Food Allergy Counseling

Food Allergy Counseling
Sloane Miller, MFA, MSW, LMSW, Food Allergy Counselor Speaking At Mylan Specialty / EpiPen Event (© Noel Malcolm 2013)

Tuesday, July 28, 2015

Recipe: Quick Strawberry Jam, Food Allergy Free


“Too acidic. Too many. About to turn.”

That’s what I saw when I looked at the huge clamshell of organic Driscoll strawberries that I purchased at Costco recently. What to do with them? Easy. Make a quick jam.

Also called a refrigerator jam, these are made with few ingredients, no pectin and no sterilization of jars. This jam is meant to be eaten within a few days of making and trust me, it won’t last longer because you will be gobbling it down and spreading it on everything.

For the OAS amongst us (a nice explanation of Oral AllergySyndrome here on Allergic Living Magazine) cooking ripe fruit in the summer can allow you to eat it without local allergy symptoms. I’m that way with stone fruits: peaches, apricots, cherries, plums, all become more edible, less mouthy-hurty, when cooked.

Here are some recipes for quick strawberry jam. The Kitchn, Martha Stewart and Real Simple Magazine.However, I make these quick james often, without a recipe. And you kinda can’t go wrong. But here’s a loose recipe of how I put it all together.

Quick Strawberry Jam
4 cups Strawberries, rinsed, topped and halved
Juice from one juicy lemon
½ cup of sugar in the raw



In a heavy non-reactive pot, bring the mixture to a boil and simmer for about 20 minutes. You may mash some of the fruit with the back of a spoon if you like but I like whole chunks and they cook down quite nicely with or without mashing. After about 20 minutes, taste and adjust seasoning e.g. you might like more sugar than I do. Place into a jar or non-reactive container to cool. Try to avoid spooning 12,000 tastes but do ladle over some buttered bread, just to make sure it’s delicious. (Oh yes, it will be.)

Here’s a lovely article from Epicurious giving you 26 ideas of where to use a jam like this.

I made strawberry yogurt with mine. See above and try not to drool. But go, go cook up some ripe fruit right now.



Tuesday, July 07, 2015

Food Allergy Counseling: Confronting Versus Avoiding Your Food Allergy Fears

Recently, I went to a business lunch with two women who work in the food allergy sphere and I was feeling nervous. Not about meeting with them; they were lovely and we had an excellent bonding conversation and lunch. No, I felt nervous about eating. Even though I picked the restaurant, called ahead, the restaurant has my food allergy needs on file and they double-checked with me when I arrived. 

Still. I felt anxious. 

Sometimes, I can do all of my dining out steps and everything can be fine and still I feel nervous.   Sometimes, I can do all of my best anxiety management strategies to calm myself down and still I feel nervous. 

So what to do then? 

The natural tendency would be to avoid the situation that is causing discomfort i.e. cancel the lunch. But that wouldn’t make me feel less anxious, it would simply keep me home, alone and anxious. I’ve done that many times; many years of my life were spent avoiding the scary thing.

But here and now, I did the opposite: I confronted the anxiety head on and shared it, out loud.

When K. arrived at our lunch, sat down and settled in, I said:

Me: “Just a heads up, I’m feeling a little anxious about dining out today. I spoke with the staff and they’re all ready for me and I’ll order but I may not eat if I don’t feel comfortable and just eat afterwards.” 

K1: “OK. I understand. Do what you need to do. Is everything okay?”

Me: “Totally. Sometimes I just feel extra nervous about dining out with food allergies and today is one of those days.” 

That was the extent of the conversation. And then we all moved on to other topics and a lovely lunch. (And yes, I dined and it was safe and yum.)

How did I go from being someone who avoids to someone who confronts

There’s no easy answer, and it will be different for everyone, but for me it came down to making a very conscious decision to try another strategy. And then trying it. 

It’s not enough just to think about doing something different: you must *do* something different e.g. have a plan and enact a series of actions to back up those thoughts especially if you want a different outcome.

I wanted to meet these women for lunch and I was nervous about eating. So I did everything I needed to do to ensure my safety as much as possible and I created an emotional out-clause while still going to the lunch. That emotional out-clause (telling my lunchmates how I was feeling) created a valve: it decreased some of the anxious feelings and allowed me to sit at the table.


***


What has allowed you to sit at the table with your anxiety about food allergy risk?

Monday, July 06, 2015

Recipe: 4 Ingredient Pulled Pork

I have never made pulled pork before. In fact, I rarely make pork or even eat it. Except for bacon occasionally (at landmarc at Time Warner Center or purchased to be cooked from Marlow & Daughters in Brooklyn), I’m hardly a pork aficionado but I saw this recipe on my Allergic Girl Facebook feed a few weeks back and thought: this looks dead easy and delicious.

Brown sugar, salt, pepper and pork but plus time – what could be simpler? For this July 4th, my family did a small picnic and I asked my mom to make this – I made dessert. She made the pork butt (really a rolled up shoulder) in the oven and that worked out perfectly.  She added only 2 T of kosher salt and we both thought a touch more sugar wouldn’t have hurt but the result as is was stupendous. 

As we tore into the cooling shoulder to hand shred, tastes kept falling into our mouths. I’d make this again in a second for a crowd or for a pork loving partner.

Here's the cooling "butt" just before we started shredding. Oh my!


Best part, it’s top 8 allergen free and with five pounds of meat you can make all kinds of dishes family for days.

After we hand shredded and had many, many tastes


Here’s the original recipe from Epicurious, below with my mom’s variations:

Brown Sugar BBQ Pork Butt Recipe 
by Epicurious.com, adapted by my mom

YIELD: Serves 4–6
ACTIVE TIME: 10 minutes
TOTAL TIME: 5 hours (plus overnight seasoning)

INGREDIENTS
1/4 cup sugar in the raw (option use ½ cup sugar)
2 tablespoons kosher salt
1 /1/2 tablespoon freshly ground black pepper
1 (4-5-pound) bone-in pork butt

PREPARATION
Combine sugar, salt, and pepper in a small bowl. Place pork in foil tray and rub all over with sugar mixture, then cover tray with foil and chill overnight.

Preheat oven to 325 degrees and roast pork in large roasting pan, basting with any juices from pan every 30 minutes until pork is very tender, 4–5 hours. Let stand at least 15 minutes before shredding.

Do Ahead

Pork can be kept covered in the refrigerator after grilling for up to 5 days. When ready to serve, Preheat oven to 250°F. Place pork in a roasting pan with a few tablespoons of water. Cover with foil and rewarm pork until hot, 20–25 minutes.

Close-up of shredded porky perfection

Friday, June 19, 2015

Recipe: Burger Salad

If you’ve been reading my blog for a while you know my taste in food: clean, easy, delicious, using whole foods and seasonably available ingredients, few processed things and just plain yum. This is less of a recipe and more of a riff on a dish I had several years back and burger restaurant off of University Place now closed, called The Stand. They made a burger salad: three little slider burgers on top of a big bowl of salad dressed with oil, vinegar, salt, pepper and parmesan. Immediately I knew this was my new jam! Food allergy free for me and so easy, why did I think of it? I created my own version and added it into my monthly meal rotation. A favorite with friends and family too, it’s ridic easy and top eight allergen free (if you don’t use the parmesan cheese)!




In the picture above, I made a turkey version, using ground turkey dark meat (way more flavor packed), got a great Maillard on it (that’s the crusty meaty part) and served with fresh bi-color corn. 

***

Recipe: Burger Salad for One

Ingredients:
Romaine lettuce -  washed and chopped
1/4 pound of freshly ground meat (turkey, chicken, beef - use your fave)
Freshly squeezed lemon juice 
Kosher salt
Freshly ground black pepper
Extra Virgin Olive Oil
Parmesan cheese (optional)
Serve with fresh steamed veggies (like corn, broccoli, spinach - anything you like but definitely round out the meal with some extra beautiful veggies)

Assemble your salad first in a nice big bowl that you will also use for serving: use fresh lettuce, seasoned with salt, pepper, lemon juice and a little bit of olive oil. 

Next cook up your burger. Make sure to season your burger with salt and pepper, don’t skip this step and cook on high heat with plenty of oil. 

I use the diner-style technique for these burgers outline by the New York Times here and here.

Serve the burger over the salad while the burger is sizzling hot. I drizzle some of the cooking fat over the salad. Trust me, it’s divine. 

Serve, enjoy, repeat.

Monday, June 15, 2015

Review: Storylines, Guggenheim Museum

Storylines at the Guggenheim Museum

Imagine you’re strolling slowly through a field, a lawn, even Central Park. You see two butterflies, dancing with each other, swooping, playful, graceful. You watch as they flirt around a nearby tree, through some low shrubs, around some blossoms. As you slowly stroll, they discovered you and flit their way in your direction. Your strolling slows as they come closer and closer and then you’re surrounded by two dancing butterflies.

For several moments, they dance around you like you’re the flower, a welcome third in their dyad. You become part of their story and they become a part of yours. Your breath and their breath synchronize and then something even more magical happens: three become one. Just for a moment. And then just as spontaneously they move on, encircling another flower, or tree or person, dancing, flying swooping, elegant and free.

That’s the experience I had the other day at the Storylines exhibit now open at the Guggenheim Museum as two dancers, who are part of an art installation within the Storylines exhibit by Gerard & Kelly called Timelining encircled me and included me in their dance. It was thrilling. 

The two couples (one in the left of frame and one in the center of the frame) are all Gerard & Kelly dancers


Here's some basic information about the Storylines from the Guggenheim website:

Bringing together over one hundred works from the Guggenheim’s contemporary collection, Storylines examines the diverse ways in which artists today engage narrative through installation, painting, photography, sculpture, video, and performance. For these artists, storytelling does not necessarily require plots, characters, or settings. Rather, narrative potential lies in everyday objects and materials, and their embedded cultural associations. In projects created through extensive research, acts of appropriation, or performance, the artists in Storylines  uncover layers of meaning, turning to individual experience as a means of conveying shared stories, whether real or fictional.
  
We all have stories. Ones that we tell to ourselves, that we tell to others, ones that we tell about ourselves to others. This exhibit seeks to explore how several artists tell stories in multiple mediums. It’s a thinky museum show; not a romp through rooms upon rooms of pretty pictures from old masters. To be fair, there are pieces that can be simply looked at but mainly this is an interactive show and I’m still interacting with it, at least conceptually, ten days after seeing the press preview.

I don’t have a snappy review of it or even a critique, but I’ve definitely been moved by several of the pieces there and it’s a show whose core concepts around narrative are close to my heart as a writer, artist, improviser and psychotherapist.

Here’s the core of what the exhibit is about should you wish to see it on a visit to New York City this summer and fall. 


The ceiling of the Guggenheim, by Frank Lloyd Wright
A beautiful reading room nook off one of the exhibit floors





Wednesday, June 03, 2015

Food Allergy Counseling: Your Middle School Aged Child and Worry Versus Vigilance

The fourth and final installment of my middle school aged child* and food allergies blog post series (here are parts onetwo and threeis to give this dynamic that I’ve been exploring a name. 

I think of it thusly: worry versus vigilance.

What we with food allergies need to do is separate worry about a food allergic reaction from practicing vigilance around how to manage food allergy risk whilst living a full, fun life.

This practice is a skill set I use as a food allergic adult and I teach this skill set to my food allergy counseling clients.  

It will be refined over time by the person with food allergies as circumstances and life stages change. For now, I will break it down into its most basic definitions for parents of children with food allergies.**

WORRY
The feeling of worry is based on the “What ifs” scenarios that runs through our minds (“our” refers to the person with food allergy at any age): what if I ate my allergen by mistake, what if that restaurant cook didn’t wash their hands of my allergen before creating my food, what if I didn’t read that label closely and my allergen is hidden in that snack, what if this doorknob has my allergen smeared on it, what if I want to kiss my date and they ate my allergen? 

What if scenarios involve an endless series of questions without an action to get those questions answered adequately. These scenarios may or may not be rational thoughts/concerns but the feeling of anxiety, worry, panic that can set in when the implied question of food allergy risk isn’t answered begins to grow at an alarming rate, resulting in feelings of anxiety that can easily lead to panic. And classic panic attacks can feel very close to anaphylactic reaction. 

VIGILANCE
The practice of vigilance is one of remaining watchful and alert and calmly thinking through a food allergy scenario. I call it “If this, then that”: if I don’t feel safe at this restaurant after communicating my needs clearly, then I won’t eat, if I don’t understand all the ingredients on this label, then I won’t eat it until I can get more information, if I don’t have my emergency medication on my person, then I won’t eat, if I accidentally ingested my allergen, then I will enact my anaphylaxis protocol, if I don’t fully understand my food allergy diagnosis, then I will explore options with my board certified medical health practitioner.

Vigilance is defined as the action or state of keeping careful watch for possible danger or difficulties and taking the necessary action. Remaining vigilant doesn’t mean you aren’t worried or anxious but it does mean that in addition to those feelings you take an active role in calming yourself and taking appropriate steps to stay safe. 

See the difference? Radical, right?

Vigilance gives us agency over our lives with food allergy and risk; constant worry invokes feelings of helplessness and paralysis, with little to no action over our lives with food allergy and risk.

Ask yourself: What is your normal state of being around food allergy risk? Are you constantly worried? Do you feel helpless or out of control? Do you feel prepared? 

Using my previous posts (onetwo and three), explore your child’s fears while giving them hard facts about disease management. Have deeper questions? Ask your board certified pediatrician and/or allergist. Feel overwhelmed and need more support? Consider consulting with a child psychologist, a licensed social worker (like me) or a psychiatrist.

Remember above all, separating worry and vigilance is a process and a practice. There is no perfect. There are good days, better days and days of pure food allergy crapola. That’s okay. Keep going.

***


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

** Please note: these posts are also for any tween, teen and/or adult with severe life threatening food allergies and anaphylaxis.



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.

***

Here are parts one, two and three of this blog series on middle school aged children and anxiety around food allergies.


Tuesday, June 02, 2015

Recipe: Chickpea and Pasta Salad Salad



When the weather heats up here in New York City, and these tar covered streets hold in the heat and distribute it directly to your body when you walk, major ugh,  I like to cool down with more cool salads and more water-based fruits and veg.

Last night though it was beautifully unseasonably cool for June 1. So, I wanted something warm but not hot, salad-y yet with some heft. And I invented this recipe. I'm calling it: Chickpea and Pasta Salad Salad. You could have the pasta salad solo; or the salad solo. But why not mix them all up, have a super healthy dish that is a whole bunch of BIG salad!




It’s free from the top eight allergens, easy, delicious and light, perfect for the summer months or an unseasonably cool night.

It’s also can be made in scores of variations. Use your favorite salad base. Use your favorite bean. Use your favorite citrus-based salad dressing. And use your safe-for-your pasta. Below is my version because it’s what I had on hand but I’m certain I’ll be playing with variations all summer long.

***

Chickpea and Pasta Salad Salad
(I didn't measure. Just use the serving size that you like for you!)

Ingredients:
Romaine lettuce  washed and chopped
Bell peppers – washed, deveined and chopped
Canned chickpeas – drained and rinsed
Tinkyada Gluten-Free organic rice pasta - cooked until al dente and drained 
Freshly squeezed lemon juice 
Kosher salt
Freshly ground black pepper
Extra Virgin Olive Oil
Red pepper flakes (optional)

While the pasta is cooking, assemble your lettuce and peppers in a big bowl. Generously season the undressed salad. In a small bowl (better yet, a tupperware to store the extra), toss the chickpeas with a splash of olive oil, lemon, salt, pepper (and red pepper flakes, if you’re using them). Taste and adjust seasonings as needed. Once pasta is cooked and drained, add to the seasoned chickpeas and mix together. Add more olive oil and lemon, salt and pepper and taste again. Now add the pasta/chickpea mixture to your seasoned salad base. Take a bite. Is there flavor? Does it need more lemon? More salt? Some fresh herbs? Keep adjusting until it’s just right for you. Serve warmish and enjoy! 

Thursday, May 07, 2015

Interview: Jerome “The Bus” Bettis, Auvi-Q


Recently I was offered an opportunity to interview Jerome “the Bus” Bettis – NFL Hall of Famer for National Allergy & Asthma Awareness Month as he traveled to Washington D.C., on behalf of Sanofi US, (makers of Auvi-Q) with the Allergy & Asthma Network (now AAN, formerly AANMA), to share issues and initiatives with members of Congress and staffers on behalf of people with anaphylaxis and related conditions. 

From Sanofi US: Jerome, and Sanofi US, the makers of Auvi-Q® (epinephrine injection, USP), are supporting this event and working with AAN to raise awareness about anaphylaxis, advocate for access to emergency epinephrine and to create awareness of Auvi-Q. This is Jerome’s first time going to The Hill to advocate for severe allergies and he is very excited to help in educating people. The event, now in its 18th year will take place May 5 through 8, 2015 as part of Allergy & Asthma Network’s 30th anniversary celebration.

Jerome was diagnosed with a severe allergy to shellfish more than 27 years ago when he was 14 years old. (Jerome talks about that in Coping magazine.As I did some background reading on Jerome, I realized we are in the same generation. He was, like me, most likely was not given any kind of prescription for an epinephrine autoinjector upon diagnosis. Jerome confirmed this when we spoke, he didn't know epinephrine autoinjectors were even available. In fact Jerome says, he did not get any autoinjector device until the Auvi-Q

NB: It was not standard practice until very recently. So those of us diagnosed in the 1970s, 1980s and even the 1990s simply did not have epinephrine autoinjectors. We were told: “avoid your allergen, take an antihistamine and get to a hospital”. That was it. I talk about this more in my book: Allergic Girl: Adventures in Living Well with Food Allergies (Wiley, 2011).

The landscape of food allergies has radically changed in that one aspect since were children: epinephrine autoinjectors are readily available and are widely prescribed. In fact epinephrine is now considered the most important first line of defense in an anaphylactic event. 

***

Allergic Girl: How did you cope, knowing you were shellfish allergic but had no emergency medication to carry with you?

Jerome Bettis: I avoided all seafood and fish. I was so scared that I would have a reaction that I locked myself away. That was my main coping mechanism because I didn't have any type of epinephrine autoinjector. And I was really careful. The only thought was to get antihistamine if I ran into trouble, way into my adult years and I just stayed away from fish.

AG: How was the experience of getting your first Auvi-Q?

JB: Exhilarating. It opened me up to not be scared and try dishes because before I just wouldn't try anything. Now that I have the Auvi-Q with me I’m never concerned. It takes the paranoia away. In the past, if I had a problem I would think: “where is nearest drugstore in case I need an antihistamine?” Now with the Auvi-Q I feel more at ease with eating and dining out on the road.

AG: What motivational words would you have for athletic teens who have been recently diagnosed with food allergies, like you were at 14, and feeling nervous about “getting back into the game?”

JB: Don’t be afraid to be different, it’s okay. Don’t be afraid to answer the question about who you are, and that you have food allergies. The more people you tell about your food allergies, well, if they care about you they will care enough to know about you. I have friends who watch out for my shellfish allergy. They warn me about dishes before I even have a look at the menu.

Another thing. Having food allergies taught me that I needed to be conscious and careful of everything that I am putting into my body. From a really young age. And that was really helpful and a great lifelong skill to know.

AG: Having a life threatening experience, like anaphylaxis from food allergies or an uncontrolled asthma episode, is the catalyst for many people, young and old, to make life changes and take their health more seriously. (Jerome talks about a severe asthma attack during a 1997 football game and how that was a game changer for him.) What would you say to anyone right now about how and why they should get a jump on their health?
  
JB: For me, that situation was eye opening. I told myself that I had to become educated. That led me on the course on where I am today. I wanted to be proactive, be informed and create awareness around food allergies.  Because I did not know there were options available for years and years like Auvi-Q. There are now options for all of us with food allergies. You don't have to be like me not knowing that these medicines are available.

AG: What might you say, man to man, to other young men with food allergies about how they can take care of both their health and their independence?

JB: Men, we think we’re invincible or immune – that anaphylaxis will never happen to me. I would tell any young man: This is life threatening. You need to have an action plan. If you don’t have a plan you will be in serious trouble if you have anaphylaxis. You’re prepared about everything else, you need to prepare for this.

 I have a five point plan:
--Avoid the allergen.
--Have two epinephrine autoinjector devices.
--make sure that people that are with you, that they know that you are allergic. And that they know how to help you.
-Practice with an epinephrine autoinjector trainer.
--If you use your epinephrine autoinjector, that is not the end of situation. You need to seek emergency medical attention.           

AG:  Here’s a question from a food allergy mother via my Allergic Girl Facebook page: What would you say to young kids that think their dreams are limited because of their food allergy? 

JB: I would say that your dreams do not have to be dashed because of food allergies. You can live life to the fullest as long as you have an anaphylaxis plan.

AG: Here’s another question from a food allergy mother via my Allergic Girl Facebook page: How to you handle traveling?

JB: I have two Auvi-Q devices with me at all times that allows me to travel without the fear of anaphylaxis. Be diligent about your food allergies and avoid a place that has your allergens; for me that’s a seafood restaurant. Anytime time I travel I tell everyone around me about my food allergy. But as you cannot be 100 certain have your two Auvi-Q devices with you at all times.

Here's Jerome playbook with many helpful hints and lifestyle strategies about stay safe and having fun while managing risk.

Auvi-Q also offers a $0 co-pay for their devices. Go to their website for more information.

Thank you, Jerome and Auvi-Q!


Wednesday, May 06, 2015

Please Don't Pass The Nuts: One of Healthline’s Best Allergy Blogs of 2015



Healthline Best Allergy Blogs of 2015



What a lovely honor to be named one of 21 of the best allergy blogs of 2015 by Healthline

I'm in the excellent company of friends, colleagues, fellow advocates and bloggers. 

Check us all out.

Wednesday, April 22, 2015

Ready, Set, Success! Telesummit, Dr Liz Lasky


What if there was an easy way to:

Figure out what you want
Make that vision crystal clear
Tackle the barriers
Act on that vision
Live the life of your dreams

I am one of 21 experts that my friend and colleague Dr. Liz Lasky, LCSW, PhD recorded in her telesummit: “Ready, Set, Success!” beaming out May 1, 2015.


Click here to register for “Ready, Set, Success!” and start getting your success on right now!