Food Allergy Counseling

Food Allergy Counseling
Sloane Miller, Food Allergy Counselor (Picture © Noel Malcolm 2013)

Thursday, April 10, 2014

Food Allergy Counseling: Review of Sarah Wilson, I Quit Sugar

Copyright 2014 Clarkson Potter

I Quit Sugar by Sarah Wilson is not a food allergy related book nor focused on any kind of food allergy issue. 

I Quit Sugar by Sarah Wilson is about cutting out hidden, and not so hidden, sugars from one’s diet. 


Sarah (who has both Graves & Hashimoto diseases, both autoimmune diseases), found that being low to no sugar helped her body and her overall wellness immensely and almost immediately. If that might be you, too, then read on.  



***

I Quit Sugar by Sarah Wilson lays out an 8-week process of eliminating fructose and added sugars from one's diet to recalibrate one body. Sarah gives recipes to help one along with a sugar-free lifestyle quest.

Overall, I really like her attitude of approaching any new diet regime: be gentle and kind to yourself. 


The format is done well with many pop-outs of tidbits of info and bottom line dos and don’ts – easier to follow that way especially as the first third of the book is how her plans works; the second two thirds are recipe driven.

The book is informative but not deep research driven; it’s more lifestyle choices and how these choices affected the author personally. I Quit Sugar by Sarah Wilson is an easy read with some valid points about sugar consumption in America and sugar’s potential affects on the body.

I’m not a huge sugar consumer and not a major processed food consumer. Having said that there are plenty of places that I still cut corners, like buying and using pre-made organic tomato sauce (still filled with fructose) or a cookie every now and then or some food allergy free chocolate. It’s not a perfectly sugar-free diet however, my diet works perfectly for me. And the author also stresses that point (which I like and agree with wholeheartedly): there is no one size fits all diet for health. Do the best that you can with what’s available and what your body needs.

I Quit Sugar by Sarah Wilson has 108 fun, easy recipe ideas, if you know how to cook. This is not a beginner’s guide to cooking cookbook. However, as an experienced cook, I appreciate her “I use the same few ingredients multiple ways so you don't have to go out and buy fancy ingredients” approach. It’s how I cook as well.

It's worth noting the following: 


The recipes are written in a "throw in and bit of this and that" format. If you need more precise instructions, this book may not be for you. 


This recipes are also heavy on the use of tree nuts (including coconuts), eggs and cheese. Proceed accordingly.


By week 4, Sarah's weekly dietary instructions become more focused on feelings around food and social engagements around food; so, it's not a strict "eat this, not that" 8-week diet book.


Excerpt here via her publisher, Clarkson Potter

Having said all of that, if you are looking to cut sugars out of your diet, and already know how to cook and throw together meals, this may be a good resource to start that de-sugaring process.


As in all things, any dietary change should be in conjunction with a board certified medical professional who can address any medical needs that may be driving that dietary change.

Friday, April 04, 2014

Recipe: Nut-free, Dairy-Free, Gluten-Free Chocolate-Chocolate Chip Cupcakes with Chocolate Chip Frosting



Look at that glorious cupcake with chocolate chip frosting. It’s calling to you isn’t it?
It’s a birthday cupcake that I made for D. He loves, loves, like cannot let one day pass without chocolate. So, I made a dozen cupcakes and one nine inch round cake. All made from scratch with these capable hands!  

Shhh. 

The cake is from a box. It’s a good box. King Arthur Gluten-Free Chocolate Cake mix. It’s certified gluten-free. It’s also nut-free and made without diary, too.  And it was my idea to add chocolate chips to it. And I made the frosting by hand. And added chocolate chips to that, too. 

So, that counts as homemade. Really, I promise you it does.

How did I do it?

Here is the King Arthur Gluten-free cake mix label.

The adds in are:

  • 4 eggs. I use Organic Valley
  • Vegetable oil. I use extra virgin olive oil by Lucini.
  • Water. I use tap.
  • Gluten-free Vanilla Extract. I use Bourbon Vanilla by Nielsen-Massey. (No liquor from Kentucky is involved. The “Bourbon" name comes from the beans that are used in that specific extract. They are harvested from Madagascar, which is one of the Bourbon islands.)
  • I added about two handfuls of mini-chocolate chips by Enjoy Life Foods. Top eight allergen free.


For the frosting I altered the recipe on the back of the Dominos Confectioner’s Sugar box recipe. So easy!
 Here’s my frosting recipeHere’s a funny video I made with performer and comedian Rebecca Vigil as we made the frosting.

Gluten-free baking can be tricky (read: major bake fails or buying expensive ingredients you never use again). King Arthur’s makes an excellent product that all my guests (GF and non-GF) love and I love to serve. So really, when are you getting your cake on?


Monday, March 17, 2014

Recipe: Irish Soda Bread: Gluten-Free, Dairy-Free, Peanut-Free, Tree Nut-Free


I adapted my own Gluten-Free, Peanut-Free and Tree Nut-Free recipe from last year and made it dairy-free (and even better). 


Gluten-Free Irish Soda Bread
Adapted from Glutino’s recipe and further adapted by Allergic Girl

1 box (15 ounces) King Arthur Gluten-Free Pancake Mix
2 large organic eggs
¾ cup orange juice
2 tablespoons olive oil
¾ cup golden raisins (soaked overnight in OJ)
2 teaspoons caraway seed
2 teaspoons grated orange rind
1 tablespoon oil to brush top of bread (optional)

The night before or at least 30 minutes before soak the raisins in OJ, enough to cover them.


Preheat oven to 350 F.  Lightly oil an 9-inch cake pan or glass pie plate. Set aside.

In a large bowl, mix all wet ingredients together plus caraway seeds and raisins in their OJ. Add the dry pancake mix to the wet mixture. Mix until it comes together. Spread into prepared cake pan.  Brush with 1 tablespoon oil (optional). Bake 35-40 minutes or until top is brown. Cool slightly. Cut into wedges and enjoy with butter (or butter substitute) and your favorite jam.

Friday, March 14, 2014

Food Allergy Counseling: Interview with David Stukus, MD

I first noticed Dr Stukus on my Twitter feed (@allergicgirl). An allergist based out of Nationwide Children's Hospital in Ohio, Dr Stukus’s feed is filled with practical advice about environmental allergies, food allergies, asthma and eczema i.e. atopic disease. He tweets about talking with patients and patient education in a real and relatable way like when he reminded us all of risk factors for a teenager with food allergy.  

See this example:

Recently met new #foodallergy patient with every risk factor for death: teenager, nut allergic, doesn't carry epi at all times, has asthma

When I discussed those risk factors, it really got their attention (and that of parents) - important discussion to have #foodallergy

I also noticed that he was regularly myth busting about atopic disease. Have a look at some of these tweets about alternative treatment for IgE mediated food allergy:

Dear patients with true IgE mediated #foodallergy who seek 'treatment' at a chiropractor: This will not go well for you.

Difference of opinion begins with definition of #foodallergies. I'm talking IgE mediated immunologic reactions...

Dear practitioners 'treating' #foodallergy w/spinal manipulation: Stop. Leave these people alone. Make your money somewhere else.

And late last year, in November, he made national news with a presentation he made at the American college of Asthma Allergy and Immunology: Allergy myths busted: Guess what you didn't know about gluten? - TODAY.com. His myth busting included some of my favorite myths that I hear all of the time like, “you can’t be allergic to my dog, she’s hypoallergenic.” 

To that Dr Stukus wrote:

Myth 1: If you’re allergic to cats or dogs, it’s best to stick with hypoallergenic breeds.
Actually, there is no such thing as a hypoallergenic pet, Stukus says, because “every single pet will secrete allergens.” And it doesn’t make much of a difference if the pet has short or long hair, because the dander that people are allergic to doesn’t come from the fur – it comes from the animal’s saliva, sweat glands and urine.

Which I tell people all of the time but they never seem to get.

I wanted to know more about the doctor behind the myth busting and tell-it-like-it-is-tweeting allergist. So recently, I had a chance to ask him a few questions. 

Read on!

***




Allergic Girl: What’s your professional background?

Dr David Stukus: I am a board certified Allergist/Immunologist and Pediatrician. I am from Pittsburgh, PA originally, and I attended undergraduate and medical school at the University of Pittsburgh. I completed my pediatric residency and spent an extra year as Chief Resident at Nationwide Children's Hospital in Columbus, Ohio. I completed my fellowship in allergy/immunology at The Cleveland Clinic Foundation and then joined the staff at the Children’s Hospital of Pittsburgh for three years before moving back to Columbus and Nationwide Children’s Hospital in 2011.

AG: Do you have any personal connections to food allergy? To allergy? To asthma? To eczema?

DS: I do not personally have any types of allergy or asthma but my 4 year old son has asthma and eczema. No one in our family has any type of food allergy.

AG: What drew you to Allergy/Immunology as your field of specialty?

DS: During medical school, I wanted to become a pediatric cardiologist, but this interest ended very early during my intern year after reading hundreds of cardiac rhythm strips at all hours of the night.

I then became very interested in asthma after caring for so many children with asthma in various settings. Asthma is a leading cause of emergency room visits and inpatient hospitalizations at almost every children’s hospital. I became fascinated with the variety of patients, different presentations, and how difficult it is to control. When I explored specialties that care for asthmatic children, I then became very interested in food allergies, immune deficiencies, and other allergic conditions.

AG: You’ve written a lot about allergy myths, where do you think they come from and how are they perpetuated?

DS: Some of them come from physicians who continued to practice outdated medicine or continue to make recommendations that have been disproven through research. Other myths are like any urban legend, which start by word of mouth and take on a life of their own. I also believe the growth of the internet has perpetuated and also started many myths. The internet can be a wonderful resource but is not regulated in any way and is filled with misinformation.

AG: What do you recommend to your patients when confronting friends and family especially when they insist they know the “truth”?

DS: I try to educate my patients and families as much as I can with evidence and even some talking points to discuss with others for certain situations. I recommend trying to remove emotion from any conversation and to use any difference of opinion as a starting point to engage in discussion that can help provide education and awareness to both sides. Everyone comes out a loser in a shouting match.

AG: Let’s talk about IgG, IgA and IgE – what are all of these letters and what do they mean in food allergy blood tests?

DS: Ig is the abbreviation for ‘immunoglobulin’, which is the technical term for antibodies. Antibodies are part of our immune system. The letters A, G, and E all indicate different types of immunoglobulins, which have different roles inside the body.

IgA is an antibody that lives mainly on the surface of the upper and lower respiratory tract, including the nose, sinuses, throat, and lungs. IgA serves as a first line of defense and protects against bacterial infections.

IgG is a memory antibody that forms after exposure to vaccines, infections, and any environmental exposure, including foods.

IgE lives on allergy cells called mast cells, which are found everywhere throughout the body. 

IgE is involved in the hypersensitivity response to allergens, including airborne and foods. If someone forms IgE towards an allergen, then exposure to that allergen causes the mast cells to open and release chemicals (histamine) that then produce symptoms of an allergic reaction.

AG: What are the myths around these blood tests and why do you think they persist?

DS: There are several myths surrounding these blood tests and most persist due to personal or financial gain as practitioners or laboratory facilities can make money by ordering extensive testing, which may have no utility whatsoever.

In regards to food allergy blood tests, IgA has no role. IgA plays a role in celiac disease, which is not a food allergy, but an autoimmune condition where some people produce IgA that attacks their own intestinal cells in the presence of gluten.

IgG is not a validated or recognized test for the detection of food allergy. The governing bodies of AAAAI and ACAAI both discourage use of food specific IgG testing in the diagnosis or management of food allergy. Most experts agree that this likely represents a memory response, thus higher exposure to a certain food will produce a higher IgG level. IgG is also formed when people undergo immunotherapy and develop tolerance to an allergen, thus suggesting that IgG is actually protective and not involved in any type of allergic response or intolerance.

IgE blood tests by themselves measure sensitization and are not diagnostic for food allergy. They are not a good screening test due to high rates of falsely positive results that often lead to diagnostic confusion and unnecessary dietary elimination. Blood IgE tests are very helpful in confirming a suspicious history of food allergy reaction or following levels over time in someone with known food allergies to determine whether they may have developed tolerance.

AG: Which letters are most important if you suspect you have a severe food allergy?

DS: IgE is the only antibody involved in an immediate onset hypersensitivity (anaphylactic) response to foods.

AG: What is the gold standard for food allergy diagnosis?

DS: The gold standard is the history of what happens when a specific food is ingested. If someone has a food allergy, then they develop an immune response to that food. This is then reproducible with every single exposure, with characteristic symptoms such as itchy skin rash called hives, swelling, vomiting, and can progress towards difficulty breathing/swallowing, loss of consciousness and even death.

If someone can eat a food but doesn’t have any symptoms, then they are not allergic to that food. In addition, if someone is having chronic symptoms (stomach pain, diarrhea) that happens no matter what they eat, then they also do not likely have a food allergy and need to consider other underlying causes of their problems.  Lastly, the longer the list of suspected food allergies grows, the less likely it is that a person has true allergy to all of those foods and the more likely it is that they have other underlying conditions causing their symptoms.

AG: According to a recent study (Anaphylaxis in America: The prevalence and characteristics of anaphylaxis in the United States) the three main causes of anaphylaxis are medicine, foods and insect venom. Are their myths around anaphylaxis that you can dispel?

DS: The biggest myth is in regards to treatment of anaphylaxis. Self injectable epinephrine is the first line and ONLY effective therapy for anaphylaxis. This remains very poorly understood from patients, emergency responders, and even physicians. Antihistamines and steroids are second line treatment, to be given only after epinephrine.

Another big myth is that people don’t realize death occurs from allergic reactions, with approximately 150 people dying each year from anaphylaxis.

AG: Let’s dig in the myth of the hypoallergenic pet. Where do you think this started?

DS: A lot of this myth is based upon financial gain, with some breeders and companies marketing ‘hypoallergenic pets’ to customers, which cost significantly more than other breeds. This is likely perpetuated by people who have pet allergies themselves but continue to want to live with pets.

AG: What are the realities and what the falsehoods about pet allergies? And pet allergies including asthma like mine?

DS: Realities are that any pet will release allergen into the air, which is called dander. Some people may only have allergy symptoms when exposed to certain breeds or individual pets, whereas others may have symptoms around all types of one animal. There is no test available to determine allergy towards specific breeds. The only way to know if a specific pet will bother someone is by exposure.

Pet dander is what causes allergy symptoms and this is released from saliva, urine, and sweat glands. It spreads throughout any home in which pets live and will be on clothing, deep inside carpeting, and throughout the ductwork.

The only effective way to rid a house of pet dander is to remove the pet from the home, and even then, it can take 4-6 months before all the allergen is gone. It can help to restrict the pets from the bedroom at all times, vacuum and dust regularly, and wash the animals, ideally twice a week.

Falsehoods include the belief that some pets do not cause allergies. Allergy to pets has absolutely nothing to do with hair length, shedding, or breed.

People with asthma and allergies to pets can have both long term loss of asthma control with more frequent daytime/night symptoms and also more frequent asthma exacerbations that may require emergency room treatment or prednisone.

AG: When someone, like me, has allergic asthma to pets, would a mask work to protect me or allow me to stay where a dog/cat longer? (Specifically, my father wants to know.)

DS: Please tell your father that wearing a mask is not a very effective way to reduce exposure to pet dander for reasons discussed above regarding the ubiquitous nature of microscopic pet dander throughout any home in which pets reside.

AG: What is the one question you wish every patient would ask you during a consult?

DS: What is the most important thing I can do to make sure my child stays healthy?

AG: What is the one action you wish every patient would undertake to help you help them?

DS: If we discuss a new therapy, whether it be a new medication or other strategy, I wish they would at least try it for some period of time to help determine whether it is helpful or not.

AG: What are three things to tell your food allergy patents that give them hope, empowerment or courage?

DS: You can still enjoy life if you have food allergies.

With education comes knowledge, and with knowledge comes understanding. Once you understand your food allergies, you can deal with any challenges.

While not ready just yet, there are promising new research trials underway right now that offer some hope in regards to a possible cure for food allergies one day.

***

Thank you Dr Stukus for all that you do for the allergy community – keep doing the great work!

Tuesday, March 11, 2014

Food Allergy Counseling: Dating, Food Allergies, Soap

Tree nuts show up in the funniest places. A few weeks back, having a conversation with D. about my food allergies (this was after the kissing convo), all of sudden he said, “I use almond soap in the shower? Is that problem?”  

My first thought was no, probably not. He had showered hours before. And unless it was some fancy scrubbing soap with almond chunks (which it probably wasn't), synthetic almond fragrance (more likely in a commercial shampoo) shouldn’t have any protein in it and therefore shouldn’t be a problem. Even so, his shower had been hours before and we had been hanging out already for hours; I had touched his skin and nothing, no reactions. 

D., a conscientious person, emailed me a picture of the ingredient label from the soap the next morning. It was Dr Bronner’s Almond Soap. I know Dr Bronner’s; I’m a second generation user of their Peppermint Soap. My dad used the soap back in the 1970s:  “wash your hair and your teeth!Dr Bronner’s is a natural company that prides itself on natural ingredients. 

And indeed, the Dr Bronner’s Almond Soap uses a natural almond fragrance. Here are the ingredients: Water, Organic Coconut Oil*, Potassium Hydroxide**, Organic Olive Oil*, Organic fairDeal Hemp Oil, Organic Jojoba Oil, Natural Almond Fragrance, Citric Acid, Tocopherol. Again, fragrance shouldn’t have any protein in it but I figured I’d give the website a quick look. On Dr Bronner’s FAQ page here, they state that their products are free from tree nuts.

So, no reaction from contact and the company states no tree nuts in ingredients which confirms my lack of reaction. I went one step further and emailed the company to triple check. Their reply was very interesting.

Thank you for writing. Our soaps are all natural and pure as you can get. We are certified organic under the food grade standards. We do not use any synthetic ingredients in our soaps. The Natural Almond Fragrance in our Almond Soaps is Natural Benzaldehyde from Cassia flowers.  The scent is very similar to almonds, but without any traces of nuts or cyanide. FAQ's Ingredients Breakdown: https://www.drbronner.com/customer-service/faqs/ingredients/

So no almonds involved at all. This is not uncommon, you see this with almond flavoring as well, frequently made from peach pits (similar botanically and cheaper) and not containing any almond at all. But it always pays to communicate, check and double check. 

Bottom line is if there is no reaction, there is no problem.

Wednesday, March 05, 2014

Cuties Oranges: Product Review




Winter in the North East means citrus season and I always have oranges around in some form all winter long. Right now I have a bag of Navels oranges, some Temples sent to me from Florida and a half bag of cuties sent to me by cuties.

Cuties are clementine oranges that consist of two varieties of mandarins: clementines and W. Murcott. They have a thin peel and very little pith. And no pits, which I love. The taste is sweet like a clementine but with an edge of a bitter bite, like mandarins or tangerines or kumquats. A sophisticated clementine.

Why I especially like clementines is that they are a snack that travels well, no refrigeration needed and they come with their own cross-contact free zone – a peel! They are small, easily fitting into a pocket or purse, are healthy, have fiber and vitamins. Seriously, a no-brainer, top eight food allergen free snack.


Thank you for these delicious samples, Cuties, love’em!

Tuesday, February 25, 2014

Food Allergy Counseling: Food Allergy Mortality Discussion for Healthcare Professionals, AllergyHome.Org

I had a version of this conversation with D. a few weeks after the kissing conversion, about food allergy risk: 

The bottom line is there is a risk I could die from accidentally ingesting one of my allergens (tree nuts or fish). I do everything I can to manage that risk, including carrying emergency medication. It probably won’t happen but it is possible and I live with that risk every time I eat, dine out and travel.  

We were talking about risk generally and I felt it important to help him understand that this is a deep truth of my life. It has probably helped to shape who I am, how I view the world, how I interact with the world and how I move through the world. (This is among the many, many, many other factors that shape who any of us are.) I accept my food allergies and I do not let that one aspect of my life define the rest of my life. However, I am aware that the risk is very real. My job is to manage that risk while having a life.

When did I know that truth? At an early age. How did I find out? That's hazy. Back then, there were no support groups or national non-profits dedicated to education and awareness; no other kids for me to talk to, no parents for my parents to connect with. I imagine my awareness came after years of doctor’s appointments and overhearing bits of conversations and putting it together. Not ideal and definitely scary and anxiety-producing.

But how do families and adults these days address the possibility of a fatality from food allergies? At what age does one have that conversation? With what language? It is a complex question with a complex answer. And it’s not only about the children: many parents cannot handle this information (a possibility of a fatality from food allergies) and choose to remain in denial about the real risks of food allergy exposure, thus potentially endangering their child’s health and well-being. Truly, it’s an issue that must be tackled from a multi-viewpoint perspective. Not so easy to do in a 20 minute consult with a doctor. OK, near impossible.

Dr Mike Pistiner in a recent post on his website Allergyhome.org begins to tackle the over-arching concerns from a Healthcare Professional perspective (as in the professionals who dispense information to you about disease management).

It is a conversation to have with your pediatrician and allergist about real risks, and how to engage your feelings as a parent first and then your child about this very serious issue in order to integrate the information in a helpful, useful, un-fearful way.

This is something I’ve talked about directly with my teenaged food allergy counseling clients and with parents within a food allergy counseling relationship. 

f you have concerns about how to engage either your medical team or you family about, the possibility of a fatality from food allergies, contact me about a short term counseling program, today.

Friday, February 21, 2014

Food Allergy Counseling: Kids With Food Allergies: Epinephrine Free Seminar

Our friends at Kids With Food Allergies (KFA) are hosting a free seminar about epinephrine with my colleague, allergist and food allergy dad, Dr Mike Pistiner.  Here’s more from a press release from KFA:

Everything You Want to Know About Epinephrine and More SIGN UP NOW

Angela Nace, PharmD, and Michael Pistiner, MD, MMSc, will answer your questions about epinephrine. Submit your questions in advance on the registration form. We're very excited to continue to bring physicians and experts to you in a free format that is easily accessible. Space is limited, so be sure to register early. We thank Mylan Specialty for sponsoring this event.

RSVP: https://www4.gotomeeting.com/register/170327023
Date: Wednesday, February 26, 2014
Time: 7 pm Eastern | 4 pm Pacific
Where: Your computer or mobile device 

They will review what epinephrine is and how it is used to treat anaphylaxis (severe allergic reactions), the different brands of auto-injectors available and topics such as:   

-What body systems does epinephrine work on and what does it do to each of them? How does it work differently than antihistamines? 
-Is epinephrine dangerous? 
-Can the effectiveness of epinephrine wear off if used too much? 
-Why does it need to be kept at a certain temperature? 
-Does epinephrine not work sometimes? Why? 
- Is it okay if my baby/child weighs less than what is recommended on our dose?  Is it safe to give that dose? 

Tuesday, February 18, 2014

Allergic Girl: Interview, DNAinfo.com

A much beloved Kips Bay / Murray Hill neighborhood restaurant that was on the forefront of gluten-free dining and allergen-awareness here in New York City, Bistango, is opening a second location on the Upper East Side (1420 Third Ave at 77th street.)

I’ve been going to
Bistango for a few years now. I’ve consistently had safe and yummy dinners that were prepared by an allergen-aware staff.  If you’ve been there you may recognize it as the setting for the last scene of my Allergic Girl: Adventures in Living Well with Food Allergies (Wiley, 2011) book trailer.



Last week, I was interviewed by DNAinfo.com to reflect on the news that
Bistango is opening a second location. A quote:

“[Owner] Anthony is a true restaurateur in that the customer comes first,” she said. “He focuses on what each customer needs and then tailors a menu to that.”

Read the full story here on DNAinfo.com.

I can’t wait to try it out. 


Best of luck to Anthony and the whole Bistango team!

Friday, February 14, 2014

Food Allergy Counseling: Kissing & Food Allergies: Valentine’s Day Edition

Picture it. A cold, January Friday night. Date Two with D.. Metropolitan Museum.

D. and I have strolled into the Temple of Dendur, a separate building that houses an ancient Egyptian stone temple. The museum is practically empty. The lighting near the Temple is low and there are ripples of light on the wall opposite us: reflections of a pool below. The conversation slows to a halt as D. looks at me, his eyes softening and intensifying.

In that moment I had two thoughts: he’s going to kiss me (yay) and he probably ate chocolate with nuts recently (uh oh). He had told me a few days prior that he loved high quality chocolate, often with nuts and ate it every day.

He leaned in, and kissed me softly on the mouth.  I pulled back and placed my hand on his.

“I totally want to kiss you back. But did you have chocolate today?”

“Yes.”

“What kind?”

Toblerone.” 

And in two blinks, his expression changed.

“Nuts,” he said. “I didn’t think it could transfer. And it was a while ago. Would that matter?”

Thus, began a conversation about my food allergies and kissing.

It’s a conversation I’ve had often over the last few years: a combination of being single and dating, and, I suspect, dating healthy eaters who enjoy diets rich in seafood and tree nuts e.g. every man I’ve dated in the last three years loves almond milk. Seriously. 

The conversation I have about food allergies and kissing ranges from highly nuanced to short and sweet, depending upon a variety of factors. In the beginning of a dating relationship, certainly on date one or two, I usually stick to the facts: I can't kiss you if you've eaten my allergen recently. This is what we need to do. 

On this date, even though it was date two, D. expressed some interest to know everything I could tell him in order to keep me safe (and to satisfy his curiosity about what I was telling him). I offered to email him my food allergy list as well as the only major salvia study that talks about how to rid one’s salvia of peanut protein (a study often extrapolated for other allergens). D. read the information and said that it helped him to understand better my medical needs and how to keep me safe. The next time we met, I brought him some safe chocolate (both Divvies & Enjoy Life Foods) and we had big kisses, which were totally lovely.

Yay.

Seems easy, right? Straight forward? An easy exchange of information?

Not exactly. Stories, press releases and interviews on the Internet from large news organizations and national non-profits (many in which I am quoted) state that you have to tell your partner about your allergies and not kiss them if they have eaten your allergens. Totally true.

But how does that play out in the real, offline world?

If you are the one explaining your needs, it can feel awkward. Or weird. It can feel confrontational or feel unromantic and informational. For your potential kissee (and I just asked D. what he thought), it can be frustrating in the moment because this person wants to kiss you and can’t. He added that he felt curious about the information I was telling him but also wondered how kissing me would work down the line?

So, then, not so straightforward. Not such a clean, exchange of simple information.

I’m not saying don’t have the conversation. You have to. I have to. And there are a thousand ways to get it done, in your own way and time. And with every person you kiss, the conversation will change, be differently great or differently awkward or a combination of both (which, I find, is usually the case).

My point is: if you are anticipating feeling all of these uncomfortable feelings (and/or more/different ones) and thinking maybe I’ll skip the conversation this kissing holiday or any kissing opportunity, don’t. You and your partner will probably feel all of these feelings and ones I haven’t even described here. It’s normal. It’s natural. Feel the feelings and have the conversation anyway. You may get kissed, you may get someone who isn’t interested in knowing more; that’s the risk.

But that is a way easier risk to handle than the risk of a severe food allergic reaction or anaphylaxis.

Go out there this holiday and get your kiss on, safely!


**

Generally speaking my food allergy and kissing conversation contains a version of these basics:

I have food allergies and this is what food allergies are
This is what I’m allergic to
This is what can happen during a severe allergic reaction
For me to kiss you safely, these factors are vital

Want more? My book Allergic Girl: Adventures in Living Well with Food Allergies (Wiley, 2011) has a whole chapter on dating and food allergies and you can get it here.