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1. How many children in your household have a
physician-diagnosed allergy to corn?
2. In what year was your child’s allergy to corn diagnosed?
3. Did your child's allergist include corn allergy as
part of a standard panel of testing?
4. Did you have to request that your allergist test your
child for a suspected corn allergy?
5.
Did your child’s
allergist ever refuse to test your child for a suspected allergy to corn? If yes, what was the allergist’s reason for
refusing the test?
6. Did you ever seek a second opinion for a suspected
corn allergy because your allergist refused to test for an allergy to corn? If
so, was your child's allergy to corn confirmed after seeking a second opinion?
7.
Did your child’s
allergist prescribe an epinephrine auto-injector pen for your child as a direct
result of your child’s anaphylactic reaction to corn/corn-derived ingredients?
8. How many times in the last year have you had to
administer an epinephrine auto-injector pen to your child due to his/her anaphylactic
reaction to corn?
9. Did your child’s allergist or pediatrician ever advise
you that even though your child has a confirmed allergy to corn, it would be
safe to continue consuming corn or corn derivatives?
10.
Has your child's
pediatrician been helpful in recommending corn-free foods, fluids, supplements,
or medications for your corn-allergic child?
11.
Has your child
ever been diagnosed with "failure to thrive" as a result of his/her
allergy to corn?
12. Did your physician or hospital prescribe medications
for your corn-allergic child that contained corn-derived ingredients, even
though your child’s allergy to corn was clearly indicated in his/her medical
records? If yes, how was this issue
resolved?
13. Are you aware if your medical records have declared
you (the parent) as “non-compliant” for refusing physician-prescribed
medications due to corn-derived ingredients in the prescribed medications, even
though your child’s allergy to corn was clearly indicated in his/her medical
records?
14.
Does your child
require compounded medications to exclude corn?
If yes, does your insurance cover the cost of compounded medications?
15.
If your child
requires compounded drugs to exclude corn-derived ingredients, was the pharmacy
able to fill the prescription to exclude corn?
Were there any drugs prescribed by your child’s physician that could not
be compounded to exclude corn-derived ingredients? Please explain.
16.
If your child has
required hospitalization, was the hospital fully equipped to treat/nourish your
corn-allergic child? If no, please
explain.
17.
If your child was
hospitalized, did you ever have to advise the hospital against administering
dextrose IV fluid to your child, or was the staff already aware of the warning
on the product information sheet accompanying dextrose IV fluids that it should
not be administered to corn-allergic patients?
18. Did any medical professional ever administer dextrose
IV fluid to your corn-allergic child, even though your child’s allergy to corn
was clearly indicated in his/her medical records? If yes, did your child suffer an allergic
reaction to the dextrose IV fluid? If
yes, how was this situation resolved; e.g., did you file a report with The
Joint Commission?
19.
Does your
corn-allergic child have ready-access to corn-free antihistamines? If no, please explain.
20.
Did/does your
corn-allergic infant have ready-access to corn-free formulas and baby
foods? If not, how do you deal with
this?
21.
Is your child
ingestion-reactive to corn?
22.
Is your child
contact-reactive to corn?
23.
Is your child
inhalation-reactive to corn?
24.
What are your
child’s symptoms after exposure to corn?
25.
Have you
consulted with a nutritionist as a direct result of your child's corn allergy
diagnosis?
26.
Was your
nutritionist able to recommend safe sources of corn-free foods?
27.
Do you feel that
your nutritionist was trained to address a corn allergy diagnosis?
28.
Has a food
manufacturer ever refused to disclose if their product(s) contain corn/corn-derived
ingredients upon your request?
29.
Has a food
manufacturer ever told you that their products are safe to consume since the corn
“protein" has been removed? Did
your child then suffer an allergic reaction to this product as a result of your
child's corn allergy? If yes, how was
this issue resolved; e.g., did you file an adverse reaction report with the
manufacturer, the FDA, or the applicable health department?
30. Explain how an allergy to corn restricts your child's
school activities. Have you had to
resort to home schooling as a direct result of your child’s allergy to corn?
31. Explain how an allergy to corn affects your child's
social activities outside of school?
32. Please explain how your child’s allergy to corn has
impacted your life (emotionally, financially,
etc.).
33. Does the fact that corn allergen warnings on product labels are voluntary hinder your ability to safely nourish
your corn-allergic child?
34. Due to corn-derived purification chemicals in some tap
water, can your child safely consume tap water in your home; or have you been
required to purchase corn-free water from another source, or install a
corn-free water filtration system in your home?
35. Has any medical or academic professional ever implied
to you that “There is no such thing as an allergy to corn,” or that “Corn is
hypoallergenic?” As a result, did you
feel that you were demeaned in any manner?
If yes, please explain.
36. Please add any additional information about your
child’s allergy to corn that is not addressed in this survey.
_______________________________________________________________
Thank you for your
participation is this survey.
Diane H., Corn
Allergy Advocate
Founder, Corn
Allergy Advocacy/Resources
