Food Allergy Counseling

Food Allergy Counseling
Sloane Miller, MFA, MSW, LMSW, Psychotherapist; Specialist in Food Allergy Management, Speaking At Mylan Specialty / EpiPen Event (© Noel Malcolm 2013)

Monday, October 24, 2016

Food Allergy Counseling: Maintaining a Healthy Lifestyle, Preparing Your Produce

My haul from Costco today

A follower on my Instagram account asked me how I eat all those luscious cupcakes and weekend pancakes and still stay slim?

And it’s true, I do eat pancakes almost every weekend and cake, cookies and/or chocolate whenever I want.

So, how do I do it?

I will be posting my strategies and thoughts on my Allergic Girl Facebook page, here on my blog and on Instagram.

Today my tip is about food prep, supporting your diet goals and setting yourself up for excellence.

I shop two or three times a month at Coscto for my fruit and veg; I eat that much fruit and veg daily.

Above is a picture of what I bought today. 

And below is a picture of what I did for about 30 minutes when I got home i.e. I washed, chopped, prepped, bagged and Tupperwared everything so it’s all nice and ready to grab.

My fridge after food prep

Need a snack? Sliced apples and oranges are ready. Want a salad? Look, one’s already made and waiting! Isn’t that glorious?

Part of the challenge when you buy a ton of fruit and veg is that they need preparation: chopping, slicing, coring, peeling, etc.. The prep can be a barrier to eating all of that wonderful produce and it can end up sitting in bags, rotting in your fridge in just a few days. All that wasted goodness, health and cash.

So, by taking some time when I get home from shopping and prepping fruits and veg, getting them closer to being ready to eat, I cut out that challenge and make it so much easier to grab a healthy snack, setting myself for excellence and supporting a health diet with healthy habits.

Monday, October 17, 2016

Recipe: One Pan Turkey Scramble

What to make with eight ounces of frozen ground turkey thigh? 

I typed that into Google and  Simply Recipes's "Mom'sGround Turkey & Peppers" recipe popped up. I love the Simply Recipes site and this recipe was so easy: turkey, peppers, onions, garlic and chili powder. 

I used shallots (had no garlic) and halved the recipe and was so yum. I had made a batch of brown rice and put it right over but would be on top of a great salad, too.

Thank you, Simply Recipes!

Monday, October 10, 2016

Food Allergy Counseling: Emotional Agility in Children and Adults

This is a fantastic, short article from the New York Times Well section on how to embrace your child’s emotional experience and teach them to embrace it as well; also works for adults!

“How children navigate their emotional world is critical to lifelong success…Dr. David offers four practical steps for helping a child go through, rather than around, a negative emotion and emerge ready to keep going — feel it, show it, label it, watch it go."

Read more here on the New York Times website.

Thursday, October 06, 2016

Allergic Girl Counseling: An interview with Sloane Miller, Food Allergy Canada

Food Allergy Canada interviewed me earlier this month on a topic rarely explored in print: self care for those of us managing food allergies. 

Here's the article: Food allergies and emotional resilience: An interview with Sloane Miller and Pauline Osena and quote from me.

“As an adult with food allergies (and asthma, allergies and eczema)…being open, present and vulnerable are all values I hold dear and knowing when I’m feeling extra food allergy vulnerable and need more support is an important skill I’ve fostered.”

Read more on the Food Allergy Canada blog.

Monday, September 26, 2016

Recipe: Apple Spice Cake, Nut-Free, Gluten-Free

Honey cake is a traditional cake for the Jewish New Year celebration. This weekend, I was hoping I could turn Namaste Food’s spice cake mix into the honey cake of my dreams. And I documented my trials on Instagram @allergicgirlnyc #allergicgirl

Alas, I could not. I substituted one third cup of honey for the one third cup of water called for, hoping that would balance out the moisture levels. I was so wrong. The cake took twice as long to bake, thus it was overbaked and tough, the honey flavor totally disappeared, overtaken by spice and it was soooo sweet. My honey cake experiment was a total fail. Here’s a picture of my over baked darling.

I totally enjoyed it but I wouldn’t make it again.

Next, I considered an apple cake with honey glaze. Oohhh. Aaaahhhh. I washed, skinned and chopped one large apple and layered into the loaf pan with the spice cake batter, made as directed. Out came a lovely apple spice cake.


Next, I created a honey glaze with 1 cup confectioner’s sugar, 2 T of honey, 2 T of milk and mixed that and drizzled over the warm cake. Alas, the cake needs no honey drizzle. It’s truly perfect just as is. Here's a video of me tasting it for the first time with a drizzle.


So this year, I won’t bother with a honey cake, but an easy apple spice cake will grace the table and everyone will love. 

*I may make some ice cream to go on top. Two ingredient, nut-free ice cream recipe here.*

Tuesday, September 20, 2016

Recipe Collection: Rosh Hashanah 2016, Nut-Free, Gluten-Free

Last year's Rosh table

It my favorite time of year – the Jewish New Year. It’s a truly beautiful holiday, one that is centered on taking time to reflect, atone and forgive. It’s also one of the best dinners in the Jewish calendar. Every part of the meal is based on sweetness to bring in a sweet new year.
The last few years we’ve made basically the same meal, it’s free from my allergens, everyone loves the dishes and it’s delish. Here is a roundup of the menu with links to recipes for each dish:

Apples and honey
Chicken with honey and cumin
Sautéed green beans with fried shallots

This year I may try another gluten-free, lactose-free sweet noodle kugel.
I tried it once before and didn’t love it but I going to go back in!

And instead of apple spice cake, I'm thinking I'll make a honey spice cake.

Keep your eyes peels for those new dishes and recipes.

L’shana tova!

Friday, September 16, 2016

Food Allergy Counseling: Interview with Kyle Collins, Manhattan Digest, How to Get Your Goals

Kyle Collins of kindly interviewed me last month for his series “How to Get Your Goals”Here’s an excerpt:

Sloane suggests thinking back to see what’s worked best for you before in order to develop a plan that has a better chance of working for you now.

“So, first things first: Know yourself,” Sloane says. “Do you need external pressure or are you self-directed? Does outside structure help or do you prefer a more internal organic approach to solving challenges? Figure out how you actually function in the here and now and how you do your best work, and do more of that.”

You can read more here. And if want some one-on-one support about reaching your goals, contact me today!

Monday, September 12, 2016

Allergic Girl: Giella, Mascara Giveaway on Instagram, September 12, 2016

I met Giella years ago, when she had a booth at Bendel’sGiella can custom blend any makeup you want (like replicating a color that has been discontinued) for the same price as department store brands. She has some premade makeup as well, like her mascara. When, very often, the only makeup I wear is mascara, I want a good one. I love the mascara by GiellaIt thickens and lasts and makes your lashes look really full. 

Here are the ingredients. 

Giella kindly offered to do a mascara giveaway through my Instagram account - yay! The contest will only run for 24 hours.

Are you on Insta? Come over to AllergicGirlNYC on Instagram today, follow my account and keep your eyes peeled for the contest and how to enter.

*As always, check with your medical professional about your personal needs.*

Monday, September 05, 2016

Redshirts at Star Trek: Missions, September 3, 2016

One of my many hobbies is musical improv. I’ve written about it on my blog talking about: “Yes, And…”;  how to “play” as an adult, a video and recipe with a huge improv-world star, a sample of a letter asking my teammates to refrain from eating my allergens before performances and pushing past your fears.

This weekend, my dream team of performers, Redshirts, is going to boldly go where no musical improv team has gone before: Star Trek: Missions.

To make a dream I didn't even know I had come true is beyond fulfilling, beyond joyful and beyond nerve-wracking. But above all, I cannot wait to sing my heart out, laugh my ass off and have a ball with these wonderful crewmates.

Monday, August 29, 2016

Interview: Dr Chitra Dinakar & Dr Jay Portnoy, Proximity Food Challenges

Recently, the journal of the American College of Allergy, Asthma and Immunology published a letter in their Annals of Allergy, Asthma and Immunology from Chitra Dinakar, MD 
and Jay M Portnoy, MD of Children’s Mercy Hospitals in Kansas City, MO. In it, they describe the scores of patients they see with one overriding concern: fear of casual contact with their allergen. To that end they combed through the existing literature and created a simple solution to calm the fears of their patients with food allergy fears: proximity food challenge tests. I had an opportunity to interview them via email. Please read the below.

As always, consult with your medical health care provider for your needs and DO NOT DO THIS AT HOME unless directed by your medical health care provider.


Allergic Girl: What prompted your team to create the "Proximity Food Challenge Test"?

Dr Chitra Dinakar & Dr Jay Portnoy (MD): We observed that many children/individuals/families with food allergies appeared to be in a state of worry, not knowing when accidental contact with the trigger allergen will set off the dreaded, life-threatening anaphylactic reactions. They were experiencing significant impairment in their quality of life, with many of them making multiple adjustments and accommodations in the way they interacted at school and work, often resorting to sitting all by themselves at peanut-free tables (and allergen-free tables), and going to extraordinary lengths to avoid social situations where there might be exposure/casual contact with the suspected allergen. 

It was not hard to understand why they were doing it: published literature is conflicting, with some earlier reports suggesting a heightened risk of reaction on contact or inhalation of food allergens (e.g., peanuts) in public places such as airplanes and baseball games.

However, reassuringly, contrary to those reports, some recent studies (including those from our center), indicate that the risk of a severe reaction is largely related to ingestion or contact of the allergen with mucus membranes (and rarely, inhalation, such as with shellfish and aerosolized peanut dust), and not with casual contact on intact skin. Therefore, in order to address the concerns regarding the possibility of airborne and contact food sensitivity in individual patients, we developed the Proximity Food Challenge test at our center. This test helps them understand, in a safe and monitored setting, what to expect with similar exposure in a real world environment in the future.

AG: What is a "Proximity Food Challenge Test"?

Dinakar/Portnoy: In order to help children/individuals attending the food allergy clinics at Children’s Mercy Hospital determine the degree of sensitivity to casual airborne or skin exposure, (and based on the 2014 Food Allergy Practice Parameter Update recommendation to “Teach patients that ingestion, rather than casual exposure through the skin or close proximity to an allergen, is almost the only route for triggering severe allergic/anaphylactic reactions), we started offering the option of undergoing "Proximity Food Challenge Test".

Our approach, containing the key elements of the protocol described in a study by Simone et al, is adapted to be conducted in an office setting equipped to handle anaphylaxis. After obtaining verbal consent, the provider opens a jar containing the suspect allergen, often peanut (since it is the most feared) in the room. While conversing, the peanut butter jar is then brought increasingly closer to the child. If there is no reaction, a dab is applied on the patient’s arm, and the patient monitored. Five minutes later, the food allergen is washed off with soap and water.  In situations where there is heightened anxiety secondary to the perception of occurrence of a previous reaction, an attempt to mimic the scenario may be undertaken in a double-blind, placebo controlled fashion.

In our experience, the Proximity Food Challenge has helped alleviate fears of the families and enabled the child to integrate in the social network at school and in the community.

AG: Incredible! In your letter you state that “…misinformation regarding the triggers of anaphylaxis is widespread.” What are three of the most prevalent myths you hear in your practice at Children’s Mercy Hospitals and please correct them!

Dinakar/Portnoy: Myth 1: casual contact (through the air, on skin contact or just being in the presence of a trigger) will cause anaphylaxis that could be life-threatening.

This is a myth and is not true. In general, the food allergen needs to be absorbed into the body to cause a reaction. In other words, one has to eat a food or have it touch mucus membranes (e.g., inside of the eyes, nose) or broken skin (e.g., individuals with open sores, eczematous lesions) to have systemic symptoms and anaphylaxis. Other types of exposure can cause skin rashes and swelling of eyes, lips, fingers etc (and of course, can be extremely anxiety provoking), but typically does not cause anaphylaxis. Rarely, inhalation of aerosolized food allergen (as when shellfish is being cooked, or peanuts are shelled) can cause systemic symptoms.

Myth 2: Ingestion of a food you are allergic to will always cause life-threatening anaphylaxis.

In real life, most food reactions involve itchy mouth, rashes, hives, swelling of lips and tongue, or vomiting. Many commonly reported reactions to fresh vegetables and fruits are due to the plant proteins cross-reacting with pollens in the air (food-pollen syndrome), and is typically limited to symptoms around the mouth and throat and are not anaphylactic. 

However, reactions can progress to anaphylaxis and be life-threatening, therefore taking reasonable precautions to prevent exposure, and treat reactions, is strongly recommended.

Myth 3: Epinephrine is a dangerous treatment.

In fact, we all produce epinephrine. It is a natural hormone that is made in our adrenal glands (adrenal comes from the Latin for “near the kidney”. Renal = kidney. The adrenal is near the kidneys). Epinephrine, (commonly known as “adrenalin”), is naturally produced in our body when we get excited, or do a burst of physical activity. Epinephrine is therefore a safe drug that is extremely effective. Unfortunately, many folks prefer giving antihistamines such as Benadryl instead of epinephrine because of their fear that epinephrine is a dangerous treatment. This may be appropriate for very mild reactions only. If 2 body systems are involved or the patient is having difficulty breathing or low blood pressure, epinephrine should be given first. The sooner the better. If you wait too long (eg: more than 6 minutes) it will not work as well.

AG: Much of the currently published literature about allergens and casual contact involves peanuts, exclusively. For many with anaphylactic allergies to the other top allergens (tree nuts, dairy, eggs, wheat, soy, fish & shellfish), they worry that the studies about peanuts do not apply to them. How can they be reassured that studies about one allergen are safely extrapolated and apply to their needs/real risks?

MD: Casual contact with peanut does not cause anaphylaxis. That is also true for the other foods. The only exception is crustaceans (a subgroup of shellfish which also includes mollusks and cephalopods). Crustaceans like shrimp, lobster and crab, are often prepared by boiling. The vapors can carry allergens into the air so it is possible to have mild reactions in a seafood restaurant that prepares food that way. Also being within breathing distance when peanuts are being shelled, or any process that causes breakdown of the allergen and dispersal in the air, can potentially cause anaphylaxis.

AG: Proximity food challenges are an incredible idea and one that I hope spreads to other centers for excellence. Until that time, will you be expanding that idea/teaching it to other allergy/immunology practices?

MD: We are trying to spread the message. The first step is with this publication. When ideas are published after meticulous peer scientific review, they are accepted better by the medical community. We have already received encouraging positive feedback from a few colleagues regarding this manuscript.  We will try to spread the message at educational sessions at local, regional and national meetings. We have also written about this in Missouri Medicine.  Hopefully, the message will find its way to the lay community through blogs such as yours (thank you very much for your initiative!). Patients who have undergone this procedure have been very grateful for the lightening of their anxiety burden. Hopefully, they will also help spread the message and will advocate to food allergy support groups about the advantages of seeking this type of testing.

AG: How can patients advocate for themselves and ask for their allergist to implement this idea?

MD: Patients should ask the doctors to help them determine if casual contact is a trigger for their child. They should be aware that this will help them and their child integrate better in activities of daily living and in their social/cultural fabric. They should mention that they read about the proximity challenge being performed at other centers and request that the doctors contact us/read the article/read your blog to find out more information. It is a very simple procedure, and apart from being time-laborious, is not very hard to perform. Patients will most certainly find that the peace of mind they gain after the test is done is well worth their efforts.

AG: For anyone with food allergies feeling confused about allergist recommendations regarding avoiding contact with their allergens and how to do so without avoiding one’s life, how would you suggest they engage their allergist in a conversation about real risk versus low-to-no risk situations?

MD: I would suggest that they explain to the allergist that they would like to identify the types of exposure that are not life-threatening for their child/individual in order to better fit in at school/home/work settings. Getting this help from their allergist will help alleviate some of their anxiety.

AG: For allergists reading this, how would you suggest they better help / communicate real risk to patients?

MD: I think the allergist may want to consider bringing up the possibility during the clinic visit, and discuss the pros and cons of performing these challenges.


Thank you, Chitra Dinakar, MD 
and Jay M Portnoy, MD!