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Top 10 Tips for Dining out with a Nut Allergy

Top 10 Tips for Dining out with a Nut Allergy

Recent media around attempts to debunk people having food allergies are not helpful to those of us who sincerely have a food intolerance. If like me, you or your child has to carry an epi-pen then dining out can be difficult as there is a lack of understanding by many restaurateurs and wait-staff about food allergies. Media stories also do nothing to help break through this. 

Here are my Top 10 Tips for dining out with a nut allergy, gathered over almost 40 years of experience.

Read recipes be familiar with what goes into various dishes even if you don’t cook especially as food trends can change traditional recipes.
Some cooks blur the lines when it comes to baking so watch out for almond or hazelnut meal being used to replace flour.
Some cuisines are better than others when it comes to using nuts choose Italian over Indian, French over Middle Eastern.
Desserts can be the most dangerous so aim for things like crème brulee, pannacotta, and lemon tart but always ask about garnishes.
For sweet tooths always avoid friends, coloured French macaroons (very popular at the moment) and check the bases of cheesecake don’t use walnuts. Also Blue Sapphire Gin is made with almonds.
Usually the better the restaurant the better the understanding and the willingness to make a substitution.
Cross contamination is not usually an issue in restaurants but be very careful with ice-cream parlours and gelato shops often they don’t clean the scoopers well enough to reduce the risk.
Don’t rely on menu descriptions especially in restaurants where English may not be the first language spoken.
When travelling overseas it may be an idea to have a written copy in a few different languages of I’m allergic to nuts which you can show when ordering food.
Be clear that you have an allergy and its not that you don’t like nuts. We need to educate people that food allergies are genuine and potentially life threatening. 

Please enjoy dining out and, as frustrating as it is when people don’t listen or dismiss you, remember there are loads of websites where you can post reviews so really the onus is on the restaurant to treat you well. 

Article submitted by What Can I Eat subscriber

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Tree Nut Allergies

Tree Nut Allergies

Prevalence of Tree Nut Allergies
There is a geographical variation in the prevalence of tree nuts which relates the type of nuts consumed in that country. In Australia cashew nut allergy is the most common in infants affecting 0.33% and hazelnut 0.18% and walnut 0.16%, with allergies to Brazil are almond being rarely seen (1).    In the USA tree nut allergy has been reported to be increasing with walnut, almond and pecan being the most common (1).  In the UK the most common tree nut allergies are to Brazil, almond and hazelnut (1).   Cashew nut allergy appears to display a similar clinical history to peanut allergy including wheezing and even anaphylaxis (1).  Oral Allergy Syndrome (OAS) is also seen with hazelnuts, hence the importance of the true diagnosis of nut allergy (1).  With tree nut allergy, it is estimated that only 9% of allergies are outgrown with cashew nut allergy rarely being outgrown (1). 
Foods and Allergens
Tree nuts include cashew, almond, Brazil, hazelnut, chestnut, pistachio, pecan, walnut, macadamia nut, pinenut and coconut (1).  As with legumes it is the plant food superfamily classification of the allergens in tree nut allergy which are of importance (1).  
Studies have shown a strong clinical cross reactivity between tree nuts and peanuts within allergic individuals. In the general population the risk of having both is 2.5 %.  The risk is considerably higher in atopic individuals and studies have estimated this to be 23 ? 50 %. 
Oral Allergy Syndrome can also be triggered by tree nuts, with the most common cross reactivity occurrs between allergens from almonds, hazelnuts, and walnuts and the antibodies to the main birch pollen allergens (1).  A similar cross reactivity can also occur between latex and some tree nuts (1). 
Diagnosis of Tree Nut Allergy
Skin prick tests and specific Ig E tests in conjunction with a good clinical history are keys to the diagnosis of tree nut allergy. When these results are contradictory then a medically supervised  oral food challenge is required for diagnosis (1).  
Management
At present the only effective and proven management of any tree nut allergy is the total avoidance of the offending allergen (1). 

Table: alternative name for nuts and foods likely to contain nuts

Nut Alternative Names 
Hazelnut Filbert, cob nut
Macadamia Queensland nut, candle nut
Pecan Hickory Nut
Spreads Chocolate Hazelnut Spread
Snacks & Sweets Cereal bars, mixed nuts, praline, nougat, Turkish Delight, marzipan
Cakes & Biscuits Cookies, brownies, fruit cake, anything with marzipan, almon croissants
Ice Creams Nut toppings, pistachio ice cream, kulfi
Vegetarian Meals Nut Roast, Veggie Burgers
Sauces Almond essence, nut oils
   
   

References: 
1.     Tanya Wright and Rosan Meyer., Dietary Management of Milk and Eggs -Food Hypersensitivity: diagnosing and managing food allergies and intolerances ? edited by Isabel Skypala, Carina Venter; Wiley and Blackwell 2009, Part 2, p 117- 128. 
2.    Consumer Information: Information for Allergy Suffers: Food Standards Australia New Zealand, April 2010. www.foodstandards.gov.au

by Julie Albrecht Consultant Dietitian-Nutritionist  A.P.D. 

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Watch out for these ingredients on a Nut Free Diet

Watch out for these ingredients on a Nut Free Diet

If you or your child has a peanut allergy, it is safer to avoid all nut products as many people who react
to peanuts also react to tree nuts (other nuts). Tree nuts include: almonds, brazil nuts, cashews,
chestnuts, hazelnuts, macadamia nuts, pecans, pine nuts, pistachios, walnuts.
The following ingredients are or may contain peanuts.

Arachis oil*  Hydrolysed plant protein
Beer nuts  Hydrolysed vegetable protein
Chopped peanuts  Mixed nuts
Cold pressed peanut oil  Monkey nuts
Defatted peanuts  Peanut butter
Expelled or expressed peanut oil  Peanut flakes
Fresh peanuts  Peanut flour
Granulated peanuts  Peanut oil
Ground nuts  Satay

*Arachis oil may be used in food products and also in certain cosmetic and pharmaceutical products
such as aftershave or eczema cream – highly sensitive individuals may react to arachis oil from these
sources. Always check with your pharmacist that the product does not contain arachis oil or nut
products.

Will peanut allergy soon be treatable?

Will peanut allergy soon be treatable?

NEW ORLEANS – Two studies presented at the 2010 Annual Meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI) examine the use of oral immunotherapy in peanut allergic children and continue to add hope that a treatment may be on the horizon.

Both were completed by researchers at Duke University and the University of Arkansas for Medical Sciences. In one, peanut allergic children were randomized to receive either the peanut oral immunotherapy or a placebo. The subjects went through initial escalation, build-up and maintenance dosing. This was then followed by an oral food challenge.

Twenty-three children reached the oral food challenge, 15 had received the oral immunotherapy and eight had received the placebo. During the oral food challenge, the median cumulative dose of peanut tolerated was only 315 mg for the placebo group compared to 5,000 mg (~15 peanuts) for the oral immunotherapy group. In addition, the oral immunotherapy group saw median titrated skin tests decrease from baseline to the oral food challenge.

Median peanut IgE and IgG4 levels were also measured. IgE levels did not change from baseline to the oral food challenge in either group, while IgG4 levels increased from baseline to the oral food challenge in the treatment group.

“We are encouraged by the results of this first blinded, placebo controlled study for oral peanut immunotherapy. The differences in the treatment and placebo group are significant and help guide us to the next studies,” said A. Wesley Burks, MD, FAAAAI, one of the study authors.

In the other study, the researchers looked to identify whether subjects who received the oral immunotherapy could safely ingest peanut after stopping the treatment.

Twelve peanut allergic children who completed all phases of oral immunotherapy, along with meeting certain clinical and laboratory criteria, participated in a final oral food challenge 4 weeks after they stopped receiving the oral immunotherapy. The amount of time the children received the oral immunotherapy ranged between 32 and 61 months.

Nine of the 12 subjects passed this final oral food challenge and now have peanut in their diets.

“We are now trying to identify characteristics in those subjects who were able to stop the therapy to better understand who might be a good candidate for this treatment,” commented Burks.

Over the course of the treatment, peanut IgE levels decreased from the baseline with IgG4 levels increasing. Titrated skin prick tests also decreased from the baseline. These immunologic changes support the development of tolerance.

The AAAAI (www.aaaai.org) represents allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic and immunologic diseases. Established in 1943, the AAAAI has nearly 6,500 members in the United States, Canada and 60 other countries. If you believe you may have a food allergy, consult with an allergist/immunologist. To find one in your area, visit www.aaaai.org/physref.

Editor’s notes:

  • These studies were presented during the 2010 Annual Meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI) on February 26-March 2 in New Orleans. However, they do not necessarily reflect the policies or the opinions of the AAAAI.
  • A link to all abstracts presented at the Annual Meeting is available at annualmeeting.aaaai.org

 

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Living With Nut Allergies

Living With Nut Allergies

The incidence of nut allergy is on the increase in Western societies, as is the attention it receives from the public and from the media, yet little research has been carried out on the impact of living with the condition. 

A University of Leicester, UK, research project is now to look at the views and experiences of children and their families living with nut allergy, which accounts for the majority of severe food-related allergic reactions. 

Peanut allergy, which currently affects around 1 per cent of children, is the most common food trigger of anaphylaxis. 

Funded by MAARA (Midlands Asthma and Allergy Research Association), Dr Emma Pitchforth, of the University`s Department of Health Sciences, is carrying out a qualitative study involving interviews with children and their parents. 

Depending on the age of the child, they may be interviewed separately or with their parents. 

The two-year research project is being carried out with colleagues Dr David Luyt and Dr Emilia Wawrzkowicz, consultant paediatricians involved in the management of childhood allergies. 

From these investigations, the team hope to understand better the impact on family and everyday life of living with these allergies. 

They will be looking at sources of information and strategies families use to cope. 

The interviews will be audio-recorded (with permission) and the resulting transcriptions will help the researchers to identify recurring themes. All data is anonymous and confidential. 

Dr Pitchforth commented: "First allergic reactions to nuts usually develop in children at a young age and do not resolve as they get older. This means that for those affected nut allergy is a permanent, potentially life-threatening condition. 

"Clinical management of nut allergy typically involves educating children and their families to avoid all products containing nuts. They need to learn to recognise early signs of allergic reaction and to administer self-injectable epinephrine when they need to. 

"The number of deaths resulting from nut allergy is extremely low, but it is a risk and patients are told to avoid all types of nuts and their traces, and to carry an `Epi-pen` at all times, in case they suffer an anaphylactic shock." 

Information sourced from medicalnewstoday.com

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Nut Allergy Symptoms

Nut Allergy Symptoms

Step 1 
Know the different nut families. Affected patients often have allergy symptoms in relation to particular categories of nuts. For example, an allergy to walnuts often coincides with an allergy to pecans. Other nut families include: pistachios and cashews; beechnuts and chestnuts and hazelnuts, filberts and hickory nuts. Brazil nuts, macadamia nuts and almonds don`t seem to be related to any other nuts. 

Step 2 
Be cautious of tree nuts if you have an allergy to peanuts. While people with allergies to tree nuts aren`t always allergic to peanuts, those with a peanut allergy are significantly more likely to be allergic to other types of nuts as well. Cashews, walnuts and pistachios, in particular, tend to cause similar reactions because they contain the same allergenic proteins as peanuts. 

Step 3 
Note the first symptoms of an allergic reaction. Though all allergic persons should know the signs, children especially should be warned to watch for tongue swelling, hives, tightening of the throat and vomiting after possible exposure to a tree nut or tree nut product. These symptoms can signal the beginning of a very serious systematic reaction known as anaphylaxis, which needs immediate medical attention. 

Step 4 
Pay attention to persistent itchy skin rashes, nasal congestion, diarrhoea and hives. These lesser allergy symptoms can be related to chronic exposure to the allergenic proteins in nuts but, if they occur within 2 to 4 hours of consumption, can be an indication that more severe symptoms may develop. 

Step 5 
Ask questions and read labels carefully. Many products have "hidden" nuts in them that can cause an allergic reaction. Be specifically cautious with candy, cookies and other deserts, donuts, granola bars, pesto sauces, suntan lotions, shampoos and flavoured coffees. 

Information sourced from ehow.com 

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