I just came across an article from an recent Sunday Telegraph headlined ‘Food fight over allergy ban’ which investigated, once again, the extremely knotty problem of whether or not you should allow allergens into a household with an allergic member. There are in fact, two questions:
1. Does excluding a food or group of foods from the diet, especially of babies and very small children, make it more or less likely that they will react to those foods when they do encounter them?
2. If a person, especially a child, has a food allergy or a serious food-related condition such as coeliac disease, should they (or their parents) try to exclude that food entirely from their environment, if necessary making all other members of the family go gluten or nut free, in order to achieve this?
As far as the first question goes, with reference to babies, the jury is still firmly out and looks unlikely to reach any verdict in the near future. So, should pregnant women from atopic families avoid peanuts? There is no clear answer and although a number of trials are ongoing to attempt to find one.
In adults the suggestion that avoiding a food can sensitise you to it and therefore you will develop an intolerance to it when you meet it (as suggested by one dietitian in the Sunday Telegraph article) seems weird – especially since it is very unlikely that by the time you have reached adulthood there are many foods with which you would not have come into contact and therefore have been sensitised to.
What is maybe more likely is that, if you are sensitive to a certain food or have problems in digesting it, when you remove it from you diet, you will become super-sensitive to it for a period of three months to a year (depending on the individual) until your general digestive and overall health, and therefore tolerance, improves – after which you will probably be able to cope with that foodstuff again.
The much trickier question is to what extent an allergen (or gluten in the case of a coeliac) should be excluded from the environment of the affected person. And although there have to be guidelines for public places (such as schools), within the home this really has to be a matter of individual family choice, entirely dependent on circumstances and the personalities of both the person with the allergy and other family members.
That said, especially these days when the range of really acceptable ‘freefrom’ foods is growing ever wider, there are very few foods the exclusion of which would have a seriously deleterious effect on a family’s health. Despite the propoganda from the Milk Marketing Board, there are plenty of excellent sources of calcium apart from dairy products (pulses, green leafy vegetables, fish with bones etc etc); gluten is a glue used by the food industry to create a vast range of processed foods without which our diets would be a great deal healthier; nuts are highly nutritious (and delicious) but there are many other sources of equally good nutrition. However, it does still remain true (although hopefully this will become less the case fairly soon) that many of the alternative ‘freefrom’ foods are significantly more expensive.
However, the point is less the cost than the principle. If you have a very allergic child or one who is very badly coeliac, the stress of ensuring that they remain safe from their allergen if it is around in the house may take a terrible psychological toll on both the family and the child. If the childs belongs to a relatively relaxed family, has an easy going personality and is secure in the knowledge that they can always use an Epipen or other effective medication to deal with a reaction, the existence of the allergen in the house may not cause anyone much stress. But if the child is anxious or a worrier they can easily become paranoid and if they are to cope with the dangers of life in an allergen filled world, it may be better for them to be able to rely at least on an island of allergen-free security in their home. (See this report from FAAN about a severely allergic child who suffered from major anxiety about his condition.)
In nutritional terms, feeding the whole family on nut, gluten or dairy-free diets need not be an issue, but siblings (and even occasionally one or other parent) may have issues with restricted diets that have nothing to do with nutrition. So you need to be sure that you have everyone very firmly ‘on board’ before you dramatically restrict their diets (and their ability to have friends home to socialise etc) for the sake of one family member. (See this post about ‘hugging your non-allergic child’.)
In practical terms also, it is impossible to ever 100% guarantee that any environment will be absolutely 100% allergen free and even if you can get close to that within the home, once you get outside, it is completely impossible. So some allergy specialists feel that it is better for an allergic person, adult or child, to learn to cope within that allergic world rather than trying to create an allergen-free one for themselves. This is the argument used against banning peanuts, for example, from schools. It is better for the child to learn to take appropriate avoidance and protection measures in school which they can then apply wherever they are rather than creating a false sense of security by making the school peanut free – an almost impossible task in practical terms anyhow.
This argument apart, why should 95% of pupils be prevented eating a perfectly healthy, and indeed nutritious, food such as peanuts for the sake of 5% who can’t eat them? Should we not be educating the 95% to understand about the allergy of the 5% and to treat their allergic friends with care and respect? Well, yes, of course we should but, in an imperfect world this does not always to happen and, sadly, food allergy bullying is still, and is likely to remain, regrettably common. See this recent report from the University of Leicester.
I remember, some years ago, reading a report of a meeting of Tourette’s sufferers. (For those who don’t know, Tourette’s Syndrome is the condition in which, while you are 100% mentally and psychologically normal, you constantly shout out and make sudden and violent physical movements that you cannot control.) The comment of one attendee was that it was so relaxing, for once in his life, not to have to worry about what he was shouting out and likely to hit, because everyone else was doing it too. For a serious allergy sufferer there may be a similarity. You lead your life in a world in which you have always and constantly to be on your guard; maybe you need one place, even just one room, where you know that there are absolutely no allergy dangers and where you can go, just now and then, to relax.
But as ever, it comes down to the individual – how serious their allergy, how competent they feel to deal with it, their own personality traits, the support they get from friends and family.
Meanwhile, I remain constantly in awe of how those with serious allergies do cope and manage to live relatively normal lives – like Ruth Holroyd who writes the excellent What Allergy? blog and who has written several articles for us including drawing up an invaluable Allergy Action Plan. Despite being anaphylactic to milk and nuts and intolerant of a load of other foods Ruth continues to get out and about, was a guest at last year’s FreeFrom Food Awards party and is carving herself a good career, within the limitations of where and how she can work, as a writer.
I think you’ve totally captured the difficulty with this issue. As an adult who has had food allergies since she was a child, things were quite different 25 years ago. I don’t think my parents ever thought about eliminating all my allergens from the house. The thought just didn’t occur to them and there was far less information available about food allergies. So, we had to make our own rules. I got special pans and dish cloths. I never used anything that hadn’t gone through the dishwasher first. If they cooked something I was severely allergic to, like nuts or eggs, I would stay out of the kitchen until they’d cleaned up. I’ve gone on to live with various roommates, none with allergies, and I’ve always kept the same practices. Happily, I’ve never had a cross-contamination issue at home. However, as you’ve pointed out, anxiety can play a role; so, while it worked for me, it won’t work for everyone. The key is, as you’ve suggested, for every family to evaluate the situation and choose what works best for them. That may include complete avoidance.
Thanks for your wonderfully common sense comment.
I do think that paranoia can be a genuine concern in terms of managing allergies – although I absolutely accept that living with a potentially fatal condition such as a serious food allergy, especially if it is in a young child, is an incredibly scary position to be in. But one must bear in mind both that, given the number of serious allergy sufferers, the number of fatalities remains tiny and, even more important, the vast majority of those fatalities occur when an Epipen/epinephrine has not been carried, has not been used or has been used incorrectly. So if you always carry and, and use, your emergency medication, your risk of a fatal episode plummets to a very tiny risk.
For more on both of these read the article Ruth Holroyd wrote for us and that I mentioned in he original blog.
This is a very interesting subject and one I am asked about a great deal. In our household it’s just me with an allergy and I’m a grown up (sometimes I do wonder) so I do ban nuts. All nuts. Nuts are not allowed across this threshhold. Even the smell of nuts makes me nervous.
However, when I was growing up my parents didn’t ban allergens from the household. As Atopicgirl above says, it just wouldn’t have occured to them. However they and my brother and sister were very careful when they ate nuts. One of my first earliest attacks happened when a bowl of nuts was finished and refilled with crisps. I dived in on the crisps, but of course there was peanut residue in the bowl and I was very ill. We learnt from our mistakes. Who would think that tiny traces of nuts like that could cause such a violent reaction? Nuts weren’t a big part of my mums cooking pattern anyway, in fact she never cooked with them, however my dad and brother had peanut butter and did enjoy nuts. I just kept well away. Our doctor didn’t really know what was happening to me, his advice was just for me to not eat nuts! So we just all muddled along with too many mishaps once we all realised the severity of my reactions.
There was no such thing as an epipen back then. The first adrenalin I was prescribed was a phial and separate needle injector. I was expected to break the seal, with the needle and draw up the adrenalin and then administer. I never used it. My poor mother spent many nights at my bedside waking me every half hour to check I was still alive. It is scarey to think of that now but there just wasn’t the knowledge and information then. Thankfully I’m still here to tell the tale.
However the dairy issue is an interesting one. I don’t feel it’s healthy to insist that my husband should cut out dairy too. If you don’t need to cut it out milk, cheese and yogurt can be very good for you. It’s not healthy to cut foods out unless you have to, but you can live without nuts easily.
Now, at home, I make my cup of tea or coffee, move it away to another surface, and then make his with normal dairy cow’s milk. All milk must be mopped up and cloth cleaned immediatlely. Cheese is kept in a sealed airtight container. My allergy is not so severe that I cannot be near others eating dairy containing meals so this works OK.
The other things which are milder allergies just mean we have to make two meals. One for the tomato loving husband and one for me with special gravy to create an almost comparable sauce. I can’t actually stand the taste of the things I’m allergic to so that’s fine with me.
The intolerances I do crave. I crave warm bread and fried eggs. And if I’m really good and have avoided them for a while I can enjoy them, with a digestive enzyme or two, as a special treat. Eggs cooked in a cake however for me are fine.
The world will never be allergen free so is it unrealistic to insist the world around your child should be? Children will grow and up and have to cope with life avoiding their allergens but I can see why people want to create their home as a safe haven, the one place their child is completely safe and free to relax, express themselves etc. But is that the best thing for other siblings who may not have allergies? I suppose they can have allergen loaded treats when they are outside the house.
I am sure if my parents had known that this mystery illness, which my mother eventually worked out was to nuts after I accidentally ate a peanut butter sandwich, could have killed me they might have been more vigilant and banned these foods, but they didn’t know. I’m quite glad I didn’t know actually. Growing up with that fear would have been horrible. It’s bad enough knowing now how careful I need to be.
For a while I did step back, I stopped going out, I was scared to eat at friends, or go out for a meal, even my family were guilty of not quite getting it. But that was partly my fault. I was so embarrased about speaking about it I suffered in silence. But that’s no life. It’s a half life, one that left me depressed and unhappy. I had to be honest with people. Tell them how it was. Explain my allergies to them and most people are incredibly supportive and helpful.
So I had to be brave and get out there. And if I don’t truly trust a restaurant I won’t eat there. I won’t starve to death. So the worst case scenario is that I go hungry till I can find something safe to eat. One can usually find some fruit or plain crisps in most places.
With regards to the worsening in reactions after cutting out foods. That has happened to me. Foods that used to give me eczema, a mild allergy, now cause very severe allergic reactions. My allergy specialist says they see this more and more in people who manage to cut out a food they are sensitive to too well, the body them remembers the allergen if accidentally that allergen is consumed and the subsequent reaction may be far worse, and worsen with each exposure.
Gosh, where did that all come from? A very complicated issue though. Thanks for raising.