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.

Raising a Nut Allergic Child in the 70’s

Raising a Nut Allergic Child in the 70’s

The following was written by my mum, she explains what it was like to have a child with a nut allergy

38 years ago.

Karen was 3 when she had her first reaction, it was from a Corneto ice cream with hazelnuts on top, we first noticed her lips and face swelling up and had no idea what was wrong (it was scary) we took her to Hospital where they treated her, but I can’t remember what medication was prescribed to her, they just said that it was probably to do with the nuts.

Back then it was unheard of, we didn’t know of anybody else having a nut allergy as it was not talked about then as it is now, there certainly wasn’t any support network.

Whenever we went to family and friends I didn’thave to worry as back then most foods where home made and if brought from a shop, they didn’t contain nuts as they do now and we didn’t have to read labels as much as one does now. If we ate in a restaurant we had no need to ask about nut oils etc as they were not used, as cooking was mainly done using fat or lard.

I have often wondered why it happened to Karen, she often used to tease me and say it was because I ate a lot of nuts when I was pregnant, which I didn’t and obviously Karen didn’t when she was pregnant with Kane and he still has the nut allergy.

Both myself and Husband come from large families and on my husbands side there was asthma, but no nut allergies as far as we can tell . My son also has a slight nut allergy mainly walnuts, we are unsure about his children as they have never been tested so far.

A theory that I have as to why these allergies are becoming more prevalent are how clean people are nowadays, I ran a clean household, but we did not have all the bacterial wipes and associated cleaning products as they do now, maybe sometimes mums worry about keeping children too clean and wrapped in cotton wool!

It wasn’t until Karen was in her teenage years that she had her first allergy test and then we realised just how bad her allergy was and knowing what we know now we realise how lucky we were not to have lost her that day.

I think it is so much harder these days as so many products contain nuts or traces of nuts, I also think that factories or food producers should have separate areas for making nut free products, which would make life much easier for people like Karen and Kane .

I hope that has given you an in sight as to how things have changed and how different it would have been for us mum’s 30 odd years ago to raise an allergic child.

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Peanut oil labeling exemptions, peanuts on planes

Peanut oil labeling exemptions, peanuts on planes

…and the real purpose of the new “hypoallergenic” peanut

When news of the novel USDA approved hypoallergenic peanut spread through the social media, I and many other FaceBook parents of peanut allergic children reacted with horror.

Despite the media filtered promise that this new peanut would reduce chances of a reaction and might even, through the early introduction of low doses, prevent the allergy, they weren’t buying it.  It didn’t matter that Dr. Oz had posted that this was “good news for peanut allergy sufferers”.  Parents were adamant.  “I still wouldn’t play with my daughter’s life.” “No way!” “Russian roulette!”

A closer read in fact revealed the opposite to be the scientific case.  Horticulture expert at U. of Georgia Peggy Ozias-Akins confirmed, “Given the number of allergenic proteins in peanuts, I doubt that developing an allergen-free peanut is realistic.”  The parents’ instincts were right.  So why the dangling carrot?

The peanut industry is nervous. Peanut is not just in sandwiches or served on planes. Peanut oil that is refined to reduce sensitizing proteins is used in vitamin capsules, baby formula, disguised as vegetable oil in many foods.  In fact, the FDA’s move to reduce trans fats recently paved the way for increased use of refined peanut oil because it is a healthy alternative. This peanut oil is everywhere, except on the label.

The FDA acknowledges the existence of trace proteins in refined peanut oil.  But with a history of use, the oil appears to be safe (GRAS, generally recognized as safe) says the FDA and is exempt from food labeling.  This decision is fully supported by the WHO.

But things are changing.  A new study by Scott Sicherer, Jaffe Food Allergy Institute, NY, has revealed an “alarming” and unexplained increase in the number of peanut/nut allergic children to 2.1%, or 1.6 million. Given this mysterious epidemic, the very valuable GRAS status for refined peanut oil is poised to change along with its labeling exemptions.

If you saw peanut oil as an ingredient, and you had a life threatening peanut allergy, would you buy the product?

Indeed, between 1993 and 1999, at the start of the allergy epidemic, the peanut snack market fell from 14.4% to 12.%.  But peanut food use was in decline less from allergic concerns than from perceived worries over “bad” fats according to a 2008 MA thesis by Emmanuel Foko.  And so, when news emerged that peanuts actually contained “good” fats, sales rallied not just to individual consumers but also to manufacturers.

In short, peanut food sales are up.  So why is the Georgia Peanut Council fighting so hard to keep peanuts on airplanes? A $20 million annual loss is marginal within a multi-billion dollar industry.

It is an industry liable to the winds of policy and government regulation.  Is this a slippery slope?

If the threat of peanut to society is perceived to be so bad as to ban it from planes, next might be trains, public spaces.  And if the threat to millions forces the FDA to revoke the GRAS status of refined peanut oil and demand labeling, this would turn consumers away from it in foods.  The European Food Safety Authority in 2004 investigated the safety of this oil concluding that “fully refined peanut oil” in foods could indeed cause allergic reactions.  It should be labeled.

But the likely consumer backlash to finding refined peanut oil in their food might pale in comparison to the response of parents when they learn that the oil is also a common vaccine ingredient.

Peanut oil made its debut in injected meds at the end of WWII.  An army doctor invented a method for prolonging levels of penicillin in the blood by mixing the drug with refined peanut oil.  As the body metabolized the oil, the drug was slowly released.  Doctors quickly recognized that the oil had sensitized some people and moved to better refine it. Peanut oil thus gained a history of use so that by the 1960s, peanut oil was a simple choice for Merck to include in its new aluminum based vaccine additive, Adjuvant 65-4. Since then, peanut oil has been a common ingredient in vaccines.

Labeling the oil on vaccine package inserts has also been debated.  While it makes sense to warn consumers of sensitizing ingredients, corporate law and ethical guidelines have been at odds for years over whether consumers really need to know.  Proprietary vaccine formulae are protected from Freedom of Information provisions in the UK, US, Canada.  New guidelines from the European Medicines Agency recommend that consumers have a right to know – and yet, there continues to be no legal obligation for a maker to reveal this information.  And why would they? The US government says trace proteins in peanut oil are safe.

And so, now enters the protein-reduced peanut that Dr. Oz tells viewers is good news.  Its arrival follows Dr. Sicherer’s alarm and a rumor that 5% of Americans are now peanut allergic.  Saving the day is the USDA and U. of Georgia to solve our worries with a hypoallergenic peanut. They already know that for those allergic, buying GMO peanut butter would be like buying a bullet-resistant vest.  But the new peanut is not for these non-consumers.

The GMO reduced-protein peanut it is intended to maintain the threatened GRAS status and the labeling exemptions for refined peanut oil.  Refining an already low protein peanut would allow it to pass new standards of safety so that they can continue to use the peanut oil without informing consumers.  Here’s the big picture:  the peanut industry has backed itself into a corner and without these government protections, it and the vaccine makers would be met by a blow to consumer confidence such as they have never seen.

Article submitted by: Heather Frasier, guest contributor for What Can I Eat and author of “The History of the Peanut Epidemic”

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Tree Nuts Are Hiding

Tree Nuts Are Hiding

Rhonda Lewis is the parent of an allergic child and allergic herself so she “gets” food allergies.

As a mum of kids with food allergies and having lived with a nut allergy myself for over 30 years, I’m pretty good at thinking about hidden sources for nuts. I often share these insights with friends (and strangers) who are newly diagnosed with food allergies and call me to ask for help. So many labels make finding tree nuts or peanuts difficult as the labelling might be poor, or the nuts called different names. This is particularly challenging for tree nuts as there are so many that a manufacturer might say “tree nuts” on a label, or might simply say “almond” for example which is just one of the tree nuts. Often, people allergic to a few tree nuts avoid all tree nuts but that is a personal and individual decision which can be made in conjunction with your allergist. Here’s a tree nuts list I have compiled and want to share…

  • Artificial nuts (some have a peanut/tree nut-based flavouring)
  • Baked goods and baking mixes
  • Bean bags
  • Bird seed and pet food
  • Cereals
  • Coffee grinders used to grind nut flavoured coffee
  • Cosmetics (hair products and skin care products, lotions, soap, sunscreens)
  • Crackers
  • Dressings
  • Gianduja (a creamy mixture of chocolate and chopped nuts found in premium or imported chocolate and ice cream)
  • Granola bars
  • Gravy, sauces and marinades
  • Household items (some toys and beanbags may be filled with stuffing made from crushed nut shells)
  • Kick sacks / hacky sacks
  • Main course dishes (for example, almond chicken)
  • Mandelonas (which are peanuts soaked in almond flavouring)
  • Marzipan Cake (marzipan is an almond paste)
  • Massage oils
  • Mortadella (smoked sausage made of pork, beef, wine and spices may contain pistachio nuts)
  • Muesli and other breakfast cereals
  • Natural and artificial flavourings and extracts (for example, pure almond extract)
  • Nougat
  • Pesto Sauce or crushed nuts in other sauces
  • Salads (for example, Waldorf salad)
  • Snack foods (including candy, chips, chocolate, popcorn, snack mixes, trail mixes, crackers)
  • Spreads
  • Sundae toppings
  • Trail mixes
  • Vegetarian dishes

To read more tips from this blogger go to Allergysense.com

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