Food Allergy Awareness Week

This week is FAAN's Food Allergy Awareness Week

FAAN is of course the Food Allergy and Anaphylaxsis Newtwork, who is the leading advocacy organization for allergy awareness in the U.S. They do tons of good work and just as importantly make it easy for you to go out and advocate for your needs on a state and local level. The page I linked to in the first paragraph has a variety of links on it that will lead to activities, projects, and materials that will help you.

Allergy awareness isn't limited to the U.S. either. April saw the World Allergy Week sponsored by the World Allergy Association.

Anaphylaxsis Australia has its own Food Allergy Awareness Week starting May 14.

Allergy New Zealand follows with its Allergy Awareness Week from May 20-26.

Not all the attention is on food allergies and less is focused on milk allergy specifically, but all the fuss is worthwhile. Allergies are increasing everywhere and nobody really understands why. The consequences of allergies, especially in children, are severe and real, even if some people make light of the excesses that any movement is heir to. I've written dozens of entries about parents who used their own experiences with their own children to start businesses or organizations to help others. It's a great way to pay forward for the help that all of us have already been given by caring others.

Food Intolerance vs. Food Allergy

One link in particular from the Great Page of Food Allergy Informational Links that I posted yesterday stood out for me. Of all the thousands of questions I've received over a quarter century of talking about lactose intolerance, probably the most frequent and most confusing is the difference between a food intolerance and a food allergy. Let's start with this short article on the Palo Alto Medical Foundation site, Food Allergy vs. Food Intolerance.

A food allergy is actually an immune-system response. When someone eats certain foods (such as those listed above), the body mistakenly treats an ingredient in the food (usually a protein) as if it were a harmful pathogen. The body responds by creating a defense system (antibodies) to fight it. The allergic symptoms occur as a byproduct of the action of the antibodies that battle the invading food. Food intolerance is a broad term that describes any adverse reaction to food. ... Non-allergic food intolerance is often limited to an uncomfortable digestive-system response. The most common example of food intolerance is lactose intolerance, in which one's body is unable to break down the sugar (lactose) in dairy products. Other food intolerances can be caused by irritation to the digestive system by an ingredient in the food consumed.

That's the basics. Allergies and intolerances are different conditions, produced by the body reacting in different ways, often to a different set of triggers, with different symptoms and different severity. You wouldn't think that anybody would mix them up. And yet, life is never that simple and clearcut. The big issue for most of you reading this is dairy. Dairy is the trigger - the sole trigger - for lactose intolerance. Only the milk of mammals contains lactose: it's not found anywhere else in nature. Digestion breaks down milk into its smallest and simplest components and one of these is the compound sugar known as lactose. No digestive system of any mammal can digest lactose. It must be broken down into its own components, the simple sugars glucose and galactose, before it can be absorbed by the intestines. That's pretty weird if you think about. Why would a nursing mother go through the long series of extremely complex chemical reactions necessary to produce a unique compound sugar that can't be used in that form by the offspring? Nobody really knows. It's a scientific mystery. And a useful argument against the notion that humans or mammals or any living thing was "designed." Who would design a boondoggle like this? To break down, digest, a compound chemical the body manufactures enzymes, proteins that act as catalysts to speed up the process. The enzyme that digests lactose is called lactase. (Sugars end in "ose"; enzymes end in "ase". Remember that for your next crossword puzzle.) If the small intestine doesn't manufacture lactase, or creates too little of it, then some lactose will continue through the gut and wind up in the colon. Two things can happen during that journey, both bad. One is that lactose reverses what is called the molality of the system. Normally water enters the body from the intestines, nourishing you and leaving the end product, the stool, moist but intact. Lactose creates an environment in which water is pulled from the body into the intestines, setting up conditions that usually manifest as diarrhea. In addition, many of the dozens or hundreds of species of bacteria that live in your colon will jump on the lactose as a source of food, ferment it, and produce gas as part of the fermenting process. Heavy, smelly, long-lasting, awful gas - by itself or in addition to the diarrhea - is the consequence. Put together, those are the symptoms of lactose intolerance. Any other symptoms in an adult are extremely rare. Allergic reactions make more basic, underlying sense than lactose intolerance. You obviously want your body to fight off foreign invaders in your environment or in your food. But - here's where we question the whole "designer" thing again - the body often gets it totally wrong. Sometimes perfectly good, even healthy and helpful chemicals trigger reactions. In food, these reactions are always triggered by proteins, and never by sugar of any sort. You cannot be allergic to lactose. Only the proteins in milk, which are mostly in two families, the caseins and the wheys, can set off an allergic reaction. In theory that sounds like a great dividing point. In the laboratory it is. In life, there are few times when you have a dairy product that contains only proteins or only lactose. They almost always come mixed. How do you tell which is causing the problem? The best way is by the symptoms. Lactose intolerance always and only causes intestinal distress. A dairy allergy seldom does. Another link on that great links page lead to an informational page from the Journal of the American Medical Association.

SYMPTOMS Allergic reactions to food can be mild to severe. They usually occur within a few minutes of eating a food, though they rarely appear a few hours after ingestion. Symptoms can include runny nose, itchy skin, rash or hives, tingling in tongue or lips, tightness in throat, hoarse voice, wheezing, cough, nausea, vomiting, stomach pain, or diarrhea.

Those symptoms are in rough order of how common they are. Notice that stomach pain or diarrhea are last on the list. They do occur in certain people. Even so, the fact that the symptoms overlap coming from food in which the triggers overlap is a recipe for confusion. Doctors can usually sort this out just from listening to you describe your symptoms. And there are tests both for lactose intolerance and for food allergies that will definitely separate them. If you don't want to wait, the easiest first step is try lactase pills, available in any supermarket or pharmacy. Those work well on most people with lactose intolerance. If they don't, then the next step really is to see a doctor. A great many gastrointestinal illnesses produce the same symptoms and some, notably irritable bowel syndrome, can also be triggered by dairy. The cures for those are seldom as easy a box of inexpensive pills. Make sure you get the treatment you need.

Great Page of Food Allergy Informational Links

Food allergies have exploded over the last two decades and nobody is quite sure why. Until scientists can tease out the true explanation from the hundreds of suggestions made, sufferers and parents of children with allergies need to learn all about them. What to avoid, what to do if symptoms arise, how to substitute for trigger foods. In that way allergies are much like lactose intolerance: the same behaviors need to become automatic. Kristen sent me a great page of useful links that appeared, of all places, on the website of LionsDeal Restaurant and Office Wholesale. Restaurants are taking allergies and intolerances with far greater seriousness and understanding than they did before the incessant publicity on them started. The people at Lion's Deal did a good amount of research and put it together on a page called Kitchen Guide: Food Allergy Information. The links all head to major academic and governmental bodies or allergy organizations, so the information is sure to be authentic. Thanks to LionsDeal.com for gathering this information for their restaurant clients and to Kristen for making me aware of it in a place I'd never think to look

Health Professional Quality Answers on Food Allergies

Pulse is a UK site intended for health professionals only. That's code for saying that they use medical terms and expect their readers to understand them.

That's okay. The answers are pretty straightforward, and most people with food allergies have already encountered these terms over the years.

The current topic is Key questions on food allergies. "Allergy GPSI Dr Adrian Morris answers GP Dr Mandy Fry’s questions on diagnosing cow’s milk allergy, prescribing Epipens and the value of allergen avoidance in pregnancy."

Here are some excerpts that are of concern to those with dairy allergies.

2. How can you confirm a diagnosis of cow’s milk allergy?

Cow’s milk allergy is relatively common in infants (1:50) and rarely develops after one year of age. Symptom improvement on a cow’s milk-free diet and recurrence of symptoms with reintroduction of cow’s milk formula is the most accurate diagnostic method.

Skin prick tests using fresh cow’s milk and RAST blood tests for cow’s milk protein IgE antibodies are the only reliable tests and have 60-90% accuracy. The higher the milk-specific IgE, the more likely there is to be a clinically relevant milk allergy. On the other hand, IgG antibody testing for cow’s milk proteins (casein and b-lactoglobulin) is of no diagnostic use.

The clinical history and observation of the infant feeding are very helpful, and a family history of atopy increases the likelihood of a food allergy. Cow’s milk allergy can manifest with immediate urticaria and facial angioedema and respiratory, oral and laryngeal symptoms, as well as deteriorating eczema in addition to typical symptoms such as vomiting, diarrhoea, persistent reflux, food refusal and even anaphylaxis in severe cases.

Mildly milk-allergic infants will tolerate small amounts of processed dairy produce such as yoghurt and cheese. Infants with severe cow’s milk allergy will react to traces of milk protein in partially hydrolysed formula, and even breast milk, as well as any skin contact.

3. What are the best formula alternatives and what role do other milks play?

Cow’s milk-free formulas are expensive - £8 to £20 per 400g. Amino acid-based formulas such as Neocate and Pepdite are best because they are completely free of cow’s milk protein, but are more expensive than extensively hydrolysed formulas such as Nutramigen and Pregestimil, which are the current preferred cow’s milk-free formulas. Exquisitely sensitive infants may react to traces of cow’s milk protein even in extensively hydrolysed formulae.

An amino acid-based formula provides a good therapeutic trial for initial diagnosis of cow’s milk allergy, after which it would be cheaper to switch to an extensively hydrolysed formula – if it can be tolerated.

Although soy milk is the cheapest alternative formula available at around £4 per 400g, 20% of cow’s milk allergic infants will develop a concomitant soy allergy. The fear that soy milk phyto-oestrogens can feminise male infants is without scientific foundation.

Goat’s milk is inappropriate as it contains many of the allergenic proteins found in cow’s milk, so should not be recommended. Comminuted chicken meat suspensions are another alternative, particularly if there is associated carbohydrate intolerance.

4. How many affected infants will grow out of a cow’s milk allergy?

Half will outgrow their cow’s milk allergy within one year, 75% by two years and 90% within three years. Cow’s milk protein intolerant infants with problematic gastro-oesophageal reflux and colic usually spontaneously recover by the end of the first year. This represents a delayed hypersensitivity to the cow’s milk protein resulting in oesophageal inflammation and eosinophilic infultrates. Depending on severity it makes sense to rechallenge cow’s milk allergic children after one year and then every six months thereafter. In severe cow’s milk allergy challenge testing should not be contemplated outside a hospital setting.

The rest of the article is way too long to repost, but contains a lot of good general information for parents of kids with food allergies. Please take the time to read it.

Sophie Safe Food Guide

It's been three years since I posted about Emily Hendrix's Sophie-Safe Cooking: A Collection of Family Friendly Recipes That are Free of Milk, Eggs, Wheat, Soy, Peanuts, Tree Nuts, Fish and Shellfish.

Ms. Hendrix has not been idle since. She recently alerted me to her new endeavor, the Sophie Safe Food Guide.

Sophie Safe Food Guide will expand your options and speed up your grocery shopping. Once you have registered for a free membership, you can set up a profile listing the dietary restrictions of members of your family. Using the profile you build, the Sophie Safe Food Guide will search ingredient lists containing 16002 foods, and match your needs with items that you can find in the grocery store. Not sure if this will be helpful? Try it out...for FREE!

There's also a premium membership for $3/Month or $30/Year that offers a few more bells and whistles.

Top 50 Allergy Blogs. Guess Who's Number Five

What's the banner line under my title? "The latest news on avoiding dairy products if you are lactose intolerant, have milk allergies, are a vegan, or want to keep kosher."

I mean that. I don't concentrate on allergies specifically, but I try to provide as much information as I can gather specifically on dairy allergies and generally on food allergies that have info for those who want to avoid dairy.

That's why it was such a pleasant surprise to named one of the 50 Best Food Allergy Blogs by Nursing Schools.net.

Here's what they had to say, and the listing of their first five.

The following blogs, listed in no particular order, have lent their voices to the community at large as a means of shedding light on the undeniably challenging trials they must face. With deeply personal stories, recipes, research and commentary, they take to the web and find ways to quell the suffering of those for whom gluten/wheat, dairy, eggs, corn, soy, seafood, tree nuts, peanuts and much more may mean anything from short-term illness to death. Their perseverance, strength and sociopolitical efforts ought not go ignored or brushed aside.

However, please do not take the statements here as medical fact. What works in one patient may not necessarily prove worthwhile for another's needs. Nothing replaces expert consultation with a medical professional the blogs here merely provide support and suggestions.

1. The Food Allergy Queen

Kishari Sing loves food, even working as a caterer for a while. Unfortunately, she also suffers from a number of different allergies including rice, soy, tomatoes, garlic, wheat, tree nuts and much more. But she has applied her creativity and culinary experience to creating excellent recipes for others in her situation, and The Food Allergy Queen is essential reading because of it.

2. Food Allergy Assistant

Food Allergy Assistant provides detailed information on life with various food allergies, with plenty of resources available on support groups, coaches, recipes and more.

3. Please Don't Pass the Nuts

A social worker who both suffers from and works with food allergies keeps an absolutely essential blog about maneuvering through life saddled with such conditions. Anyone with any sort of food-related allergy or asthma needs to bookmark or subscribe immediately.

4. Allergy Moms

Parents of children with strict food allergies band together to exchange ideas, information and recipes to keep them as safe and healthy as possible. Be sure to check out the rest of the website as well!

5. Planet Lactose

Planet Lactose Publishing specializes in dairy-free, kosher and vegan cookbooks for anyone with staunch dietary restrictions. They keep a great blog to inform readers of their latest offerings.

If you're coming here from that blog and reading me for the first time, let me stress that I do much more than point you to the new cookbooks that you might want to check out. I list new dairy-free and lactose-free foods, report on clinical testing and new allergy symptom relief testing, correct mistakes made by overenthusiastic or overcredulous websites, and generally keep my eye open for anything and everything that you need to know.



I am an information provider. I don't review or do tastings or create recipes. Those other blogs on the list do a great job of that, I'm sure. My role is unique. I make sure that you get correct, up-to-date, factual treatments of critical issues. I'm not kind to those who don't live up to those standards. I've been writing about lactose intolerance and related issues for a quarter century, so I have a huge depth of experience to draw on.

I also have a website, Steve Carper's Lactose Intolerance Clearinghouse. I've pretty much stopped updating it since it was so much easier to post new information here in blog form. Even so, there are over 100 pages of information on it, and much of it is still as good as the day I started the site in the ancient era of 1997. Most of it's a lot newer, of course. You'll find many pages on books and dairy-free products there that can't be found in a single place elsewhere.

Want more? There's my gigantic book of earlier blog postings, revised and updated and sorted into convenient categories, at Planet Lactose Publishing.

And please stop back here again. I'll have something new and delightfully interesting for you to read.

Massachusetts to Require Food Allergy Warnings

People with food allergies don't want to feel different, don't want to be restricted in where they go or what they do. Yet common sense tells us that restaurants are potential sinkholes of allergens lurking not just in every food but in the utensils used to make the food, even the very air wafting around the kitchen.

What to do? Keep those with allergies out of restaurants? Nobody wants that. What about listing the complete ingredients of every food on a menu? Not practical unless you plan on replacing short, cheap printed menus with electronic books to cover the hundreds of pages of fine print necessary and be updatable every time an ingredient changed.

Massachusetts is planning on a middle course. A story by Stephen Smith in the Boston Globe revealed that the Massachusetts state Department of Public Health will vote in April on whether it should require restaurants and their workers to be better informed about allergies and respond when customers mention their allergies.

Although most peoples' immediate reaction might be, "of course they should," statewide regulations are notoriously bad for getting "shoulds" correct.

What will Massachusetts require?

Every menu in the state would be emblazoned with this admonition: "Before placing your order, please inform your server if a person in your party has a food allergy."

Oh. You'd never have thought of that on your own, I'm sure.

This one sounds a bit better.

thousands of restaurant workers would undergo training and then return to their kitchens, sharing lessons on how to prevent dishes from being contaminated with allergy-inducing ingredients.

Wow. Thousands of trained workers. Can't complain about that. Until you find out that Massachusetts has 17,000 restaurants that the regulations will cover. (None of them fast food restaurants, BTW. They would be exempt for the time being.) Those thousands amount to one per restaurant.

By next January, at least one worker from each restaurant would be expected to undergo training, which largely involves viewing a video Tsai helped create. It would be up to local boards of health, which are responsible for assuring that restaurants abide by food safety laws, to monitor whether establishments are complying.

It's not clear from the article what happens if that one trained employee leaves.

As for the rest of the staff, the regulations "would force restaurants to plaster a food allergy poster on the kitchen wall."

Wow, again.

A slightly more reassuring part of the article is this section:

Suzanne Condon, director of environmental health at the Department of Public Health, described how restaurant staff should respond when a customer reports an allergy to peanuts, for example. "The server is supposed to notify the staff involved with the preparation of the food that a member of the party has a food allergy," Condon said.

That not only means making sure there are no peanuts in the dish the diner has ordered. It also means being vigilant that the utensils and surfaces used in the preparation of that order have not been exposed to peanuts.

That's better, certainly, at least from our point of view as consumers. How feasible this is in a busy restaurant is harder to answer. In a world in which peanuts are forbidden from entire airplanes and school cafeterias because of the danger of accidental contamination, how can a restaurant that uses peanuts in dishes keep them totally separate from all foods?

The regulations introduced yesterday reflect the handiwork of the Massachusetts Restaurant Association and the Food Allergy & Anaphylaxis Network. The Legislature and Governor Deval Patrick broadly endorsed the concept last year by adopting the Food Allergy Awareness Act, leaving the specifics to the Department of Public Health.

Dr. Michael Pistiner of Leominster, who treats patients every day with food allergies, helped develop the regulations. Still, he said yesterday, diners who know they have reactions to certain ingredients must be their own best advocates.

"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."

Of course, and I would have ended this post with a similar homily. The nicest thing I can say about Massachusetts's plan is that it is a first step that might spark more awareness. It's not a solution in any sense. We have a very long way to go before allergens in restaurant food are properly addressed.

Halloween Allergy Anxiety

Which would be a bigger surprise to you? That 80% of mothers with allergic children "say Halloween causes a great deal of anxiety"? Or that 20% of mothers don't?

The survey, conducted by the MomCentral.com website, also found that 20% of moms get so hyper about the holiday that they are thinking about having their children give up trick-or-treating entirely.

Why? Probably because they are uncertain about how much they know and about what to do. As the survey found:

•61 percent of children have been prescribed an epinephrine auto-injector; however, only 23 percent of them carry it with them at all times.

•One in five moms is unsure how they feel about their school's emergency plans in place to deal with a severe allergic reaction.

•While many moms feel they have good information on food allergies, they also expressed a clear desire for more: 78 percent of survey respondents say they would benefit from additional information on food allergies and how best to prepare for and treat allergy-related medical emergencies.

I've mentioned before that children and teenagers tend not to carry their auto-injectors with them. This is one of those parenting challenges that no outsider can solve. Getting your kids to carry reminders that they are different is a constant battle.

By now you may be guessing that I'm quoting from a press release that is related to injectors. You are quite correct. This one is by the maker of EpiPens.

Unlike all too many press releases, fortunately, they tone down the hype and focus on helpful advice.

Tips for an Allergy-friendly Halloween

For parents of children with food allergies, monitoring Halloween candy is just one way to avoid an accidental allergic reaction. Stacy DeBroff from Mom Central offers additional tips for enjoying an allergy-free holiday:

•Find Allergy-Free Activities: With a little research, you can find many festive activities right in your own backyard. Take the family pumpkin picking, on a hayride or for a scavenger hunt.

•Bring the Fun to Your Child: Consider hosting your own costume party for your child's friends. Invite everyone over for pumpkin carving, bobbing for apples, spooky stories, a scavenger hunt and other Halloween-themed games. This way, your child can still have fun and you can control all the goodies that are being passed out.

For those children who do go trick-or-treating, the American Academy of Allergy, Asthma, and Immunology (AAAAI) offers these helpful tips:

•Never Go Alone: Always accompany younger children trick-or-treating and have older children go out with friends.

•Inform Others: Make sure all the adults and friends in your group know about your child's food allergies and what to do in an emergency.

•Pack Medication: While out for Halloween, make sure you or your child is carrying an epinephrine auto-injector. Make sure your child's friends or other adults know how to administer this medication.

•Provide Safe Snacks: Provide your close neighbors and even your child's teacher at school with safe treats or even non-food items like stickers that can be given to your child.

•Check the Goodies: Carefully read labels or check the candy company's Web site to make sure the product doesn't contain something that can cause an allergic reaction. It's important to remember that the ingredients of 'fun size' candy bars may differ from the regular-size bars.

•When in Doubt, Throw It Out: If you can't find information on a treat's ingredients or are simply not sure if it's safe, then throw the candy away or stick it in a treat jar that is out of the reach of the child.

•Avoid Snacking: Eating dinner before trick-or-treating might curb your child's urge to sneak goodies from the bag.

Gluten-Free Asian and European Travel Cards

Translation cards - cards with the words, phrases, and questions you need to know about food sensitivities in other languages - are a handy travel item. I've written about the SelectWisely firm before, in both Food Sensitivities Translation Cards and in Food and Travel Translation Cards.

They're back in the news with a new offering, as the title indicates, Gluten-Free Asian and European Travel Cards.



The inevitable press release tells us more.

The new gluten-free cards have been developed to help people with gluten intolerance improve communication when dining and purchasing meals. All of the cards feature English text describing what foods to avoid along with a picture of a stalk of wheat within the international prohibitory sign (red circle and slash). The European cards also have the English text translated into Spanish, French and Italian. The Asian cards have the English text translated into Chinese, Japanese and Thai. The card is laminated, simple to use and easy to carry, allowing travelers to keep them in their pocket or wallet to use when they are ordering meals at restaurants.
... All cards have English text, a picture and multiple language text allowing restaurant wait staff and kitchen staff who speak different languages to understand.

About the allergy and medical translation cards:
22 types of cards are currently available in the following categories:

Food Allergies
Gluten-free/Celiac Disease
Diabetes Emergency and Pharmacy
Asthma Emergency
Lactose Intolerance
Penicillin Allergy
Smoke-Free
Low-salt Diet
Vegetarian and Vegan
General Emergency
Special Orders

15 common languages are available (English, French, Spanish, German, Italian, Chinese, Japanese, Thai, etc), plus an additional 40 languages through our Special Order program. The Special Order program provides translations for unique food allergies and medical conditions in less common languages (Catalan, Vietnamese, Khmer, Croatian, Czech, Laotian and more).

Over 130 common food allergens are available including nuts, peanuts, wheat, milk, shellfish, soy, sesame and others. Additional non-food allergens are available for translation including latex, sulfites, MSG, bee stings and penicillin.

8 Holiday Allergy Tips

For someone who grew up in the 1950s there's an illicit thrill in digesting the Reader's Digest. No, not that kind of digesting. Well, the same root word. Making smaller. Like lactase digests lactose by cutting it in half, into glucose and galactose.

Anyway, the good gray RD, now in color, presented 8 Fall Holiday Tips for Those with Food Allergies, abstracted from a probably longer piece put out by The American College of Allergy, Asthma and Immunology (ACAAI).

So here, slightly shortened even further, are tonight's Top Eight:

1. Tricks and treats: Purchase treats that your child can enjoy safely, and swap them for treats with allergens after trick-or-treating. Send candy your child can consume to school parties or send non-food goodies such as Halloween stickers.

2. Be the class baker ... to ensure there will be foods available your child can enjoy.

3. Inform your guests: Let guests know that you or your child have dietary restrictions, and offer to let them bring holiday themed plates, cups or napkins, rather than food.

4. Give your host a heads-up: If you'll be attending holiday festivities away from home, let your host know about your food allergy. Offer to bring safe foods for you and others to enjoy.

5. Don't overlook the turkey: Basted or self-basting turkeys can include common allergens such as soy, wheat and dairy. [A] turkey labeled "natural," ... should contain nothing but turkey and, perhaps, water.

6. Hang on to food labels: ... Keep the ingredient labels from the food you are serving for allergic guests to review before digging in.

7. Carry medications: Always have emergency medications on hand just in case.

8. Discuss strategies with your allergist: ... Your allergist also can help you and your child become "label detectives" so you both know what ingredients to watch out for.

For more information about allergies and asthma, and to find an allergist near you visit www.AllergyAndAsthmaRelief.org.

Science Doesn't Know. And That's a Good Thing.

A major review study was just published in the Journal of Paediatrics and Child Health, Management of cow's milk protein allergy in infants and young children: An expert panel perspective by Katrina J. Allen et al.

ABSTRACT
Cow's milk protein allergy is a condition commonly managed by general practitioners and paediatricians. The diagnosis is usually made in the first 12 months of life. Management of immediate allergic reactions and anaphylaxis includes the prevention of accidental food ingestion and provision of an adrenaline autoinjector, if appropriate. By contrast, the clinical course of delayed food-allergic manifestations is characterised by chronicity, and is often associated with nutritional or behavioural sequelae. Correct diagnosis of these non-IgE-mediated conditions may be delayed due to a lack of reliable diagnostic markers. This review aims to guide clinicians in the: (i) diagnostic evaluation (skin prick testing or measurement of food-specific serum IgE levels; indications for diagnostic challenges for suspected IgE- and non-IgE-mediated food allergy), (ii) dietary treatment, (iii) assessment of response to treatment, (iv) differential diagnosis and further diagnostic work-up in non-responders, (v) follow-up assessment of tolerance development and (vi) recommendations for further referral.

In short, while true food allergies, those mediates by the IgE antibody, can be relatively easily identified by testing and managed by removing the offending food, a different and assorted set of reactions that use pathways in the body other than IgE are much harder to pin down. The symptoms come late and are hard to match up with particular foods, the tests are uncertain, removal of the food doesn't always give immediate relief.

An article on the study by Michael Woodhead also says that "is still controversy about the role of cow’s milk in infant colic and constipation."

This is part of the reality of scientific medicine. Cause and effect are hard to put together. What happens in one person is not a reliable guide to what happens in another. Large numbers of reactions are needed to put together correlations, and even when that is accomplished the problem of what is occurring in a specific individual may still not be resolvable.

Understandably, most people don't want to hear this. They want certainty. They want a doctor to tell them what is wrong and how to fix it. This anxiety multiplies when children are the ones with conditions, children who cannot properly describe their symptoms and lack any understanding about their bodies.

Often, these parents go nuts.

Like parents of autistic children. They are the current poster children, to use an unfortunate but apt metaphor, for not getting it. I wrote last month about a new study of autistic children that found that they didn't have more gastroenterological problems then other children.

I didn't begin to suggest that this study settled the issue. On the contrary, I wrote:

This is just another medical point against the need for the [GFCF] diet. Medicine is like that. One single study is not enough. Like a jigsaw puzzle, it's the cumulative picture painted by many pieces, many studies that reveals the direction medicine moves in. That picture is not yet complete.

Like every medical study of food and disease, this study had its flaws. I said every and I meant every. No study is ever large enough, representative enough, thorough enough, detailed enough. That's why a consensus must be formed from a sufficient number of studies to patch over all those holes to make a smooth road toward an answer.

Anne Dachel at Age of Autism doesn't appear to understand this. In an article Autism Experts Only Seem to Know "What Doesn't Work" she lambastes the insufficiencies of the study and the media reports that cited it.

Suddenly however, thanks to one small study in the U.S., we can forget about all this research. Rather than conclude that these new findings challenge many previous studies and more research is needed on this important issue, it seems that, in the word of Nancy Snyderman, "the findings are very conclusive."

I did find an article that mentioned the limitations of the Mayo Clinic study. In the Medpage Today story, Most GI Problems Are Not More Common in Autism (HERE), it was reported, "The study authors acknowledged some limitations of the study, including the retrospective design, use of an almost all-white population, and the failure to assess the duration, severity, and recurrence of GI symptoms."

A couple of points must be made. First and most important, new studies are found to contradict older studies all the time. That's the point of continuing the do studies. If any one study isn't sufficient and complete, more studies need to be done. And often - very, very often - the new studies show the older ones to be wrong. Your personal emotional investment in the older studies is not considered.

Second, this one new study does not end the discussion, despite what Dachel implies. Research is ongoing. Not only will other studies compare gastrointestinal problems among other groups of children, but long-term studies are taking place at this moment that will more directly look at the effectiveness of the GFCF diet.

Was this study a significant one, for all its flaws? Apparently so. Several doctors involved used it and a second study released at the same time in England to state categorically that no evidence existed that the food cures that these parents tout so heavily truly improves autistic children.

Dr. Nancy Snyderman: "The findings are very conclusive: There is no link between illness in the gut and the signs and symptoms we see in autism."

Dr. Samar H. Ibrahim: "There is actually no trial that has proven so far that a gluten-free and casein-free diet improves autism."

Dr. Alan Edmonds: "The bowel habits of young children with autistic spectrum disorder, in general, are no different from the rest of population."

Yet Dachel concludes her piece with an unthinking attack on the medical community:

There are thousands of parents who report that their kids were typical healthy children until they regressed into autism and developed gastrointestinal problems. Why wasn't there a study done looking at this particular group?

And why isn't anyone interested in looking at the kids who were severely autistic but who've make incredible gains after being on a regimen of diet and supplements?

And what about all those doctors everywhere treating autistic kids for their concomitant bowel disease? Are we to believe that they're seeing these patients for imaginary illnesses?

Thousands of anecdotal reports are not evidence. Concerned parents do not treat their children like animals in controlled laboratory conditions. They do everything in their power to help them to improve. How can they say the diet was the specific activity that helped? What about the supplements? What about the care and attention they were given? What about mere aging and development? On the flip side, what bowel disease did they have? Did the group really have an unusually high number? Were their other contributing factors? What happened in their lives, their environments, their genetics?

The best studies can barely touch on these issues because it is impossible to slice a human life into neat and non-intersecting causes. Individual cases are meaningful only to the individual. Groups often tell different stories, results that are not as certain or as favorable as the one the parent tells.

And yet, a dozen negatives may all prove to be wrong if a better positive result appears. Possibly the big studies that are awaiting completion will confirm Dasher's opinions and suspicions. Progress is certainly slower than she hopes and I emphasize with her frustration. (Remember that no studies at all on lactose intolerance are ongoing that would help explain the dozens of questions about life without lactase we still have no answers to.) I will be disappointed if those studies remain negative and her attitude does not change. At some point railing against all conventional medicine puts you in with the cranks and that route is hopeless.

The proper answer to many questions is medicine is "we don't know." Despite all the advances, the insights into genetics, the new ways to look into the body, the more delicate and sensitive tests, we still just don't know so very much. Pretending that an answer is already available but remains unseen by the legions of experts dedicating large chunks of time and effort to the problem is disheartening and dangerous. Human, though. Sad, but human.

Food Allergy? It May Be in the Air You Breath

As astounding number of different foods cause allergic reactions in at least some people, foods that seem to have little in common. Not only that but food allergies are often strangely specific and regional in nature. The deadliest allergies are not necessarily the commonest allergies and the percentage of people who react to allergens also varies. People often don't know if they have an actual allergy, but their suspicions run rampant: self-reported allergic reactions may be 30 times higher than reactions found by testing.

Time to bring in the science. Probably the biggest group looking at the mysteries of allergies is EuroPrevall:

EuroPrevall is an EU-funded multidisciplinary integrated project (IP) involving 17 European member-states, Switzerland, Iceland, and Ghana. Of the 63 partners, there are 15 clinical organisations and six small-medium sized enterprises (SMEs) as well as the leading allergy research organisations in Europe. Since the project began new partners have also joined from New Zealand, Australia, Russia, India and China.

The website isn't a thing a beauty. I've run in circles trying to find a supposedly downloadable brochure, with no luck.

With luck, the researchers can find their way around the scientific side more easily. One major approach EuroPrevall has taken is to study the regional differences in allergies, hoping to find clues to the way they occur. Andrew Watson wrote about one major and fascinating result in this week's New Scientist magazine, Food allergies get curiouser and curiouser.

Southern Europeans, in countries bordering on the Mediterranean, react to apple peels, cooked or uncooked, including the remains in processed apple juice. Those north of a sharp line running across the bottom of France, mid Italy, and northern Greece only react to the uncooked flesh. After age three, apple allergy is one of the commonest complaints of those visiting clinics.

What sense could this possibly make? That's where the comparative studies prove their worth. That sharp line marks the southernmost limit of areas where birch trees grow. Birth tree pollen is a common cause of hay fever. That line is also the northern boundary of a line of peach allergies.

When the scientists look at the individual proteins they find two allergens in apples: Mal d 1 in the flesh and Mal d 3 in the skin.

Here's the connection. The protein Mal d 1 is similar to the birch pollen allergen Bet v 1. The peach protein Pru 3 p is similar to Mal d 3. People get sensitized by one kind of pollen, priming the immune system. When they eat the similar protein in another food the immune system reacts.

The direction of the connection can also be explained. People breathe in birch pollen, sending the pollen directly into the bloodstream. This bypasses the digestive tract so it doesn't get broken down and denatured. But a later bite of the apple triggers a reaction as soon as the protein makes contact with the mouth.

In more formal terms:

Significantly, this line marks the southern limit of the birch tree, a plant whose pollen is one of the causes of hay fever in northern Europe. Clues for this link lie in the different proteins found in various parts of the fruit: the flesh harbours an allergenic protein called Mal d 1, while the skin is relatively rich in Mal d 3. The structure and composition of the Mal d 1 protein strongly resembles the allergenic protein Bet v 1 found in birch pollen. This means that people who suffer from birch pollen allergy may be primed to overreact to Mal d 1 - explaining the prevalence of the allergy to apple flesh in this region.

A similar cross-reaction explains the allergy to apple skin found in southern Europe. In this case, a prior sensitisation to the Pru p 3 protein in peaches, which bears a strong similarity to Mal d 3, seems to be the culprit. What's more, Mal d 1 breaks down when heated while Mal d 3 is heat resistant, which neatly explains why northern Europeans are fine with cooked apples and pasteurised apple juice but apple-allergic people in the south cannot cope with these fruit in any form...

These numerous examples of cross-reactions raise another question: why does Bet v 1 cause an allergy to the Mal d 1 protein but not the other way around? Researchers believe it's because Bet v 1 enters the body via the lungs, so it is not broken down by digestion and can reach the bloodstream intact, where it activates the immune system. Mal d 1, on the other hand, is broken down during digestion, so it loses its capacity to prime the immune system. Once the immune system has been stimulated by the Bet v 1, it may then become sensitive to similar looking proteins like Mal d 1 - sensitive enough to trigger a reaction when it comes into contact with the mouth.

The EuroPrevall teams are finding additional examples of this cross-sensitization:

a link between house-dust-mite faeces and shrimp allergy, and another between mugwort pollen and an allergy to carrots, celery and sunflower seeds ... This also explains why some migrants from east Asia to northern Europe suddenly develop an allergic reaction to jackfruit once they have come into contact with birch pollen. The allergen in jackfruit does not on its own sensitize the immune system, but once birch pollen has done the job, the immune system may react to jackfruit too.

With pre-primed individuals suddenly coming into contact with foods they might not other have eaten - sunflower seeds, like soybeans, are used extensively in the food industry - allergies may start erupting where never before seen.

As always, knowing a possible underlying feature of a problem gives hints at a solution but doesn't provide any ready answers. Taking some of the mysteries out of allergies still is a welcome first step.

Donate Food Allergy Books to School Libraries

We've all had one of those "why didn't I think of that?" moments. I had another just now, reading the news.

The article was FAST group donates food-allergy related books to libraries from Nashoba Publishing, a group of small newspapers in suburban Boston.

The article, really a reprinted press release, said that:

The Groton-Dunstable Food Allergy Support Team (FAST) recently presented 50 books dealing with food allergy awareness to the school district's libraries.

FAST is a group dedicated to providing information and support to families coping with allergies, promoting allergy awareness in our school community, and working with the Groton-Dunstable Regional School District to ensure a safe environment for children with allergies.

One goal for FAST this year was to increase the awareness of food allergies and their severity at all grade levels of our school district by providing educational materials. FAST believes all children, as well as teachers and school personnel, can benefit from these books, not just those with allergies.

"We constantly see students without allergies supporting their friends who do have allergies," noted FAST Co-Chair Lisa Chau. "Through educational materials, these students can gain an understanding and appreciation of this serious health concern, and provide peer support to their friends with allergies."

FAST worked with the school district to select age-appropriate books for all levels, from preschool through high school. These books will be available to students when they return to school in September. FAST was able to provide these books through generous grant funding from the Groton- Dunstable Education Foundation, Inc.

What a great idea. Any of the dozens of support groups around the country could copy this. It's easy, inexpensive, and effective.

Thanks for making my day, Groton-Dunstable FAST.

Food Allergy Tests Can Be Unreliable

There are two major types of food allergy tests. A blood test checks to see whether or not you have a particular antibody called IgE. Skin prick tests reveal reactions to the potential allergen.

Both are good in certain ways. Both also have major problems that people must understand.

Emily Sohn gave some basics in the Los Angeles Times.

IgE tests are very good at confirming the lack of an allergy -- but only when the antibody is just plain missing. In many cases, for reasons scientists don't understand, just about everybody has antibodies to foods they don't react to. ...

These skin tests are fairly reliable when they're negative. Positive reactions to foods, on the other hand, are wrong up to 50% of the time.

Someone with a milk allergy might develop bumps from beef and pork pricks, and someone with an egg allergy might react to chicken and turkey pricks, simply because the proteins in those food groups are similar enough, or because a person has sensitive skin.

Allergy tests also have the same underlying problem that plagues testing for lactose intolerance. Even when the test predicts the allergy properly, it can't predict the severity of the reaction.

Food and Travel Translation Cards

One of the first posts I ever made on Planet Lactose was on the extremely apropos Food Sensitivities Translation Cards services that, as the title suggested, manufactured little cards people could carry in their wallets, pockets, or purses with the phrases they vitally needed translated into the language of the country they visited.

Both firms are still in business. The British firm, DietaryCard.com offers:

4 types of Dietary Alert Card:-

For celiacs and other diners following a gluten-free diet, we offer Classic Coeliac Cards.

For diners coping with a nut allergy or another medical condition necessitating a strict nut-free diet, we offer No Nuts Cards.

For diners with food sensitivities requiring help choosing from menus we offer Custom Card 1.

For diners with severe food allergies requiring help choosing from menus we offer Custom Card 2.

And the American firm, SelectWisely.com, got itself a spiffy write-up by Jen Leo in the Los Angeles Times.

Do your allergies (or your child's) make it challenging for you to travel abroad? Selectwisely.com helps liberate travelers who have food allergies and other health concerns.

What's hot: If you are a traveler who has a food allergy, you can order a translation card that lets restaurant servers and store clerks -- really, anyone who has a hand in serving you food -- know that there's an issue. The site offers cards in more than 25 languages. Its example of what it calls a "strongly worded" card shows variations of "I have a life-threatening allergy to shrimp" in the foreign language (Thai, in the example) and English with a visual aid on one side of the card. If you are allergic to nuts, that specific card will list a variety of nuts. There are also emergency cards for those who cannot eat gluten, who have diabetes or asthma, are lactose intolerant or are vegetarian. Prices for the cards vary from $6.50 to $9.50 (plus shipping), and you get two identical cards sent within one to three business days.

Nice to see businesses to cater to special foods need succeeding and staying available for years on end.

Reason 12,765,876,761 to Avoid Chiropractors

I know some of you out there believe in chiropractic medicine. I have friends who swear that a chiropractor has helped relieve their pain. It's high on the list of alternative medicines.

It's nuttier than a gluten-free non-dairy fruitcake.

Take this article by Stephanie Sandoval, who does the Your Health column for ABC15 News in Phoenix. Sandoval of course has no health credentials of any kind.

She interviewed Dr. Tony Rodriguez of the Infinite Healing Center, someone who insists that chiropractic "adjustments" can help with digestive diseases and allergies.

Digestion problems
In the case of digestive disorders such as acid reflux, stomach ulcers and constipation there can be a direct link to a spinal problem as the cause.

Dr. Rodriguez says in the mid back the 5th thoracic vertebra relays information to the stomach.

Adjusting a fixed or subluxated vertebra in this area can directly improve symptoms.

Additionally, the 1st lumbar vertebra connects to the large intestine, which if irritated can create diarrhea or constipation.

A second and just as important cause of digestive problems is reaction to irritants and foods.

This inflammation of the gut can lead to a whole host of problems stemming from poor gut function.

Improper digestion and absorption of food can lead to bacterial overgrowth and an inability for the gut lining to keep out bad guys.

A chiropractor can order tests that can point out irritants in foods and bacterial imbalance that may be a part of the problem.

Allergies
Allergies are estimated to affect 30 million Americans. An allergic response is an over protective response from the immune system to an allergen: pollen, dust, milk, dog or cat dander.

For most, these allergens don't create a negative response. But, for many of those that do suffer from allergies, the reaction may not directly be related to the offending allergen.

Dr. Rodriguez says in the spine, the 3rd cervical vertebra directly correlates with the sinuses.

Relieving pressure in the neck can help clear sinuses and reduce allergy symptoms. He adds, food is one of the most common types of allergies.

The guts inability to filter can create fatigue, congestion and outright allergic reactions.

This is not medicine. This is not science. Nothing in medical literature supports this.

What it is is quackery. Gibberish. Moonshine.

Alternative medicine? The alternative to medicine is crackpottery. Don't go there.

UK Also Marks National Allergy Week

The U.S. has a national Food Allergy Awareness Week.

Nadine Stewart of Lactofree wrote me to tell me that the U.K. has a similar National Allergy Week, starting today.

She also sent me a press release which, like most press releases, was mostly a commercial for the company. Part of it had some objective information, and that part I'm happy to share. For the commercial, just click on the link and go to the Lactofree site.

So what is lactose intolerance? It is thought to affect up to 15 per cent of the population and is the body’s inability to produce enough of the enzyme lactase in the digestive tract. Without it, lactose (the natural sugar in milk and other dairy products) cannot be digested properly, so suffers can feel bloated or experience vomiting and stomach pains after consuming milk or milk-based products.

However, because these symptoms are not limited to lactose intolerance the condition is often misdiagnosed as irritable bowel syndrome (IBS). Furthermore, some people who experience symptoms of lactose intolerance cut out dairy entirely, believing they are dairy intolerant, without realising that lactose is present in other products.

What’s the difference between lactose intolerance and milk allergy?

Milk protein allergy is when the immune system overreacts to one or more of the proteins found in milk. Milk allergy can be severe and in some cases can cause an extreme and severe reaction know as anaphylaxis (the whole body is affected, often within minutes of exposure to the allergen). When someone has an allergy to milk they can experience symptoms in addition to digestive discomfort, such as skin rashes, eczema, nasal congestions and coughing and the swelling of the lips, mouth and tongue.

In the past these were sometimes called ‘milk intolerances’, but an intolerance doesn’t involve the immune system so it is important to distinguish between them. While lactose intolerance can cause a great deal of discomfort, it won’t usually produce a sudden or dangerous reaction.

12th Annual Food Allergy Awareness Week Starts Today

This year's Food Allergy Awareness Week (FAAW) runs from May 10 through May 16. The theme is "Take Action, Prevent Reactions."

FAAW is organized by FAAN, the Food Awareness & Anaphylaxis Network.

The site suggests:

Mark the week by increasing awareness at schools, talking to your elected representatives, or planning a fundraiser. You can hand out fliers, put up posters, or display educational materials. Download materials to get involved!

Our goal for 2009 is to receive proclamations from all 50 states. We already have proclamations from: Alabama, Connecticut, Georgia, Illinois, Maine, Nebraska, Nevada, New Jersey, North Dakota, Pennsylvania, South Dakota, Texas, Virginia, and Wisconsin.

Food Allergy Treatments Enter Testing Phase

"All other allergies have lots of treatments," says Anne Munoz-Furlong, founder of the Food Allergy & Anaphylaxis Network. "With food allergy, we have nothing: Avoid the food, take epinephrine (adrenaline shots to counteract anaphylaxis, a deadly reaction) and get to the hospital."

It's a little too early to run to your doctor, but a variety of treatments for food allergies - at least for the very young children who are first developing allergies - are in the testing phase, according to an article by Rita Rubin in USA Today.

Early results in tests on humans look promising for three experimental treatments:

•Oral immunotherapy. Under close supervision by health care professionals, patients swallow tiny but gradually increasing amounts of the foods that trigger their allergies, with the idea of building immunity. This method is being tested for peanut, egg and milk allergies.

•Sublingual therapy. Drops containing proteins that trigger allergies are put under the tongue, where they are absorbed into the bloodstream. This method is being tested for various food allergies.

•Food allergy herbal formula-2. Known as FAHF-2, this pill (not available in stores) is based on a 2,000-year-old Chinese remedy. It contains nine botanicals, including ginseng and oil made from cinnamon tree bark. It is being tested for peanut, tree nut, fish and shellfish allergies.

Building tolerance can take a year or more, and parents with children in the studies must drive them to a research center every other week. For a few, the round trip is hundreds of miles — a small price, in parents' eyes.

"This is the first time that we have a number of studies going on at the same time," Munoz-Furlong says. "This is huge for the food allergy community. We finally can say that probably in 10 years, the landscape will look very different than it does now."

Kids with Food Allergies Celebrates Passover and More

The organization, Kids with Food Allergies is a major resource for parents. You can find large amounts of information on their website, including a convenient page that summarizes US FDA and USDA food allergy recall alerts. (You can also subscribe to get the recall info sent to you.)

Another free resource is a 24-page .pdf titled Passover: Celebrate with Food Allergies and Have Fun, Too!.

Other resources are reserved for parents.

More than 14,000 parents have joined Kids With Food Allergies, a nationwide nonprofit organization offering online food allergy support groups for families raising children with food allergies.

The Value of a Family Membership: Parents love our online food allergy support group, information, news and allergy-free recipes. We invite you to become a KFA Family Member and gain the special privilege of full access to our services:

± Support forums for Parents of Food Allergic Kids

Online support groups connect you with other food allergy families nationwide. Our peer-to-peer support will help you adapt to the food allergy lifestyle. Do you have questions about school allergy plans? How to use food allergy recipes? How to breastfeed with food allergies?

± Our growing Safe Eats ™ food allergy recipes database
Search our database for hundreds of recipes free of milk, egg, soy, wheat, peanut, tree nut, sesame and other common allergens. Receive cooking support and recipe help in dedicated Food & Cooking forums.

± Food allergy articles, FAQs, publications, and other resources