What is the chain 'Wagamama's' like when catering for allergies?

*Please note that whilst some chains of takeaways and restaurants do have a company-wide policy regarding how to handle allergens it has been brought to my attention that different locations can differ, whilst one location of a particular chain may be great with handling allergies a different location of the same chain may be somewhat clueless. I will be talking about the particular location/s of the chain I have visited and how I have found them. The particular food allergies that I suffer with are anaphylaxis to: peanuts, all tree nuts, crustaceans and molluscs.*

My second review will be that of Wagamama's. I have personal experience with: Glasgow City Centre, Edinburgh Lothian Road and Edinburgh Ocean Terminal. I've eaten many times in their chain and have had the same experiences in every location I've visited and every time I've visited. This blog will be focusing on my latest visit which was on 11th December 2017 at the Glasgow City Centre location. 

As soon as I walked in I alerted the server who sat us that I have several severe food allergies. They asked if gluten was an issue, the reason for this is they have a set menu for people with issues to gluten. I do not have an issue with gluten so they gave me their normal allergy folder along with one of their standard menus so I could compare what I decided on from their normal menu to what was in their allergen folder to see if I could eat it. Their allergen menu is very detailed and has not only if the food contains the allergen but also if the food may contain the allergen, if the food is cooked/prepared where allergenic ingredients are used and if they're able to modify the dish to exclude the allergen.

I was eating out with my boyfriend so we decided on 4 sides to share:

• Pork Belly and Panko Apple Hirata Steamed Buns
• Korean Barbecue Beef and Red Onion Hirata Steamed Buns
• Bang Bang Cauliflower 
• Pulled Pork Steamed Gyoza 

I decided on the Chicken Raisukaree as my main course. 

On checking the allergen folder I was happy to note that none of what was chosen contained, may contain or cooked/prepared in the same area as my allergens (tree nuts, peanuts, crustaceans and molluscs). 

The server came and on explaining I had several allergies he explained that he'd have to call his manager over as only the manager is allowed to take orders that involve any allergens. The manager arrived swiftly and asked what I'd like. He then compared what I'd decided on against the allergy folder to ensure that there would be any problems with what I'd wanted to order. Like myself he found no issues. 

On putting the order through he placed a note beside everything I'd ordered about my 4 allergies so as to alert the kitchen staff and try to limit any potential for cross contamination. The manager let me know that whilst they do everything they can to reduce the risk of cross contamination because there's allergenic ingredients in the kitchen they cannot say that the area is 100% free from allergens, this is a standard response I hear from everywhere I eat out so personally didn't worry me. 

The food arrived promptly and looked and smelled amazing. It tasted absolutely delicious too! I was happy to find that I had no issues with allergy-related problems.

 

Pork Belly and Panko Apple Hirata
Steamed Buns

Korean Barbecue Beef and Red Onion
Hirata Steamed Buns

Bang Bang Cauliflower

Pulled Pork Steamed Gyoza 

Chicken Raisukaree

My experiences at Wagamama's are always fantastic. They appear to have a company-wide policy that only the manager of the restaurant is allowed to take orders where someone has an allergy, I feel this is a great policy as who better to know about the allergy policies of the company than the manager themselves? It definitely put my mind at ease knowing that the manager themselves talks to you and tries to put your mind at ease. Their allergy folder is absolutely fantastic, it's one of the best allergy folders I've come across when eating out as it contains such details that also help reassure me that the company is taking allergies and anaphylaxis seriously and also shows that they want to try cater for everyone which shows they are very good with inclusion. I personally feel Wagamama's as a whole go above and beyond for their customers and always put the health of their consumers first. The fact the manager also goes through the allergy folder to double check everything you're wanting to order as it can be surprisingly easy to miss something or think something is safe that isn't, it definitely makes me feel a lot better about eating at Wagamama's. The fact that not only do they have a fantastic allergy folder but they also alert the kitchen to try minimise any risk of cross contamination is yet another thing that helps put people at ease when eating out. I highly recommend Wagamama's to people living with allergies as they truly do everything they can to try cater for you and include you.

If you'd like to check out their allergen menu before visiting please visit: https://www.wagamama.com/allergen-information

How is the restaurant 'Bella Italia' at catering for people with food allergies?

Finding "safe" places to eat out when suffering with allergies and anaphylaxis is an absolute nightmare! Anxiety kicks in if you've not eaten somewhere before and you spend time stressing over whether or not the food you're going to eat will be okay. Thankfully, in December 2014, a new legislation was introduced which in turn means that takeaways and restaurants must know if there is the presence of one of the top EU allergens (eggs, tree nuts - brazil nuts, almonds, hazelnuts, macadamia/queensland nuts, pecans, walnuts, pistachio nuts and cashews -, peanuts, milk, fish, crustaceans - e.g. crab, lobster, crayfish, shrimp, prawn etc. -, molluscs - e.g. squid, oysters, muscles etc. -, soya, sesame seeds, cereals containing gluten - in particular wheat e.g. spelt, khorasan wheat/kamut etc., rye, barley, oats or their hybridised stains etc. -, celery and celeriac, mustard, lupin and sulphur dioxide and sulphites) (Food Standards Agency, 2014). The restaurant or takeaway must either have an allergen menu clearly displaying what each of their foods contain regarding the top EU allergens or they must be educated enough about it that they can provide assurance about what would be safe to eat for someone with that particular allergen, whilst this is now legal restaurants and takeaways do not have a legal obligation to display or know about if their food items "may contain" that particular allergen or if there's a risk of any cross contamination of that particular allergen to the food item. This definitely makes it a lot more problematic regarding finding safe places to eat. I will be starting a new "series" on my blog where I will be reviewing certain chains of places to eat in the hopes that I can help people struggling with allergies and anaphylaxis find reassurance regarding which places to eat are good when it comes to eating food from them if you have an allergy and anaphylaxis or if they struggle to cater for people with allergies and anaphylaxis.

*Please note that whilst some chains of takeaways and restaurants do have a company-wide policy regarding how to handle allergens it has been brought to my attention that different locations can differ, whilst one location of a particular chain may be great with handling allergies a different location of the same chain may be somewhat clueless. I will be talking about the particular location/s of the chain I have visited and how I have found them. The particular food allergies that I suffer with are anaphylaxis to: peanuts, all tree nuts, crustaceans and molluscs.*

My first review will be for Bella Italia. The particular chain I visited was on Sauchiehall Street, Glasgow and I visited on the 10th December 2017. 

On being seated at Bella Italia I alerted the manager (who seated me) that I had a few severe food allergies and did they have an allergen menu I could look at. At first I was asked if my allergy was to gluten, the reason behind this is they have a separate menu where everything is gluten free. I explained that my allergies do not feature gluten and it's something I am okay with but they are other allergens. She handed me the menu and advised me to have a browse of the menu and see if there was anything I'd like and when it came to ordering food to alert my server of my allergies and they'd ensure what I was going to eat would be okay for me.

Bella Italia is mainly Italian food. First thing I noted was that the pesto they used did feature tree nuts, there was a note at the bottom of the menu letting you know this so I knew immediately to avoid choosing anything which featured pesto in it, this is quite common for pesto to contain nuts, usually cashew nuts son I personally hadn't gotten my hopes up that the pesto would be nut-free. The second thing I noted was a note at the bottom of the menu that was worded "due to the presence of allergenic ingredients in our kitchen we cannot give 100% assurance that your food will be free from allergens", this personally didn't worry me too much as this is a statement that most restaurants and takeaways use as if they do use ingredients within the kitchen they cannot say 100% that what you will be eating will be safe. I decided on a create your own pizza with roasted red peppers and olives.

When the waitress came to take my order I alerted her that I have a few severe food allergies. She explained that the allergen menu they have is really big and detailed so if I advised her what I'd like to eat she would check with the allergen folder that it would be okay for me and also speak to the kitchen staff to not only alert them to my allergies but to further clarify that what I would be ordering would be safe for me and it would also decrease the risk of any cross contamination occurring, she let me know that they'd prepare my food in a separate part of the kitchen to further reduce the risk of cross contamination.

I let her know what I'd decided on and she went off to check the allergen folder and also check with the kitchen staff, After a short while she came back to let me know that my choice of dish would be suitable for my allergies and shouldn't cause any problems.

Bella Italia seem to not only label for if a dish contains the allergens but also if there's any risk of the dish may containing the allergen or any cross contamination risk.

My pizza arrived and it looked lovely! It tasted absolutely lovely too and I throughly enjoyed it with no allergy-related issues occurring.

I found my experience to be a really good one and it really reassured me that the staff seemed educated on the seriousness of allergies and didn't just dismiss my allergies and try to make out what I'd chosen was safe. It made me feel very at ease that they also would be taking extra steps to try ensure that my food would be safe for me. Although the statement at the bottom of the menu stated that they couldn't 100% assure that the food would be safe I felt reassured that they went out of their way to try and have as little possibility of cross contamination occurring.

I definitely would recommend Bella Italia's restaurant chain to others suffering with allergies as I feel my experience was one which was really good. I'd definitely revisit Bella Italia and in the future will be exploring other locations to see if their chain allergy policies are carried over to other locations.

References

Food Standards Agency (2014), Accessed on 13th December 2017, Available at <https://www.food.gov.uk/science/allergy-intolerance/label/labelling-changes>

Things that people working/volunteering with children/young people who have allergies and anaphylaxis should be aware of

This is the first out of 3 blogs which I hope will help people who work with and/or volunteer with children and/or young people who live with allergies as well as anaphylaxis. I feel that oftentimes people can be somewhat clueless about allergies and anaphylaxis if they've never come across someone with it before. I hope these blogs can be somewhat helpful and educational about the things people working with children and/or young people with allergies and anaphylaxis can look out for and ways to best help include children with these conditions. *Please note that I've answered these questions using my personal experiences with allergies and anaphylaxis since being diagnosed at the age of 15/16, I am in no way a professional and every child/young person should be assessed differently.*

This particular blog will be focusing on different aspects of things that people looking after children/young people with allergies and anaphylaxis should be aware of and different things that should be taken note of.

1. What information should be given regarding a child/young person's allergies?

• What allergies do they have?
• If they are prescribed any medications for this allergy? If so what?
• How severe is/are their allergic reaction/s?
• If any special measures need to be carried out to keep the child/young person safe, i.e. do they need to be seated at an allergen free table, do they need to be kept away from other children/young people with that particular allergen etc.?
• If the child/young person needs to be given safe snacks so they are not left out when other children/young people have snacks?
• If they suffer a reaction what should happen, i.e. should medication be given, should their parent/guardian be called to collect them, should medical attention be sought etc.?

2. What should the child/young person tell adults looking after them?

• If the child/young person is self-carrying their medication where they keep their medication
• The adults should be alerted as soon as possible if the child/young person is feeling unwell due to an allergic reaction and procedures should be followed 
• If it is age appropriate the child/young person should let the adult know about what their allergen/s is/are
• If the child/young person feels unwell they should alert and adult looking after them so appropriate help can be sought 

3. How can the particular allergen the child/young person is allergic to be limited?

• Having an allergen-free table if the child/young person is for example eating lunch where no children/young people with foods containing their allergen can sit 
• If the child/young person is airborne allergic to their allergen it may be worth considering if a rule can be implemented where nothing containing their allergen is brought into the environment, a way around this would be issuing letters to other parents/guardians requesting when packing a child/young person's lunch they try to exclude foods with that allergen
• If the child/young person has food allergies allowing their parent/guardian to supply a box of safe treats so the child/young person with the allergy is not left out

4. Should the child/young person be in charge of their own medication?

This usually depends on the institution as well as the age of the child/young person. If there are rules surrounding the child/young person not being allowed to carry their own medication the adults in charge of said child/young person should be alerted to where their medication is kept and if the child/young person is age appropriate then they should also be told where their medication is kept. Preferably medication should not be kept too far away from the child/young person and should not be kept in a locked room/box to allow for quick and easy access if and when the medication is needed

5. What are the signs/symptoms of an anaphylactic reaction?

Anaphylaxis is a severe and life-threatening allergic reaction. It is classed as multiple mild symptoms or at least one severe sign/symptom occurring 

• Itching (mild)
• Flushing of the skin (mild)
• Hives (looks similar to a nettle rash) (a few hives, mild, lots of hives, severe)
• Swelling of the face/tongue/extremities/abdomen (severe)
• Nausea (mild)
• Cough (mild)
• Sneezing (mild)
• Runny nose (mild)
• Stomach pain (mild but excruciating pain is severe)
• Vomiting (one episode, mild, recurrent vomiting, severe)
• Dizziness (severe)
• Low blood pressure (severe)
• Shortness of breath (severe)
• Difficulty breathing (severe)
• Difficulty speaking (severe)
• Difficulty swallowing (severe)
• Increased or decreased heart rate (severe)
• Wheezing (a high pitched whistling sound) (severe)
• Stridor (sounds similar to snoring) (severe)
• Fainting (severe)
• Feeling weak (severe)
• Diarrhea (severe)
• A sense of impending doom (the feeling like something bad is going to happen to you) (severe)
• Anxiety (severe)
• Confusion (severe)
• Hoarse voice (severe)
• Pale of bluish skin (severe)
• Unconsciousness (severe)

7. What is the first thing that should be done if an anaphylactic reaction is suspected?

The most important thing is to remain as calm as possible, try not panic. Get the child/young person into a comfortable position, if they're struggling to breathe sit them upright however if they're feeling dizzy or have become unconscious then lying down is a better option. If they have medication (an adrenaline auto-injector) this should be used, if the medication is not with the child/young person someone should stay with the child/young person and someone else should get the medication. An ambulance should be called before contacting the child/young person's parent/guardian

6. Should an ambulance be called whenever an anaphylactic reaction is suspected?

If any of the severe symptoms mentioned in question 5 are exhibited by the child an ambulance should be called. If the child has medication in the form of an adrenaline auto-injector this should be given before calling for an ambulance. An ambulance should be phoned before the parent/guardian is contacted as the quicker the emergency services are contacted the quicker the child/young people will get help

8. Should other children be told about the child/young person's allergies?

My personal opinion is that yes, other children/young people should be told about the person having allergies. In particular where younger children are concerned it can better help keep the child safe. Having people surrounding the child/young person know about the allergies can mean that more people are looking out for the welfare of the child/young person with the allergies/anaphylaxis and can in turn reduce the likelihood that the child/young person may be accidentally exposed to the allergen. If the child/young person is exposed to the allergen it can also help in making sure they get help as quickly as possible from an adult surrounding them.

9. If a surface has come into contact with a particular allergen is there anything in particular that should be used to attempt to remove the allergen from the surface?

If possible the child/young person should be seated at an area away from the surface which has had contact with the allergen in question, if there's any doubt about if a surface has had contact with the allergen the steps below can be followed to minimise the likelihood that an allergic reaction will follow:

• Soap and warm water could be used with a clean cloth to throughly wash the surface which has come into contact with the particular allergen
• Baby wipes can also be used to wipe the surface when it's come into contact with a particular allergen 
• Anti-bacterial wipes (i.e. Dettol wipes) can be used to wipe the surface if it's had said allergen on it 

10. What advice would you give to friends of the child/young person with allergies?

This depends on the age of the child/young person and their peers. Examples of things you could tell a child who's quite young and may not fully understand allergies and anaphylaxis are:

• "*insert allergen* makes *insert child's name* really poorly so they can't have it"
• "Please don't share your food with *insert child's name* as it could make them really poorly"
• "*insert child's name* has a box of food they can have so if they'd like some ask an adult if they can have some safe food"
• "If *insert child's name* says they feel bad come tell an adult"
• "If *insert child's name* gets *insert symptom/s* please tell an adult"
• "If you see *insert child's name* with *insert allergen* tell them to stop and get help from an adult"
• "If you want to share your food with *insert child's name* ask an adult if it's okay first as some foods can make *insert child's name* poorly if they have it"

Examples of things you could say to an older child/young person who may have a better understanding of allergies and anaphylaxis is: 

• "*insert allergen* causes *insert child/young person's name* to become really unwell due to them having an allergy to it so they aren't allowed it"
• "Ask *insert child/young person's name* where the medications which help when they're having an allergic reaction are kept"
• "If *insert child/young person's name* says they feel unwell come and alert an adult"
• "If *insert child/young person's name* gets *insert symptom/s* come tell an adult"
• "If you see *insert child/young person's name* with *insert allergen* come and get help from an adult"

11. What are some ways of ensuring that staff/volunteers are aware of every child/young person who suffers from allergies and anaphylaxis?

• Having a note of children/young people who have allergies and anaphylaxis. If this is in an educational setting having a note beside their name in the register. For example my high school had a system where if there was a yellow square beside a student's name it meant they suffered with allergies and if there was a red square it meant they suffered with anaphylaxis 
• Having care plans for every child/young person who has allergies/anaphylaxis and having a photo of the child with the care plan so people volunteering/working with them can recognise the child/young person in question

12. Are there ways in which staff/volunteers can be trained on allergies and anaphylaxis?

• First aid courses. If these are not automatically offered by the organisation/place of work individual first aid training that is specific to allergies can be sought out at organisations such as: St Andrew's First Aid (https://www.firstaid.org.uk/), St John's First Aid (http://www.sja.org.uk/sja/default.aspx), AllergyWise UK (https://allergywise.org.uk/)
• Contacting organisations which deal specifically with allergies and anaphylaxis, 2 such examples are The Anaphylaxis Campaign (https://www.anaphylaxis.org.uk/) as well as Allergy UK (https://www.allergyuk.org/)
• Learning how to administer an adrenaline auto-injector. I have written a previous blog about this which features the 3 current auto-injectors available in the UK (epipen, jext pen and emerade) and I have included details on how to administer each of these, details on where to find a trainer pen as well as videos showing how to administer them. That blog can be found at this link: http://adifferentsortoflife.blogspot.co.uk/2017/12/how-to-use-epipen-jext-pens-and-emerade.html

How to use Epipen, Jext Pens and Emerade

No one wants to be in the situation where they need to use an adrenaline auto-injector but it's a good idea to know exactly how to use one if the situation were to unfortunately arise. Currently, in the UK, 3 different types of adrenaline auto-injectors are available, these are Epipen, Emerade and Jext pens. Each pen is different so I will be discussing how each of the pens are used as well as my experiences with both epipen and emerade pens as I have used both of these after suffering anaphylactic reactions. I hope this blog proves to be useful in helping people newly diagnosed, help the general public become more aware and more educated and also help provide experience and reassurance to people who are at risk of anaphylaxis but have never suffered a reaction before.

Epipen

Epipen is available in 2 different medication strengths, 0.15mg (the green pen for children weighing between 7.5kg-25kg) and 0.3mg (the yellow pen for children and adults weighing more than 25kg). Both pens are supplied in a sturdy outer case which protects the pen. The 2 different pens work in the exact same way which makes moving from the lower dose to the higher dose stress-free. The orange end is a shield which covers the needle and the blue cap when not removed means the needle end is not active. Here's a step-by-step guide on how to use an Epipen:

1. Remove the Epipen from it's carry case
2. Hold the Epipen in your dominant hand in a fist, the orange end (needle end) facing down to the ground and the blue cap end facing up to the sky (a way to remember this is "orange to the thigh, blue to the sky")
3. Remove the blue safety cap using your other hand, keep all fingers away from the orange end as the removal of this cap means that the needle is now active 
4. Move your hand with the epipen approximately 10cm away from your thigh
5. Swing your hand and jab the pen against your thigh at approximately a 90 degree angle and keep it there for 3 seconds 
6. Remove the Epipen from your thigh (the orange shield over the needle end extends fully to cover the needle so there will be no exposed needle) 
7. Dial 999 and seek medical attention stating you've suffered an anaphylactic reaction and have used your Epipen 

From my personal experiences with administering Epipen I found it easy to use. The one thing a lot of people ask about it is "does it hurt?" and I personally found on administering it it didn't hurt much, afterwards I'd have a sore leg for a few days but it wasn't extremely painful, I'd describe the initial pain similar to getting stung by a bee/wasp. 

It can be really helpful before you end up in the situation of having to use your Epipen to order a trainer epipen (you can get one via this link: https://www.epipenshop.co.uk/), sometimes the person who looks after your allergy and who issued the prescription for an Epipen is able to supply you with a trainer pen so it's worthwhile asking if they have any, if you can't get a trainer pen another good way of learning how to properly administer an epipen is by watching a video which shows the correct way to administer it (an example of a video such as this can be found here: https://www.youtube.com/watch?v=isyth9yqlKI). 

For more information on Epipens please visit: http://www.epipen.co.uk/

Jext

Jext pens are available in 2 different medication strengths, 150mcg (the yellow pen for children 15kg-30kg) and 300mcg (the red pen for children and adults over 30kg). The 2 pens work in identical ways which makes switching from the lower to the higher dosage as stress-free as possible. The black end is a shield which covers the needle and is inactive until the yellow cap is removed. Here is a step-by-step guide on how to use a Jext pen:

1. Take the Jext pen out of the container it's in
2. Hold your Jext pen in your dominant hand and keep the black end (needle end) facing downwards to the ground and the yellow cap end facing upwards to the sky
3. Remove the yellow cap, keep all fingers away from the black end as the removal of this cap means the needle end is now active 
4. Place the tip of the black end against your thigh at approximately a 90 degree angle 
5. Push hard against the thigh, you will hear a clicking noise when the needle has activated, keep the Jext pen in this position for 10 seconds 
6. Remove the Jext pen from your thigh and massage your thigh for 10 seconds (the black shield extends down the needle-length to fully cover it once activated)
7. Dial 999 and seek medical attention stating you've suffered an anaphylactic reaction and have used your Jext pen

I personally have never used Jext pens so cannot comment on how I find using them or how painful they are however I imagine it'll be similar to the pain of an Epipen which, as I'd mentioned above, isn't too painful, it just left me with a painful leg for a few days.

It can be really helpful before you end up in the situation of having to use your Jext pen to order a trainer Jext pen (you can get one via this link: http://www.jext.co.uk/), sometimes the person who looks after your allergy and who issued the prescription for an Jext pen is able to supply you with a trainer pen so it's worthwhile asking if they have any, if you can't get a trainer pen another good way of learning how to properly administer an Jext pen is by watching a video which shows the correct way to administer it (an example of a video such as this can be found here: https://www.youtube.com/watch?v=jJNrIBksvWk).

To find out more about Jext pens please check out http://www.jext.co.uk/.

Emerade

Emerade pens are available in 3 different medication strengths, 150mcg (the pen with yellow writing for children 15kg-30kg), 300mcg (the pen with the green writing for children and adults over 30kg but under 60kg) and 500mcg (the pen with the green writing for adults over 60kg) (please note that these are just recommended dosages, the individual prescriber may decide that the 500mcg dose is more suitable for you in spite of you being under 60kg). The end of the Emerade pen you remove is also the end where the needle is unlike both the Epipen and Jext pen where you remove the opposite end to the needle end. The needle end of the Emerade is clearly marked as such on the pen itself. Here is a step-by-step guide on how to use an Emerade pen: 

1. Remove the Emerade pen from it's outer casing 
2. Remove the cap from the needle end, keep all fingers clear of this end once the cap is removed
3. Place the now activated needle end against the thigh at a 90 degree angle 
4. Press down against the thigh and hold for 5 seconds
5. Remove the Emerade pen from the thigh and massage for 10 seconds 
6. Phone 999 and seek medical attention stating you've had an anaphylactic reaction and have used your Emerade 

I personally am prescribed the 500mcg version of Emerade due to being over 60kg in weight. I have found the Emerade pens are very easy to use, they tend to have a longer shelf-life than both Epipens and Jext pens. In terms of how painful they are to administer the Emerade pens have a longer needle than other adrenaline auto-injectors and also the 500mcg dose is a higher dose of adrenaline so I have found that Emerades are slightly more painful to use than Epipens, they don't hurt too much to administer initially but I found afterwards I had quite a stiff leg and also my leg was more painful for a few days afterwards. 

It can be really helpful before you end up in the situation of having to use your Emerade pen to order a trainer Emerade pen (you can get one via this link: http://www.emerade.com/order/), sometimes the person who looks after your allergy and who issued the prescription for an Emerade is able to supply you with a trainer pen so it's worthwhile asking if they have any, if you can't get a trainer pen another good way of learning how to properly administer an Emerade is by watching a video which shows the correct way to administer it (an example of a video such as this can be found here: https://www.youtube.com/watch?v=G7PUsftg9ls). 

For more information on Emerade please visit: http://www.emerade.com/

Drinking alcohol whilst living with allergies (and) anaphylaxis

I have lived with anaphylaxis since the age of 16. I very much spent the later part of my teenage years, like a lot of other teenagers, experimenting with alcohol in different settings whether it be house parties, parties, night clubs, pubs etc. I found I faced new challenges surrounding this, challenges which people without allergies wouldn't even think twice about. I've decided to put together some tips surrounding staying safe whilst enjoying alcohol and having a good time with allergies.

1. Ensure that you take all of your medication with you
This is really important to do in any situation but particularly where alcohol is concerned. It's been found that alcohol can increase your risk of reacting if you're exposed to something you are allergic to. Young people can find it difficult being different to their peers and want to fit in so may decide not to carry their adrenaline with them, this is a big no no particularly where alcohol is concerned.

2. Make sure you know where you are

This may seem like common sense but knowing the exact location for the place you are in whether it be a home address or the address for a bar/nightclub. I myself have been in the situation where help was delayed as we couldn't give an exact address for the place I was at, thankfully this situation didn't prove fatal. Help being delayed could potentially result in a fatality so it's vital to have a mental note of your exact location so the emergency services can be given it straight away.

3. Be aware of what your drink contains 
Many people with allergies don't realise that drinks can pose issues and could have your allergen within them, even though it seems like they are completely safe. For example amaretto can be made with almonds and would be unsafe for a person with an allergy to almonds, wine can contain sulphites so would be an issue for someone with a sulphite allergy, wine can even contain milk which could be problematic for someone allergic to milk. Drinks such as cocktails are definitely worth asking about what exactly is in them as sometimes the name doesn't fully give it away. If in any doubt it's best to avoid it entirely and select something you've had before and know is safe. I found this list to be really helpful in terms of steering me in the right direction as to what is best avoided and what I should ask about: http://www.bestallergysites.com/alcoholic-beverages-that-contain-top-allergens/


4. Have a medic alert  

This can be a life-saver if you, for example, fall unconscious (whether that be due to too much alcohol or the result of your reaction). It's not only important to help alert someone that you do have allergies but also is good for medical staff to know what to avoid giving you if you are in a situation where you may be inebriated. Where young people are concerned some people don't want to wear a medic alert as they feel they will stick out but many medic alert items are rather stylish and to and most people wouldn't notice it. There are even items that are suitable for males such as dog tags or plain bracelets. Some examples of companies which do medic alert pieces are:
Medic Alert:
https://www.medicalert.org.uk/ This is personally where I got my medic alert bracelet. Their items are a great price and there's such a wide variety, there will be something to suit most people. The good thing about this company is they create a file with your information in it, you have a membership number and medical professionals can phone up Medic Alert's number quoting your membership number and get information about you, and they also supply you with a card to keep in your wallet with more information than is on your item of jewellery.
ICE Card:
http://www.icecard.co.uk/ ICE Card supplies a range of different in case of emergency cards for a host of different medical conditions. They have wallet sized cards as well as cards which go on your keys. The cards are plain and give you space to write your personal details as well as your emergency contacts and your GP practice etc. You can also get cards which allow you to write extra information on them so you can document as much as you like. Their products are greatly priced with the allergy pack costing only £4.99 (http://www.icecard.co.uk/allergy-icecard-pack/)
The ID Band Company:
http://www.theidbandco.com/ They have a range of different styles of medical ID ranging from silicone bands, bracelets to charms and watches. They're ID's range in price and are a great value for money. There's something for anyone and they're suitable for any gender and any age.
Make your own: 
If you don't wish to purchase a medic alert an idea is to make your own. I personally have wallet cards made with with: my name, date of birth, address, GP surgery, my next of kin, medical conditions, allergies (and the reactions they cause i.e. anaphylaxis, rash etc.) and medication I take. This has proved so helpful when I've been in situations where I have had to have an ambulance phoned or I've ended up in hospital. This can be a real time saver when you have a lot of medical conditions or lots of allergies or take multiple medications. It can also really help speak for you when you can't (i.e. you're unconscious or you're struggling to breathe) it can also help in the situation where you've been drinking as sometimes when you're drunk you may struggle to make lots of sense.

5. Letting who you're with know about your allergies and what to do in an emergency
This is rather important when it comes to going out drinking. It can feel awkward in the sense some people don't like telling others that they have allergies but it can truly be a life-saver in this situation. If you were to, for example, fall unconscious as the result of an allergic reaction who your with is more likely to phone for medical help than if they aren't aware of your allergies as they may just assume it's alcohol related if they cannot rouse you. I've personally been in the situation where I was faced with a friend having to phone an ambulance on a night out, I'd become unwell in the toilets and when I was found they automatically phoned an ambulance whereas if they weren't aware of my health issues they may have just got me to go home instead, in this situation it was an anaphylactic reaction I was having so I'm very thankful they did phone for help. It can also be a good idea to let them know where you keep your medication so if you are in the situation where you are unwell they can easily find it which really speeds things up. Also let them know who you'd want contacted in the event you became unwell and needed to be taken to hospital. It can be an idea also ensuring they know certain things about you so they can tell medical staff, things like: full name, date of birth, address, next of kin contact, medical conditions, allergies, medications currently taking, GP surgery (to make this easier for them it's an idea to have it written down in some form of medic alert (see number 4 above for more information) Another idea could be to train them on how to use your adrenaline auto-injector, an easy way to do this is by ordering a trainer pen for your particular type of auto-injector, these can be found at:
Epi-pen: https://www.epipenshop.co.uk/ (free, you just pay postage)
Emerade: http://www.emerade-bausch.co.uk/patient/order-trainer-pens (free)
Jext: http://www.jext.co.uk/ (free)

6. Don't kiss someone unless you know what they've been eating
If you have any doubts as to what someone has consumed do not risk kissing them. It is a common misconception that the person has to eat the allergen to have a reaction but in a lot of patients this is not the case as the protein, the thing that causes the allergen, can be transferred from mouth to mouth contact. When people get older and start going on night's out to clubs and pubs and such, often they will kiss someone whom they have never met before and know nothing about. This is best avoided if you suffer from a life-threatening allergy, or an allergy of any sort, as you have absolutely no idea what the person has come into contact with. It is not worth risking your health over!

Carry Two Adrenaline Auto-injectors

When I think about living with allergies and anaphylaxis one thing that really resonates with me is just how vital having access to adrenaline pens are if you're at risk of anaphylaxis. Adrenaline is the life-saving drug that helps to reverse the effects of anaphylaxis within the body. I am very fortunate to live within the UK where thanks to the NHS we have access to free healthcare and do not have to pay the cost of the medication itself, whilst in England many people need to pay a prescription charge I am very fortunate to live in Scotland where prescribed medication is entirely free. I find myself thinking about those living at risk of anaphylaxis and requiring an adrenaline pen in the USA where unfortunately people are charged for the medication itself and whilst some insurance companies do cover part or all of the cost of adrenaline pens lots of people affected by anaphylaxis in some way are subjected to having to pay hundreds of dollars for adrenaline pens. Whilst we do not face this battle in the UK many people are facing their own issues.

Most guidance available suggests that a person at risk of anaphylaxis should be prescribed, have access to and carry with them 2 adrenaline auto-injectors:

MHRA (Medicines and Healthcare products Regulatory Agency):
"It is recommended that 2 adrenaline auto-injectors are prescribed, which patients should carry at all times" (Medicines and Healthcare products Regulatory Agency cited in Gov.uk, 2017)
"If you do not start to feel better, use the second auto-injector 5-15 minutes after the first one" (Medicines and Healthcare products Regulatory Agency cited in Gov.uk, 2017)

European Medicines Agency:
"It is likely that your doctor will recommend that you carry 2 injectors, in case a second dose is needed while you wait for emergency treatment" (European Medicines Agency, 2015)
"It is recommended that healthcare professionals prescribe 2 auto-injectors, which patients should carry at all times" (European Medicines Agency, 2015)

Epi Pen UK:
"Anyone at risk of an anaphylactic reaction should carry an adrenaline auto-injector with them at all times, as an immediate injection of adrenaline could be the difference between life and death" (Resuscitation Council (UK) Guidelines, 2008 cited in Epipen UK, 2017)
"People who have been prescribed an adrenaline auto-injector because of the risk of anaphylaxis should carry two with them at all times for emergency, on-the-spot use" (Drug Safety Update Volume 7 Issue 10, 2013 cited in Epipen UK, 2017)
"35% of patients may require more than one adrenaline dose" (Korenblat P et al. Allergy Asthma Proceedings, 1999 cited in Epipen UK 2017)
"It is vital that at risk patients carry 2 Epipen at all times. A second dose can be given after about 5 to 15 minutes if necessary" (Drug Safety Update Volume 7 Issue 10, 2013 cited in Epipen 2017)

However, guidance from the BSACI (British Society for Allergy and Clinical Immunology) only recommends one unless: the person is obese, the person lives in a rural location, the person has had a prior reaction which proved life-threatening or if the person required more than one lot of adrenaline in a short timespan:

"A recent MHRA drug safety update (2014) recommended that people who have been prescribed an AAI should carry two; however, normally only one auto-injector is required for self-administration during a reaction. For children, two should usually be prescribed one each for school and for home. Exceptions, when two pens may be required in one kit, that is giving the option of administering two doses, include obesity, remoteness from medical help, a previous life-threatening reaction or if two doses were required (as distinct from given) in a short time period for previous reactions, or other assessment of risk." (British Society for Allergy and Clinical Immunology, 2016)

This guidance means that a lot of people would fit into the category of not requiring having more than one pen at hand. This guidance not only means that people who have never had a reaction before but are at risk for an anaphylactic reaction would most likely only be supplied one adrenaline auto-injector but people who have suffered anaphylaxis before would also only be supplied with one if they don't fit into the categories mentioned above. 

As a result of these new guidelines many people throughout the UK are facing issues with only being prescribed one adrenaline auto-injector. This reduction in access to adrenaline auto-injectors has a high probability of allergies and the potential of anaphylaxis resulting in an increased level of anxiety, a reduction of independence and added stress. What happens if the only adrenaline auto-injector a person has is faulty? What happens if the auto-injector is used incorrectly? What happens if an ambulance doesn't reach the person within 5-15 minutes when a second pen is usually recommended to be used? Many reasons exist past obesity, rural location and severity of reaction where a second pen should be supplied to people. Adrenaline is a life-saving medication and reducing people's access to this life-saving drug could potentially result in fatalities that could otherwise have been avoided.

The Campaign For The Right To Carry 2 Adrenaline Auto-injectors was founded to try ensure that everyone has access to at least 2 auto-injectors no matter their weight, their location, the severity of a previous reaction or having a previous anaphylactic reaction. They set up a petition 3 years ago in response to the BSACI guidelines. The aim of the petition to encourage the BSACI to alter their guidelines surrounding access to adrenaline auto-injectors. This campaign has received immense support in the past 3 years from all over the UK and has even had celebrity support too. In the 3 years since the petition was set up it has gained over a whopping 49,300 signatures! This is a fantastic result thus far and it continues to be shared far and wide with new signatures being added on a regular basis. They are working extremely hard behind the scenes to promote their campaign to not only those living with anaphylaxis but members of the general public too. Many may not understand why the BSACI's guidelines are so anxiety-provoking however many people who's lives are influenced by allergies and anaphylaxis state that the guidelines are causing added stress and anxiety that doesn't exist as much as when 2 adrenaline auto-injectors are accessible. Many people live in fear of when they're next adrenaline auto-injector prescription is due that their GP/consultant will only prescribe one pen to have to hand.

For more information on the Campaign For The Right To Carry 2 Adrenaline Auto-injectors please visit:
Facebook: https://www.facebook.com/campaign42AAI/

Please also considering signing the petition to encourage the BSACI to alter their guidelines:
https://www.change.org/p/this-petition-supports-the-alwayscarrytwo-campaign-we-ask-the-bsaci-to-reverse-its-recommendation-that-the-majority-of-patients-require-one-aai-back-to-two

References

BSCAI (2016) Adrenaline Auto-injector (Accessed on: 6th December 2017) Available at <http://www.bsaci.org/Guidelines/adrenaline-auto-injector>
Epipen UK (2017) Epipen (Accessed on: 6th December 2017) Available at <http://www.epipen.co.uk/hcp/epipen/>
European Medicines Agency (2015) Adrenaline auto-injectors (Accessed on: 6th December 2017) Available at <http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/referrals/Adrenaline_auto_injectors/human_referral_000367.jsp&mid=WC0b01ac05805c516f>
Gov. UK (2017) Adrenaline auto-injectors: updated after European review (Accessed on: 6th December 2017) Available at: <https://www.gov.uk/drug-safety-update/adrenaline-auto-injectors-updated-advice-after-european-review>

Anaphylactic reaction whilst flying

Anaphylaxis is scary no matter what the circumstances are surrounding it however when you're 32,000ft up in the air...it reaches a whole new level of terrifying.

I had an amazing trip away to the Harry Potter Studio's in Watford, UK. I flew from Edinburgh to London Luton and returned via flight the next day. Everything went according to plan until the return journey. I got on the plane and talked to the cabin crew about my nut allergy. They made a special announcement stating they would not be selling nuts on-board the aircraft and asked if people could please refrain from eating their own nutty products they may have brought with them. One of the flight attendants even passed down the aisle a few times to check if people were eating anything nutty.

Within half an hour I found myself starting to become unwell. I began to feel horrendously itchy. My reaction turned from itching to coughing into difficulty breathing. I cannot begin to describe how it felt to be unwell whilst flying. You try to prepare yourself for anything happening. You ensure you have your medication with you, request a doctor's letter stating you're allowed to carry your medicines including epi-pens. You tell the flight crew about your allergy to nuts which in turn means they can stop the sale of nuts. Yet you never actually think anything is going to happen. Unfortunately this is not always the case. Even the best precautions can often amount to nothing.

I am unsure what caused my reaction. I cannot say for certain but I feel that it was down to peanuts being eaten on a previous flight, someone touching something which I in turn touched which resulted in a contact reaction to peanuts. This is the problem with the seriousness of allergies. People do not for the most part realise that ingestion is not the only thing that can result in anaphylaxis, simply touching something that has peanut protein on it or even breathing in the protein can spark a life-threatening reaction.

I am lucky that this reaction was quickly resolved and did not result in anything more than having to use an epi-pen and paramedics checking me over. I am very thankful to the airline for their help throughout the whole incident as well as the airport.