. That’s going to be something that you are not going to want to serve somebody within allergen, but when the plates and dishes and utensils go clean in the dishwasher, you are good to go.

Lynda: Thank you for that. I think we are going to go ahead and talk about our next webinar. We will be talking about — this is another Dr. Mike topic, but we will have another speaker. It is emergency planning for children with asthma and anaphylaxis. We are going to have to follow up with you on something like that, like babies with anaphylaxis. I know that is a passion project for you, Dr. Mike. Dr.

Pistiner: That’s my jam.

Lynda: Emergency planning for children with asthma and anaphylaxis will be on November 29, and we will have a speaker for that one. The following webinar — if you can go to the next slide — is

COVID, flu, RSV: How to stay healthy this winter. We will be making sure we all know how to stay as healthy as we can this winter. I think that might be our last slide, but let’s take a look and see. Yep, it is. Thank you for joining us. Dr. Mike, always fun to work with you. Hopefully we will get to do that again some time very soon and we will just go ahead and let everybody get on their way today. It is 4:59. We are ending about one minute late. Again, thank you for joining us. I hope you learned some stuff. The link to that bunch of handouts was put in the chat, and if you still need it, just email us and we will get that to you. You will see a follow-up email in about 2, 3 days with some links to other resources as well as information about the upcoming next webinar. Thank you for joining us. I really appreciate your time today. Thank you, Dr. Mike. Have a good day, everybody.

Dr. Pistiner: Happy Holidays.

Lynda: You, too.