Food Allergy Counseling

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

Sunday, February 28, 2010

Immunotherapy, Egg Allergies

From AAAAI.org: Oral immunotherapy has potential for treating egg allergic children

NEW ORLEANS – Could a treatment for egg allergy be on the horizon? Late-breaking research presented at the 2010 Annual Meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI) shows promising results for parents of egg allergic children.

In this first multi-center trial that involved Duke, Johns Hopkins, Mount Sinai, National Jewish and the University of Arkansas, 55 children between the ages of 5 and 18 were randomized to receive egg white solid oral immunotherapy or a placebo. The study spanned three dosing phases: initial escalation, build-up and maintenance. This was then followed by an oral food challenge at approximately 44 weeks to determine how many of the children became desensitized to egg.

Seven subjects withdrew before the oral food challenge took place. While 21 of the 40 who received the egg white oral immunotherapy passed the oral food challenge, none of the 15 who received the placebo did.

“Some of the most exciting research in allergy today focuses on possible treatments for patients with severe food allergy. This important study on the use of oral immunotherapy for children with egg allergy provides further evidence that a real treatment for food allergy will soon be possible,” commented Robert A. Wood, MD, FAAAAI, one of the study authors.

The mean cumulative dose consumed during the oral food challenge by those children who received the egg oral immunotherapy far surpassed that consumed by the placebo group. Symptoms reported during the dosing phases were mild to moderate with no symptoms reported in nearly 12,000 of the doses consumed by the oral immunotherapy group versus only 4,014 symptom-free doses consumed by the placebo group.

In the oral immunotherapy group, there were also significant decreases in egg IgE and egg-specific basophil and mast cell responses. The immune profiles and long-term tolerance of the children involved in the trial are being monitored.

Milk Allergy, Test

I have WFD families in this study as well as private coaching clients, some of whom reacted and had to withdraw. Such brave, brave families and children.

From AAAAI.org:

Research gets closer to a test for tolerating milk products

NEW ORLEANS – New research is leading the way to a test to distinguish children who can tolerate baked-milk products from those who cannot tolerate any form of cow’s milk.

Previous research in The Journal of Allergy and Clinical Immunology reported that up to 75% of children with milk allergy can tolerate heated milk.1 But if you are a parent of a child with cow’s milk allergy, how can you tell if your child is one of the 25% who are likely to have a serious allergic reaction to any form of milk?

In one of many food allergy research presentations at the 2010 Annual Meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI), a study by Wang et al. sought to determine whether children with different degrees of cow’s milk allergy differed in the way their immune systems recognized milk proteins. Forty-one people were recruited from a larger clinical study on the effects of ingesting heated milk proteins at the Jaffe Food Allergy Institute, Mount Sinai School of Medicine in New York.

Study results showed that Immunoglobulin E (IgE) antibodies from children who reacted to all forms of milk products (baked milk and unheated milk) bound to more epitopes than children who reacted only to unheated milk. In addition, the severity of the reaction directly correlated with the number of epitopes recognized by IgE antibodies from a child.

IgE antibodies can travel to a type of cell that releases chemicals and causes an allergic reaction. Each type of IgE has specific “radar” for each type of allergen, such as cow’s milk. An epitope is a site on a particular molecule, such as a milk protein, that stimulates specific immune responses.

"With this blood test, we hope to be able to tell which cow’s milk-allergic children will be able to tolerate milk in baked products without having to resort to oral food challenges,” explained Hugh A. Sampson, MD, FAAAAI, one of the study authors. “It may also provide some insight into the severity of allergic reaction that a patient might experience.”

Allergy, Meat

An allergy to a carb in meat? Interesting.

From AAAAI.org: Is anaphylaxis triggered by eating meat more common than we think?

NEW ORLEANS – According to research presented at the 2010 Annual Meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI.org), a carbohydrate in meat called alpha-gal is an under recognized culprit in patients with recurring anaphylaxis.

An individual who has had an anaphylactic reaction to something unknown is at an increased risk for repeated episodes if the trigger for the reaction is not identified. With recent research showing that those who have IgE to alpha-gal report anaphylaxis or hives three to six hours after eating mammalian meat, how many of these unknown cases might actually be attributed to it?

To find out, 60 patients diagnosed with recurrent, idiopathic anaphylaxis at the University of Virginia, the University of Tennessee and the John James Medical Center in Australia were identified and tested for the presence of IgE to alpha-gal.

Of the 20 patients from the Tennessee clinic, five were found to have more than 1.0 IU/mL of IgE to alpha-gal. The results from the Virginia and Australian sites showed an even higher level of positive responses to the carbohydrate. Eleven of the 22 patients from Virginia were found to have greater than 1.0 IU/mL of IgE to alpha-gal, while nine of the 18 from Australia were positive.

A broad analysis of other allergens in the 60 samples did not find any patterns that would have otherwise explained the cause of anaphylaxis in the 25 positive for alpha-gal or the remaining 35 cases.

“These studies continue to suggest not only that IgE to a carbohydrate has important clinical implications in food allergy and anaphylaxis, but that the presence of this antibody may well have been under appreciated in terms of the number of patients affected and geographical scope,” commented Scott P. Commins, MD, PhD, lead author of the study.

The AAAAI (www.aaaai.org) represents allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic and immunologic diseases. Established in 1943, the AAAAI has nearly 6,500 members in the United States, Canada and 60 other countries. To find an allergist/immunologist in your area, visit www.aaaai.org/physref.

MA Enacts Food Allergy Law

From The Boston Globe:

Massachusetts health authorities plan this summer to start requiring that restaurant staff and their menus address diners’ potential adverse reactions to nuts, dairy products, and other ingredients that can make pulses race and lungs tighten.

“My goal is to serve anyone with food allergies safely in any restaurant in the state,’’ said Tsai, winner of a prestigious James Beard Award and star of an eponymous PBS show. “I don’t buy that a restaurant’s too busy that they can’t figure out whether it’s safe to serve people. If you do not know what’s in your food at all times, you should get out of the restaurant industry.’’

This Allergic Girl's colleague Dr Mike Pistiner reminds all of us to Trust, But Verify: “This is really a ground-breaking law,’’ said Pistiner, an allergist affiliated with Children’s Hospital Boston. “But people with food allergies are still going to need to be vigilant and choose wisely.’’

Read the whole The Boston Globe article.

Wednesday, February 24, 2010

Slice, The Perfect Food

When Slice Perfect opened a few years back I went to the Upper East Side location to check it out. I thought they had decent allergen-protocol and cared about their customers but the pizza needed some work.

Here’s part of my 2007 review: "To me, the Slice Perfect plain pizza with house-made marinara sauce and rice cheese on rice flour based crust reminded me of Stouffer’s frozen French Bread pizzas that I used to eat when I was a kid [made in the toaster over, yum]. The rice crust dough, when cooled, was hard and gummy but not un-tasty... The cheese, when cooled, tasted as fake …[and the] sauce was salty, too orange, thin, and did I mention really salty?”

A lot can happen in three years.

A few weeks ago, one of the Slice Perfect owners, Miki, reached out to let me know, “...we JUST launched our new amazing gluten-free pizza crust after four hard months of testing and re-testing and adding a few key ingredients (like potato flour)!” Lissa, of Worry-Free Dinners, and I went in for a tasting courtesy of Slice Perfect. We sat down and had a two hour long chat with the GM Nina, a superstar about allergies and intolerances and about their new menu.

Slice Perfect, both locations are organic, tree-nut free and have gluten-free, dairy-free options. They make a seasonal peanut butter cookie (in the West Village location only) for both outposts so they are not peanut-free but are very careful about handling peanuts and are aware of the cross contamination risks. The other seasonal dessert they make is a nut-free, vegan, gluten-free brownie. I didn’t try either, I went straight for the gluten-free pizza and the new crust.

Nina told us that GF crust is made in a separate part of the kitchen with separate utensils and pans, however, the same oven is used for both GF and non-GF items. Slice’s GF crust contains the following: rice flour, cornstarch, potato starch among other GF ingredients. And Nina, as per my suggestion, is working on a recipe book available to all patrons upon request. Yay, Slice Perfect.

Lissa and I taste tested four types of the pizza: the intermediate goat cheese, the master sausage, the taste of India and the nut-free novice pesto. All were really delicious. The chicken sausage is made in-house and GF and mild. The chana masala had a well-rounded curry flavor. The nut-free pesto made me nervous just because so many pestos are nut-filled (even though I knew Slice Perfect had no tree-nuts anywhere). But Nina brought out the recipe cards for me to read and I dove in. The basil was fresh tasting and we tried it with the soy and dairy free Diaya cheese (made from tapioca), a nice alternative. But my fave was the intermediate with the sweet honey shallot vinaigrette, arugula, goat cheese and a tomato-y sauce.

Now to the crust, it’s softer, with some give. When it cools it stays soft (not killer hard like that last one). The flavor is right on, no gluten-free weird aftertaste that you can get with some dough, no bean taste like in the garfava versions made elsewhere. It’s an herby crust with some heat from the pepper flakes. Our pizza was a bit thicker in the center and therefore a bit raw (ack) but the edges were perfect and when I returned a second time on my own dime, with no warning, the pizza was done perfectly all the way through.

Overall, I believe Slice Perfect's commitment to its patrons, whether gluten-free, vegan, organic, allergic or Joe off the street, has strengthened and deepened over the last few years. They are transparent about ingredients and processes, and seem knowledgeable about making their kitchens as safe as they can.

If you’re thinking about going, call ahead, ask to speak with Nina who’s the general manager or Miki, one of the owners. Tell them I sent you.

Slice Perfect West Village
535 Hudson Street (Perry/Charles)
New York, NY 10014
P. 212 929 2920
F. 212 929 2987

Monday, February 22, 2010

Thank You, Anonymous New Yorkers

"Your friend from Picholine just gave me your name. I think we're long lost friends and that you've just made my day! I've quickly checked out your site & blog, love it! I've been called "the allergy girl" for a fair amount of my life too..."

That's lovely, thank you, but I don't know anyone at Picholine (I wish) and I've never even been there to dine. Hmmm.

Or this: "I recently visited The Coffee Shop at Union Square, NY and a waitress informed me about your website, after I apologetically asked a third time if the dressing on a salad really was free of dairy. I just visited your website and was thrilled to see your recommendations and blog posts."

I haven't been to the The Coffee Shop in at least two years and I know no one there either.

What's going on? I've been getting more and more blog traffic and emails like this - NYC servers/hosts/managers are giving their food allergic/food intolerant patrons my Allergic Girl website.

Wow.

I think (I hope) this means that the positivity between food allergic patrons and foodservice is beginning to happen - person by person, restaurant by restaurant. Maybe doing the Foodshow has had some impact too (I'll be there again next week).

So thank you, New York City foodservice industry for hearing us!

Friday, February 19, 2010

"You’re Such an Adventurous Eater."

During a business meeting with Chef Meghan Young of Dos Caminos Soho, a Worry-Free Dinners partner and a panelist on my International Foodservice and Restaurant Show panel in two weeks (more on that later), we were talking about food allergies and patrons and trust.

Chef said that she was really impressed that I was adventurous with food given my allergy restrictions.

“That’s because I trust you,” I said. “I know you are completely transparent about the ingredients and your methods of preparation; your servers are well trained and everyone here embraces the food allergic patron. I’ve dined here many times and have seen you in action with me and my Worry-Free Dinners members. I know how much you care and how committed you are. So because of that, yes I can say to you, sure let’s try new dish, sounds great.”

If you had asked me five years ago if I thought I would ever have a conversation like this with any chef, I would have said, “No way, just no way.” Goes to show there’s always room for growth, change – expansion within your restrictions. It's starts by having a conversation with the restaurant and by utlizing my best dining out tips.

Have any of you recently had a similar experience: someone viewing you in a new positive way that you hadn’t even seen yourself? Do tell, I'd love to hear.

Wednesday, February 17, 2010

Judith Jones, Food Allergies

So I’ve been reading the Tenth Muse by Judith Jones, Julia Child’s editor amongst other literary accomplishments. In the beginning of the book she off-handedly says the oddest thing about a presumed shellfish allergy. Here's the page so you can read for yourself.



My non-medical guess, she never had a shellfish allergy. But still the slivers of fish in her food, hidden, frightens me to no end...

Monday, February 15, 2010

“It’s not your fault”

I’ve heard this twice. In the space of two weeks. From two different restaurant general managers.

Once was at Slice Perfect in the West Village while sampling their menu. The other time was at Hearth, while talking to GM about whether they could handle food allergies; I have yet to dine there.

This declaration of my lack of fault-ness was in a direct reference to talking to the GMs about food allergies and how some people may not want to bother the chef with their requests or the kitchen or feel shy about their allergies. To which those food service professionals said, “It’s not your fault that you have allergies”.

Two GMs saying this isn’t a trend but it was worth noting. Is there a shift going on? What do you think?

Friday, February 12, 2010

Fried Rice, New York Times

Fried Rice, Dressed Simply by the Bitt-man:

"Having written cookbooks with the chef Jean-Georges Vongerichten (along with being his friend) for more than 15 years, I’ve seen him develop a fair number of stunning recipes. My favorites have always been the simple ones, those that came from his Alsatian background or his years working and traveling in Asia. And I was never more impressed than when he created his version of fried rice, topped with crisp ginger and a fried egg."


My dad makes his own version of this when I visit him. My Filipina friend Casey tells me they make a version of this back home, in Manila : garlic rice or sinangag. Rice, garlic, oil and an egg. My version is gluten-free (no soy sauce for this wheat-free gal) and so good I don’t know why I’m not eating it every morning. Probably because I'm still on a scrambled egg and corn tortilla kick, kinda Mexican inspired. This one will be next, kinda Asian-ish. So simple and so delish. OK I'll stop now.

Wednesday, February 10, 2010

Glutino, Bagels

A few weeks ago at Fairway, I bought cinnamon raisin bagels made by Glutino Foods to try. I had heard about their bagels for a while but hadn’t seen them in the stores until now.

Generally speaking I love Glutino Foods, their gluten-free, peanut and tree nut free products, especially the Gluten-Free Pantry line, have some real winners. I’ve worked with Glutino in the past and they have sent me samples in the past. So overall, a "Yay!" Glutino!

However, I’d love to see Glutino do just a little more homework on this one.

From the Glutino site: "Premium Cinnamon 'n Raisin Bagels - This California Style Cinnamon & Raisin Bagel is a perfect start to your day."

OK, so two questions: What’s a California style bagel? And why is this premium? Out of the bag, it arrives with a thud. That’s not right. And this bagel has definite hallmarks of being extruded from a mechanical tube, also not a positive sign. The bagel is highly processed, too many ingredients, some not recognizable and it tastes like it. “Ingredients: Corn mix (corn starch, skim milk powder, evaporated cane juice, salt, glucono-delta-lactone, pectin, sodium bicarbonate, sodium alginate, modified vegetable cellulose), water, tapioca starch, dried raisins, margarine (palm and palm kernel oils, soy lecithin), liquid yolks, skim milk powder, evaporated cane juice, liquid egg whites, safflower oil, cinnamon, guar gum, yeast, salt, thiamine, niacin, vitamin B6, riboflavin, iron, calcium.” When defrosted, warmed and toasted the cinnamon raisin bagel smelled right. I tried one piece with margarine and another with organic butter and regardless of which spread, the texture was off, the taste chalky with a slight aftertaste of milk powder. Not horribly unpleasant but not fantastic.

Today, I gave it one last shot and tried a toasted half with Philly cream cheese. This was the winner. The chalky under-taste disappeared or was masked by the salty spreadable cheese and I was taken back to a childhood filled with cinnamon raisin bagels with cream cheese. Happy, happy days.

So upshot: Despite their looks and their decidedly non-bagelness (bagels shouldn’t have that many ingredients nor be dense as a doorstop and I still don't know to what premium nor California refers), I gobbled them down once toasted with cream cheese. At 5.99 for five bagels is cheaper than the local varieties of gluten-free bagels available ($20 for eight for example) so I may be trying other varieties.

And meanwhile, Glutino, maybe a wee bit more R&D?

Monday, February 08, 2010

FAAN Conference, 2010

FAAN has posted their spring conference list. I went last year and this is what I posted:

Whether you or your family has been newly diagnosed or you’ve had food allergies a long time, it’s always worth it to continue to educate yourself, to meet and connect with others in the food allergic community and to know you are not alone.

And it's still true! It was super to meet other food allergy bloggers, and even some Worry-Free Dinners members. I’ll be attending this year, perhaps I'll see you there.

Here’s more info from FAAN.

Thursday, February 04, 2010

Bar Breton, NYC

UPDATE: 2012. Bar Breton is closed.

I had originally heard about Bar Breton and their buckwheat galettes reading a Twitter conversation between Celiac Chick and the Chef/Owner Cyril Reynaud. Here’s the resultant post from Celiac Chick Kelly. She personally shepherded Bar Breton through the process of making sure their kitchen was gluten-free. Thanks Kel!

I went for a girl's night out with restaurant publicist Shari (who had worked with Chef before), Catherine of A Gluten-Free Guide and gluten-free friend Danielle.

I called ahead of our reservation, did my allergic girl thing and they took copious notes. The moment I walked in the door the host (and possibly manager) took care of us personally. I identified myself to the waiter, and didn’t even have time to ask for the manager because the Chef immediately came over to hear my particular needs and walk me through the menu. Separate fryer for gluten-free items? Check. Separate crepe pan for nutella galettes? Check. He was warm and welcoming. He checked in with us after the meal. My food was safe and delicious. They did everything right.

I need to go back a few more times at different times of the day before they can go on my AGRecs list but it was a great start.

Thank you Chef Cyril and your Bar Breton team for being attentive, hospitable and serving some delicious allergen-friendly food.

Bar Breton
254 5th Avenue
New York, NY 10001-6406
(212) 213-4999

Wednesday, February 03, 2010

Monday, February 01, 2010

Food Allergies for Dummies, Wood

Food Allergies for Dummies is an indispensable guide for those newly diagnosed with food allergies written by top food allergy doctor, Robert Wood, MD, who has peanut allergies.

Dear friend Aimee's two-year-old daughter was recently diagnosed with a peanut allergy after an accidental ingestion. It was when grandpa was taking care of the kids. (Isn't that often the way?) Food Allergies for Dummies was the first book I sent Aimee and it immediately answered many of the questions her allergist did not (and probably could not) address.

For example: "How am I going to take my PA daughter on a flight?"

I told her about all the published research I had read, and all of the flights I had taken with food allergies (and no problems) and then we turned to page 198 Dr. Robert Wood says: “In most cases, peanuts of flights does not post a significant risk. I fly often, frequently on international flights, and I’ve never had an in-flight reaction...I’ve personally flown hundreds of times without any difficulty, and I have a very severe peanut allergy.”

She said she instantly felt calmer. She has returned to the book again and again (as well as become a de facto/pro bono food allergy coaching client) to get a quick answer to a question, or before she sees the allergist to get more in-depth answers.

Food Allergies for Dummies is an excellent reference book to have on hand, if you are newly diagnosed or even someone who’s had food allergies forever like me. Family and friends often need more education about what it is that you’re going through. Food Allergies for Dummies can be a primer for them or for you when they have questions that you can’t answer.

I can’t say enough about Food Allergies for Dummies; it should be in every FA person's library as a reference.

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Do you have other books that are on your quick reference list? Do tell!