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)

Friday, January 30, 2009

AG Tours the CIA

I had the pleasure of visiting the Culinary Institute of America’s Hyde Park Campus this week.

You know the CIA.

done a food allergen awareness video series for food service professionals in which I participated. CIA is also home to Chef Richard Coppedge, who wrote Gluten-Free Baking with The Culinary Institute of America: 150 Flavorful Recipes from the World's Premier Culinary College and whom I interviewed at the end of last year for Most importantly, CIA houses the brilliant chefs of tomorrow.

Yes, CIA is the foremost culinary school in America.

I was given a personal tour by Chef Elizabeth Briggs. (Thank you again, Chef Briggs!)

Grand entry way:

Hallowed hall:

Snowy overlook:

Teaching theater:

Teaching kitchen:

As she took me around the aromatic and hallowed halls of this former Jesuit monastery, she introduced me to chef after chef who expressed to their sympathy for food allergic community and their wish to arm their future chef with the necessary tools to face this increasing challenge in the foodservice industry.

Me and GF Chef Coppedge as he packs up GF goodies for me:

After my tour, I dined with the CIA Food Allergy Student Group. We laughed, we ate; we traded horror stories and happy stories: we bonded. Here we are post lunch:

They have formed a support/action group for their fellow students, chefs and food service professionals who have dietary restrictions. Four hundred students at CIA have registered their special dietary needs with the central registry. That’s a fifth of the student body [unless I didn’t calculate my math correctly and that is entirely poss; I’m not “math girl”]. This student group is motivated to get the word out and I’m sure the administration will support their efforts.

What a fun day! Thank you CIA!

Thursday, January 29, 2009

Lactose-Free Hot Cocoa Recipe


Lately all I've wanted is a cup of hot cocoa. As you know, I'm not a recipe person, more of an intuitive cook. So for this one, adapt and play as desired.

Lactose-Free Hot Cocoa 

1 T Enjoy Life chocolate chips (or another allergen-friendly chip like Divvies)
1 t vanilla (I use Nielsen Massey, nut-free and GF)
1 t raw, organic brown sugar (optional)
1 mugful 2% Lactaid milk (or any milk alternative)

Melt chocolate over low flame with 1 T of milk, sugar (if using) and vanilla to create a slurry. Once all ingredients are incorporated add the rest of the milk and heat through.

If you have some allergen free marshmallows like the coco ones from Jake Bakes or from Allergy Grocer or some Ricemellow Creme from Suzanne’s Specialties by all means, gild that lily!

AAFA, Food Allergen Labeling Survey

The Asthma and Allergy Foundation of America (AAFA)
has released the results of its online survey to learn how Americans with allergies utilize food labels to inform their choices.

Have a read here.

Live Updates from NY Council Food Allergy Hearing

OK. So this is a new media experiment.

I'm planning on using Twitter to let you know what's going on during the NY Council open hearing on potential food allergy legislation today.

Wish me luck and let me know what you think!

Wednesday, January 28, 2009

Food and Whine

Really Daily Candy?

"Food and Whine" is the best tag line you could come up with for a much needed product like Select Wisely cards that assist those of us with food allergies to dine out safely when away from home?

I’m all for witty prose, bon mots, being punny, even really well done snark. But this para is none of those.

Maybe I'm being overly sensitive to the poor choice of words.


But I know that allergies are not about being whiny, needy or complainy. For many, for MILLIONS, it is literally about life or death.

So Daily Candy, I’m not telling you how to write your pieces or edit your freelancers. All I’m saying is you’ve lost some subscribers. And in this market, I would imagine you’d want to hold on to them, not drive them away with poorly worded, unfunny product placements.

I Kissed a Kiwi

I was cruising my local Whole Foods on Thursday night after a very yum and safe dinner at Gotham Bar & Grill [we split a steak, and they made me special sides to split, spinach and mushrooms, all delish and safe] and espied organic kiwifruits from Italy. They are on sale, three for $1, so I bought one for .33.

Back at home I did some homework on the plant species of the brown fuzzy oblong shaped fruit.

According to WikiPedia:Raw kiwifruit is also rich in the protein-dissolving enzyme actinidin, (in the same family of thiol proteases as papain), which is commercially useful as a meat tenderizer but can be an allergen for some individuals. Specifically, people allergic to latex, papayas or pineapples are likely to be allergic to kiwifruit also. Reactions include sweating, tingling and sore mouth; swelling of the lips, tongue and face; rash; vomiting and abdominal pain; and, in the most severe cases, breathing difficulties, wheezing and collapse. The most common symptoms are unpleasant itching and soreness of the mouth, with the most common severe symptom being wheezing. Severe symptoms are most likely to occur in young children.

And here is what the California Kiwifruit Commission had to say about kiwi allergies.

Since I’ve never had papayas and I know pineapple makes my lips tingle, sometimes, I gave a small pause. Small because as a child I ate kiwi all the time. So I proceeded cautiously knowing that I would probably be fine. I had a small spoonful of the green flesh and the black seeds: watery, slightly sweet, tart and green tasting.

And then I waiting about 2 hours.

And nada. No reaction of any kind. So then had a bit more. And still nothing, except yum.

So in my efforts to try some new/old things, I can cross kiwifruit off the list of potentially harmful fruits and put it back on my list of things to eat every now and then, especially when they are on sale!

Tuesday, January 27, 2009

Fake Foods

A sad follow up to the olive oil fraud story: some foods are being faked.

Another sigh.

Peanut Butter Recall

Peanut butter recall in over 130 products and counting.

"The plant also produced peanut paste, a more concentrated product used in candy, crackers and many other kinds of foods. Tracking how the paste travels through the food supply can be challenging, because several companies can be involved in making the final food. For example, one manufacturer might coat the paste in chocolate and make a peanut butter cup, which is then sold to another company that mixes it into ice cream that may or may not also contain peanut butter. A grocery chain might buy that ice cream and sell it under a private label...Ms. DeWaal and other critics of the federal food safety system said that because peanut butter was considered a low risk for contamination, plants could sometimes go without inspection for a decade."


UPDATE: Just yuck. Thanks to Mme Zum for FBing this story.

UPDATE FEB 8, 2009: NYTimes story here.

Monday, January 26, 2009

Allergic Girl, Martha Stewart Living Radio

Tune in TODAY at 130pm as I will be on Martha Stewart Living Radio on Sirius Radio.

I'll be talking all things food allergies, Superbowl, Valentine’s Day and how to keep it all worry-free!

Saturday, January 24, 2009

Family WFD, March 2009

My next Worry-Free Dinners™ Family event is an early supper here in NYC on March 8th, 2009. More details can be found on the Worry-Free Dinners™ site.

Not a member yet? Becoming a Worry-Free Dinners™ member is super-easy and there's no obligation. Just send an email to to request an application so you can join us for the next WFD event.

Friday, January 23, 2009

8 Ways to Be a Grest Resto Customer

From Gourmet Magazine, this is a nice companion piece to my Cheers Experience about how to get the most out of your restaurant experience.

From Gourmet: "Going out to a restaurant is like a dance; when everything’s in rhythm, there’s a gracefulness to it: Servers make you feel good, the kitchen makes its best food, and dinner gets to you right on time. But in this dance, customers aren’t the audience; they’re the partners. Here are a few steps, both for when you’re leading and when you’re following."

Read more here and get out there and dance!

Thursday, January 22, 2009

Gluten-Free Pasta Recipes

Some nice GF recipes in the New York Times . Gluten-Free Pasta e Fagiole. And the Bit-man’s leftover pudding recipes which I bet could be done with GF noodles and made lactose-free with some tinkering.

Wednesday, January 21, 2009

Austrian Red Cabbage

Sometimes I become captivated by a new dish or a new ingredient or a new flavor and then I can’t get it out of my mind. That happened on Monday night with braised red cabbage - I know, funny right? - it was during Stefan’s bday party at one of the new Austrian restaurants in town. I ordered the duck that came in a red wine-honey reduction sauce and baby turnips, Brussel sprouts and braised red cabbage.

Something about the cabbage stopped in me in my tracks. I couldn’t get enough. I ordered a little extra for the table. And then I ordered some for dessert.

I asked Chef what was in it and if I could have a take home jar filled with it. He laughed heartily and, "I made it with TLC".

"No, no," I insisted, "Don't tease me, I need to know what’s in it."

He said the cabbage was a very traditional Austrian dish and this version was braised in port, apples, and oranges and other ingredients that he wouldn’t divulge. Drat. He didn’t even tell me about the caraway but I could taste the seeds.

What ever it was: TLC, port, caraway or all of the above, I was enthralled.

Tuesday, January 20, 2009

Cabana El Rey, Delray Beach, FL

The Christmas tree is still up and glorious in purple-blue lights. A DJ spins in the band shell and boom-boom-boom reverberates from the cruising cars on the mini-strip.

It’s Saturday night in Delray Beach, Florida.

Not ideal to try a new restaurant, on Saturday, at 8pm, in a new city but it was one of those nights: going out with a group and you gotta go with the flow.

I called ahead to Cabana El Rey and asked if they could handle my allergies; the host gave me the sense that he kind of understood what I meant. Sigh.

So before we even sat down, I asked see a manager. Irving came over. I introduced myself and told him I had some food allergies: tree nuts, fish and shellfish. His eyes glazed over.

I gently asked him, "Do you know what tree nuts are?"

"Not really," he said, honestly. I gave him an abbreviated list and I saw him begin to catch on --amazing how much communication is non-verbal isn’t it?--and then he kicked into managerial action.

"Ok", he said, "So you can’t have anything grilled, we use the same grill for fish and shellfish as we do for meat and chicken. And nothing fried; we use the fryer for everything. You can have salad. And the beans. And rice".

I said, "What about some plain chicken?"

"We can only do that pan seared", he replied.

"If it’s a clean pan, I’m in! And what about some steamed veggies and rice?"

"Yes we can do all of that," he assured me.

He asked where I was sitting, I pointed out the table, and indicated he would tell our server and come over and check on the sitch.

Yay! Indeed when everyone was still mulling their orders, the waiter leaned over and discreetly said the manager had talked with him and he had my order already placed: pan seared chicken, steamed spinach and white rice.

Rock on!

I thanked the waiter and that dish was exactly what I got! It was delish and safe. On a Saturday. During their crazy busy time. The manager checked on the meal and all was well. PS on the my check it said: “Allergy 2 seafood, pansear [sic] chicken.”

I love it when there’s a happy ending.

Thank you Cabana El Rey for a job well done!

Cabana “El Rey”105 East Atlantic Avenue
Delray Beach, FL 33444
Telephone: (561) 274-9090

Sunday, January 18, 2009

We’ve moved!

No, not me, I haven’t moved, but I have moved my allergy-friendly resto recommendations and chef chats and other cities where I’ve eaten safely to its own site: Allergic Girl Recommends.

I’ve added features like where these restos are in NYC since I get tons of emails asking, “Can you help me find something in Times Square that is safe?” [PS my general answer is stay away from midtown west if you can, and venture either a little north or a little south].

Now you can go to the new website and see what restos I suggest near Times Square or in the East village or on the Upper West Side.


Or I hope "yay". The Allergic Girl Recommends site is still in Beta, meaning I’m testing it out. So any comments, confusion, obvioso mistakes, please let me know!

Saturday, January 17, 2009

Wedding Caterers, Food Allergies

I participated during a wonderful wedding recently of a very dear friend. She was kind enough to put me in touch with the caterer directly. I spoke with Chef Jenny at Olivier Cheng caterers. I emailed her my list and then we went over the menu of what they were already serving and what adjustments I might need.

When I arrived at the reception, I found the chef and introduced myself to her in the kitchen. We confirmed my dishes and she said, "We brought yours in a completely separate container." When they served my dishes they were indeed on a different color plate entirely, making it very easy to identify.

What did I have? Passed hors d’oevres passed over me (which was fine, I had a late lunch so I wouldn’t be starved through the ceremony and the beginning reception). Then a starter of whole wheat penne was magically transformed to a green salad for this allergic girl. The surf and turf place of scallops and short ribs was transformed into a plate of short ribs with sautéed veggies for me. And they even changed the marinade of my short ribs, eliminating the Worcester sauce.

At the very end of the wedding, when the catering crew was packing up, my friend Kate saw a cooler labeled with big black lettering: Food Allergy Plate. They even created a separate cooler for me!

Excellent job Olivier Cheng, thank you! Their diligence made it that much easier for me to enjoy this romantic and beautiful event.

Wednesday, January 14, 2009

Samter Awards,

My blog post, Everyone’s Gone Nuts, written with Dr. Mike Pistiner, received a third place Samter Journalism Award in the new media category.

The Samter is given by the American Academy of Allergy, Asthma and Immunology and “… were developed to recognize the best reporting of the role of the allergist/immunologist and allergy, asthma and immunologic disease.”

Congratulations to all the winners!

FDA Taking Comments

This comes from a loyal Allergic Girl reader:

The Food and Drug Administration (FDA) is accepting written public comments on "May Contain" labeling. FDA has begun to develop a long-term strategy to help manufacturers use these statements in a clear and consistent manner, so that food-allergic consumers and their caregivers can be adequately informed as to the potential presence of major allergens.”

Here is the full FDA document.

Here is where to leave a comment on the FDA site.

Comments are due by 01/14/2009, TODAY.

Take action, let the FDA know how you feel about those “May Contain Labels”..

Tuesday, January 13, 2009

CNN Responds to LATimes OP/ED

From Allergic Girl colleague Elizabeth Landau, a very nicely done rebuttal to Joel Stein's op/ed piece in last week's Los Angeles Times.

Take that Joel Stein and Please, Don't Pass the Nuts.

Reduce-the-Risk Campaign on Airlines, Allergic Living Magazine

From our friends at Allergic Living for you Allergic Girls and Dudes in Canada [PS: Can we start something like this in the Lower 48?]:

Airlines and Allergies: Reduce-the-Risk Campaign

Dear Friends,

Allergic Living: magazine has launched an online write-in campaign to the two major Canadian airlines – Air Canada and WestJet.

The purpose? To request that Canada’s top airlines develop clear, consistent, communicated policies on food allergies that include a few measures to prevent dangerous in-flight reactions.

To gain the airlines’ interest, they need to receive great numbers of letters. So we need your help. Please take five minutes – and take part in the campaign at (see the green box, upper right).

Facts to consider:
– An aircraft, flying thousands of feet in the air, presents a unique and confined environment, beyond reach of a hospital.
– Nut snacks are commonly consumed aboard aircraft (often carried on by other passengers). There is a higher chance of accidental exposure to top allergens such as tree nuts, peanuts and sesame aboard a plane than in any other public environment – except for a baseball park.
– A recent U.S. study shows about 10 per cent of those with food allergies are having in-flight reactions. Better precautions would reduce reaction rates.
– The number of people living with food allergies has grown significantly in the past decade, representing an increasing segment of the flying public.

Your participation in this write-in effort is urgently needed. Again, you may take part at Allergic Living: Please make your voice heard, and thank you for your support.

Gwen Smith

Editor, Allergic Living

SCHIP Extended

The following is from Allergy and Asthma Foundation of America:

Leaders in the United States Congress say that they will act to extend health insurance to children in the US this week, with a vote in the US House of Representatives as early as Wednesday, January 14.

The State Children's Health Insurance Program, known as SCHIP, helps 6 million children in low income families pay for the cost of health insurance, but many others are waiting. Congressional leaders want to expand that number to 10 million children.

Expanding health care coverage for kids could not come at a better time. States plan to remove an estimated one million people from insurance coverage by the end of the year, half of them children. With the unemployment rate surpassing 7%, many families will lose employer-based coverage for their kids.

Children with asthma and allergies are particularly at risk. Asthma is now the most common chronic disorder of children, and 70% suffer from allergic asthma. Without medical coverage, access to necessary medicines, physician care and even emergency visits are a challenge. The Asthma and Allergy Foundation of America (AAFA) supports the expansion of children's health insurance for low-income children because of the important role played by insurance coverage in the management of asthma and allergies.


First, make 3 telephone calls or send 3 emails saying that you support a strong SCHIP bill now:

One to each of your United States Senators and one to your member of the US House of Representatives.

You can reach your Senators and House member through the Capitol Switchboard at 1-800-828-0498 or (202) 224-3121. Or, to email them, click on to search for the Senators that represent your state and to search for the House member that represents your district.

Next, find out how covering children will make a difference where you live. For a map showing uninsured percentages for children under the age of 18 (prepared by the Kaiser Family Foundation), click here.

Gluten-Free Bagels by Allergy Grocer

Jay, owner and mastermind behind Allergy Grocer, kindly sent me some gluten-free bagel samples to try during the fall.

Bagels can be tricky to make with glutinous flour, much less gluten-free flours. Boiled and/or baked, sweet and/or yeasty: every bagel maker has their special recipe and none are the same. Tastes vary from region to region; a New York bagel is different than a Toronto bagel.

Many in the GF community of food producers have tried to re-create this Jewish classic with varying results. Jay of Allergy Grocer makes hers from a recipe she created, under her own label. Don’t know Allergy Grocer, which also sells the Miss Robens line of products? Jay/Miss Robens makes every effort to be meticulous about allergens, here’s the company’s allergen protocol and here’s more information about how Allergy Grocer was founded.

Still, right now Jay makes these bagels in a facility that also processes nuts on different days. From Jay: “In the facility I am in while I am getting my bakery up and running...there is peanut butter used in another room and some tree nuts & sesame, (walnuts, coconut, almonds, pecans) used at a different time. And we are using dedicated equipment, washing and covering everything, and not working at the same time. All the tests came back undetectable....”

So feeling a bit uncertain, Jay sent me the paperwork that delineated those allergen tests and this Allergic Girl decided the risk was low enough to try the bagels. I know how diligent Jay is about her products. (Some companies are less so as outlined in this recent story by the Chicago Tribune).

*However, this is a VERY personal decision. If you have questions about any product, contact the manufacturer directly. In this case, if you want to know more info, please contact Jay*

So the bagels. My first response was that they didn’t brown and then, once toasted, the were very yeasty. However. After my first taste, I found I craved these bagels, as in I couldn't wait to get up in the morning to eat one! I tore through the rest of the pack of bagels, toasting them, buttering them, having my eggs with them, dreaming about them, unable to wait until morning so I could have another one! Oh boy oh boy. I turned into a very happy gluten-free bagel eating person with these delicious samples.

Thank you Jay for bringing the Allergy Grocer GF bagels to the table of products available to our community!

Monday, January 12, 2009

Peanut Butter Recalled

"Peanut butter recalled amid salmonella outbreak"

As many of you are peanut allergic, you may have overlooked the whole story but I’m not peanut allergic, I eat PB&J a few times a week so this was indeed worrisome.

From CNN: "King Nut Companies issued a total recall of peanut butter that it distributes Saturday amid fears of a salmonella outbreak that the Centers for Disease Control and Prevention said has infected 399 people in 42 states. Ohio-based King Nut acknowledged in a statement that salmonella had been found in an open 5-pound tub of King Nut peanut butter."


This letter was issued by the National Peanut Board on January 10, 2009.

RE: Press Coverage of Salmonella Outbreak involving Peanut Butter

A Reuter Newswire item today reported that Minnesota health officials announced that salmonella was found in King Nut brand peanut butter. (See links below.) According to the news reports, the peanut butter was distributed to nursing homes, schools, bakeries, and other institutional destinations and is not thought to have been sold in retail outlets. The genetic strain of salmonella found in the outbreak is being linked to the same type that has sickened nearly 400 people in 42 states.

The American Peanut Council and the National Peanut Board are working together to monitor and address the issue.

Below are some facts as we know them now and also some links to the various news reports.

According to the King Nut Company website, King Nut was the distributor and did not produce the peanut butter. Their website indicates the peanut butter was produced by Peanut Corp. of America. (PCA)

PCA, which manufacturers a variety of peanut and peanut butter products, has operations in George, Texas and Virginia.

The strain of salmonella found in the peanut butter and in other cases throughout the U.S. is Salmonella typhimurium; however, this is a very common strain. Further DNA testing to determine the exact species is required to see if there is a match with other reported cases in the U.S. before any definitive conclusions can be drawn. It is unclear how DNA fingerprinting of the strain has already been done by the Minnesota Dept. of Health and others.


As more information is confirmed, we'll have a press release available.

Sunday, January 11, 2009

LATimes, Nut Allergies

A loyal Allergic Girl reader alerted me to this op/ed piece about nut allergies in the Los Angeles Times from January 9, 2009 entitled:

“Nut allergies -- a Yuppie invention: Some kids really do have food allergies. But most just have bad reactions to their parents' mass hysteria."

It's really a reaction to a reaction to a reaction. But still, I say read it. It important to know what's out there. And remember, this is just one dude's opinion.

UPDATE: Here's an excellent response from Dr. Wood to the Stein Op/Ed.

Friday, January 09, 2009

Michael’s Genuine Food and Drink, Miami, FL

I had met Executive Chef Michael Schwartz at the 2007 Food Network Food Festival. He was just about to open his own spot and right after I saw him, his resto exploded in Florida media as well as national media. Here he is in the New York Times.

I finally had a chance to try Michael’s this past Christmas break. I did my Allergic Girl protocol and it worked like a charm. I called and spoke with the manager asking if the chef felt comfortable with food allergies. “Not an issue,” they said, “We’re happy to accommodate you.” I used putting down my requests in black and white. When I entered, I was greeted by Tamara, the Chef’s wife and business partner. I identified myself; she said they were aware of my special requests and were all ready for me.

I sat at the bar, made nice with bartender/cutie/Californian Ryan who double and triple checked my order with chef. So far, so great. I ordered a bunch of sides of veggies (I’ve had so much meat out in the last six to eight weeks that I’m back on a veggie kick, all veggies everywhere) including these totally splendelicious (yes I made that word up, thank you) flat yellow beans that are local and my new favorite thing and something I’ve never had before. Add to that a dish of fingerling potatoes, roasted asparagus and Brussels sprouts and you have my veggie dinner. However, their regular Brussels have house-cured pancetta and they got nervous that maybe some of the spices in the curing would be anti-AG. So they made a whole new fresh batch for me. I was touched. And I was sated.

As many of you know, without a caring, knowledgeable chef who has trained his staff about food allergies, all the calling ahead in the world and ressies aren’t going to help with your special requests. It was clear from the moment I walked in that this place cares about its customers. And in turn Michael’s customers clearly care about Michael’s(there were lots of regulars), I look forward to becoming one and I can’t wait to go back and try some meat!

Michael’s Genuine
130 NE 40th Street
Atlas Plaza
Miami Design District
Miami, FL 33137

Trillium Organics

The idea of a spa and spa services interests me more than the actuality of spa and spa services precisely because too many times in the past, I had a massage that ended up hurting more than healing or had a body scrub that resulted in itching more than soothing. Still, I’m ever hopeful that I will have a great service somewhere. And so I book services, conservatively. On this most recent trip to The Standard, Miami for Christmas/Chanukah 2008, I treated myself to a special mani/pedi especially as in Florida all I’m wearing are flip flops.

Here's my spa protocol and here's what I did in real life, which is virtually the same thing.

I asked ahead of the treatment what product line they use and they showed me to a line that although lovely and luscious looking in the jar, is all nuts, all the time. Sigh. Before my treatment (this really helps) I told them that I was fragrance sensitive, which I am, and allergic to nuts and couldn’t have nutty scrub products. She wrote that in my res so when I arrived my manicurist had all the deets.

I brought AG-safe cream with me and was shown a different scrubby product she wanted to use. Sadly, this too was nutty. She showed me a few other bottles when finally we hit upon Trillium Organics. Only a few ingredients, none of which were nuts or nut oils I went for it and was able to have a scrubby, spa experience after all!

The product was smooth and scrubby, not too fragrant and I had no skin reactions except the smoothest footsies ever. Going to the Trillium Organics site, I see there is even more to love and support about this company. Love it!

Thursday, January 08, 2009

“No Noots”

Went for a quick bite of beans and rice at David’s Café near Lincoln Road during my South Beach holiday. After using my lame Spanish and trying to ask our friendly server if the beans were vegetarian (I started small) and basically getting nowhere fast (except smiles and “Que”?), I asked for a manager hoping for the best.

Mr. Friendly Manager came over and told me the ingredients of the beans in English (onions, garlic, salt, vinegar, spices, oil and water). When I asked about nuts and fish (I rarely take it for granted that a dish is exactly as it appears,) he said, "No fish, no beef, no pork and no 'noots' of any kind." He explained that in spanish the word for "noots" is actually seeds and that one has to ask about a particular kind of "noot" like almond, walnut, etc. Interesting. I didn't know that.

Then he told me something even better: his brother has allergies! (not great for the brother but great for someone with allergies to find a manager who really gets it). He went on to tell me that they have to do the same thing when they go out, ask about the ingredients in dishes. And that I shouldn’t feel embarrassed to ask him the ingredients of anything. No embarrassment here!

I love when that happens: finding an allergic ally. They are everywhere.

Where did you find you last allergic ally?

Wednesday, January 07, 2009

Food Allergy Testing

This question below comes from a loyal Allergic Girl reader in response to my New Year’s Day post about my personal food challenges for this year.

“I just read your blog this morning and my question is what exactly does a blood test show? My son has food allergies. He’s 5 now and will be getting a blood test done next month. He’s never had it done before; just a skin test was done to determine his allergies. My son’s allergist said the skin test is more accurate than the blood test. So what is the difference or is there one?”

Since I’m not an allergist, (I can only relay what my trusted doctors have told me over the years) I wanted to get a medical professional to weigh in on this question as many of you have similar thoughts/concerns/questions. So, I turned to colleague Dr. Matthew Greenhawt who offered his medical opinion.

**This blog post does not substitute for medical advice, please consult your personal physician or allergist to make the best decision for your health and that of your family.**

From Dr. Matthew Greenhawt (NB: I bolded certain statements):

A food allergy is a clinical disorder based on clearly defined, repeatable symptoms that are directly attributable to a specific food ingestion. These symptoms must occur within a specific time period related to ingestion or contact with a particular food. The most important part of making such a determination is the clinical history—what actually happened or happens when a particular person ingests or comes in contact with a particular food. Without a history of symptoms, one cannot have an allergy to that item. No single test, outside of a direct food challenge, can diagnose someone as food allergic.

Allergy defines a very narrow mechanism that explains a specific type of an adverse reaction. Allergy, by the strict definition, implies that there is an antibody (IgE class) mediated reaction specifically directed at a protein that has a unique specificity for that particular antibody. If the antibody in question is bound to a particular immune cell (called a mast cell) and it comes in contact with its target, it will cause the mast cell to release chemical mediators that are responsible for symptoms such as itching, hives, flushing, vomiting, diarrhea, swelling, or decrease in blood pressure. The time course for the development of an allergy can be immediate, or in certain cases delayed by several hours. However, reactions that occur longer than 12 hours after food ingestion are unlikely to involve IgE, and hence are unlikely to be a “true” allergy by definition.

Perhaps a better framework for understanding food-related reactions is to use the concept of an “adverse reaction” to food. This implies that food ingestion is related to symptom development, but does not necessarily imply this involves IgE. Adverse reactions include immunologic (another way to describe an IgE mediated reaction) and non-immunologic reactions. Non-immunologic reactions include toxic reactions (food poisoning), chemical reactions (inability to digest lactose), and just plain old aversions to certain foods. Immunologic reactions include IgE mediated reactions, as well as cellular (T cell) mediated reactions. Though it may seem insignificant, the vocabulary is very important. This is because as a field, we are limited to testing only for the true antibody mediated reactions. As for treatment, regardless of the reaction mechanism, common sense dictates that if something is associated with a symptomatic reaction, then avoidance is recommended. Other than avoidance and carrying self-injectable epinephrine, there is nothing more that can be done.

Allergy testing can be performed on the skin or through the blood. These tests are not equivalents of one another, and give somewhat different information. However, both intend to answer the same question: to what food(s) is there a detectible sensitization involving IgE (the allergic antibody). Both forms of testing have a prominent limitation--they cannot distinguish if a positive test result really means that one has a clinical allergy to that item. In statistics, this concept is called the test’s positive predictive value. Prick skin tests have been shown to only be truly positive in 30-50% of individuals tested. However, both skin and blood tests have exceptional negative predictive values, or the probability that a negative test means no allergy. Negative allergy skin tests or blood tests are >95% predictive that no allergy exists, assuming the test was performed correctly. The best test for a food allergy is an oral challenge, but this is not appropriate for everyone.

You may be wondering why testing is necessary when the reported history is very clear that food ingestion led to symptom development. Several studies have shown that approximately 25% of the population reports an “allergy” to a food. However, when such individuals are orally challenged, only 4-8% showed reactivity. Given this discrepancy, objective means are needed to further confirm a suspicious history, as it is not safe to just randomly challenge a patient without more information.

Skin Testing
The most preferred food allergy test is the prick skin test (PST). Using an individual or muti-headed plastic bifurcated toothpick containing a drop of an allergen extract, the surface of the skin is lightly pricked and the allergen is introduced into the outermost layer of the skin. This exposes the mast cells, which may contain specifically target IgE, directly to the food extract. This will result in localized symptom development if there is recognition of the food extract by the bound IgE.

It is strongly recommended that this test be placed on the forearm, as opposed to one’s back, which can have approximately 20% false reactivity. In addition to applying the allergens to the skin, histamine and saline are applied as positive and negative controls, respectively. This is to ensure that one can mount a response (histamine) and that one is not overly reactive to non-allergenic items (saline). The test is read at 10-15 minutes to determine the degree of wheal (swelling) and flare (redness) present compared to the size of the negative control. Wheal size 3mm larger and flare size 7mm larger is considered positive. Small children will not mount as large a wheal and flare reaction as older children and adults, so it is important to interpret wheal size with the utmost caution in these instances. The larger the skin reaction, the more sensitization is detected; though this does not necessarily imply that one is “more allergic”, as smaller skin tests can still be associated with significant symptom development in certain individuals.

Blood Testing
Blood testing is referred to as either a RAST (radioallergosorbent) test or ImmunoCAP® test. RAST testing has almost completely been replaced with the ImmunoCAP® test. The ImmunoCAP® test is a newer method that allows for better quantification of the allergy units, and does not rely upon radioactivity like the RAST test does. Both systems allow for numerous allergens to be tested from a single tube of blood. Allergy blood tests are designed to measure the presence of free (not bound to any cell) specific IgE against a particular allergen, and quantify how much is present. Quantification is most accurate in the ImmunoCAP® system, and is performed on a scale from 0-6. Typically anything class II or higher is considered positive. It is very important to understand that this is an indirect method of assessing reactivity. It cannot measure how much IgE is bound to the cell, primed to react. The presence of free, specific IgE against a target does not necessarily infer the presence of an allergy, however, because free IgE is not directly involved in perpetuating an allergic reaction—only bound IgE is involved. Therefore, the accuracy of the test is far less than skin testing. Other disadvantages are that the test involves drawing blood, it may cost more than skin testing, and the results are not immediately available.

Some important caveats on how to use and understand these tests:

1) Neither test is accurate enough to be used as a “screen” to determine if a person without an appropriate history is allergic to that food. When used as such, insignificant or misleading positive tests (false positive tests) are often found. Moreover, as stated above, a positive test alone does not indicate an allergy. Blood tests are often criticized as being less accurate than the skin tests because it is an indirect test.

2) In established food allergic individuals, for certain foods both skin tests and ImmunoCAP® levels can be used to assess the likelihood one would pass a challenge. Based on data mainly from individuals with oral challenge proven allergy who were then followed longitudinally, researchers have established probabilities for reaction based on the quantity of the ImmunoCAP® level or the size of the skin test wheal. These levels are best predictive for peanut, tree nut, milk, fish, and egg. However, such levels are not necessarily applicable in individuals who were randomly tested or “screened” without specifically supporting symptoms.

3) Similarly, ImmunoCAP® levels can be followed longitudinally to see if there is a change in the level of reactivity. This is because loss of blood reactivity generally precedes loss of skin test reactivity, and because it has been shown that skin test reactions may lag behind in the resolution of a food allergy. Many allergists follow yearly allergy blood tests to monitor possible signs that a patient may be developing tolerance.

4) In general, the scratch test is the preferred method of testing. Instances where the allergy blood tests are acceptable to use as a single test are limited to instances in which skin tests can not be performed. This includes patients taking certain medications that cannot be stopped which may interfere with the results, or those with skin conditions that may make the interpretation of skin testing difficult or less reliable (such as eczema or chronic hives).

If you think that you had an allergic reaction to a food, you should avoid further exposure to the item in question and seek evaluation from your medical provider, who can refer you to a board certified allergy specialist to determine if testing is necessary.

This article is provided for informational purposes only and is not intended to replace the advice of your medical provider. Local allergy providers can be found at the websites of the American Academy of Allergy, Asthma, and Immunology ( or the American College of Allergy, Asthma, and Immunology (


Dr. Matthew Greenhawt, a Hollywood, FL native, received his B.A. and combined M.D. and M.B.A. degrees at Tufts University. He subsequently completed his pediatric residency at Children's Hospital of New York Presbyterian in New York City. He worked for two years as a Pediatric Hospitalist at Children’s Hospital of New York in the Divisions of Pediatric Oncology and Blood and Bone Marrow Transplantation prior to completing his fellowship in Adult and Pediatric Allergy and Clinical Immunology at the University of Michigan.

During his fellowship, Dr. Greenhawt was actively engaged in several areas of research, including mast cell disorders and food allergy, and has published regarding these topics. He was the principal investigator on three national studies pertaining to peanut and tree nut allergy (in conjunction with the Food Allergy & Anaphylaxis Network), and one regional study pertaining to food allergy in college students. His clinical and research interest includes food allergy, food dye and additive allergy, eosinophilic esophagitis, aspirin allergy, mastocytosis, and primary immunodeficiency. He currently continues to conduct food allergy research.

Dr. Greenhawt is Board Certified in both Pediatrics and in Allergy and Clinical Immunology and resides in the Atlanta area.

Whole Foods Pulls Gluten-Free

I'm sure you all saw this Chicago Tribune update but in case you didn’t, kinda shocking, in a great way.

“Responding to a Tribune investigation and mounting consumer pressure, Whole Foods Market said Tuesday it has pulled three popular "gluten-free" products because the items actually contain the substance.”

Read more here.

Tuesday, January 06, 2009

Open Hearing, Food Allergies, NYC

The hearing of the Committee on Health of the New York City Council on Food Allergy Issues in New York City Restaurants and Int. No. 818 originally scheduled for January 22, 2009 at 1pm HAS BEEN RESCHEDULED. The hearing will now take place on January 29, 2009 at 10am in the Committee Room at City Hall.

The legislation can be found at

To my fellow allergic New Yorkers:

Please join me January 29, 2009 at 10am for a New York City Council open hearing about placing food allergy posters in dining establishments here New York City. This is an oversight and legislation hearing, the legislation can be found here and below.

Int. No. 818

By Council Members Lappin, Brewer, Comrie, James, Koppell, Liu, Stewart, White, Jr. and Gerson

A Local Law to amend the administrative code of the City of New York, in relation to requiring posters with information on food allergies in food service establishments.

Be it enacted by the Council as follows:

Section 1. Chapter 1 of title 17 of the administrative code of the city of New York is amended by adding a new section 17-193 to read as follows:

§ 17-193. Food allergies posters. a. Definitions. 1. “Food service establishment” shall have the meaning as such term is defined in section 81.03 of the health code of the city of New York, except that it shall not include any pushcart.

2. “Covered languages” shall mean, but not be limited to, Chinese, English, Korean, Russian and Spanish.

b. The department shall create a poster containing information on food allergies for use in food service establishments. Such posters shall be available in the covered languages.

c. Every food service establishment shall post, in accordance with the rules of the department, in an area visible to anyone preparing or serving food, posters containing information on food allergies provided by the department.

d. Fees. The department shall make such posters available, and may charge a fee to cover printing, postage and handling expenses.

§ 2. This local law shall take effect ninety days after its enactment into law, provided that the commissioner may promulgate any rules necessary for implementing and carrying out the provisions of this section prior to its effective date.

Here's the invitation:

The Committee on Health of the New York City Council will hold an oversight hearing on Food Allergy Issues in New York City Restaurants and Int. No. 818-2008, a Local Law to amend the administrative code of the city of New York, in relation to requiring posters with information on food allergies in food service establishments. The hearing will be held on January 29, 2009 at 10 am at City Hall. The legislation can be found here.

We would welcome the opportunity to hear from the public. If you plan to testify, you should bring 20 copies (double-sided) of your written testimony to the hearing.

If you have any questions, please let me know.


Joseph Mancino
Legislative Policy Analyst
New York City Council

If you wish to join the hearing to listen in or to speak, please email your RSVP to Joseph Mancino,

If you can't join, feel free to comment on this post or email me directly,

The Soma Center Café, Lake Worth, FL

UPDATE 2011: Soma is closed.

On the advice of a Worry-Free Dinners Florida member I headed over to Soma Center Café on Lake Avenue in Lake Worth.

NOTA BENE: Soma Center Café is a partially raw food restaurant and not recommended for those of you who have severe tree nut allergies. Why? Because the basis of the raw food cuisine is nut meat, nut cream, nut milks and raw tree nuts. Nuts everywhere.

I was nervous to try anything; I debated walking out and trying my luck elsewhere. But I stayed and ordered lunch.

Why? Because of the staff.

Soma Center Café has a tiny kitchen with two cooks and one server/cashier/host/tending the till. The three of them were open, friendly, aware of their ingredients and accommodating. When asked, they showed me the recipe for the red lentil quinoa soup and even the box for the veggie bouillon cubes they use, which was Swiss, organic and contained only veggies and herbs and no wheat protein.

I ordered the soup as it was made earlier in the day and probably had the least potential for nutty cross contamination. I forced myself to have some faith that they use clean and safe practices. And I made my friend taste it first. And then I dug in. And it was totally safe. And vegan. And really delicious. So delicious that I might have to start making it at home.

Things always taste better when they’re safe, don’t they?

So, for a gluten-free, dairy-free, whole food, raw food eating guy or gal, Soma Center Café is an adorable setting; homey, vegan-chic with lovely outdoor seating and an indoor yoga center. It's great, check it out.

For the highly tree-nut sensitive/severely tree-nut allergic amongst us, I can’t recommend it.

Monday, January 05, 2009

Uno Chicago Grill Responds

After my last post about Uno Chicago Grill having gluten-free pizza, I received lots of online and offline comments that said Uno has some compliancy issues with their gluten-free program as of now (Dec 2008). Uno's publicist set up a chat between me and their VP of Marketing, Rick. Here’s what I came away with after an hour long conversation.

According to Rick, Uno Chicago Grill has worked on a gluten-free menu for the past three to four years. Uno's current Chief Executive Officer, Frank W. Guidara, has a “high sensitivity to issues related to nutrition and health and the Uno menu.”

QUESTION: What are the current training protocols for employees on allergies and customer care?

--According to Rick, Uno's staff receives training on a quarterly basis.

--"Staff" includes servers, managers, cooks and the culinary lead, which is the kitchen manager. The culinary lead is specially trained to run the kitchen.

--Uno's has a GLUTEN FREE button on their Uno ordering computers. (They do not have an "ALLERGY" button in their computer however.) The GF “ticket” once created is followed to ensure that that plate gets the proper attention.

QUESTION: What if you have more questions about the ingredients in your particular dish?

--Uno's has “Nutritional Kiosks” in the lobby of every Unos so patrons can get the entire breakdown of ingredients of every item on their menu. Here’s uNO'S online GF menu and allergen-protocols.

QUESTION: How is Uno's currently differentiating its packaging/processing/plating of gluten-free pizzas?

--Uno's gluten-free pizza is created by a subcontractor and is pre-cooked.

--Uno's GF pizza is thin crust.

--Uno's serves a flat bread pizza that is also thin; however, according to Rick: "The Gluten Free pizzas are round, the flat bread are oblong – the difference in shape is striking."

--To the pre-cooked GF pizzas Uno's adds GF sauce and cheese [which doesn't have any wheat based anti-caking agent] and spice mix [which is GF] all on-site.

--Uno's doesn’t have a way to delineate a take-away GF pizza order. They are looking into creating that now.

QUESTION: Is Uno currently cooking GF meals in same oven as non-GF meals ?

--Yes, but different pizza pie pans are used.


Above all, Uno's VP of Marketing said Uno's is interested in “...doing better. [We’re] committed to the well being of our guests...and we welcome dialogue with patrons or potential patrons.”

However, they only know what we like and don't like (or worse made us sick) if we reach out and tell them. This is a company that says they want to know. So I say, tell them!

If you have an Uno's near you and you’ve tried the GF products [I haven’t as it’s not in NYC yet] and you want to talk to them about it you can email: That email address goes to two women who sit outside of the president’s office. You can also call them at this toll free number: 866 600 8667, ask for the “hospitality center.”

Time Magazine, Nut Allergies

Time Magazine has been following the story of nut allergies over the last year. This week, they called Dr. Wood to respond to Dr. Christakis' nut hysteria article.

"...Wood cautions against excessive alarm. "It's an unfortunate situation," says Wood, "if a family with an inaccurate perception of the allergy leads a child to believe that a Snickers bar from 50 feet away is a lethal weapon."

Read more on the Time Magazine website here.

Sunday, January 04, 2009

Seasons 52, Boca Raton, FL

On the advice of a Worry-Free Dinners Florida member, I checked out Seasons 52 in Boca Raton, Fl.

Part of the Darden Group of restaurants (The company owns and operates more than 1,700 restaurants including Red Lobster, Olive Garden, LongHorn Steakhouse, The Capital Grille, Bahama Breeze and Seasons 52, none of which I’ve been to), I had called the Palm Beach outpost (who assured me that they could handle my needs) before I headed to the Boca Raton outpost, relatively confident that, as this is a chain, Boca Raton would be similar to the Palm Beach in abiliities.

The upshot: Not merely did Seasons 52 in Boca Raton handle my needs, they exceeded expectations regarding service, communication and an excellent Allergic Girl safe, allergen-friendly lunch in a welcoming and warm atmos.

Here’s how all went down.

Upon entering, I identified myself and my needs to the hostess, asking to speak to manager, if possible. She said the manager would come by my table. Then after we were seated, the hostess swung by to say the Executive Chef Anthony O’Neill would be by my table to personally to take care of me. Excellent!

Chef Anthony indeed strode over very soon after. I introduced myself and told him my allergy needs and asked if he might be able to make me a piece of plain grilled chicken with some roasted veggies? (It helps if you tell the kitchen what you’d like from what’s on the menu.) Easy, done sorted. I kept my order clean, plain and to the point. (I’m sure if I wanted something sauced or more complex Chef Anthony would be able to make that as well. But not on the first visit; next time.) Overall, it was a brief convo, Chef was friendly, helpful and certain that he would be able to meet my needs safely. It was that simple. It should always be that simple.

Basically, Chef Anthony said he is in the hospitality business and that it is his business to make any accommodation he can for any guest. Truly it was as if Chef Anthony had read my website and memorized what every great chef I’ve spoken to has said. Which goes to show you they are out there, even in “chains”: foodservice professionals, who take pride in their industry and can meet the needs of most every guests, even those with special dietary needs. (PS When I asked chef if they get allergy requests often, he said yes very often. They even have a regular patron who faxes in his list of allergies before every visit and Chef makes him a personally tailored allergen-free meal. How wonderful and individualized!)

Generally, the entire communication and expediting process at Seasons 52 worked exactly as it should have during this, my first visit. (Remember, I have only been there once.) However, to have a restaurant handle my needs effortlessly tells me that the Darden Group must be doing some smart food allergen awareness training corporation-wide.

Seasons 52 has a few other compelling reasons to check it out, if being allergen friendly wasn’t enough. Everything on the menu is less than 475 calories; they have nutritional information on their website; the Seasons 52 brochure says, if requested, they can give an allergic patron the entire breakdown of ingredients in a dish; and a meal is priced reasonably (at least to my NYC prices eye).

I didn’t think places like this were out there in strip mall land. Granted, I am woefully uneducated about chain restos, whether high end or family friendly; we just don’t have them in NYC. But now that I’m in Florida for a few weeks, I’m seeing a whole new side to them.

Thank you Chef Anthony O’Neill, GM Carolina Zerboni and the Seasons 52 team for a lunch well done.

Seasons 52
On Glades Rd
2300 N.W. Executive Center Drive
Boca Raton, FL 33431
Phone: (561) 998-9952
Fax: (561) 998-9930

The Ritz Carlton, Manalapan, FL

I went for a lovely, poolside-ocean-viewed New Year’s Day breakfast with the fam at the The Ritz Carlton here in Manalapan. We ate at their Temple Orange restaurant, all white chairs with orange trim and bowls of orange oranges as decoration. There were lots of families, kids in Tory Burch ensembles and mothers that look like young beachy Grace Kellys.

Instead of having the buffet ,which can be an allergic mine field, I opted for an a la carte breakfast: eggs, hash browns, a bit of bacon, berries, fresh OJ, all free of tree-nuts, fish, shellfish and wheat.

The best part of the breakfast, Sean, General Manager and all around good guy has tree-nut and fish allergies! Yes, and he totally gets it. I love finding allergic allies wherever I go.

The Ritz Carlton, Manalapan, FL
100 South Ocean Boulevard,
Manalapan, FL 33462 USA

Thursday, January 01, 2009

Food Challenges

Happy New Year everyone!

This is the year I’m going to introduce some old foods back into my diet or least test them out for how allergic I am to them now (versus a few years ago).

Eek-I know!

Some of these foods I may do as a food challenge in a doctor’s office; some I may try with a safe person nearby with meds at the ready, but I’m going do it.

Don’t think for one second that because I’m blogging about it that I’m in any way cavalier about this endeavor. I’m totally scared about doing this; I may even punk out on trying a few of these. However, most of these foods on my list I’ve had a least once (or used to eat regularly like tuna). And for one reason or another, I gave them up.

For the foods that gave me an itchy throat or itchy lips, I feel I need to test if they still do like eggplant or honeydew melon. For something like lemongrass, it put me to sleep. Which was weird, it was like I was drugged but I should try it again. For foods that I gave up after starting an elimination diet in 2005, I think it’s time to start to add some things back in and see what happens--trying any of these might give me 2-3 days of stomach discomfort, bloating, rumbling etc. etc.. and I will futher refine what I can and shouldn’t be eating. Notice I am not testing tree-nuts nor salmon, my biggies. No need; there's still an issue. But these outliers, they need to be tested.

Wondering why I’m not taking a blood test to determine my allergies? Because blood tests are inconclusive.

What is conclusive? You eat a food and you have an adverse reaction.

Here’s what the esteemed allergist and colleague Jay M. Portnoy, M.D., has to say about this from a press release on the America College of Allergy, Asthma & Immunology site.

In short: "Just because you have a positive test to a food doesn’t mean you are allergic to the food," Dr. Portnoy said. "It is really important that the symptoms correspond to the test. Personally, I’m still seeing a lot of patients who have been told by a physician not to eat foods because of positive test results, when in fact they have never had a problem with the food. You don’t want to avoid food that you are not allergic to, but you do want to avoid foods that you are allergic to. Allergists can be helpful in determining this because they have special training and experience in interpreting the test results."

So, here is my list of new/old/scary foods to try and if they don’t make me allergic or give me GI distress I may add or re-add them to my diet. At the very least, I will know where I stand now. Here’s the list in no particular order:

Flax seed
Hemp milk
Coconut water
Coconut oil
Winter squashes
Goat’s milk
Sheep’s milk
Fish--tuna, cod, flounder, fluke, sardines, anchovies
Soy, tofu, edamame, soy milk
Cow’s milk
Pumpkin Seeds
Sunflower Seeds

**REMINDER: This blog documents my personal journey. It does not substitute for medical advice. Please consult your personal physician or allergist to make the best decision for your health and that of your family’s.**