Precautions for Living With Peanut Allergy or Tree Nut Allergy

Precautions for Living With Peanut Allergy or Tree Nut Allergy

If allergy testing shows that someone has a peanut or tree nut allergy, a doctor will provide guidelines on what to do. 
The only real way to treat a nut allergy is to avoid peanuts and tree nuts.  Avoiding nuts means more than just not eating them. It also means not eating any foods that might contain tree nuts or peanuts as ingredients. The best way to be sure a food is nut free is to read the label. Check the ingredients list first. 

After checking the ingredients list, look on the label for phrases like these: 
"may contain nuts" 
"produced on shared equipment with nuts or peanuts" 
"produced in a facility that also processes nuts" 

People who are allergic to nuts also have to avoid foods with these statements on the label. Although these foods might not use nut ingredients, the warnings are there to let people know the food may contain traces of nuts. That can happen through something called "cross-contamination," when nuts get into a food product because it is made or served in a place that uses nuts in other foods. Some of the highest-risk foods for people with peanut or tree nut allergy include:
Biscuits and baked goods Even if baked goods don`t contain nut ingredients, it is possible that they came into contact with peanut or tree nuts through cross-contamination. Unless you know exactly what went into a food and where it was made, it`s safest to avoid store-bought or bakery cookies and other baked goods. 

Ice cream Unfortunately, cross-contamination is common in ice creameries because of shared scoops. It`s also a possibility in soft-serve ice cream, custard, or yogurt places because the same dispensing machine is often used for lots of different flavours. Instead, do as you would for candy: Buy tubs of ice cream at the supermarket and be sure they`re made by a large manufacturer and the labels indicate they`re safe. 

Asian, African, and other cuisine African and Asian (especially Thai and Indian) foods often contain peanuts or tree nuts. Mexican and Mediterranean foods may also use nuts, so the risk of cross-contamination is high with these foods. 

Sauces. Many cooks use peanuts or peanut butter to thicken chilli and other sauces. 

Always proceed with caution even if you are used to eating a particular food. Even if you`ve eaten a food in the past, manufacturers sometimes change their processes for example, switching suppliers to a company that uses shared equipment. And two foods that seem the same might also have differences in their manufacturing. 

Here are some other precautions you can take:
Be on the watch for cross-contamination that can happen on kitchen surfaces and utensils everything from knives and cutting boards to the toaster. Make sure the knife another family member used to make peanut butter sandwiches is not used to butter your bread and that nut breads are not toasted in the same toaster you use. You may decide to make your home entirely nut-free. 

Avoid cooked foods you didn`t make yourself anything with an unknown list of ingredients. 

Tell everyone who handles the food you eat, from relatives to restaurant wait staff, that you have a nut allergy. If the manager or owner of a restaurant is uncomfortable about your request for peanut- or nut-free food preparation, don`t eat there. 

Make school lunches and snacks at home where you can control the preparation. 

Be sure your school knows about your allergy and has an action plan in place for you. 

Keep rescue medications (such as epinephrine) accessible at all times not in your locker, but in a pocket, purse, or book bag that`s with you. Seconds count during an episode of anaphylaxis. 
Feedback from Fiona, mother of 2 children with allergies. 

" Hi Kylie.  My 6 year old daughter is anaphylactic to peanuts. Basically I don`t buy food in packets and I bake alot. The dangers are that people unfamiliar with what anaphylaxis really means think that people with allergies need to consume the item to be affected – which is not the case. Now that my daughter is at school I am completely reliant on all parents at the school to follow the school rules to maintain a `nut free` school. If a child has nuts at school and come into contact with my daughter the consequence could be dire." 

Information source from kidshealth.com 

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Seed Allergies

Seed Allergies

Prevalence of Seed Allergies  

Hypersensitivity reactions to seeds, including sunflower seeds, cottonseed and linseed have been noted since the early 1900’s (1).  Sesame allergy was first identified in the 1950’s. The increases in the consumption of sesame seeds and its products have seen an increase in the degree of the reactions, particularly in children. In Australia sesame seed allergy is more common than tree nut allergy in infants  (0.42%) and is the fourth most prevalent food allergy in this age group (1).  

Seed allergies also have geographical variation.  In Israel, sesame seed allergy is the major cause of immediate IgE allergy and the third most common cause of IgE mediated food allergy.  It is the second highest cause of anaphylaxis behind cows’ milk in infants under 2 years of age (1).  In contrast to this, mustard seed is a major allergen in children in France, with an estimated prevalence of 1.1% in children and 0.84% in adults (1). 

Foods and Allergens

Seeds come from plants with different botanical classifications (1).  The allergens in seeds are spread amongst many different superfamilies, with researchers continuing to discover new allergens within seeds (1).   Many oils are cold pressed and contain traces of protein highlighting their potential allergenicity.

Diagnosis of Seed Allergies

Clinician’s and researchers have found skin prick test and specific Ig E test difficult to interpret with respect to the diagnosis of seed allergies, hence a detailed clinical history is paramount to the diagnosis (1).  

Management

At present the only effective and proven management of any seed allergy is the total avoidance of the offending allergen (1).  At present there appears to be no evidence, which support the avoidance of all seeds, only those known to trigger the allergic reaction (1). 

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

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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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