Food Allergy Counseling

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

Monday, March 02, 2015

Food Allergy Counseling: Food Allergy Resources in Spanish

Here are two excellent, reliable resources in Spanish. Please spread them far and wide!

Food Allergy Research & Education has their anaphylaxis action plans in Spanish and English. You can download these free here. has their Living Confidently With Food Allergy handbook in Spanish as well. Here’s the link and here more information about their guide from the website:

"Living Confidently With Food Allergy is a handbook created to get needed information to all that are managing a food allergy. It was designed to give parents the tools they need to keep kids safe while addressing their emotional needs. The handbook was the result of a two year North American collaboration lead by Anaphylaxis Canada. This free, easy to understand resource was written by Dr. Michael Pistiner, Dr. Jennifer LeBovidge and the Anaphylaxis Canada team (Laura Bantock RN, Lauren James, Laurie Harada).  It was reviewed by over two dozen American and Canadian experts."

Tuesday, February 24, 2015

Chipotle, Cumin Recall 2015

I dine at Chipotle Mexican Grill multiple times a week here in New York City and when I travel. It’s delicious, the food is made consciously and humanely and best part: their food does not contain my allergens, tree nuts and fish (more of Chipotle Mexican Grill's allergen information here).

So when the recent cumin recall hit, I was a little nervous. Would this affect the cumin-heavy menu of my beloved Chipotle Mexican Grill? (More on the cumin recall here from Allergic Living magazine.) 

I wrote to Chipotle Mexican Grill directly and at first they said this (reprinted with permission of Chipotle Mexican Grill):

“…I can tell you with complete confidence that our cumin is not in any way affected by this recall. You can definitely eat our restaurants with peace of mind!”

In a second email, I asked for clarification. Chipotle Mexican Grill responded:

“There was only one plant that this affected and this is not where we
 purchase our cumin. Our cumin is whole and we grind it ourselves in our
distribution center. We have frequent audits so we can make sure that
everything is safe for you.”

So there you have it fellow food allergic Chipotle Mexican Grill lovers. Dine on with cumin confidence. 

Any further questions, contact Chipotle directly.

PS Chipotle Mexican Grill was number one in allergy friendliness according to a recent Allergy Eats poll. I concur.

Wednesday, February 18, 2015

Food Allergy Counseling: Your Middle School Child and Writing Down their Food Allergy Fears

As I discussed in this earlier post, the Middle School* years are a pivotal age range for kids. It’s the time that they start becoming more independent in many aspects of their lives. It’s a great phase – full of exploration, fun, special skills, deeper friendships and an understanding of their place in the larger world. 

For parents of kids with severe, life threatening food allergies, helping your child become more independent and responsible can have some added challenges. 

One of which is that your Middle School aged child frequently has new and deep concerns, fears and questions about food allergies and their medical diagnosis. A lot of them. These questions are different than a few years ago and they are different than they will be a few years from now; but these questions, if they go unanswered or are answered with half answers, can grow into massive, irrational fears. 

For example, *if* your Middle School aged child has:

--heard and processed half conversations (or even arguments) between you and your spouse about food allergies or their seriousness or their management; 

--picked up pieces from allergist and pediatrician visits but not the full story as they weren’t engaged in the conversation or even really a part of the office visit; 

--if they have been told misinformation by a well-meaning school teacher, who has no clue what they are talking about; 

--if they have read something online from an untrusted source (the definition of a Doctor Google); 

--or perhaps they have done what all kids do: heard one thing and then thought it meant something else because they didn’t have the knowledge or context to process it, they can end up with a lot of myths about food allergies and food allergy risk that they believe are true. And usually they really aren’t.

Your Middle School aged child needs answers to their food allergy fears and questions now in a new and different way. They are able to process complex information in a more dynamic way. So let’s let them get that new information so they can start to identify and separate real food allergy risk from food allergy fear.

Frequently with my Middle School aged food allergy counseling clients, I will ask them to tell me what their fears are and their questions about their food allergies and we write them down together. The general themes I’ve heard concern death, casual contact, how epinephrine works, needles and how to protect themselves. 

Let’s jump into the scariest one for everyone who manages food allergy risk: the possibility of death from an accidental exposure to one’s food allergen. 

A Middle School aged child understands death in a new and deeply profound way, perhaps even existential. The deaths they may have experienced like the death of a loved one, a beloved pet or even a friend or the parent of a friend has a different effect on their lives as a middle schooler than, say, a pre-schooler. Additionally, it is developmentally appropriate for Middle School aged children to start to ask and experience themselves as a human being in the world; even that there is even a larger world that they need to concern themselves with! 

This is an elemental question that Middle School aged children are grappling with and it’s our job to help them grapple.

Of course, as a parent (or a adult loved one), it can be deeply upsetting, difficult and heartbreaking to hear a child talk about their fears about death.

But parents, I urge you to first examine * your * thoughts, fears and understanding of food allergy risk. Children, as you know, are little sponges watching and listening to everything you do and they will mirror your feelings, whether you have expressed them directly or indirectly. If you believe deeply that your little one will grow into a self-sufficient adult with food allergies, they most likely will. If you have deep worries, fears about risk and allergens and managing them (and/or a history of anxiety), and believe there is danger and risk around every corner, your child cannot help but pick up this attitude, too, and mirror your worries and fears. 

Parents, maybe you still have questions about food allergy risk, diagnosis, definition or your anaphylaxis action plan? Get medical clarity, work with a therapist, talk to your partner about your concerns so you can help your child navigate this next developmental phase which is the beginning of how to be in the world and of the world (my favorite quote from the movie Sabrina.)

By the Middle School years, it is time for honest age-appropriate talk about real food allergy risk versus food allergy fear. And, as a family, this needs to happen together, ideally. 

Allow your child the space to express their fears about food allergies in words, drawing and in play.

Have them write down their questions about food allergies or help form their fears into actionable questions.

The next step is to take those questions to your trusted local allergist to get real answers which will help them learn how identify and separate real food allergy risk from food allergy fear.

My next post will cover this topic.

*I'm using Middle School aged children to represent the middle school years 8-12.

NB: When fears are not managed, children can suffer or withdraw. If you witness troubling behaviors in your child, please have them evaluated by a local child psychologist, social worker or psychiatrist as well as your allergist and your pediatrician.

Monday, February 16, 2015

Recipe: Nut-Free, Gluten-Free, Easy Granola

Breakfast this week: yogurt, granola, bananas and more maple syrup. So yum!

 “The more prepared I am, I the more spontaneous I can be.”

I said that during a session with a food allergy counseling client last week and it is so true for those of us who have severe life threatening food allergies.

Running around town like I do, I frequently need to eat a snack on the go.  Anything safe that I can grab and go and keep in my pocket or purse that doesn’t spoil is great.

Homemade granola has been my go-to snack since I saw this Mark Bittman recipe in 2009. I didn’t know granola could be made so easily and so well. I simplified the recipe further to four ingredients. I make large batches, and then take small snack packs with me so I always have a safe snack and can be spontaneous!


Easy Granola Recipe

4 cups of Rolled Oats
½ cup Maple Syrup
A few dashes of cinnamon
A dash of kosher salt

Preheat your oven to 350 degrees. Line a large and deep baking pan with parchment paper (makes clean up incredibly easy). In a large bowl, combine all ingredients and mix until each oat is coated with maple syrup. Taste. If the mixture needs more cinnamon, add one more dash. Bake in the oven, stirring the oats and turning the pan every ten minutes. The oats will be done when they sound dryer as you stir, smell fragrant and look brown toasty, about 25 minutes. Let the mixture cool thoroughly, place in an air tight container and store. Since they don’t have any oil they should not go rancid quickly; however mine haven’t ever lasted more than a month, because I gobbled them down.


Friday, February 13, 2015

FDA Consumer Update: Dark Chocolate May Not Be Milk Free

From the FDA Consumer Updates site, a warning about dark chocolate; essentially that it may still contain traces of milk.

“If you or someone in your household is allergic to milk, take heed: a recent study by the Food and Drug Administration (FDA) tested 100 dark chocolate products and found that many contained milk. More importantly, you can’t always tell that’s the case simply by reading the food label….Consumers who are allergic to milk should be aware that a high proportion of tested dark chocolates contained milk.”

The only thing missing from this  FDA Consumer Updates site article that would be the most useful to the milk allergic community is what brands were tested and found to have traces of milk when they made claims of milk-free, vegan and/or allergen-free.

Stay safe everyone!

Wednesday, February 11, 2015

Food Allergy Counseling: Westchester FARE Walk for Food Allergy, Taking Charge of Food Allergies Event, March 1, 2015

*UPDATE: Pictures of the event are on the Facebook Westchester FARE Walk for Food Allergy site.*

I’m excited to announce that I will speaking to parents and middle school aged children during this every special FREE event hosted by Westchester FARE Walk for Food Allergy and underwritten by FARE

If you are in the tri-state area, consider joining us. 

And do make sure to come say “Hi” to me or buy a copy of Allergic Girl: Adventures in Living Well with Food Allergies (Wiley, 2011) and have it signed!

"Join us for a very special discussion about the social and emotional issues facing parents and children who are living with food allergies. Top mental health professionals will lead an informative discussion with the group, followed by breakout sessions for parents and children. This event is funded by the Westchester FARE Walk for Food Allergy."

For more information and to register for FREE visit:


130 Hommocks Road
Larchmont, NY 10538
March 1, 2015
2:00pm – 4:00pm

Hope to see you there!

Tuesday, February 03, 2015

Food Allergy Counseling: Your Middle School Child’s Food Allergy Fears

Being in Middle School* is a really interesting age for kids. It’s the time that they start becoming more independent in many aspects of their life. Physically they are growing and able to use their bodies in new, powerful ways; think group sports and competitions. Cognitively they are able to handle more complex information, more logic and reasoning; as well as more mature aspects of moral reasoning. Emotionally there are changes, too. In a deeply profound way, ten year old children start noticing and thinking about their place, their role in the larger, outside world.

For children with severe life threatening food allergies, many who have been told their entire lives they could die from a food allergic reaction, the prospect of a fatality takes on a whole new meaning at this age. “Like, I could die, die?”

While five year old children don’t need a more specific context (death doesn’t have the same meaning at that age), a Middle School aged child, who is more aware of the world and their place in it, needs a context for this information and fast. And at this age, they are able to cognitively and emotionally handle more information; in fact, they crave it.

As a food allergy counselor, I believe strongly in giving children information in an age appropriate way so they can integrate their food allergy diagnosis into their sense of self and become independent, self-aware teens with full lives and to continue that integration into adulthood.

One major issue Middle School aged children have is the separation of irrational fears about food allergies and the facts of food allergies. In my food allergy counseling practice, I help Middle School aged children learn how to separate irrational fears from real food allergy risks, a skill set they will need for the rest of their lives.

Firstly, we talk about the fears through drawings or writing stories. If I see them in my office (versus through video chat session), we may play a game to help them process and describe these fears. Fears can take metaphoric forms like fearing the family house might burn down, someone might break into their house or even feeling like there is a ghost following them. I have worked with children with all of those fears. These are essentially fears of the unknown and a profound feeling of a loss of control, which needs to be examined and managed.

I validate Middle School aged children's feelings and fears all along this process: food allergies are real, serious and our feelings around them can be scary. They (the feelings and the food allergies) are also manageable with information, facts and a plan.

Secondly, we explore how a Middle School aged child understands their food allergy diagnosis: what are the facts, as they understand them, what is their plan, as they understand it? Very often children at this age have only pieces of the picture of food allergies, usually the death piece, but not the fuller picture of what food allergies are, how they work in the body (or don’t work) and what a food allergic reaction and its progression looks like.

Many Middle School aged children don’t remember earlier infant reactions or have never had a reaction and were diagnosed through testing as an infant. Without memories they have overblown ideas of what can happen; and with memories they can have even more overblown ideas of food allergic reactions.

Grounding Middle School aged children in the reality of disease management in an age appropriate way can help them learn how to separate reality from fantasy; fact from fiction. Once we are able to introduce this concept to children, I work with them, giving them more tools to calm themselves when they feel anxious and ways to ground themselves in the facts of food allergies.

This is beginning: airing the fears and getting to the facts.


*I'm using Middle School aged children to represent the middle school years 8-12.

NB: When fears are not managed, children can suffer or withdraw. If you witness troubling behaviors in your child, please have them evaluated by a local child psychologist, social worker or psychiatrist as well as your allergist and your pediatrician.

Tuesday, January 13, 2015

Recipe: Vegan Lentil Soup with Spinach and Avocado

Lentil soup January 13, 2015, 1:03pm

Lentil soup is one of my go-to recipes.
It’s vegan. (But you can add sausage to much delight!) 
It’s food allergy free. (Top 8 allergen free, but not for you legume allergic folks, natch)
It’s hearty. 
It’s incredibly healthy.
It only takes about an hour to cook.
And it has infinite varieties. 

This week, my lentil soup includes spinach, a squeeze of lemon and a half a perfectly ripe avocado. Here’s the recipe. Makes 4, 1 cup servings.

Lentil Soup with Spinach and Avocado

1 cup of green lentils, rinsed 
1 T extra virgin olive oil
1 small onion, chopped
2-3 garlic cloves, minced
1 inch of fresh ginger, skinned and minced
2 carrots, scraped and chopped
1 large bay leaf (or two small ones)
Fresh baby spinach, one handful per serving of soup (broccoli, chard, kale, collards or escarole works beautifully here, too)
¼ fresh lemon to garnish (lime would be perfect, too!)
½ ripe avocado to garnish
Salt and pepper to taste
Water (you could use commercial chicken broth or veg broth if you like, just cut out the salt)

In a large heavy bottomed pot on medium heat, sauté onions in olive oil until translucent and fragrant (5-7minutes). Add in garlic and ginger and sauté for 2 minutes, also until fragrant. Then add carrots and sauté the whole lot for another minute or two.  Add lentils and bay leaf, stir into veggie mixture until coated and mixed through. 

Add 8 -10 cups of water and one teaspoon of salt (you can add more salt and/or water as needed). Bring the whole mixture to a boil and then simmer for 45-minutes to an hour until lentils are tender. Adjust seasonings i.e. add more salt and freshly ground pepper.

When you’re ready to serve, add your favorite greens and warm through by stirring into the soup still simmering on the stove. It will only take a minute or two for the greens to cook and brighten; that's when they are at their best. This step is crucial: if you cook greens with this soup (which you can absolutely do) they tend to get soggy, overcooked and sad. You want bright green, happy greens like you see in this picture. 

A squeeze of lemon brightens the whole dish and lemon (any citrus) helps the body digest the nutrients in green veggies.

Avocado is perfect on top: a smooth, cool texture on top of hot and hearty. Also, because it’s a vegan, almost fat free soup, the healthy fat in avocado will help you feel full longer. 


Wednesday, January 07, 2015

Food Allergy Counseling: Interview: Lily Roth of Food Allergy Survival Guide College Edition

During the 2014 FARE teen conference a few months back, I was following their twitter feed and discovered a new resource for teens entering into college: Food Allergy Survival Guide College Edition. Written by a teen Lily Roth, and her mom, Nancy Popkin, it offers excellent, first-person, real world advice about the whole college process, from choosing the right program for you through that first scary year on your own.  

*As with everything health and lifestyle related, please check with your medical health provider about your specific needs.*

I had a chance to ask Lily some questions about her excellent site. Read on!


Allergic Girl: What are your food allergies?
Lily Roth: I have anaphylactic allergies to milk, eggs, seafood, tree nuts, nightshade vegetables (potato, tomato, eggplant, pepper) and spices like cayenne and paprika, plus a few fruits and I don't eat wheat and soy because of another autoimmune condition. I also have asthma. 

AG: What was your motivation to create your Food Allergy Survival Guide College Edition website?

LR: I decided to make my Food Allergy Survival Guide College Edition website because I felt like teens with food allergies were kind of ignored. There is a lot of support for food allergy parents and young food allergic children, but after elementary school the support kind of ends.

For me, the whole college process was frustrating. During my sophomore and junior year of high school, my parents and I went and looked at six different schools within three hours of home. Some of the schools I did not like and the ones I liked, didn't seem to have the right program, were very competitive or were not in a desired location. The last school we visited was the University of Pittsburgh. I fell in love with it from the moment I toured; they had the academic program I wanted and they were in the perfect location. The only problem was that it was six hours from my house, and at the time my parents were a little nervous about me going far away.

At the beginning of my senior year of high school, I applied and accepted to the University of Pittsburgh before the end of September. I knew that I wanted to go to Pitt and my stubbornness was not going to let my food allergies stop me from going to my dream school.

After the frustration of getting accommodations for my food allergies and spending months trying to learn how to manage my food allergies and other medical conditions on my own, I realized I would have loved to have met someone who had done it before. I would have loved to have had a mentor who could tell me how they did it, and I know that my mom would have loved to have talked to a mom who had sent their child with food allergies off to college. And because of that Food Allergy Survival Guide College Edition ( was born.

It covers college application to college graduation and everything in-between. It is also ever evolving and we are continuously adding to it so that we can keep it as up to date and as comprehensive as possible. 
AG: Who is the Food Allergy Survival Guide College Edition website for?

LR: While it is mostly geared toward food allergic high school and college students, there is also a parents only section and a section for college guidance counselors.
We also have a chapter of the guide that is geared towards newly diagnosed teens, and teens also managing other autoimmune conditions in addition to food allergies. 

AG: What tools and resources did you find most helpful in creating the Food Allergy Survival Guide College Edition website?

LR: I found my mom to be a very useful resource. She is an award-winning writer and she was very good at catching my spelling mistakes and writing content for the guide.

As I was writing this guide, I was simultaneously Co-Chairing a FARE committee of college students and parents that was writing a guide for FARE to put out for teens going to college with food allergies and their parents (the guide should be released soon).

The committee was helpful in coming up with tips for students going to college with food allergies, which I found useful. Most of the content though, has come from my own personal experience and things my family has found to be beneficial.

AG: What would you do differently now that you have been in college since the fall of 2014?

LR: I would worry less about what people thought about my allergies. I graduated from Abington Friends School in Jenkintown, PA. It is a small private Quaker school where everyone knows everyone and everyone is accepted for who they are. All the teachers and staff along with the students knew about my allergies, and it was just part of who I was--no one really cared ore judged me for them, but I was still the food allergy kid.

I went into college with the mindset that I didn't want to be the food allergy kid because I didn't want people to think I was weird or weak. I spent a lot of time the summer before my first semester worrying that I wouldn't find friends as amazing as my Abington Friends School Friends and that people were going to think that my food allergies made me weak and that they wouldn't want to be my friend because of them.

In the first hour of college, I learned that I was highly mistaken. No one really cares about my allergies, and I have found amazing friends who I love and trust to take care of me if I have anaphylactic reaction. 

AG: What are your three top tips for college-bound high schoolers?

1. Don't be worried about living in a single. When we went to the disabilities services for my apartment accommodation (because my allergies are too hard to accommodate in the dining hall) they told me they could only give me a single because they didn't think it would be safe to be using in mixed-use. For a while I was disappointed I couldn't have a roommate, but honestly I love having a quiet place to study when I need it, and the authority to invite over friends whenever I want without having to worry about bothering my roommate. 

2. Don't choose your college because of your allergies. If you don't go to the school that you love, you are not going to want to be there and college isn't going to be a fun experience. Choose a college and then figure out what accommodations you need to live there and study there safely. At one point, my parents wanted me to go to Temple, which is close to home and while it is a good school, I know I would have spend my entire time wishing I was at Pitt instead.

3. Carry your epinephrine autoinjector. Sure Epi-Pens or Auvi-Qs don't always fit discretely in your little black dress or in your jean pocket, but they can be life saving and the reason that food allergies are often fatal is because epinephrine isn't used fast enough. Even if you haven't had an anaphylactic reaction before, you can never be too safe. A really quick way to loose your parent's trust in your ability to go to college and be independent is to not have your epinephrine on you.

AG: Where can we find you?

LR:  You can find me volunteering as an EMT, doing community service, playing tennis or studying (you have to do a lot of that in college.) As far as social media goes, you can find our guide, Food Allergy Survival Guide-College Edition on Facebook ( and Twitter ( You can also find me on Facebook ( and Twitter (

Thank you, Lily!

Lily Roth, used with permission.