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Today’s guest post is by registered dietitian, Sian Riley, founder of The Internet Dietitian.com. As well as having wide professional experience of advising people with food allergies and intolerances, Sian is also herself an “allergy mum” (with one of her children having a delayed milk allergy). Since my son’s peanut allergy diagnosis, I have often wondered what nutritional benefits nuts would have brought to his diet. What foods should he be eating in their place? Here Sian shares her tips for ensuring that your child’s nut allergy diagnosis doesn’t lead to a nutritionally compromised diet and that they still develop and enjoy a healthy relationship with food  – Louise

No nut nutrition

by Sian Riley (see Biography below)

A ‘nut allergy’ includes an allergy to tree nuts, peanuts (officially a legume, not a nut) or both. Doctors’ views differ as to whether it is necessary to avoid all nuts or just the specific ‘nut’ you are allergic to. Whichever nuts your doctor advises you to avoid, you must exclude them totally from your diet and this includes tiny amounts entering food through contamination during the manufacturing or cooking process.

Living with a nut allergy is extremely stressful and adjusting to a new nut free lifestyle can be a daunting and anxious time. Often the biggest challenge ‘nut free’ families face is the very real fear of this contamination exposing their family to nuts through processed foods and/or from eating out. The stress of preventing this accidental exposure can indirectly lead to a nutritionally compromised diet by fearing foods, leading to fussiness (particularly in children) and a limited diet.

Good nutrition isn’t just about eating the ‘right’ foods, there is also a huge social and emotional side to food that shouldn’t be ignored. Your family’s nutritional habits and attitudes are sown in these early years and affect how they eat for many years to come.

Here are my top tips for the nut free family and making sure your ‘No Nut Nutrition’ is safe, nutritious and enjoyable!

1. Read labels

There’s no avoiding this one! Reading labels to identify allergens will become a regular part of your shopping trips. Nuts and peanuts are each classed as one of the top allergens, so by law need to be included in the allergy labelling information on processed foods (until December 2014). Shopping may be time consuming in the early days, but it’ll soon get quicker as you become an expert in your family’s needs. Keep regularly double checking food labels though, as manufacturing processes and suppliers can change, resulting in a previously ‘safe’ food becoming at risk of contamination from the allergen. Using internet grocery shopping may help to make the process quicker, as labels can be scrutinised online. Supermarkets can also provide you with ‘free from’ information and advice – online or in store.

2. Focus on the positive

Creating a positive attitude to meal times and food will help to encourage a healthy relationship towards food for your whole family. Give as much focus to the foods your family can eat, as to food they’re allergic to – giving a balanced communication. Having ‘fun with food’ through cooking, baking and shopping will help build this healthy relationship. Growing fruit and veg in your garden is also a brilliant way for your family to learn about new foods whilst celebrating their horticultural success.

3. Variety

Variety is really important to ensure your family gets a full range of nutrients. See ‘The eatwell plate’ below. It’s easy for any family to get ‘stuck in a rut’ when it comes to meal options, but even more so for the family dealing with food allergies. Try to introduce a new recipe or meal once a week to extend your menu choice.

4. Support

It is crucial to get individual support and advice from your allergy specialist, GP, Health Visitor and Dietitian. They can advise you on local allergy groups and support you and your family in your unique situation. The internet also provides great support;  allowing sharing of your experiences and recipe ideas with other families in a similar situation. Get the most out of these websites by reading and contributing to online communities such as NutMums and Mumsnet.

5. Home cooking

Much of the risk of contamination comes from processed foods. Learning to cook from scratch will ensure your food is safe and you might even save some money in the process! It doesn’t have to be gourmet standard, start simple and have fun!

6. Empower and educate

An important stage in kids growing up is experiencing and developing their independence. This can be done as early as able – you know your own child. Educate the whole family about nut allergies and encourage the family to get involved in cooking and preparing meals. Give age appropriate jobs to the kids. Even the youngest can watch, stir and chop (with a butter knife). Getting creative in the kitchen will give them the opportunity to enjoy food, learn about good nutrition and understand where allergens can enter the cooking process. This will empower them to ask the right questions about food prepared for them and give them essential cooking skills for the future. You never know – they might become the next celebrity chef!

7. Be prepared

Being prepared and organised will optimise your families nutrition and safe avoidance of nuts. If you’re travelling abroad, consider getting a translation card from Allergy UK in your chosen language. Discuss your family’s allergies with parents before a party or play date and consider taking along some ‘safe’ food options. Contact restaurants beforehand if possible and don’t be afraid to ask lots of questions until you feel reassured about eating there.

8. Guilt

Parenthood and guilt come hand in hand, but more so for the family facing the day to day anxiety of a nut allergy. Even doing your best, there will be situations out of your control. Take time out to look after yourself and manage this additional stress and hard work in your life. Talk to family and friends and help them to understand the extra strain an allergy adds to daily life.

The Nutrition bit!

Although nuts have a lot of nutritional goodness (see my previous blog post if so desired!), a varied and balanced nut free diet should provide all the important vitamins and minerals.

Here are some of the important nutrients related to nuts, and some nut free alternatives.

Nutrient Why is it needed? Nut free alternatives
Vitamin E Protects our cells from damage Avocado, vegetable oils &
margarines
Omega 3 fatty acids Essential for cell membranes Oily fish, seeds such as linseed
/flaxseed and their oils
Selenium Protects our cells from damage Bread, meat, fish, eggs, milk
Iron Transport of oxygen around our body Dark meat, green leafy veg, eggs,
dried apricots
Zinc Supports our immune system Meat, dairy, fish, shellfish, fruit
and veg
Niacin Essential for making our DNA Meat, fish, wholegrain cereals
Magnesium Vital for growth and repair Green veg, wholegrain cereals
 

The Eatwell Plate

The eatwell plate is a great model for the whole family (over 2 years of age) to follow, particularly when following a ‘free from’ diet. It will help you and your family get the balance right over the whole day and includes all meals, drinks and snacks.

The-eatwell-plate3

  • Green – Fruit and Veg

Fruit and veg should make up 1/3 of your ‘plate’ and include the recommended 5 or more portions per day. Fruit and veg provide important goodness such as fibre and a host of vitamins and minerals. Aim for a ‘rainbow plate’ – lots of different colours to give a variety of nutrients.

Choose fresh, frozen or tinned and select unprocessed where possible to avoid contamination and the all important label reading.

Peanuts are classed as a legume, as are peas. There may be some cross reactivity, so it’s important to discuss with your doctor if you can include other legumes in your ‘nut free’ diet.

  • Yellow – Starchy carbohydrates

Again, starchy carbohydrates make up a 1/3 of your ‘plate’. Important source of Fibre and B vitamins. Rice, potatoes, bread, oats, cous cous, quinoa and pasta are all nut free, however label reading will still be required to check for ‘may contain’ warnings. Choose wholegrain where possible for Fibre and maximum nutrition.

Breakfast cereals are a really important source of nutrition as well as being the 1st crucial meal of the day. Close inspection of the label is required, as sometimes nuts are added. Nut free alternatives such as Porridge Oats, Readybrek and plain Weetabixs are good options to ‘break-the-fast’. Check out Nutmums ‘nut free food’ list for more options.

  • Pink – Protein

Protein is essential for growth and repair and should be included at each meal. Meat, fish and seafood are all good protein sources. Aim to have fish twice a week, with one of those being Omega 3 containing oily fish (such as Salmon, Sardines, Mackerel). Vegetarian protein sources include eggs, quorn, beans, lentils and soya. All these protein sources are nut free – again, read the labels for ‘may contain’ warnings, particularly if any ‘extras’ might have been added during the manufacturing process.

Beans, soya and lentils are classed as legumes, as are peanuts – so as above, discuss with your doctor any possible cross reactivity with these foods.

  • Blue – Dairy

A good source of Calcium and important for healthy bones and teeth. Aim for 3 portions a day of  milk, yoghurt and cheese. Choose lower fat versions where possible and if appropriate. Double check the label of other dairy products for potential allergens and be aware that nut milks are becoming increasingly popular and may be used in home cooking and baking.

  • Purple bit at the bottom – Foods and drinks high in fat and sugar

These foods should be limited, but the odd treat is fine and helps to maintain ‘normality’ in your family’s diet. The ‘everything in moderation’ rule applies here! Again careful label reading is required……but you already knew that!

And finally, whilst you’re reading all those labels – check the salt content! Too much salt in the diet can cause health problems later in life. Adults should be having less than 6g (1tsp) per day, half that for children 4-6 years old.  Reduce your family’s salt intake by using herbs and spices instead, and don’t add salt at the table or in your cooking.

Please share your tips and personal experience in ‘No Nut Nutrition’ below.

Biography

SIAN RILEYSian Riley is a registered Dietitian and a busy mum to 3 young children.

With particular interests in food intolerances, allergies and family nutrition, she has recently founded a business ‘The Internet Dietitian.com’ – providing ‘made to measure’ nutritional advice via e-mail consultations.

“Food to live, food for life”

Please have a look at her website for further information and blog posts.

www.theinternetdietitian.com

 

Internet Dietitian

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Today’s guest post is by Michelle Byrne, who runs the Manchester Allergy Support Group. Since my son’s peanut allergy diagnosis, we have so far holidayed in Britain. When I began attending the support group in May 2013, one of the things I wanted some advice on was how to go about holidaying abroad, in the least stressful way possible. Michelle had spoken about this to the support group back in January and had lots of information about what you can do (particularly before departure) to reduce the risks. I’m delighted that Michelle has kindly agreed to share with Nutmums.com her tips on how to travel safely with allergies (and eczema and asthma). The message? Preparation is key! Louise

Holiday preparations

by Michelle Byrne (see Biography below).

It is possible to have an enjoyable holiday if you have allergies – it just takes careful planning. You need to think carefully when choosing your destination, which time of year to travel, your accommodation and mode of transport. There are also various things you can do before departure and items you can pack, which will minimise your risks.

Destination

Climate:

  • Extremes of climate are often detrimental to those with asthma.
  • Colder or more temperate climates tend to be preferable for those with insect allergy and eczema.

Native Language:

  • Unless you (or a travelling companion) are fluent in a foreign language, then English-speaking countries are preferable.
  • Check whether a translation product has been produced for the country you are visiting. Allergy UK and Allergy Action provide translation cards.

(Louise’s note Jan 2014: a reader has also recommended Dietary Card).

(Louise’s note Jan 2015: when holidaying in Turkey, one nut mum discovered that most restaurant staff were Russian! Her recommendation would be to also take Russian translation cards to Turkey).

Standard of Local Healthcare Provision:

  • Third-world countries are unable to provide a standard of healthcare comparable to that in westernised places.
  • Some destinations may be remote, making access to healthcare difficult.

Availability of Replacement Medication:

A report in 2003 found that adrenaline auto-injectors were:

  • Readily available in most European countries as well as North America, Australia, Israel and South Africa.
  • Not available in many other popular travel destinations including Turkey, Egypt, Thailand, Malaysia or Indonesia.

The current situation can be clarified through contacting the embassies of the intended destination(s).

Availability of Food:

  • Check whether there is, for example, a supermarket in the locality where you can purchase allergy safe food.

Time of Year

When choosing a time of year to travel, check:

  • Your destination’s climate.
  • (If relevant to you) when plants/vegetation will be pollinating/flowering.

Accommodation

Camping Holidays:

  • Camping holidays can be an issue for those who have pollen and insect allergies.
  • Consider cotton-lined sleeping bags if you have a skin condition.

Residential Breaks:

  • Self-catering holidays are usually preferable for those with food allergy.
  • If you have a dust mite allergy, think twice about staying in olde worlde destinations, carpeted and exuberantly furnished hotel rooms or highly ornate places.
  • Those with allergy to animals must avoid staying in accommodation that permits dogs/cats.

Means of Travel

To Destination:

  • Flying can be problematic for those with nut allergies.
  • Different airlines have different/no nut allergy policies. Here are links to various airlines’ nut allergy pages:  British Airways, Aer Lingus, Alitalia, American Airlines, United Airlines, Virgin Atlantic. Always check as the policies can change. It is always advisable to contact the airline BEFORE booking and outline any specific concerns.
  • Keep in mind that just because an airline does not serve peanut snacks, it does not mean it is peanut-free. The airline may include peanut ingredients in its meals, or other passengers may carry peanuts on the plane with them.
  • A nut-free meal can be requested, but cannot be guaranteed to have been produced in a nut-free environment and may therefore contain traces of nuts.  It is prudent for those with nut allergy to take their own food onboard flights.
  • Surfaces of cabin furniture may possibly have traces of nuts.  Such exposure can be minimised through wiping surfaces that you are to come into contact with.
  • Changes in air pressure within an aircraft may be problematic for those with long-standing breathing problems.  Consult your GP/chest physician prior to booking a flight.
  • Fumes from steam trains/narrow boats etc can exacerbate asthma.

Around Destination:

  • Open-air modes of transport expose one to insects/pollen/fumes/dust, all of which potentially exacerbate allergic disease conditions.
  • Those with asthma should avoid animals as fur can exacerbate the condition.
  • Those with insect allergy should also remember that animals attract insects.

Health Insurance

European Health Insurance:

  • UK residents should take a (free) European Health Insurance Card (EHIC) (formerly form E111) to obtain medical treatment if visiting a European Union country, Iceland, Liechtenstein, Norway or Switzerland.

Travel Insurance:

  • Those seeking cover for potential anaphylaxis should not have to pay an additional premium when travelling within Europe, as anaphylaxis is an emergency and covered by the EHIC.
  • Mainstream insurers do provide cover for those with severe allergies, though this may require medical screening and payment of an extra premium.  Should difficulties be encountered, contact the Anaphylaxis Campaign Helpline (01252 542029).
  • It may be cheaper to purchase annual travel insurance as opposed to travel insurance for each individual holiday.
  • Avoid holiday health insurance policies that exclude treatment of any “pre-existing health condition” (as this could include allergies).

Prior to Travelling

Important Telephone Calls:

Call:

  • The airline to check their current (1) Peanut Policy as it can change and (2) rules for carrying medication. Request written confirmation from the airline. Such documentation may help if flights are rescheduled en route.
  • Your GP to request written confirmation for the necessity to carry adrenaline auto-injectors.  Some GPs may charge a fee (around £10-£15) for providing such documentation.
  • Your chest physician (if you have a chronic chest condition), as investigations may be necessary to ascertain if one can withstand the changes in pressure inside the aircraft whilst in flight.
  • The Anaphylaxis Campaign (01252 542029) for any further queries, and also information on equivalent support organisations in the country you are visiting.
  • The Embassy and/or Tourist Office of the countries to be visited, for advice on:
    • emergency numbers in that country (for example, 911 in North America, 112 in Europe,  000 in Australia, 111 in New Zealand,  119 in parts of Asia);
    • the ambulance provision at your destination.  For instance, in France it is the fire service that provides an ambulance service;
    • the local food specialities and their likely ingredients; and
    • whether the medications you plan to pack are actually permitted in the destination country (it illegal to possess some medications in certain countries).
  • The proprietor at your destination to discuss, for example:
    • if the food prepared on the premises is suitable for your food allergies; and
    • the bedding (can feather pillows be substituted with synthetic? do you need to bring your own?)

ICE:

  • Store your next of kin’s telephone number in your mobile phone’s contact list under ICE (In Case of Emergency). Emergency services look for this when assisting unconscious patients. Obviously, make sure the contact list is accessible without a password.

Packing

Medication:

  • Discuss travel intentions with GP reception staff when requesting more medication than usual (or an earlier repeat prescription), to avoid GP rejecting requests.
  • Order and pack more medication than is required – in case there are journey delays or spillages.
  • Ensure all medication (1) is comprehensively labelled (2) complies with fluid restrictions enforced by airline (3) will remain in date throughout the duration of the planned trip.
  • Pack a copy of the repeat prescription request form/current medication list (using non-proprietary/generic terminology) for reference in an emergency.
  • Ensure that you and your companions know how and when medication (especially adrenaline auto-injectors) should be administered.
  • Give your travelling companion a spare adrenaline auto-injector to carry, so that if your bag goes missing, you will have a back-up.
  • Obtain a doctor’s letter explaining necessity to carry adrenaline auto-injector. 

Sun Creams:

Patch test sun tan lotion prior to travelling. For advice, see The National Eczema Society’s factsheets “Eczema and the Sun” and “Sun Screens and Ingredients: What to Look For”. Generally aim for at least SPF 15 with both UVA and UVB protection. Sunscreen to be applied about every two hours (and after swimming).

Insect Repellents:

This will deter biting insects, but not venomous insects. Check you can tolerate the product before travelling. Consider that asthma may be exacerbated through use of vaporised/aerosol products.

Medical Pendants:

Consider wearing a pendant which details emergency medical information. For example, Medicalert or SOS Talisman.

Apps:

  • St John Ambulance First Aid App (free) Guidance for first aid responders to emergencies, including how to administer CPR (Cardio-Pulmonary Resuscitation).
  • Anaphylaxis Coventry University Medical (free) Personalised anaphylaxis management plan, including your allergens, emergency contacts, medications and emergency procedures (including video explaining how to inject epinephrine). Users can also set reminders for auto-injector expiry dates.

Translation Card:

  • A translation card containing allergy information and what should be done in an emergency should be obtained (see above).
  • Translation cards can be hand-written by someone who knows the native language. For a school trip, members of the language department could provide invaluable advice/assistance.
  • Obviously a more foolproof means of conveying information about allergies is to be able to communicate in the native language (or travel with someone who can).
  • If you have internet access on your phone, Google can be used to provide on-the-spot translations.

Medication Carry-Cases:

If you carry all medication in one pouch/case, this makes accessing them easier in an emergency. It is advantageous to use a purpose-made carrier as they:

  • Are frequently brightly coloured and thus highly visible to/easily found by medical personnel/others for use in emergencies.
  • Provide protection to the medication from extremes of temperature and mechanical damage through knocks/bumps.

[Louise’s note – for details of the online stockists I have come across, see EpiPen accessories.]

Plug Adaptors:

  • Many countries have different plug sockets to the UK.  An adaptor must be packed in order to use a nebuliser in certain destinations.

Clothing:

  • Cotton clothing is best for those with skin conditions as it is cooler and less irritating.
  • Avoid bright colours if allergic to insect stings.
  • Shoes are preferable to open footwear for those with insect sting allergy and skin conditions.

Sterile Wipes:

  • Important for those with food allergies, to wipe surfaces off which food is to be eaten, to ensure any contamination by possible allergens has been removed.

Perfumes:

  • Should be avoided by those with asthma/eczema/insect venom allergy (insects are attracted to perfumes).

Food:

  • Pack some safe non-perishable snacks.  Some of which should be taken in hand luggage on flights for consumption during the journey.

Bedding:

  • Consider taking one’s own bedding, especially if one has a marked allergy to dust mite or synthetic coverings.

Cash:

  • It is prudent to carry some cash (say, at least £100) in the local currency when abroad as some medical establishments refuse to treat patients without a cash payment in advance.

On Arrival

Clarify Local Healthcare Provision:

Make sure you know:

  • The location of the nearest hospital (and whether it is state-run or private)
  • The location of the nearest pharmacy.
  • Whether your hotel has an in-house doctor.
  • Contact details of local taxi firms.
  • All of the phone numbers one is likely to need in an emergency.

Medication:

  • Medication must be carried at all times.

Food:

  • Choose plain simple foods without sauces or dressings.
  • Do not eat foods, the constituents of which are not known.
  • Ensure those preparing food are aware of your specific allergies.  For non-English speaking countries, provide a written translation detailing your allergy and what to do in an emergency.
  • Be aware of international culinary differences and methods of food preparation.  For instance, Spanish chefs frequently use ground almonds in place of flour in cakes, French bakers often use lupin flour in bakery products (this can evoke reactions in those allergic to nuts).
  • “Standard” items on chain restaurant menus are cooked with different ingredients from region to region, so it is possible that one’s “usual” from the UK may not be suitable abroad.  Contact the International Customer Helplines of the chain restaurant prior to travelling.

Water Sports:

  • Chlorine in swimming pools can exacerbate both asthma and eczema. (Use medication/creams prophylactically if chlorine has provoked exacerbations on previous occasions).
  • Sand/salt in seawater often exacerbates pre-existing skin conditions.  Avoid direct contact with the skin through wearing of adequate clothing/footwear and use of appropriate creams.

Biography

michelle_byrneMichelle Byrne is allergic to nuts and various other foods and is also asthmatic. Although she had a reaction to nuts aged 3, it was not until she was 19 that, whilst training to be a doctor, she realised she could have a severe allergy and need to carry an EpiPen. In February 2012, Michelle set up the Manchester Allergy Support Group, which meets 7.00-8.30pm on the first Monday of the month in Flixton, Manchester.

The group is supported and endorsed by the Anaphylaxis Campaign and regularly has guest speakers including, for example, specialist allergy doctors and nurses and representatives from the National Eczema Society.

For more information, see the group poster (which includes Michelle’s contact details) and a list of the group’s discussion topics for 2013.