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tree nut allergies and vegan food - a dangerous combination

5/29/2019

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With vegan diets on the rise due to medical conditions, health trends and availability of products at your local grocer, what does this mean for those with life threatening food allergies? Many vegan food products on the market contain tree nuts, particularly cashews. Can someone with a tree nut allergy even be a successful, thriving vegan? 

I've pondered these issues for the past few years, ever since my brother-in-law went vegan after suffering a heart attack. Then a second brother-in-law went vegan after his diagnosis of advanced heart disease. I have the utmost respect for people taking care of their health and improving their diets. And I know it wasn't easy for these meat eating, cheese loving, red wine drinking guys (actually, I think they still drink red wine). But I also want to protect my daughter, who has an anaphylactic allergy to peanuts, soy, peas and tree nuts.

So when the requests starting coming for our family get togethers to be vegan - and also gluten free for some others - in addition to my already existing requests for food to be peanut and tree nut free, it became a real challenge to safely feed everyone. Simply put, while most people in the general food eating population think it's incredibly innovative and fabulous that cashews can be turned into everything from cheese to burgers to, well, cheese burgers, it is just another dangerous food for someone who is severely allergic to tree nuts. Sometimes it can also be fatal.

Recently I stumbled across an amazing website - the F.A.T.E. Initiative (www.fateinitiative.com). F.A.T.E is a non-profit organization dedicated to training and educating individuals on life-saving practices in situations relating to food allergies. The site was founded by Joey Salmingo, of Markham, Ontario, in memory of his sister. Two years ago, 30-year old Joanna Salmingo purchased some mochi at her Whole Foods market. According to the Whole Foods website, "mochi ice cream is a trendy Japanese-American dessert made of bite-sized ice cream balls enveloped in sweet rice dough." According to me - it's good stuff and my daughters and I were instantly smitten with the pretty colors, interesting taste and texture, and novelty of this new dessert treat. 

Joanna Salmingo also had tried mochi before and liked it. She was not allergic to the mochi she had before. However, two things happened on the fateful day that Ms. Salmingo consumed the mochi from Whole Foods. First, there was no list of ingredients or allergy warning on the mochi display. Food items sold on the store shelves require a list of ingredients and highlighted list of top 8 allergens as per food labelling laws. But this display lacked any ingredient or allergen information. So Joanna, thinking she was not allergic to mochi, thought she would try some, assuming it was just rice and ice cream. 

Second, and most critically, the mochi that was purchased and consumed by Ms. Salmingo, who had a life threatening allergy to tree nuts, was vegan mochi. This unlabelled vegan mochi was displayed with the other mochi flavors. While the display screamed "Vegan!" there was no indication that vegan meant that ice cream was replaced with cashew milk. Tragically, Ms. Salmingo died almost immediately after eating the mochi she had no idea contained cashews.

The F.A.T.E. initiative was created in her memory, to educate others on the importance and necessity of proper training and labelling with food service at restaurants, airlines, schools, and more. Please check out this amazing website when you can. ​Whole Foods changed their displays after this incident and added proper labelling; but it is unfortunate that it took a tragedy for this to happen. 

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Praline On Me

5/24/2019

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As my daughter popped a cheese and cracker sample into her mouth at the gourmet food store in our quaint seaside village, my emotions went from fear to panic to relief in less time than it takes to say praline mustard glaze. “WHAT are you doing?!?” I asked as she confidently approached the sample offerings and started to feast as if she does this on the regular. Turns out she does. College kids love free food samples, am I right? I ask her “how do you know these crackers are safe?” Eye roll. Mom I have these every time I’m come here.

I want to believe her but have never seen her just eat something without carefully checking ingredients. It’s not ok till I say it’s ok. I scan the cracker ingredients and sure enough they are fine. OK ... so crackers, whipped cream cheese and praline mustard glaze ... and that’s when fear turns to panic.

“WAIT does that say PRALINE? THERE ARE PECANS IN PRALINES!!!” I said, my heart started to beat faster. She looked at me with the stone cold glare of a teenager who knows unequivocally that she is right and mom is wrong. Then I guess I’m not allergic to pecans,. And then she shrugged and went to look at the sandwich specials.

Wait, what? In 2005 when my now college age daughter was in kindergarten and just diagnosed, her allergy screening indicated a slight allergy to pecans. So she has avoided them for 14 years (or so I thought!) This meant never having pecan pie at Thanksgiving dinner, for anyone. No cinnamon buns from the bakery. Conflict with grandma who always has pecan walnut ice cream in the freezer. And just like that, with no food challenges, no OIT treatment, no dr visits, she is now cleared to eat pecans. Wow. Grandma will be thrilled! I’m thrilled.

We all know this could have ended differently. A mistake like that could easily have led to anaphylaxis or an itchy throat and hives at minimum. It was a good opportunity to remind her to always always always read labels. Even if she’s had the food before. Especially if there is an unfamiliar word on the label. Prior to today she had no clue that pralines are synonymous with pecans. Now she knows.

I think about what could have hppened, but push it out of my brain with a new thought. One less ingredient to worry about, one less nut to avoid at holiday celebrations and to ask others to ban from their menus. One less food that is going to cause an allergic reaction.

I should be ecstatic but I’m still a little freaked out. Nothing like a little scare to keep us on our toes. But I will end with this - if you and your kids can tolerate pecans, this really was a delicious treat.

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the peanut mom bully (PMB)

5/5/2019

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​There are bullies, There are moms of bullies. And there are moms who are bullies. When it comes to dealing with our kids' food allergies around other families, some moms just stink. Let's call them peanut mom bullies or PMB for short.  Dads can ben PDBs too but for some reason I've noticed it more with the moms.

Just this morning I read about some PMBs who handed out peanuts at a baseball game even when they knew three kids on the team are allergic. PMBs sometimes choose to ignore the announcement on the airline when there is a person with a life threatening tree nut allergy and may open a bag of almonds just because her kids want them. There are PMBs who call the school principal to complain about the no cupcake rule in class because of food allergies, and then send in treats anyway because how could her kid celebrate a birthday without chocolate in school?  I have some PMBs in my family. I'm not sure these people are out to hurt anyone, in face it's the opposite. They just don't get it. They don't understand how serious - and sometimes fatal - food allergies are. They don't know what it feels like to be in our shoes. They lack empathy.

Empathy is the ability to feel or understand what someone is experiencing by trying to look at it from their perspective.  PMBs are seeing things only from their perspective. They are typically feeling threatened that another parent is telling them how and where to feed their child. Or they perceive that their kid will be slighted to not get a food treat in their classroom on their birthday or some peanuts and crackerjacks at the big game. Never mind that there is a real physical threat if allergic kids are around these allergens or other kids eating them. If only they could understand the anxiety our kids face every day just trying to stay safe. If only they could feel the terror we feel when we have to call 911 and stick a needle full of epinephrine into our child's little leg. If only they could share the pit in our collective stomaches when a member of the food allergy community loses a child to anaphylaxis. If only they could get it.

Bullying of kids with food allergies on the rise. According to Food Allergy Research & Education (FARE), About one in three children with food allergy reports being bullied as a result. It's a huge problem and there have been documented cases of anaphylaxis and even death, as a result of food allergy bullying. Recently, three teens threw cheese at a boy they knew had a serious dairy allergy. He went into anaphylaxis and died on the way to the hospital. Cheese.

How do we teach empathy to the PMBs? Change takes time. I truly believe that over time we can alter people's attitudes. It would be crazy to light up a cigarette around a baby. It would defy logic to bring a dog who bites to a playground of children. And remember when cars didn't have seat belts?

All these public health risks have been remediated by advertising campaigns, safety legislation and changing thoughts and behaviors over years and years. I hope it doesn't take too long, because I want PMBs to get it. I hope someday they will understand and relate and see the greater public health issue. I do think if we keep speaking up, presenting facts and advocating for our kids, PMBs will someday be a thing of the past. Until then, don't forget to bring 2 epipens with you and be aware of the signs of anaphylaxis because PMBs are unfortunately are not extinct yet.



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True Confessions of a cross-contaminator

5/1/2019

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How would you like school kitchen intel from an allergy mom? I thought so.

​I assist in the preparation of breakfast and lunch for about 100 4th - 8th graders at a small private school on Boston’s north shore every day. It’s a scratch kitchen and I work with a Johnson & Wales chef and a kitchen manager and pastry chef. We make everything from scratch, including barbecue sauce, vinaigrettes, granola, veggie burgers and so forth. 
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I will start with the many virtues of our kitchen. First, it is very clean and organized. Our chef has a fantastic relationship with the Board of Health inspector who visits us several times a year. The food is a huge selling point for the school; it is known as the best school lunch in the area, hands down. We pride ourselves on healthy delicious homemade meals that fall within the government dietary guidelines.

Also, we take food allergies very seriously. We are nut free and peanut free. We offer a pbj sandwich but use sunbutter. There are many food allergies among the student body. We know who has them and what they can eat. They ask a lot of questions, clearly well trained by their parents! We will accommodate any special requests such as a cheese free taco or gluten free pasta. There are also other food and diet issues that many of our students struggle with such as celiac, diabetes, seizures, anorexia, depression, you name it. Overall, we do the best we can to protect every student.

That said, cross contamination is very real. I will start with the obvious - the salad bar. Over 100 kids and teachers cram their way along the double sided 14 unit salad bar. Which means tongs are being double dipped, chickpeas are flying into the carrots, cheese cubes are in the honeydew. Then, there is the reuse of the cutting knives and cutting boards in the kitchen. If we are making a dedicated meal for someone with allergies, we will use a separate knife and board. But for the general public, they get reused. Nuts are avoided but I still prepare egg, dairy, tuna, sesame, chickpeas, edamame and wheat at my station pretty much every day with sometimes just a wipe down of the knife and board. I use common sense but there is no requirement to sanitize our instruments between foods. So I wouldn't assume that any prep person out there is doing that, especially if I'm not.

I couldn't forget the sunbutter spreader and the hummus scoop. We have one of those superduper industrial washing machines that revs up to 150 degrees of water shooting out from every direction. It’s hard for an item to come out not clean and sanitized. But for some reason, that spreader and that scoop need to be rewashed every single time. They are seriously sticky.  

With vigilance and good communication, a reliable food allergy management plan can be followed. Students with allergies should either talk to us about the safety of our hot lunch, or bring their own lunches. They should not eat from the salad bar or try something without identifying that they have an allergy. Same as in the real world, school cafeterias are a great place for allergic students to learn how to communicate about their allergies. So talk to your school nurses and food directors and let’s work together to keep everyone safe and healthy. If you find the staff is not adequately responsive, get a cute insulated lunch box and load it up with safe food. But give it a shot - the kids are very excited when they get to each what their friends are eating!



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