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Happy Thanksgiving: Make sure everyone's food is allergen-free

Preparing for holidays is stressful enough for many. For food allergy families — those who have life-threatening reactions to certain foods — additional stress includes worrying about what food will be served, bringing a supply of safe food, traveling with possible hidden allergens and navigating the comments from others who are unaware of the dangers.

Many adults and children coping with food allergies enjoy the support and understanding of their friends and families. Like me, they are extremely grateful for the acceptance and adjustments made to keep them safe.

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But some may find that food can contribute to misunderstanding and unnecessary drama on the holidays and the days in between. While managing food allergies does get easier with time, food allergy awareness, cooperation and a heightened level of vigilance will always be required.

According to a Food Allergy Research & Education (FARE), food allergies impact as many as 15 million Americans, including 4 percent of adults. Food allergies don’t just affect children

While the Centers for Disease Control offer national guidelines on food allergies in schools, what is needed is more public health information about food allergies for all. Public service announcements, such as these from End Allergies Together and FARE, designed to raise awareness about food allergies and possible anaphylaxis, are essential not just at this time of year, but always.

While American Airlines recently announced that passengers with nut allergies will be allowed to pre-board, not enough is being done in the public sector to legislate for the health of all Americans.

Festive holiday meals are the stuff of culinary legend. Each dish may be steeped in longstanding family tradition, or a sign of new growth on our family tree. Newcomers to the table of family or friends endeavor to impress us with their sophisticated dishes from the pages of the holiday edition of lifestyle magazines or some blogger’s new twist on a classic. Others opt to buy prepared dishes.

All of these well-meaning folks may have little awareness of the potential impact of the ingredients contained in the food they are contributing to the holiday meal. Milk, eggs, fish, shellfish, tree nuts, peanuts, wheat, soy and sesame are among the most prevalent allergies in the U.S. and the typical Thanksgiving meal may include them all.

Elegant appetizers often include shrimp or crabmeat. Cheese boards and fancy dips sit atop seeded crackers or crusty breads. Bowls of nuts are on many side tables. Consider the chestnut, sausage and sage stuffing; sweet potatoes with marshmallows and pecans; and creamed vegetable casserole all added to table. Pumpkin pie, served with a side of whip cream, sits alongside a store-bought apple pie and a nutty carrot cake.

Even if you avoid the obvious, hidden dangers are present. Cross-contact with sesame at a manufacturer or baking facility could make bread, bread crumbs, stuffing, bakery goods or crackers unsafe for the sesame-allergic. Dairy allergic individuals must avoid cream, cheese, butter, ice cream and yogurt, among many other foods with milk proteins.

For the peanut allergic, a chocolate dessert made with chips or chocolate manufactured on a line shared with peanuts might provoke a reaction. Nuts used as garnish, or even a serving spoon could contaminate a dish.

My family’s journey with food allergies had its start on Thanksgiving, after eating mixed nuts led to a mild reaction. We managed at home with antihistamines and the reaction resolved, but others have had different experiences. Many end up in the emergency department.

A new population-based survey, conducted by Dr. Ruchi Gupta and her team at Northwestern University published in the journal Pediatrics, updates prevalence data on childhood food allergy, suggesting that 7.6 percent of kids in the U.S. have food allergies, with nearly 4 in 10 allergic to multiple foods. Many reported treatment in the emergency department for a reaction to a food in the last year.

Parents of children with food allergies, as well as food-allergic people of all ages, approach the holidays with varying degrees of trepidation. Comfort levels will vary and plans must be tailored to address the risks. Whether or not a child or adult has experienced a significant reaction or anaphylaxis due to consuming their allergen, their assessment of the risk involved — as evidenced by their own experience or advice from their providers — will lead them to actively plan and advocate for a safe holiday meal.

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Some opt to stay home, missing out on family events and prepare their own food with safe ingredients. Always careful to check ingredients and verify food safety, others offer to bring safe at-risk dishes so as to ensure that their allergen is avoided. Others coping with food allergies have successfully negotiated changes in recipes and ingredients, along with safe preparation that avoids cross contact, to facilitate inclusion. If food can be prepared safely by omitting or substituting an ingredient, many agree to these concessions to safety.

Here are some tips to make the holiday meals safe for everyone:

Communicate

Ask about foods that must be avoided due to allergy and listen to the response. Every food allergic individual and family has their own “comfort level” based on previous reactions and their own experience. For some, reading labels may be enough, although it is insufficient for sesame allergies. Others avoid any products that have precautionary warnings, such as “may contain” or “manufactured on shared equipment” or “processed in a facility” with allergens. For others, reading labels is a first step, but they also contact each manufacturer of selected products and develop a safe shopping list that must be rechecked periodically. Find out what the safe haven foods and brands are and to the best of your ability, consider adapting recipes to include those items.

Consider retooling recipes to include allergen substitutes

Allergy families become quite adept at making these alterations or finding safe foods. Ask about them and try to include them in at least some of your dishes.

Create an allergy aware environment in your home

Serve those with food allergies first, so that they can be assured that safe food hasn’t come into contact with allergens. Make sure guests know not to move utensils from dish to dish and consider segregating “safe foods” to a separate area with designated serving utensils. If dishes containing allergens are served, make sure they are located away from the safe food area. Avoid cross contact between food items and keep serving areas clean.

Remind guests to wash up, not only before meals, but after handling food

Get in the habit of washing hands both before and after eating. Ensuring that children wash hands and wipe off faces before engaging in play or sharing toys is especially important. Food-free play areas and plenty of wipes can help minimize risks of inadvertent exposure.

Food allergies affect millions of Americans every day. But Thanksgiving is one potentially dangerous day for those contending with food allergies. Better awareness will make everyone thankful.

Josie Howard-Ruben, PhD, APRN is an assistant professor at Rush University College of Nursing and advocates for food allergy awareness, education and legislation. She is a Public Voices Fellow through The OpEd Project.