Posts Tagged ‘Anaphylaxis’

Food Production and the Problems of Eating Out for Nut Allergy Sufferers

Below is an article I wrote for Hwyl, the Arts supplement of the postgraduate newspaper The Cardiffian, which is associated with Cardiff University. It is about the problems of eating out for nut allergy sufferers and the considerations chefs must have when preparing meals in a kitchen environment with regard to allergens.

It features comments from Cardiff-based chef Dewi Reed and the Anaphylaxis Campaign, about this food production process.

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Nut allergies are fascinating and frightening medical conditions, which present sufferers with more problems when eating out than you might think.

Each allergy is unique to an individual and can vary in form and severity, producing contrasting allergic reactions from one person to another. The same person can have varying degrees of tolerance to different types of nut, so they may not be allergic to peanuts but extremely allergic to walnuts, for example.

To confuse matters further,some people’s allergies are so severe they can have a reaction by touching a surface which previously had nuts on it. This indirect reaction from nut particles makes food preparation and kitchen management vital to keep nut allergy sufferers safe when they eat out.

Deri Reed, the Cardiff-based Ethical Chef who specialises in vegetarian cuisine, is renowned for using fresh ingredients to create locally-sourced Welsh recipes, and commented on allergens.

63 Layers Damascus Steel

Deri Reed: Chefs must be careful in the food preparation process [image courtesy of Jarod Carruthers]

He said: “As a chef you need to make sure all your staff are aware of changing and cleaning boards after preparation of nuts.

“But most restaurants will have nuts in the kitchen and are unlikely to take responsibility if there are traces of nuts found in foods, as a kitchen’s menu is usually ever-changing.”

Another consideration sufferers must bare in mind is nut oils used in the cooking process, but Deri insists this is a smaller threat.

The Ethical Chef, based in Whitchurch, added: “Food will hardly ever be cooked in nut oils, unless you are going to a fancy restaurant. However they might be used in dressings.”

The Anaphylaxis Campaign’s guidance for caterers in dealing with severe food allergies says: “Customers are still being ‘caught out’ by unexpected ingredients after receiving false assurances from staff that a particular food product is safe.”

The guidelines want restaurants to be honest about what is in food and state they should never guess about allergen presence. It also suggests a nominated person who knows this information should be on duty at all times.

So while eating out, a nut allergy sufferer has greater concerns than simply avoiding foods with nuts in. Rather scarily, nut-free food may have been accidentally contaminated in the kitchen.

While cities like Cardiff provide magnificent and varied choices for snacks, lunch and fine dining, it is still very difficult for nut allergy sufferers to feel safe while eating out.

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Pre-Holiday Checklist for Nut Allergy Sufferers – 5 Useful Tips

January is a popular time of year for people to go on holiday, jetting off away from Britain’s winter cold. Or with 2013 now upon us, people might be starting to think about Easter and summer holidays. For nut allergy sufferers, there are a few extra considerations beyond the manic pre-holiday mayhem, which will make their lives a bit easier when managing their allergies abroad.

I’ve listed five useful things you can do before you board the plane or hit the road, which will make your holiday a bit more stress-free.

1. Learn a new language!

If you are going on holiday in a non-English speaking country, learning a few words or sentences could help you vastly. Even if you know the word for ‘nut’ in the language of your destination, it will certainly help you when studying food packaging ingredients in a foreign language. Sentences would be even more helpful for communication in a language you don’t speak. Do your homework before hand. Ask people fluent in the language or use Internet translator websites like Google Translate or BabelFish. I have vivid memories of asking an unsuspecting and increasingly-confused German shop-worker ‘I… have… a… nut… allergy. Does… this… food… have… nuts… in?’ in my rather detached German, whilst holidaying in the Black Forest. We got there in the end, and I stayed safe. I was very glad I had done my research before hand, and scribbled down a few useful sentences.

2. Your EpiPen is as important as your passport!

Little Protection: My everyday bum bag for carrying EpiPens

EpiPens are Very, Very Important Abroad. Make Sure You have Packed Them – PLEASE DO NOT FORGET THEM

Do not get on the plane without your EpiPen. In the usual mad packing rush, make sure you have it with you. Prioritise it highly and rank it alongside your passport. I cannot stress enough how important your EpiPen could be abroad. The same rules apply abroad as they do here – the EpiPen is a life-saver in an emergency situation. In foreign surroundings it could buy you the necessary time it takes to contact the emergency services. Also, EpiPen is a world-recognised brand, and will communicate to emergency services you suffer from Anaphylactic reactions. With this theme, I move on to tip 3…

3. Put on your SOS Talisman and forget about it!

If someone abroad sees one of the company products – whether this is a bracelet, a necklace or a keyring – there is every chance that they will recognise the brand. Consequently, they will recognise that you suffer from some allergy or condition. Make sure the information inside the Talisman is up-to-date before you depart, especially your doctor’s details, your medical condition and your vaccination history. If anything, the importance of the SOS increases if you are having an allergic reaction abroad because there is a greater chance that you won’t be able to communicate. The SOS is a great little tool, really easy to carry and very difficult to lose. So when you have put the piece of jewellery on in the first place, you don’t have to worry about it after that.

4. Inform Travel Companies about your Allergy. TWICE!

Airplane

Inform Travel Companies About Your Allergy [Image courtesy of xlibber]

Whether you are travelling by coach, plane or any other means, it is really important to tell travel companies that you have an allergy – both when you book and on the day. This is especially important for people with more serious allergies who can have an allergic reaction through breathing in nut particles in the air (although even if your allergy is not this serious it is still important to inform such companies). On planes and coaches you are in confined spaces where this type of reaction is a serious threat, and the company will make provisions to make sure nuts are not consumed by anyone on-board. You might become the anonymous Mr/Mrs Unpopular for a moment or so, but it is certainly a sufficient precaution!

5. If You’re Not Sure, Don’t Eat It! Don’t take the Risk.

This is the hardest piece of advice to give, because people who know their own allergy have built up a set of personal rules with regard to what they trust eating. When you are on holiday, you will probably want to try the local cuisine. For some people it is one of the main attractions of holidaying abroad. But the last thing you want is to take a risk, consume nuts and end up in hospital. My mentality with food is that if I’m not sure, I don’t eat it. And for me, this mentality would be all the more prominent abroad where you are more likely to stumble upon food you have never had before. You might be disappointed at not being allowed to a certain cuisine when your friends and family are tucking in, but it is better to be safe than sorry.

For more details and tips, please have a look at the Allergy UK page for travelling abroad with a food allergy. It’s an excellent page. Finally and most importantly, enjoy your holiday! By taking these 5 simple steps your nut allergy won’t get in the way of you having the time of your life.

Meet Nano, the Nut Detection Dog

Medical Detection Dog: Nano Poses for a Photo [Image owned by Yasmine/Stuart]

A Nut Detection Dog?

When you think about a sniffer dog, you might think of a dog using its sense of smell to detect crime evidence, drugs and even bombs. I bet you don’t think about a nut detection dog. But for sufferers who have very serious allergies, a detection dog would prove very valuable. I’d never heard of one though, until recently.

Yasmine, a woman who lives with her partner Stuart in Worcester, works in IT Infrastructure support, where she is part of a team looking after 11 offices in Asia, Europe and the United States. She has an allergy to peanuts, walnuts and cashew nuts, and has gone into anaphylactic shock several times after eating nuts by accident.

Her allergy is perhaps the most serious kind, where she does not need to physically eat a nut to have an allergic reaction, but can also react when she touches them. When she is exposed to them through smell she will have a mild reaction such as swollen eyes and itchy skin.

She said: “It seems the more reactions I have the stronger they get. When it first started 7 years ago I could stop it by taking antihistamine, but now the reaction is very fast and I always get very confused. Lately I’ve had a few reactions, and one resulted in a hospital visit. In the last 7 years I’ve had about 18 severe reactions and about 30 mild ones.”

Her allergy affects her daily practices: “If I’m at home or in the office I have routines, which makes life easier. I can cook my own food and bring lunch boxes to work. If I do go out for a meal I try to eat at the same places where they know and understand my allergies. If I meet friends for coffee in town I only have drinks.”

When Yasmine was forced to go to hospital during business trips, a colleague suggested she look into what could be done to help her. She researched immunisation processes, but was told by the allergy clinic it was not possible at the time, as the process was at least 8 years from being on the market.

Training a Medical Detection Dog

Yasmine was determined to find a solution. She said: “No one at work forced me to travel, but I felt, for personal reasons, I did not want to change my job or stop travelling as that would be the first step towards restricting my life.

“A few months after that, I saw a programme about someone who trained a peanut detection dog in the United States. It got me thinking that I have a dog, so why not try it? It took a lot of phone calls to various dog training groups around Europe until someone told me about Medical Detection Dogs. I sent in an application form and got called for a meeting where they agreed to help me train Nano.”

Nano During his Training [Image owned by Yasmine/Stuart]

Nano, a black toy poodle, is Yasmine’s dog of about 3 years. She decided to get a poodle because she is also allergic to fur animals.

Nano’s training is the pilot scheme for nut allergies of Medical Detection Dogs – a UK-based charity which trains dogs to help people with life-threatening health conditions. The charity is funded by donations, and relies upon their volunteers to do the fundraising for them. They have previously trained dogs to help their owners manage diabetes type 1 and narcolepsy.

Regarding the training, Yasmine said: “First, Nano is being taught to detect whole nuts, and then smaller and smaller pieces as well as nut oils. When this has been achieved he will start detecting nuts and nut traces in food.

“He is doing very well so far. He is able to detect nut traces and nut oil on different surfaces such as tables, door handles, keyboards and phones, and the next step is detecting these substances in foods.”

Looking to the Future

How does Yasmine hope the scheme will change her life? “For me, this is about getting back my independence. At the moment there are so many situations that I will avoid such as going to dinner with friends. Going to stay with friends and family would mean they have to ensure food and surroundings are kept nut free. If Nano does pass his training it will allow me to do things like these again.

Nano Sniffing a Bookcase [Image owned by Yasmine/Stuart]

“At work, for example, when I go to someone’s desk to help with their computer, I will of course use their keyboard. This is just one area where Nano can help by checking there are no nut traces on the keyboard, mouse and desk. If I attend a business dinner or I do go out with my friends, he can double check the food for me, as well as the place where I am sitting.

“Another very important scenario is aeroplanes. This is where I feel most vulnerable as I know if anything were to happen it will be hours before I can get medical attention. By having Nano with me he can check the row I will be sat on and also alert me to any traces of nuts.”

And what about the future? Yasmine believes nut detection dogs can become more commonplace in sufferers’ daily lives, and they can be a real and great help to people with allergies.

She added: “My wish is that Nano is the first dog, not the only dog, to be trained like this. I think as a parent of a child with a severe nut allergy this would be such a helpful tool. If an adult like myself finds life with an allergy difficult, it must be nearly impossible for a parent to check everything.”

I completely agree with this sentiment. My own allergy is worrying enough, but I have never had an allergic reaction without eating a nut. For people with allergies as serious as Yasmine’s, this is a constant worry and threat. But a nut detection dog would make life so much easier for sufferers, and perhaps more importantly, it would ensure their lives are not fully restricted by their allergy.

I would like to thank Yasmine for allowing me to interview her, and for sharing her story with me. She is writing a blog about Nano’s training, and I would encourage you to read it, because Nano’s training is so interesting and remarkable. You can find it at nanothenutdetectiondog.wordpress.com. I would also like to thank Medical Detection Dogs for allowing Yasmine to talk to me about the scheme.

Allergic Reactions: What Happens?

For information about nut allergies from someone who knows what they are talking about, I spoke to Claire Dunne, a fourth-year medic in training at Cardiff University. I’ve read many online articles about nut allergies which are hard to understand and very confusing for someone like me who does not engage with anything remotely Science-like! So I wanted a simple explanation of nut allergies, and how they work.

Nuts!

Nut Bowl: [Image Courtesy of IainBuchanan]

Anaphylaxis, Intolerance and Reaction Rates

I first asked about the rather confusing and terrifying concept of anaphylaxis. Claire said:

“It’s like a whole body version of a rash, which results in your blood pressure dropping steeply and could even cause the airway to close. The blood vessels become leaky, releases fluid into tissues and everything swells. That is the visible swelling you can see when someone is having an anaphylactic reaction. You are more likely to get an anaphylactic reaction than with most other allergies.”

I wanted to know why some people are ‘intolerant’ of nuts in the first place. How do nut allergies occur?

“Sufferers are not allergic to the nut itself, but a specific protein within nuts. When you are first exposed to nuts, you don’t have a visible reaction but your body produces white blood cells (mast cells) with ‘weaponry’ specific to the protein in the nut you ate, because it identifies it as a threat, which it shouldn’t. These cells then lie in wait in the body and if you are exposed again they are ready to attack immediately by releasing the chemical histamine, which is what causes the symptoms of an allergic reaction.”

Something that has always intrigued me is why some people have a reaction when they smell or come into contact with the nut, when others only react when they consume it. Claire said that there is no formulaic answer:

“It is completely dependent on the person. With more serious allergies people are allergic to particles of nuts that are in the air, and they have a reaction to it. It depends where mast cells are activated, in one place or everywhere in the body. The only way you can tell how allergic a person is, is to do a challenge test [be exposed to it, in other words]. This is not often done with nuts because of the high risk of anaphylaxis, but with other allergies like lactose, for example, it is more common.”

With these, an allergic reaction will constitute a small illness for the person not a life-threatening reaction, so it is safer to do it, Claire tells me.

Eating Nuts with No Reaction?

I wanted Claire to explain how it is possible for nut allergy sufferers to consume nuts and not have a reaction. In my own case I had a Grade 2 RAST Test reading for hazelnuts but was fine after eating Nutella. According to Claire, there could be a number of reasons why this happened.

“The first is that people who have allergies to a specific nut might not be adequately exposed to it to trigger a reaction. This can happen even if they consume it. The food itself may have very low nut content so a person might not have a reaction. Or, the mass of food eaten is very small, so if it is consumed in such a small amount, put simply, it might not be enough to trigger an allergic reaction.”

The second reason I found particularly interesting, and concerns the cooking process of food. Claire said: 

“When food is cooked, it can affect the proteins in it. They become denatured or altered into something that a sufferer is not allergic to.”

Cake Closeup

Baking and Cooking MIGHT Denature Proteins in Nuts: [Image Courtesy of su-lin]

This makes sense thinking back to Claire’s explanation of why people are allergic to nuts. Sufferers are not allergic to the nut itself, but instead proteins inside it. So if these proteins are changed in the cooking process, you could effectively eat a nut without being allergic to it. “But this does not mean it is safe to eat nuts if they are cooked. This is just a theory some people believe” Claire stressed.

Growing out of Allergies

There is a lot of online content about growing out of allergies, but I don’t know how much of it I can believe. Claire tried to clarify the matter for me:

“It is possible to grow out of allergies. It is quite common for asthma and hay fever sufferers, for example, to find that their situation improves. But nut allergies are funny [odd, certainly not laughable!]. It is possible to grow out of them, but you usually don’t – again because it is usually an anaphylactic reaction. Most people have a first exposure to nuts when they are young and they avoid nuts in their diet from then onwards. So even if you have grown out of a nut allergy it is hard to tell that you have, simply because you go out of your way to avoid them.”

I then asked Claire about something which I have heard of, where a sufferer can, in theory at least, make their body build a tolerance to nuts.

“It’s called Desensitisation Immunotherapy. It has to be done in hospital, in a controlled environment. Your body is injected with tiny amounts of the substance you are allergic to and it gets used to it over time. It will come to a stage where the body doesn’t see it as a threat any longer and an allergic reaction is not triggered when it is exposed to the substance. Again though, it is more common in asthma and hay fever and dangerous for nut allergy sufferers. It is a long process where you have to have many sessions of the Immunotherapy in hospital.”

It will be a long time in the future where such treatment becomes commonplace for nut allergy sufferers, I am assured.

And Finally…

… a very quick word on the importance of EpiPens, which I intend to write an entire post about in the future.

“They contain adrenaline, basically. They can give someone having an allergic reaction that extra bit of time while the Emergency Services are getting to you.”

They are vital, in other words.

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