Fish-free: all about fish

Sticking closely to my previous under-watery theme, let’s take a look at fish…. What are the challenges of fish-free living?

Apparently, 40% of fish allergy sufferers report being able to eat fish as a child. The majority of all allergies come on (and sometimes disappear) in childhood. This might make it a challenge for those who are caught unawares but it’s probably easier to understand what to avoid as an adult.

The EU legislation just refers to “fish” as  a whole and it does appear that allergies across the group are common. In addition cross contamination risks seem fairly high. So the recommendation from the Anaphylaxis Camapign is to avoid all fish if you have an allergy to one.

Shellfish and fish allergies are sometimes lumped together, but not always. They’re biologically different so it’s likely to be bad luck, rather than a cross-sensitivity, if you do have allergies to both.

Beers and wines are sometimes filtered using fish guts, but I don’t know how much of a risk this poses for allergy sufferers.  Drinks are not subject to allergen-labelling requirements in the same way as food, and so with drinks usually unlabelled, maybe it’s best seeking out vegan options to be on the safe side (but don’t get me started on the sulphur dioxide issue). Other unusual places to watch out for the presence of fish include Worcestershire sauce, and Caesar salad dressing.

 

Thanks for reading this part of my series on the top 14 allergens. To find out what I’ve learnt about the other 13 please head to the blog series home.

Mollusc-free: all about molluscs

Molluscs: the third and final part of the underwater allergens.  In fact, it’s only partly underwater. But what does it mean to be mollusc-free? A bit like with crustaceans, I was a bit hazy as to what molluscs were but luckily Wikipedia informed me that there are 85,000 species out there, of which, I imagine, humans eat only a handful. Given so many species I’d be interested, mollusc allergy sufferers, to know whether you’re allergic to one species or many.

Squids are the biggest and slugs and snails the most numerous. So you’re most at risk in seafood restaurants, or in France. It’s weird, I’ve never heard of anyone eating slugs, but given my research, I don’t see a reason why not.

I don’t think I’ve ever seen a ‘may contain’ for molluscs. I don’t know if that’s because they’re rarer, so cross contamination into places they’re not supposed to be is rarer; or because people aren’t good at labelling. Some sites tell me to beware of stocks. I’ll look out and report back!

As you’ll know if you read my crustaceans part, I really dislike seafood, and apparently molluscs make up the other part of shellfish, so my question mark over shellfish remains. Are you likely to have an allergy to both crustaceans and molluscs? How about fish as well? I couldn’t find any research, so let me know anecdotally instead. A short blog: it seems the internet is a little blank on the subject.

Thanks for reading this part of my series on the top 14 allergens. To find out what I’ve learnt about the other 13 please head to the blog series home.

Crustacean-free: all about shellfish?

lobster on a plate

What about crustacean-free eating? This time the legislation just says ‘crustaceans’ and with me not being a biology whizz I have to admit I don’t even know what that includes. Luckily Wikipedia comes to my rescue and tells me it’s a large and diverse group, with the most common items being:

  • crabs;
  • lobsters;
  • crayfish;
  • shrimp;
  • krill;
  • woodlice; and
  • barnacles.

In general I consider crustaceans to be synonymous with ‘shellfish’ but actually it’s the woodlice that interest me: not a common food product, but actually eating insects is getting more trendy; and possibly necessary if the world is to feed its growing population. With crustaceans and insects being anatomically similar, people with crustacean allergies are advised to be cautious (read more about insects here).

I don’t often see a ‘may contain crustacean’ label, but, as a vegetarian, I often come across prawns in vegetarian dishes. I’m not allergic like Jerry, but I detest prawns! Is the use of crustaceans in (British) food sufficiently niche that there’s little risk of cross-contamination? Would that explain why we don’t see many ‘may contain traces of crustacean’ labels? I imagine it’s more difficult than it appears on face value. Prawn crackers do contain prawn but prawn cocktail flavoured crisps do not. So happily, we’re able to eat the classic Skips on a crustacean-free diet, even if we have to avoid exotic food. That provides some relief, right!?

Thanks for reading this part of my series on the top 14 allergens. To find out what I’ve learnt about the other 13 please head to the blog series home.

 

 

 

Peanut-free: all about peanuts

photo of peanuts

Following on from my recent nut blog, I thought I’d tackle the obvious non-nut: the peanut. Is peanut-free living more or less challenging than the other nuts?

Peanut allergy is probably the most well known of allergies, which potentially increases awareness amongst non-allergy sufferers more wary,  in turn potentially making an peanuts as an allergen easier to avoid. That said, a lot of people lump all ‘nuts’ together, including true nuts, peanuts, coconuts, pine nuts, etc. Peanut allergy is also renowned for its severity: we hear in the mainstream media about those people who can’t be in the same room, aeroplane cabin, etc. as someone else eating peanuts due to the risk of airborne reactions, although some sources (for example, the Peanut Institute ) suggest that this is unlikely.

On the other hand “[p]eople with confirmed peanut allergy may have cross-reactivity to tree nut, soy, and other legumes, such as peas and lentils” (citations provided on the Wikipedia article “Peanut allergy”). Yep, Jerry has adverse reactions to varying degrees to all of these foods (which seem to be consistent with eosinophilic oesophagitis).

It’s also interesting to think about peanut oil – not used super commonly, and thought to be okay for lots of peanut-allergy sufferers, but it’s good to be on the look out. Jerry’s always been warned about watching out for food establishments that use peanut oil, but has yet to come across one that does so.

Jerry recently bought some sunflower butter (specifically meridian organic sunflower seed butter), to try and recreate the peanut-butter experience. However, we discovered it carries a  “may contain peanuts”, which suggests it’s missing its main market.

Peanut allergy appears to be on the rise. And it’s said that children with peanut allergies are less likely to outgrow them than other allergies. So we should all be becoming more aware of these kind of issues. Hopefully we’ll see more adult-focused resources as there is currently a lot of child-focused advice on living peanut-free.

 

Thanks for reading this part of my series on the top 14 allergens. To find out what I’ve learnt about the other 13 please head back to the blog series home.

Jerry’s Allergies

A central list of all of my food allergies! I’ve gone for a traffic-light system:

  • red – severe life-threatening allergies;
  • amber – moderate/mild allergies to foods that I can usually tolerate in small amounts;
  • green – no allergy;
  • red-amber – allergies to foods in their raw form.

I hope this list will be of use to the family, friends and professionals who cater for me, and demonstrate that there are plenty of yummy wholesome meals that can be concocted from foods in the green list!

Severe allergy (risk of anaphylaxis):
  • egg (except egg lysozyme in cheese)
  • peanuts
  • nuts
  • molluscs
  • crustaceans (shellfish)
  • fish
  • poultry (i.e. chicken, turkey, duck)*

I avoid all products with “may contain x“/”made in a factory handling x“/”made on a line using x“/”not suitable for x allergy sufferers” labels for these foods.

*Poultry is not one of the 14 major allergens that have to be emphasised by law. Extra attention is therefore required where poultry might be used, such as in gravies, stocks, frying grease (duck fat) or pâtés.

Moderate to mild allergy (e.g. risk of urticaria, vomiting, mild asthma attack, eczema):
  • wheat (tolerated in small amounts)
  • soya (tolerated in small amounts)
  • coconut
  • mushrooms
  • legumes (including common beans i.e. white (haricot) beans, green beans, runner beans)
No allergy:
  • milk (butter, cream, yoghurt, cheese)
  • tubers (including potatoes, sweet potatoes, cassava, yam)
  • meat (anything with four legs i.e. pork, mutton/lamb, beef, rabbit, horse, porcupine!)
  • rice, maize/corn, pearl barley, quinoa, oats, flax/linseed, teff
  • most vegetables (see exceptions)
  • alliums (onions, garlic, shallots, leeks, chives)
  • most fruit (see exceptions)
  • salt, pepper, herbs, spices (including mustard), ginger
  • sunflower, linseed, pine nuts, rapeseed
Allergy to raw forms only:
  • celery, carrots
  • apples, bananas

 

Nut-free: all about nuts

Bowl of nuts

In today’s post we’re looking at nut allergies, and the challenges of nut-free living. To be clear, this blog doesn’t cover peanuts (as they are a separate one of the top 14… watch this space for that blog).

What does the legislation say?

Nuts, namely: almonds (Amygdalus communis L.), hazelnuts (Corylus avellana), walnuts (Juglans regia), cashews (Anacardium occidentale), pecan nuts (Carya illinoinensis (Wangenh.) K. Koch), Brazil nuts (Bertholletia excelsa), pistachio nuts (Pistacia vera), macadamia or Queensland nuts (Macadamia ternifolia), and products thereof, except for nuts used for making alcoholic distillates including ethyl alcohol of agricultural origin

One nut-free or all nuts-free?

Many of the people I know with ‘nut’ allergies, are allergic to one or more, but not all nine… which makes the ‘may contain nuts’ label frustrating – why can’t the legislation be as for gluten, where products must be labelled with which gluten-containing ingredient poses the risk risk (so you never see ‘may contain gluten’, but ‘may contain wheat’ or ‘may contain barley’). Nut-free living is hard enough as it is.  And if you want to dive into ‘may contain’ labelling issues, take a look around here for example (I’ve already started lining up resources around this for my posts after I finish the top 14).

Almonds

Almond powder, used in a number of things but occasionally in gluten-free baking (while we’re on the subjects of allergens). You can be directly allergic to almonds, or, less commonly, allergic to birch pollen and gain a cross-sensitisation allergy (read more here). Almond is also found in handwashes and shampoos, leading to some skin issues, and in some gins so Jerry avoids these too, although of course non-foodstuffs and alcoholic drinks don’t have to be labelled (see legislation above).

Brazil nuts

Brazil nut allergy is thought to be the most common of nut allergies (excluding peanuts) and usually sufferers don’t grow out of it. This story is almost incredible, but at least the concept shows the care that partners of allergic people have to take too.

Cashews & Pistachios

Apparently these share a similar structure and you are very likely to be allergic to both, or neither, says the Anaphylaxis Campaign. It’s funny because they are not the nuts that I would have matched as most similar to each other. Cashews are also found in shampoos and are common in lots of cuisines.

Walnuts & Pecans

And we have another pairing, but at least these actually look similar to each other! Like almonds, pollen cross-sensitisation is possible, although most people have a primary allergy, says the Anaphylaxis Campaign.

Hazelnuts

Once again, we can have milder cross-sensitivity through to life threatening sensitivity. Often an ingredient/or a ‘may contain’ in chocolate, this one makes Jerry particularly sad!

Macadamia

The most obscure of the nuts (to me), seen in Ben and Jerry’s ice-cream and becoming more commonly found in dishes. Not much more to say on this – one to watch I guess?

What about: coconut, pine nut, chestnut…?

In America, coconut is classified as a nut, but not in Europe. In fact, it’s used quite commonly in free-from products (I’ve even made coconut whipped cream while testing out menus for this project). Appears to be taxonomically and anatomically different to nuts, but has lots of people with allergies to it.

Pine nuts are seeds, and while there are a handful of people with allergies to them, they don’t tend to be linked to allergies to other ‘nuts’.

Chestnuts are taxonomically and anatomically different to nuts and peanuts. Allergies are uncommon in the UK, although chestnuts make it into the top 8 in the US. Recommendation is that you don’t need to avoid chestnuts unless you actively know you’re allergic to them.

So that’s a quick whizz through some notes about nuts! As always, please share any resources or your own experiences 🙂

Thanks for reading this part of my series on the top 14 allergens. To find out what I’ve learnt about the other 13 please head to the blog series home.

My IgE Results

I thought I’d finally have a crack at a blog: I seem to write for hours, switching topic, and never publishing a thing! I’m keeping this one simple by digging out and publishing my old specific immunoglobulin E (IgE) radioallergosorbent test (RAST) results. I say “old” because they date from 2005, when I was 16 years old. The first table details the foodstuff I was tested for, the specific immunoglobulin E concentrations in thousands of units per litre, and a summary of how I handle the foodstuff as far as my exclusion diet goes. The second table classifies specific IgE concentration from negative to strongly positive. Here goes:

Foodstuff Specific IgE (ku/l) Exclusion diet details
Apple 76.10 – Avoid raw apples
– Eat and drink cooked and pasteurised apple in sauces, desserts, juices and cider
Chicken 56.70 Avoid
Egg >100.00 Avoid (including skin contact, which causes swelling)
Milk 2.85 – Avoid raw milk
– Eat and drink pasteurised and sterilised milk, and as cream, yoghurts and cheese
Wheat 12.60 Avoid, except in small quantities such as in gravies
Mixed nuts 79.30 Avoid
Peanuts 90.70 Avoid
Salmon 11.00 Avoid
Sesame 16.00 Avoid
Mixed seafood 18.50 Avoid
Soya 26.20 Avoid, except in small quantities
Turkey 11.70 Avoid
White bean 8.75 Avoid
Specific IgE (ku/l) Result classification
<0.35 Negative
<0.7 Weakly positive
<17.5 Positive
>17.5 Strongly positive

As far as I remember, these are my most recent blood tests. I vaguely recall having a more recent skin prick test but I might have to see if my GP has those results. I know from mishaps that I still react to eggs, wheat, soya and white bean. Of course, the choice of specific foodstuffs in 2005 wasn’t unintentional: at 16 I had a pretty good idea of what was and wasn’t safe! What’s more, the list is far from exhaustive. I avoid all fish and poultry, mushrooms, coconut in large quantities, and pretty much everything in the Fabaceae family (beans and chickpeas) in large quantities. So 13 years on, is it worth a follow-up test? I know for sure I’d like like a breakdown of “mixed nuts”… and I’d be curious to compare all this with my IgE results for my safe foods.

Sulphite-free: all about sulphur dioxide

suplhite-free wine?

Have you heard of a sulphite sensitivity or sulphite allergy? Today’s blog is about a lesser-known reaction to an extremely prevalent ingredient. Sulphite-free living is a challenge…

What does the legislation say?

Sulphur dioxide and sulphites at concentrations of more than 10 mg/kg or 10 mg/litre in terms of the total SO2 which are to be calculated for products as proposed ready for consumption or as reconstituted according to the instructions of the manufacturers;

Annex 2 of Reg 1169/2011

So what are sulphites and sulphur dioxide, and are they different?

Sulphur dioxide and sulphites are usually food and drink additives (otherwise known as E numbers) used as preservatives. But there are naturally occurring sulphites, such as in wine. Outside of the realm of allergies, other legislation limits the total concentration of sulphites in our foods. They’re pretty powerful ingredients: would you want your internal organs ‘preserved’!? Probably not while you’re alive!

What are some of the challenges?

The range of products containing sulphites is large – things like dried fruit, wine, juices and powdered and pickled food. But it depends on manufacturing methods: I’ve found dried fruit which is sulphite-free (or at least, isn’t labelled!). The relative lack of knowledge about sulphite allergies means diagnosis and having people take your allergy seriously can be difficult. I found this article written by a sulphite allergy sufferer to be very informative.

Wine

The main area that interested me for the Merry Jelly’s project was alcohol. If we were to run a bar (or serve Prosecco jelly!), we would have to understand sulphite-free wine. After lots of investigation, it seems that wine is never completely sulphite-free, although sometimes can have levels lower than the 10mg/kg limit and therefore doesn’t require the ‘contains sulphites’ label.

However, many organic wine producers are quick to say that ‘natural sulphites are not the problem, it’s just the nasty additives which cause the problem’, implying that wine with no added sulphites is fine, whatever their concetration. Is this true? Calling all sulphite allergy sufferers: please let me know if you’ve tried one of these naturally occurring sulphite wines and found it okay. In general, we remain a little sceptical of anything that claims it can’t be damaging your body if it’s natural (after all, the other 13 allergens are all ‘natural’ and cause some people no end of damage…).

In practical terms, our current policy at the Merry Jelly is to use alcohol that declares itself to be so low in sulphites that it doesn’t require allergen labelling. And, as always, to be as transparent as we can with you, our guests. We would love to hear your thoughts.

Thanks for reading this part of my series on the top 14 allergens. To find out what I’ve learnt about the other 13 please head back to the blog series home.

Egg-free: all about eggs

Now I come to an allergen that I do know a bit more about: eggs.

Interestingly, some people are only allergic to egg white, some people only egg yolk, and some people both… For Jerry it’s both and his most severe allergy, so here I’ve tracked some of the perils, but also some of the comforts, we’ve found while coping with an egg allergy.

Issue 1: Cocktails

“the particulars referred to in points (b) and (l) of Article 9(1) [which includes the listing of allergens] shall not be mandatory for beverages containing more than 1,2 % by volume of alcohol.” says the EU, article 16.

So this makes alcoholic drinks pretty dangerous all round from an allergen point of view. Nuts, eggs, gluten – throw it all in and don’t tell anyone. Argh.  As for egg, cocktails are the most risky: with frothy cocktails apparently all the rage.  Most of the large cocktail bars I’ve researched do have an allergen list on their website, but only a few listed the ingredients in the main menu. (Be at One is already one of my favourite cocktail bars, and look at the way they list their menu!)

What’s more, unless a bar takes action to use different shakers, the risk of egg white contamination in a non-egg cocktail is pretty high. Following an A&E trip, I don’t think we’ll go out for cocktails again, but cocktail bars could do a lot to make people with dietary requirements more welcome. Vegans, don’t you also have a problem with the proliferation of egg in drinks?

Issue 2: Gluten-free bread

The prevalence of gluten-related health issues has meant that restaurants are now pretty good at whipping out a gluten-free alternative – from dough balls and rolls to pizza and pasta. And many of them are good. Sadly the majority of gluten-free dough, to have the right consistency, contains egg, which can be super deadly. As far as I know, this is all own-brand supermarket breads and some highly recommended brands (like Genius and Warburtons –  even their wraps which may contain egg gave Jerry a reaction).

As regular bread doesn’t contain egg, non-allergenous people often don’t realise. We’ve double checked before when the gluten-free “egg-free” bread was just too soft (and it was too good to be true). There are alternatives (BFree, Pizza Express) but it’s a minefield out there.

Issue 3: Egg lysozyme

Big panic the day we noticed egg listed as an ingredient in hard cheese. Was this new? Jerry had always eaten cheese with no problem. So what was going on? One research paper showed that people with egg allergies didn’t appear to react to Grana Padano (an Italian hard cheese). This is consistent with our personal experience. Of course, all dishes containing hard cheese are now labelled on allergen menus as containing egg. Although technically correct, this adds another layer of obscurity for egg-allergy sufferers, who need to dig further to find out whether a dish contains only egg lysozyme or other egg.

Issue 4: Vaccinations

“Two vaccines in the UK routine schedule contain small amounts of egg protein – the MMR vaccine and the flu vaccine.

Flu vaccine is grown on hens’ eggs and is capable of triggering an allergic reaction. Children and adults with an egg allergy are therefore advised to have an alternative, such as an egg-free inactivated flu vaccine.

MMR vaccine is grown on cells from chick embryos, which isn’t the same as hens’ eggs and therefore doesn’t trigger an allergic reaction. Children and adults with a severe egg allergy can safely receive the MMR vaccine.” states the NHS. 

As an asthma sufferer, Jerry is routinely offered the flu jab. He’s generally been turned away due to his egg allergy, but finds that clinicians’ approaches vary greatly, with some more risk averse than others.

In 2012, when he needed a Yellow Fever vaccination before travelling abroad, the nurse was reluctant to administer the vaccination. After consultation with the duty doctor, and with an adrenaline auto-injector to hand, they agreed to go ahead. Following the vaccination, he was asked to wait at the practice for 30-40 minutes to mitigate the risk. He suffered a mild localised reaction – a rash and swelling – which calmed down within an hour or two without any further treatment. In th end, a small price to pay for Yellow Fever immunity!

Thanks for reading this part of my series on the top 14 allergens. To find out what I’ve learnt about the other 13 please head to the blog series home.

Gluten-free: all about gluten

ear of wheat

 

I’m starting with gluten, and what it means to be gluten-free, because there’s so much info on it but it’s a bit new to me. Jerry has tested negative for coeliac disease (blood tests), but does react adversely to wheat*, so we’ve found the gluten-free movement incredibly helpful in bringing wheat-free products to the foreground. Nonetheless I’ve had to learn a lot about gluten-free, specifically for this project.

As an aside, we have recently been experimenting with adding gluten back into wheat-free flour. With Jerry avoiding both wheat and eggs, this has made baking so much easier. However, the jury’s out on whether this truly provides a healthy alternative for him. Back to gluten-free…

What the legislation say about labelling:

Cereals containing gluten, namely: wheat, rye, barley, oats, spelt, kamut or their hybridised strains, and products thereof, except:

(a) wheat based glucose syrups including dextrose;

(b) wheat based maltodextrins;

(c) glucose syrups based on barley;

(d) cereals used for making alcoholic distillates including ethyl alcohol of agricultural origin.

Issue 1: Oats

The ironic thing is, oats don’t contain gluten – they contain a similar protein but one which, according to coeliac uk, most sufferers can eat (but of course it’s perfectly possible that you’ve also got issues with eating avenin – I am not a doctor recommending that you try).

The reason most oats aren’t gluten-free is because they’ve a high risk of cross-contamination. So should we be consistent in the way we treat oats, and use ‘may contain’ warnings much like we do with nuts, milk, soya etc?

However, because the legislation calls out oats as a gluten-containing cereal, they have to be labelled. Hence we have the unusual situation of products labelled as containing ‘gluten-free oats‘, where the oats are listed as a top 14 allergen (because it’s a cereal containing gluten… even though it’s not). Time for a legislation update?!

Issue 2: Beer

Next we head onto gluten-free beer. Again we have a bolded ingredient on the back of every single bottle in our local supermarket – this time it’s barley.  Now here I’ve found it much harder to unpick than oats:  most of the rest of the world also seems confused.

It appears that brewers have two choices:

  • make ‘beer’ from something other than ingredients containing naturally-occurring gluten (and risk not being able to call it beer) or
  • make normal beer and try to remove the gluten afterwards.

    In the USA they seem to not allow this removal of gluten malarkey, but we seem to think it’s alright in Europe, and this seems to be the popular choice for gluten-free beer available in our shops. But barley malt extract, which appears to be any barley gone through the brewing process, has to be at less than 20ppm if in a gluten-free product, and to be considered safe for coeliac sufferers, again according to coeliac uk.

All this seems to mean that gluten-free beer on the whole isn’t gluten-free but has levels low enough not to affect most people. I think?

Issue 3: Wheat

OK I’m cheating a bit here, because I’m going to write a bit that’s not all about gluten. But hey. Despite wheat not being in the top 14 allergens per se, lots of products are labelled ‘gluten and wheat free‘, which makes me think there must be other people who are specifically avoiding wheat, rather than gluten. I used to think this was because you could remove gluten from wheat, although I haven’t seen it (let me know if you have). I read that 30% of bakery staff develop an allergy to wheat, which seems pretty incredible. So it’s dangerous (but yummy) stuff. If you want to add to my knowledge about what people are really allergic too, head over to my data collection blog.

Thanks for reading this part of my series on the top 14 allergens. To find out what I’ve learnt about the other 13 please head back to the blog series home.