What do you eat? Food Allergies at Christmas

Christmas is coming soon! There will be parties, pets and foods to navigate for our family. My side of the family is quite large, we have a big family party on Boxing day, I have 2 children and 8 nieces and nephews, so it is wonderfully chaotic with 10 children.

I think food allergies are genetic on my side of the family. My brother and his youngest daughter are dairy intolerant, his other 3 children all outgrew their dairy intolerances with time. All 4 of his children have egg intolerances, but are able to eat cooked egg.

My sister recently went vegan to improve her psoriasis and she has found that has really helped, her oldest and youngest sons are slightly dairy intolerant, but do have it in small amounts.

I am the only one of my siblings without intolerances to food, so it does seem unfair that my daughter, A, is the one who is severely allergic to milk, eggs and pineapple (amongst other bits and pieces). My youngest daughter was intolerant to milk as a baby, but only very mildly and grew out of it really quickly.

What do we eat at parties?

Long gone are the days of a sit down meal, where we used to eat cold meats , chips and pickles (still for me an all time favourite boxing day meal). This became impractical in terms of space over the last few years with all the extra children. This option could be considered a decent allergy-friendly meal, but A hasn’t eaten much meat since she was 3, only recently started eating chips and does not like pickles. We would always make her an alternative of fish, rice and raw vegetables (as she also does not like cooked vegetables). This is still her favourite meal.

We now do a Boxing Day buffet and the 4 families bring leftovers from Christmas Day and whatever we have baked/cooked. Things my daughter loves at the buffet are:

  • jelly (making sure it’s vegan for my sister)
  • homemade ginger biscuits (recipe has no eggs and uses a dairy free spread to replace butter)
  • homemade chocolate concrete (dairy and egg free) – I bake without recipe – still making since 2012!
  • rice (which goes with the turkey curry/chilli, she doesn’t like spicy food – but loves the rice)
  • chips
  • crisps (salt and vinegar and cheese and onion both have dairy in them, once set out in a bowl they look the same no matter the flavour – so always plain ready salted)
  • jam tarts (my mother made these for years as egg free jam tarts are hard to find, but we have recently found that Asda do them and they are very reasonably priced)
  • vegan cupcakes (usually found from Pinterest, changes every year as I have never found one that my daughter loves – she does not like the cakey texture, the other children always eat them no matter A’s opinion)
  • popcorn – salty or sweet but never toffee as that often contains milk
  • raspberry sorbet – found in most UK supermarkets, dairy/egg free, raspberry is the best in our opinion
  • party rings – dairy and egg free – nothing special, just a biscuit that all the kids (and my dad like)
  • veggie sticks – cucumber, carrot and celery are family favourites (yes the children like celery)
  • breadsticks (not cheesy or with sesame – just plain – these are nice and cheap as well)
  • Haribo / Moam – only the goldbears have a pineapple one, her pineapple allergy is not that severe, we know which colour they are and pick them out
  • freezer lollies – cheaper the better, we have to watch out for pineapple as it’s in more things than you think

What is banned?

The list of banned food became more and more lax as the original 8 children got older, they were less messy eaters, acutely aware of A’s allergies and better at hand-washing. We now have an incredibly messy toddler and baby in the family, so we have returned to banning a few items.

  • the poor dog, my sister’s beautiful basset hound, Nora, is the first to go. A is very allergic to dogs, it exacerbates her asthma and irritates her eczema. I have never asked my sister to do this, she just thinks it’s best for all us to have a great time and not worry about medication so much. She also does a deep clean in the doggy rooms to get rid of all the hair. Nora has a wonderful time eating things she shouldn’t at her other Grandma’s house around the corner.
  • Cheesy crisps, quavers, mini cheesy bites, cheese puffs, onion ring corn snacks – the dust on those things get everywhere and have led to A’s eyes closing on more than one occasion.
  • Ice-cream – too messy in terms of cross contamination – A once had a reaction to touching a table where ice-cream had been spilt and then wiped (but not really cleaned). As a toddler one Christmas she had a horrible burn-like mark on her cheek from being kissed by a person who had eaten ice-cream.
  • Chocolate – Christmas is the season of chocolate, but we avoid it at large get-togethers for the same reason as ice-cream, warm melted chocolate on kids hands gets wiped on every surface and door handle until a reaction is inevitable.
Nora the Basset

Family Attitudes towards our Food Allergies

It wasn’t easy when A was little, I think the family found it strange that she didn’t outgrow her allergies like the other children in the family. My side of the family really saw the severity of her allergies with the ice-cream kiss incident and have paid a lot more attention since. None of them have ever try to undermine me or offer her something that she probably shouldn’t have.

Anecdotally I hear a lot of people say that their in-laws are the worst for making mistakes and being unreasonable, especially at holiday celebrations. I have to say I am very lucky with mine. My partners side of the family is very small, his step-sister is vegan and his stepmother was a vegetarian until her 60s when she started eating fish. When A was small and we struggled they gave us lists of things we could make, made things from scratch for her and found (and continue to do so) lots of lovely vegan treats which A can enjoy. Last week they gave us Gourmet Vegan popcorn (which amused me as popcorn is mostly vegan anyway), but they are very supportive and I am glad they are part of our family!

How are your family at Christmas? Do they accommodate for your allergies?

What is your favourite allergy friendly-recipe?

Whatever you do this year have a wonderful Christmas and a Happy New Year!

Jemma

Disclaimerour food allergies are unlikely to be the same as your allergies, always read labels and ingredients carefully, some of the foods we have are “may contain” – these are suitable for our child, but may not be for you.

Stay Safe – always remember to take your epi-pens, inhalers and anti-histamines to parties with food.

Fish Allergies

This was previously posted to my old blog, Itch, Swell, Ooze, Wheeze in September 2014. This is an updated version for 2019.

I have always felt that a diagnosis of fish allergy can be quite vague, ‘fish’ is such a general term and encompasses many thousands of species of fish, so it is a more complex allergy to deal with than its name suggests.

A diagnosis of fish allergy may follow as a result of a reaction from eating fish.

An IgE allergic reaction to fish is an immune response triggered by a response to proteins in the fish, the symptoms of which would be throat swelling, facial swelling, anaphylaxis, hives etc.  Allergy UK estimate that 15% of people suffering from a fish allergy also reacted to vapours released when cooking.  Once medication is taken these effects should reduce quickly (except in the case of anaphylaxis, this can take longer to recover from).

non-IgE allergic reaction to fish would be delayed up to 72 hours after ingestion and generally affects the gastrointestinal system, the symptoms are varied and many.  After antihistamines are taken it still might take several doses and days to reduce the symptoms associated with the reaction.

When fish is tinned or smoked the histamine level increases, so may also affect those who have a general histamine intolerance.  In these type of reactions the amount of histamine in the body builds up from various foods and environmental factors to cause an allergic reaction.

A vomiting/diarrhoea reaction to fish can also be caused by food poisoning.  It is more likely in the UK that food poisoning from fish will be caused by bacteria called Eschericia coli (E coli).  The onset of is unlikely be immediate, but may be confused with a non-IgE reaction, especially for those who already have multiple non-IgE allergies.

Another possible misdiagnosis of fish allergy might be scrombotoxicity.  This occurs as histamine is released from the fish flesh in some types of fish and causes an allergic like reaction with intense itching, fast pulse and skin flushing.  This reaction is due to the direct toxic effect of spoiled food so is referred to as food toxicity rather than a true allergic reaction.

Diet Management

For fish allergies a well taken history and food diary (challenges in mild cases) is the key to discriminating between an allergy to one species of fish, groups of fish or all fish.  It is thought that about 40% of people can tolerate more than one species of fish and in the case of those with multiple allergies it is important to avoid unnecessary diet restrictions.

Some smoked or canned fish contain high levels of histamine causing reactions.  Other commercially processed fish are lower in allergenic proteins due to loss of IgE binding so cause less reactions.

Like any allergy avoidance is key, if anaphylactic to fish avoid any products which ‘may contain’ fish.  The hidden places for fish allergens are:

  • Certain salad dressings
  • Worcester Sauce
  • Pet foods
  • Prawn crackers
  • Thai foods
  • Pizza
  • Stock Cubes
  • Relish (caponata)
  • Fish oil and Glucosamine Supplements
  • Lip Gloss/Lip balm

Key Allergens/Proteins in Fish Allergy

The key protein associated with fish allergy was always thought to be Parvalbumins, which are a group of proteins found in most species of fish.  It is found in different concentrations in different species of fish, which would be an indicator that this is the offending protein if certain fish can be tolerated and others cannot.  

Parvalbumin is a very stable protein, so able to cause reactions when cooked or as vapour during cooking (but food is thought to be 20-60% lower in parvalbumins when cooked).  It is found in high concentrations in the light muscle of fish rather than the dark muscle, so fish like cod and carp are higher in parvalbumin levels compared to swordfish and tuna which have lower levels as they have more dark muscle tissue (tuna parvalbumin is structurally different which is an important factor in allergenicity).  This would mean the size, age, health and species of the fish affects the protein levels, which is why it sometimes seems a mystery that you are reacting to fish and other times you can tolerate it.

Parvalbumin is the protein used for skin prick testing and RAST tests, so you/your child may show as negative to these tests if their allergy is to other proteins found in fish, namely endolases, aldolases, collagen and most importantly gelatin.

Gelatin is a protein found in both mammalian and fish meat/skin and is a common allergen.  It is possible that some fish derived gelatin contains parvalbumins and vice versa.  Fish gelatin is used less often than mammalian gelatin in food products, but its use is on the increase in pharmaceuticals and health supplements.  

Manufacturers are more likely to declare in food products where gelatin is derived from fish, but medicines in the UK and US do not yet have to declare their allergens.

Jemma

Disclaimer

This is a blog and should not be used for advice on diagnosis or treatments. 

If you think you may have a food allergy please contact your GP in the first instance to discuss treatment options.

References and Further Readings

Websites

http://www.nhs.uk/conditions/food-poisoning/pages/introduction.aspx

http://www.allergyuk.org/fish-and-seafood-allergy/fish-and-seafood-allergy

http://www.allergyuk.org/common-food-intolerances/histamine-intolerance

http://toxinology.nilu.no/Researchareas/Foodallergens/Factsheets/Fishallergens.aspx

http://www.foodallergy.org/allergens/fish-allergy

http://www.sciencedaily.com/releases/2013/12/131211093728.htm

http://toxinology.nilu.no/Researchareas/Foodallergens/Factsheets/Fishallergens.aspx

Research Papers

Fish allergens at a glance: variable allergenicity of parvalbumins, the major fish allergens, http://journal.frontiersin.org/Journal/10.3389/fimmu.2014.00179/full

Specific IgE to fish extracts does not predict allergy to specific species within an adult fish allergic population, http://www.ctajournal.com/content/pdf/2045-7022-4-27.pdf

IgE antibody to fish gelatin (type I collagen) in patients with fish allergy, http://www.ncbi.nlm.nih.gov/pubmed/10984381

Important variations in parvalbumin content in common fish species: a factor possibly contributing to variable allergenicity, http://www.ncbi.nlm.nih.gov/pubmed/20559001

Cross-reactivity in fish allergy: A double-blind, placebo-controlled food-challenge trial, https://www.jacionline.org/article/S0091-6749(17)30741-8/abstract

Fish collagen is an important panallergen in the Japanese population, https://onlinelibrary.wiley.com/doi/abs/10.1111/all.12836

Allergy to fish collagen: Thermostability of collagen and IgE reactivity of patients’ sera with extracts of 11 species of bony and cartilaginous fish, https://www.jstage.jst.go.jp/article/allergolint/65/4/65_450/_article/-char/ja/

Why do we have 14 allergens?

Have you ever found that as your food allergy is not on the top 14 allergen list you are taken less seriously at work or school, by friends, family or your GP? 

If the food you are allergic to does not need to be labelled it must be less serious, right? This kind of thinking could have significant consequences for the person suffering from the allergy.  Many people living without allergies don’t realise that you can have anaphylactic reactions to food that are not in the top 14. 

How were the top 14 allergens decided upon?

In 2003 12 top allergens were covered in Annex IIIa of the EU directive 2003/89/EC which is the directive which covers the labelling of allergens in food.  The original 12 in 2003 were

  1. Gluten
  2. Crustaceans
  3. Eggs
  4. Fish
  5. Peanuts
  6. Soybeans
  7. Milk
  8. Tree nuts
  9. Celery
  10. Mustard
  11. Sesame Seeds
  12. Sulphur Dioxide

This was not a static list and work into better understanding of food allergies across Europe continued.

EuroPrevall was a large-scale study which launched in June 2005 across Europe.  It consisted of 3 main parts, birth cohort studies, Community Studies and Outpatient Clinic Studies.  The project was funded by the EU to inform on the bigger picture surrounding the incidence of allergic reactions to food in different European countries, advise on the effect of allergies on the quality of life of sufferers, standardising allergy diagnosis and work towards making standardised food labelling across the EU.

In January 2008 a proposal was put forward by the European Commission to look at labelling issues which had arisen since the last EU directive and reviewing all the new allergy research in the EuroPrevall studies.  This was discussed in 2011 by European Parliament and EU Regulation 1169/2011 was published in November 2011.  These directives were more explicit in what was covered by the regulations.  At this time Molluscs and Lupin were added to the original 12, taking the number of allergens to be labelled up to 14.

What do countries on other continents label?

The EU has regulations on 14 allergens, compared to the US which has 8 and Japan which has only 5.  What I found most worrying is that some countries don’t have labelling laws at all. 

I would love to hear from you if I missed out your country, let us know what the regulations for labelling allergens are where you live!

Are we done?

No, the list of allergens is unlikely to remain static.  The EuroPrevall studies may have concluded, but there is another large-scale follow-up study called iFAMM, Integrated Approaches to Food Allergen and Allergy Risk Management.  This newer study will incorporate study data from the US and Australia as well as continuing studies in Europe.

Does your food allergy make the top 14 or are you allergic to something more unusual?  Let me know on Twitter, Facebook or comment below, I am always interested to hear from you!

Jemma


Disclaimer

This is a blog and should not be used for advice on diagnosis or treatments.  If you think you may have a food allergy please contact your GP in the first instance to discuss treatment options.


References and Further Readings

Studies under EuroPrevall

  1. A framework for measuring the social impact of food allergy across Europe: a EuroPrevall state of the art paper, 2007, https://onlinelibrary.wiley.com/doi/10.1111/j.1398-9995.2006.01303.x
  2. Food allergy QoL questionnaire for children aged 0–12 years: content, construct, and cross‐cultural validity, 2008, https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2222.2008.02978.x
  3. Factors influencing the incidence and prevalence of food allergy, 2009, https://onlinelibrary.wiley.com/doi/10.1111/j.1398-9995.2009.02128.x
  4. The EuroPrevall surveys on the prevalence of food allergies in children and adults: background and study methodology, 2009, https://onlinelibrary.wiley.com/doi/10.1111/j.1398-9995.2009.02046.x
  5. Health‐related quality of life of food allergic patients: comparison with the general population and other diseases, 2010, https://onlinelibrary.wiley.com/doi/10.1111/j.1398-9995.2009.02121.x
  6. The multinational birth cohort of EuroPrevall: background, aims and methods, 2010, https://onlinelibrary.wiley.com/doi/10.1111/j.1398-9995.2009.02171.x
  7. Online version of the food allergy quality of life questionnaire–adult form: validity, feasibility and cross‐cultural comparison, 2011, https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2222.2011.03711.x
  8. Can we define a tolerable level of risk in food allergy? Report from a EuroPrevall/UK Food Standards Agency workshop, 2011, https://onlinelibrary.wiley.com/doi/10.1111/j.1365-2222.2011.03868.x
  9. The EuroPrevall birth cohort study on food allergy: baseline characteristics of 12,000 newborns and their families from nine European countries, 2011, https://onlinelibrary.wiley.com/doi/10.1111/j.1399-3038.2011.01254.x
  10. The EuroPrevall outpatient clinic study on food allergy: background and methodology, 2015, https://onlinelibrary.wiley.com/doi/10.1111/all.12585
  11. Prevalence of food sensitization and probable food allergy among adults in India: the EuroPrevall INCO study, 2016, https://onlinelibrary.wiley.com/doi/10.1111/all.12868

Other further reading of note

https://www.food.gov.uk/sites/default/files/media/document/top-allergy-types.pdf

https://allergytraining.food.gov.uk/english/rules-and-legislation/

https://www.efsa.europa.eu/en/efsajournal/pub/3894

https://efsa.onlinelibrary.wiley.com/doi/epdf/10.2903/sp.efsa.2014.EN-696

https://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2003:308:0015:0018:EN:PDF

https://eur-lex.europa.eu/legal-content/EN/ALL/?uri=CELEX%3A32011R1169

Click to access guide_asiapacificfoodlaw_sep2018.pdf

https://ec.europa.eu/food/safety/labelling_nutrition/labelling_legislation_en

New to food allergies? How to get started

Have you just been diagnosed with a food or environmental allergy?  Welcome to the allergy community!

How did I start?

Nearly 10 years ago, my lovely 5-month-old daughter had dairy for the first time and was rushed to our local hospital after having a severe allergic reaction.  I was in limbo for a short time where I didn’t know what to feed her, what food we should be avoiding, and I didn’t know anyone else who had experienced the same thing. My GP, health visitor and hospital all failed to give me the right information to help feed my baby safely. So where did I look?

As I am based in the UK I found the best places to start were

But I also used more global resources by looking at

I hope you also find this to be a good jumping off point.

At the moment there is plenty of information on Twitter and a large allergy community there (which I wish was the case 10 years ago when I started) and I was surprised to find a lot of information on Pinterest, especially if you are looking for special recipes avoiding multiple allergens. It’s another wonderful resource.

I have to say though my primary resource for information continues to be Facebook groups , especially if you join one based in your country.  I am now only in 2 groups on Facebook which I continue to find useful as my daughter heads towards her tweens and teens.

Please come and join one of our groups, especially if you are struggling with a newly diagnosed child, introduce yourself, let us know what allergies you have and you will often find multiple members of the group willing to offer help and advice.

Let me know in the comments what websites you have found useful.

Jemma

Welcome!

Welcome to my new allergy blog!

I have lots of great ideas of things to research and write about – I intend to look into the UK’s top 14 allergens in more depth, continue to write about more unusual allergies and help you find the information you need to live a healthy life with allergies.

Coming Soon! Linked Pinterest, Facebook and Twitter accounts.