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My family’s “free from story” has recently been featured on the Holland & Barrett website. In the post, I talk how we were thrown into the nut free world when my son had anaphylaxis at 20 months old and the massive learning curve in those first few months after diagnosis, when we were trying to figure out how to keep a nut allergic toddler safe and well.

In this post “Going on holiday with a nut allergy”, I share my tips on holidaying with a nut allergic child. This was originally published as a guest blog for Holland & Barrett.

PLANNING AND GETTING ORGANISED

As any parent knows, holidaying with small children requires a lot of organisation. Holidaying with a food allergic child requires organisation and then some! Prior to taking a child with a severe nut allergy on holiday in the UK, you would be wise to look up your nearest supermarket, chemist and hospital and research safe local restaurants in advance. Holidaying abroad requires even more preparation.

TRAVELLING ABROAD – FLYING ‘NUT SAFE’

At one of our first allergy appointments, we were told that flying might be a risk for our son. For example, if an airline hands out bags of peanuts and each passenger opens their bags at roughly the same time, we were advised that the peanut dust thrown into the air might be enough to trigger an allergic reaction.

The prospect of your child suffering anaphylaxis during a flight doesn’t bear thinking about. Yes, you could administer the EpiPen, but the shot of adrenaline can be only a temporary fix. Getting your child to a hospital for emergency treatment would be a challenge if you were 35,000ft, mid Atlantic.

CONTACT THE AIRLINE IN ADVANCE – WHAT TO CHECK

You need to make arrangements with the airline, to keep the flight as nut safe as possible. A 2013 US study identified various safeguarding measures a nut allergic passenger could take, which would reduce the risk of a reaction mid-flight. Measures included not using the plane’s pillows or blankets and asking for a nut-free buffer zone (where passengers within a certain number of rows do not eat nut products during the flight).

When we travelled to Portugal last year, my approach was to confirm with the airline by email that:

  • We could bring our own safe food on board (rather than trusting an airline meal to be nut-free).
  • A note had been added to our booking, alerting check-in staff, security and cabin crew of the allergy (and of our need to carry EpiPens).
  • They would restrict the sale of nuts on the flight and make an announcement asking passengers not to eat nuts or nut products.
  • We could pre-board, so that I could wipe the tray tables, arm rests and area around my son’s seat with travel disinfectant wipes.

Even taking these precautions, there is no guarantee the flight will be 100% nut-free. However, they helped me have peace of mind that I had controlled the risk as much as I could.

TRAVEL INSURANCE – CHECK IF YOU ARE COVERED OR HAVE TO PAY EXTRA

Yes, check whether a travel insurance policy covers anaphylaxis. Some either don’t, particularly where a child has been hospitalised for an allergic reaction in the previous 12 months, or charge a huge premium for anaphylaxis cover – around £100 is not unusual.

CARRY A EUROPEAN HEALTH INSURANCE CARD (EHIC) WITH YOU

It’s also worth applying for a European Health Insurance Card (EHIC), so you are entitled to free, or reduced cost, healthcare in Europe. The card does NOT replace travel insurance – you need both. But if you’re holidaying in Europe and you’ve got an EHIC, you’ll be entitled (in most European countries) to the same treatment that local citizens are entitled to – extremely useful in emergencies. It’s completely free and valid for up to five years.

EMERGENCY MEDICATION

It’s a good idea to have a spare set of EpiPens, in case the first set is used (or lost) during the holiday. If you are going somewhere hot or very cold, have you got an insulated EpiPen case to carry them in? You may also need a doctor’s note, explaining the need for EpiPens, to show security staff at the airport.

READING FOREIGN LABEL TERMS FOR ALLERGY SUFFERERS

Although you may now be a pro at deciphering food labels in the UK, you need to learn how to do the same in a foreign country. If you travel within the EU, the top 14 allergens must be highlighted in the ingredients list in the same way as in the UK. If you are travelling somewhere that is popular with British tourists (or ex pats), you may find labelling in English. If not, you need to swot up on the translations for your allergens. I found it useful to know the translation for the phrases “contains” and “may contain” too.

DON’T GET ‘LOST IN TRANSLATION’ – CARRY TRANSLATION CARDS

If you are travelling to a non-English speaking country, could you explain your child’s allergy to a restaurant manager? If your child suffered anaphylaxis, do you know the emergency number to ring and enough of the local language to summon an ambulance? This is where translation cards are invaluable. You can order translation cards from a professional provider (such as Allergy UK). They describe your child’s allergy in the local language and detail how to describe an anaphylaxis emergency. Make sure the whole family has a few copies just in case and also, practice saying the phrase/condition in the local language. Keep a set in your hotel room too – next to the phone in case of an emergency.

‘I HAVE A NUT ALLERGY’ WRIST BANDS AND NECKLACES

On that note, particularly if your child might be attending a kids club, it’s worth considering getting your child a waterproof wrist band or necklace medallion with ‘nut allergy’ on (these can be ordered online in advance and often in various foreign languages).

PACK SAFE FOOD SUPPLIES

It’s a good idea to pack some safe food in both your hand luggage (for the journey, with sufficient supplies if you are delayed) and your suitcase (just in case the range of safe food at the local supermarkets is limited).

EATING OUT

It pays to research the potential restaurant options in your resort online, in advance. I emailed our hotel prior to departure. We set our expectations at eating in for the entire holiday, so were very pleasantly surprised when the hotel manager talked us through the safe food options on arrival.

WHAT TO DO AND WHERE TO GO IN AN EMERGENCY

As well as knowing how to call an ambulance, it’s reassuring to know the location of the nearest hospital, chemist or doctor. You can research this in advance and could keep a map handy with each location marked.

IN SUMMARY…

Going on holiday with a nut allergy can be daunting. When we holidayed abroad, I felt thrown completely out of our comfort zone. We went from feeling confident (in so much as you ever can be) in managing our son’s allergy, to going back to that sense of trepidation you have in the first few weeks post diagnosis, where everything is new. We will definitely holiday abroad again. It would be a shame to let the food allergy shrink our family’s horizons. Travelling abroad safely can be done, with extra energy and additional organisation.

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The Nutmums nut allergy friendly restaurant directory is growing – with ten new reviews added this week! The restaurants, pubs, cafes and ice cream parlours listed have all been road tested by fellow nut mums … who were so impressed with the confidence-inspiring service they received, they felt compelled to spread the word!

Check out the latest reviews for:

If none of these are near you, Nutmums.com can help you find a safe restaurant recommendation in the following ways:

  • Search the nut allergy friendly restaurant directory. Once you’ve entered a location and clicked “search”, you can filter the results by clicking “radius” to find restaurants closer to home.
  • If it’s a chain you are after, then browse the list of Nut allergy friendly restaurants: national chains.
  • Click on the “Eating out” option on the home page. The drop down menu lists different areas of the country. (And the list of areas is continually growing, as new reviews for different areas of the UK are received).

Eating Out

Where do YOU eat out with your nut allergic child?

Whether it’s a branch of a national chain or your local independent cafe, I would love to hear your success stories!

Let’s spread the word about nut allergy friendly restaurants, cafes or pubs. If you have found somewhere which caters well for the nut allergic customer, please recommend them to the Nutmums community by posting a review here.

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Just a quick post to say, inspired by Claire’s comment on the Nutmums Facebook page, we took the children for their first McDonald’s on Sunday.

I had heard word that the Golden Arches were a good bet for allergies, both from our hospital and from fellow allergy parents.

The McDonald’s website says (as at 25 May 2014):

Nut allergy information McDonalds

You can also use their Meal Builder tool to check which menu items contain which allergens.

We went to McDonald’s at the Trafford Centre, Manchester. I understand some branches have tray liners, with allergen information for each product on the reverse. Spotting that the trays bare, I was relieved to see the queues were fairly civilised, so I psyched up to begin the “nut chat”. I explained to our server about D’s allergy and asked whether the children’s Happy Meals were nut safe. After checking with her supervisor, she returned with a laminated card detailing which foods contained which allergens. Despite needing a magnifying glass to read it, even I could clearly see that all of the Happy Meal variations were shown as not having peanuts or tree nuts as an ingredient. I was told that the only food they had which contained nuts were some types of McFlurries and these were kept in sealed packs.

So a happy meal we had, and I’m really pleased to have found another national chain to the growing list of nut allergy friendly restaurants. It’s heartening to know that wherever we are travelling in the UK, we’ll have the option of a McDonald’s.

As regards the McFlurries, after our visit I emailed McDonald’s to ask:

“which McFlurries contain peanuts and/or tree nuts? Is there a cross contamination risk with peanuts / tree nuts for the other types of McFlurries? How is the risk controlled?”

They replied,  referring me back to the Meal Builder tool, so I’ve asked again. Update hopefully to follow!

McDonalds

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I live in Brussels, Belgium with my husband and 2 children, Amber aged 4 and George 5.  We have been here 3 years and have another year to go. George had an egg allergy as a baby which he subsequently grew out of, but then went on to develop a mild allergy to sesame which was being managed by the NHS in the UK. We avoided all seeds and nuts as a precaution….he accidentally ate a breadstick containing peanuts where he went into anaphylactic shock nearly 2 yrs ago here in Belgium. We saw an allergy specialist in both UK and Belgium and prick tests show he is allergic to sesame, most tree nuts, pine nuts and sunflower seeds…

If I was to be honest, I just wanted to come home to England, but here we still are!

We have had a range of experiences living here in Brussels and travelling to other European countries which I thought other parents may find interesting/useful if they are planning a trip away.

French and Flemish (type of Dutch) is spoken here (Flemish in the North and French in the south and Brussels). English is understood and spoken to varying degrees across the country especially in Flanders and Brussels. All products have ingredients in both languages and occasionally English. I do not speak French or Flemish and have managed to get by with English and poor Spanish!

As Belgium is the land of praline chocolates; I do not trust any such product (either as chocolate on its own or chocolate biscuits, hot chocolate, ice-cream etc), labelled as containing nuts or otherwise. As with the UK, I do not buy any products made on the premises such as in bakeries or supermarkets (including sausages etc) due to cross contamination issues. Almond croissants are common here and sesame is everywhere.  I have yet to find a processed bread product that does not refer to sesame or nuts, the only products I do buy are processed tortilla wraps and pita bread. I have invested in my own bread-maker although it is difficult to find quality bread flour that is free from nuts and sesame.  All European countries need to comply with the European food labelling law but I tend to choose products that have a “may contain milk” or other allergen (not including nuts of course!) as I feel more confident that cross contamination issues with all allergens have been considered. As with the UK I don’t purchase any “artisan” products.

Fortunately as we live close to the UK, our car is fit to bursting on return trips from the Ashford Sainsbury’s. We are also fortunate to have a couple of stores in and around Brussels which stock British products such as Stone Manor and Homes Shop Abroad.

I have also learnt not to presume that a “safe” product in the UK is safe abroad. I bought some Quorn pieces the other day and noticed that the factory it’s produced in contains nuts, which is different from UK Quorn pieces. This was particularly annoying! It is also a surprise to see that some general cooking oils may contain nuts. For us, eating out is off the menu and likewise to treating the kids with ice-cream from ice-cream parlours. I tend to buy a box of ice lollies from the supermarket and treat the kids this way and when we return to the UK we feast in Pizza Express as  many times as we can!

My most anxious moments are leaving my son at school. He started his new English/French school a month after his allergic episode and it has been a constant uphill struggle to educate his teachers. I was finally invited to give a presentation this week to 50 teachers at the school and it was well received. There doesn’t appear to be nay national “every child matters” policy as there is in the UK. To be fair, it seems nut allergies amongst Belgian kids are not as common as the UK. I have been told that mustard and celery are common allergens in France and I find it fascinating that such differences exist in neighbouring countries. Epi pens are 50 euros each here, we have 2 at school and 2 at home,  but our health insurance (no national insurance here) covers about 70% of the cost. Piriton equivalent is about 10 euros a bottle.

I go through phases of whether I want to travel to other countries with my son due to my anxiety regarding his allergies, but we have been to Slovenia, Spain, and Portugal so far. We have found it easier to choose self-catering accommodation so we can prepare my son’s food although this means its not much of a holiday for me! Bread is the main issue and I have even taken frozen bread in my suitcase! We always take plenty of safe snacks to last the holiday and have discussed with my son that if he wants to experience travelling to new places he has accept that the food may not be very exciting. One day we couldn’t find any safe food, so resorted to my emergency tin of baked beans which he had to eat cold. We also take an emergency packet of freeze-dried “mountaineering” food just in-case. I then cook him everything he wants on our return home.

We have had issues with Mark Warner in Portugal where despite informing them at every opportunity about my son’s allergy (including talking to the chef), he prepared some rice crispy chocolate treats using unsuitable chocolate. It was only from my knowledge of living on the continent that made me question the chocolate and wanted to see the packaging. On inspection of the Belgian chocolate used, we noted it contained nuts. We have also purchased mini bread sticks in Spain which stated the ingredients on the packet, only to find them filled with sesame. I was also surprised to find that processed/packaged ice-lollies sold everywhere in Andalucia often stated that they may contain nuts.

Despite the extra challenges that living abroad creates, we are trying to live life to the full and are in the process of organising a 3 week camping trip through Germany and Switzerland this summer. I have decided that I am going to learn how to make unleven bread as fresh safe bread is always my biggest headache when travelling. My advice would be to take cereal, bread and plenty of snacks for the holiday, self-catering eases the eating out anxiety and to stay vigilant with all unknown foods and ice lollies.

French translation:

Groundnuts – l’arachide
Peanuts – cacahuetes
Nuts –  noix
Almonds – amandes
Sunflower – tournesol
Walnut – noyer
General nuts  – fruites de coque

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Firstly let me introduce us. We are a family of 4. Our daughter C is allergic to tree nuts and celery. She had her first major reaction aged 4 just weeks after starting school. We are now very used to living with her allergies. She was recently re tested on her 8th birthday and sadly reacted to both still quite badly during skin prick tests. Her next tests will be when she is 13.

We have only been abroad once since we discovered her allergies and that was on a P&O cruise ship and our experience with her was first class. This year we braved Disneyland Paris for a long weekend with my family.

We left armed with lots of food snacks and small cereal boxes in our case, along with her epipens and piriton. I had printed some translation cards just in case we needed them for back up but having been to Disney a few years ago English was spoken by nearly all we encountered.

On the Eurostar we had breakfast included with our seats. My mum had made them aware of her allergy – but they weren’t aware. So she couldn’t eat the food on there – but I had packed a small variety sized box of cereal so they got her a bowl and milk and she was happy as Larry. We later found out that the food they served was from Waitrose so if we were to do it again I would check in advance.

We stayed in a Disney hotel – Hotel Cheyenne. At the check in desk we were given a big allergy booklet showing us where we could get the special allergy meals from and what items were served for breakfast.

Included in our room price was breakfast – again I remembered it from last time and so came prepared. Breakfast is a continental buffet. Breadrolls, croissants etc – so a big no no for us. I asked for the allergy safe food – after being passed to 5 members of staff I was shown who could help me. The lady then passed me breads, cakes and biscuits. All individually wrapped. I asked to see the packaging and 2 of the items contained traces of nuts and peanuts!!! ARGHHH – so we stuck to our variety boxes and cereal bars.

In the park itself there are a number of restaurants that serve a special allergy free meal. The choice was pretty poor – a couple of options and not very child friendly. She had a rice and meatball dish. It was a frozen ready meal that I then had to heat in the restaurant microwave for 6 minutes. It was very expensive – 11 euros – but worth it for the peace of mind.

The best restaurants were in Disney Village. We ate twice in Planet Hollywood– both times we were served by an English waitress and everything was checked directly with the chef and she had a great choice. Meals out for us can be harder due to the celery allergy too – but again they were fab at checking everything. We also ate in the Rainforest Cafe – the manager was Irish and they made her a meal that she loved and we felt really happy with. Both restaurants are more pricey than others – but we were happy it gave us peace of mind. One of those nights the rest of my family ate in McDonalds which had been our back up plan before we arrived- but beware in there you order on a terminal yourself and in the UK there is celery present in a lot of their foods so for us it wasn’t an option to eat there.

There are lots of snack outlets in the park. We took our own popcorn as I remembered popcorn was everywhere but she was delighted to be allowed a giant candy floss stick for the night time light show.

Overall I would say preparation is key! I did find it hard work but some of that was due to the fact we were travelling with my parents and sisters and I felt guilty that we all had to eat in places suitable for C – but my family didn’t mind at all. As with all mums on here we all know the types of foods that are risky and when you had a different language in the mix it does make it harder. But we had fun and for me that was all that mattered (once I knew she was safe).

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If you can’t trust the NHS, who can you trust…

My daughter recently passed a peanut challenge. I should have left the hospital happy and relieved that, rather than following in her big brother’s footsteps, she had escaped the shadow of life threatening food allergy. And happy and relieved was how I felt, in the main. Yet there was also something bugging me: I had been required to sign a disclaimer that the hospital food might contain nut traces.

On one hand, the hospital were saying the same as any restaurant would say: there are nuts in the kitchen and therefore we can’t “guarantee” our meals are 100% nut free. However, restaurants don’t ask you to sign a document. When eating out, there’s also usually the scope to chat through with the chef or manager what they would do to minimise the cross-contamination risk. If you don’t like what you hear, you can take your business elsewhere.

If my son has an allergic reaction resulting in a hospital stay, would I be happy for him to eat food that I had acknowledged may contain nut traces? No. He would be fine eating the hospital’s sealed juices, jellies and ice cream (and such like), which are prepacked and bear an ingredients list. However, we would have to bring in safe food for his “main courses” from home. Having your child in hospital is a stressful and draining enough time, without the additional burden of co-ordinating going home for food supplies.

What if a food allergic adult was admitted to hospital (for whatever reason, allergy related or not) and didn’t have a supportive family or friends who could bring in safe food? Would they be faced with a choice of risky food versus no food?

And shouldn’t a hospital, of all places, understand the need to feed a severely allergic child food that is free of their allergens?

I sensed a new allergy induced headache coming on…

Conflicting food labels and customer service information

Then the other Saturday, I read a Tweet from Waitrose about its Woodland Friends Easter egg hunt box, advising it wasn’t nut free. What? But there were no nuts in the ingredients … there was no “may contain nuts” warning on the pack … and hadn’t a fellow nut mum told me they were on the Waitrose list of foods suitable for those avoiding nuts? Hackles immediately up, I joined in the thread. It transpired that the Tweet had been wrong and Waitrose confirmed they WERE nut free.

Although this turned out to be a false alarm, it highlighted the importance for allergic customers of a company’s food labelling and website (or customer service channels) telling the same story.

These two incidents got me thinking about the various food allergy bees in my bonnet. Whilst I’m not by nature the militant, campaigning type, there seems to be an ever increasing list of wrongs to right in the world of nut allergy. What’s fuelling this indignation on my part? Some might say it stems from a sense of injustice that my child has a life threatening food allergy. I think there’s more to it than that. To me, it’s more about:

  • Seeing policies and customs which could (at worst) endanger my child’s health or (at best) exclude him in some way, and
  • Realising that the issues could could easily be remedied, but aren’t, because they benefit someone’s commercial interests or form part of an institution’s system.

In addition to safe hospital food and consistent allergy information, here are the other items on my nut mum manifesto:

An end to back covering may contain labels

This one hardly needs any introduction. May contain labels serve a useful purpose IF used genuinely to flag a potential risk of cross contamination during the manufacturing process. They are not helpful if used simply as a back covering measure, either where the risk is incredibly remote or where they are slapped on to every product indiscriminately.

At the end of last year, Alpro began adding “may contain traces of almonds and hazelnuts” to all of its soya products, despite planning apparently exemplary allergen controls. Tesco have now added “also, may contain nuts” to seemingly every own brand product, even including items such as orange juice, ham and prepared vegetables (sign the Petition here).

Defensive nut warning labels undermine the legitimate warnings. And if we get to the point of may contain saturation, where almost every product carries a nut warning, food shopping with confidence for your allergic child will become impossible.

Take a stand on nut allergy discrimination

In Wheeldon v Marstons, an employment tribunal, at a preliminary hearing, held that a chef’s severe allergy to nuts was a “disability” under the Equality Act 2010. It seems only a matter of time before this principle is confirmed by a higher court. Then, going forward, whether it be:

  • A restaurant refusing to make a single nut safe dish.
  • A nightclub banning EpiPens.
  • A party venue refusing to cater for an allergic child’s birthday.
  • A nursery refusing an allergic child a place.
  • A school excluding allergic children from school dinners.

… the spotlight needs to be shone on incidences of nut allergy discrimination and those found responsible held to account.

Introduce unassigned EpiPens in schools

In the US, an estimated 20-25% percent of children with peanut or nut allergies have their first reaction at school before they’ve been diagnosed. If my daughter suffered anaphylaxis, even with my express permission, the nursery or school would not treat her with one of my son’s EpiPens. They would have to call 999 and hope the paramedics arrive in time.

The US has the School Access to Emergency Epinephrine Act. Caroline Sloan has launched a campaign for EpiPens to be more widely available in Ireland following the death of her 14-year-old daughter Emma in December 2013 (sign the Emma’s Voice Petition here).

Isn’t it about time the UK followed suit?

GPs and health visitors to warn new parents of the peanut allergy risk

Given a child has a higher peanut allergy risk if they (or an immediate family member) have a food allergy or other allergic condition (such as hayfever, asthma or eczema), why don’t GPs and health visitors warn of the the associated (potentially life threatening) peanut allergy risk when prescribing blue inhalers and eczema creams to babies?

It seems that GPs are prompted by their computer at nearly every appointment to ask how many units of alcohol you consume in a week (love to know the stats on how many women say “erm, 10”, but I digress…). If the system can give this prompt, why not a “peanut allergy warning” prompt when issuing asthma and eczema medications to infants?

Are there any more?

So these are the food allergy bees in my bonnet. Do they tally with yours? Or are there more injustices out there which I’ve not yet encountered in the nut allergy world?

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We’ve just returned from our first abroad holiday post peanut allergy diagnosis. I thought I would report back on our nut allergy triumphs and fails, in case anyone else is thinking of travelling to Portugal in the near future…

The journey

Check in

We flew with Monarch airlines. My first nervy moment was at check in at Manchester airport. As our suitcases trundled off along the conveyor belt, I asked if it would be possible for us to board early on account of my son’s nut allergy. My request was met with a blank look. Despite my three calls to Monarch customer services (before booking, immediately after booking and a couple of days prior to departure, when I was assured everything was in place), my son’s medical condition hadn’t been noted on “the system”, as promised. Computer was saying dunno.

The check in lady at Manchester amended our notes for our outbound flight but warned us to visit the Monarch desk in Faro on the return leg, to make sure the gate staff and crew were aware for the journey home. Somewhat indignant, I went to the Monarch desk at Manchester airport, who assured me that the medical notes were definitely on our booking for both legs of the journey.

On checking in for the return flight, we were failed by “the system” once more. The computer was showing no record of my son’s allergies. What followed would have been quite comedy, if it wasn’t so serious. Basically, me saying “no amendoim, no fruta seca” repeatedly, reinforced with jesturing “no” (picture a hand jive move) and pointing at the computer monitor whilst saying “need notes!”. With the help of a translation card, we overcame my lack of Portguese and the check in lady’s lack of English, and details of D’s allergy were again added to the system.

The flights

I’m pleased to report that once the initial customer service fail was overcome, the Monarch gate staff and cabin crew were fantastic on both legs of the journey. On the way out, we were allowed to board first, so I could get to work with the dettol wipes on the tray tables, arm rests and area around my son’s seat. The crew also made not one, but two, announcements advising that they would not be selling nut containing foods and asking passengers please not to eat nut containing snacks during the journey.

Aside from one passenger who insisted on eating their toblerone (“I’ve just paid a fiver for this”), the people in the rows around us complied with the request. One delightful chap on the outbound journey had a bit of a rant, saying “I’m tempted to open a bag of nuts and see what happens”. Then again, he had another moan later when he couldn’t lower his tray table fully as his stomach was in the way… so the world was seemingly out to inconvenience him that day.

Whilst the PA announcement was greatly appreciated, hearing it actually knocked me for six on the flight out. “Today we have a young man on board who is severely allergic to nuts…”. It might have been the 3AM start taking its toll but the announcement made me feel extremely sad. I’m not usually prone to self pity about D’s allergy, but this brought the fact of his allergy home. I felt sad that a young boy had to board with the special assistance group, sad that the allergy singles him out. Luckily D was unaware of the announcement and was able to simply enjoy the thrill of going on a plane. And I had to give myself a shake and make appropriate excited comments as the flaps on the wings moved and we could see clouds, rather than dwell on all things nut allergy.

The hotel

Restaurant and take away

We stayed at the Four Seasons, Vilamoura. Although we had an apartment, our rate included breakfast. We set off expecting to fully self cater and with the attitude that any meal out would be a bonus. I had emailed the hotel twice prior to departure to ask if the restaurant could cater for nut allergies and had not had a reply, so I didn’t have high hopes that we would be eating there at all.

However, on arrival the manager told us they were aware of D’s allergy and they knew he must avoid peanuts and “dried fruits” (nuts). He mentioned several items on the children’s menu that were safe, such as fish fingers, chicken nuggets and some pasta dishes. He advised us to mention the nut allergy to his staff each time we ordered food (which of course we would), just in case he wasn’t around to supervise D’s meals.

This was fantastic, as we were able to eat in the hotel bar area and order from the take away menu (I went to the bar to order this, rather than risk mis-communication if I phoned down).

Buffet breakfast

The other thing which was excellent about the hotel – and a pleasant surprise – was the breakfast buffet. I had packed Weetabix and had been expecting to use these, with a bowl of milk from the hotel. However, the hotel had individual boxes or Kelloggs cereals, each labelled with the ingredients in English. So D had the option of Chocos or Special K (Chocos won), plus yoghurts and a selection of whole (as opposed to prepared) fruits. There may well have been other “safe” items (for example, the cooked breakfasts), however we had enough to go at from the prepacked items on offer.

Eating in: the supermarket shop

As well as our packed lunches for the plane, in our suitcases I stashed:

  • Weetabix
  • Bagels
  • Tortilla wraps
  • A bag of pasta and a Dolmio stir in sauce
  • Fabulous Bakin’ Boys chunky butter flapjacks

This way I knew that, arriving mid-afternoon, if the worst came to the worst, we just needed to find a tub of the ubiquitous Laughing Cow cheese and a carton of milk and we had the first 24 hours covered.

Once we found our feet, we shopped for groceries at AliSuper (Atrium Vilamoura) and, more often, Jafers (in the Old Village). Jafers stocked a raft of familiar brands, for example, Dolmio, Heinz, John West tuna, Nescafe, Oreos, Philadeplphia, Robinsons squash. Many brands had the ingredients listed in multiple languages, including English. Dolmio and John West (for example) had completely English labels.

Before we travelled, I had familiarised myself with the various terms for nuts (for example, “amendoim” for peanuts and “fruta seca” for nuts). One element I wish I had paid more attention to was the other common allergens, as this would have made reading contains boxes and may contain labels quicker. For example:

  • Ovo – egg
  • Peixe – fish
  • Leite – milk
  • Sementes de sesamo – sesame
  • Soya – soya
  • Trigo – wheat

For a detailed list, see the translation materials on the Allergy Action website.

Slightly confusingly, some products had Spanish labelling. Oreo, for instance, were labelled:

“CONTIENE TRIGO, GLUTEN, SOJA. PUEDE CONTENER TRAZAS DE LECHE”

Which I gather means “Contains wheat, gluten, soya. May contain traces of milk” (which tallies with their English packs). With no knowledge of either Portuguese or Spanish, the warnings were simple enough to make out.

Many food labels also had a phrase such as “manténgase en sitio fresco y seco” immediately after the ingredients and allergy information. I did have a brief dither as to whether this could be referring to nuts and factories, but it simply means the product needs to be stored in a cool, dry place!

The key words to look out for (as well as amendoim, fruta seca and the specific names for tree nuts) are:

  • Contém (or “contiene” in Spanish) – contains…
  • Pode conter (or “puede contener” in Spanish) – may contain…

For example. a packet of Nacional spaghetti was labelled “Pode conter vestigios de ovo” (may contain traces of egg) and a Calippo lolly “Pode conter vestigios de leite” (may contain traces of milk).

One final point on Portuguese labelling – remember your glasses! My eyesight is shocking but I’m fine reading UK labels (with glasses on and in a good light!). However, some Portuguese ingredients lists were positively microscopic. Probar ham, for instance, had tiny white writing over a pale green back photo. I don’t know if they have different font size rules in Portugal, but be prepared to squint!

Eating out

Il Lamparo, Vilamoura marina

On our first afternoon, we ventured down to the Vilamoura marina. The walk took longer than expected as we got lost on the Pinhal golf course … in the rain. Walking round the marina, there weren’t many restaurants which looked hopeful. Chinese, Thai, Indian, ice cream parlours, pubs with men shouting at football on the TV. Very little leapt out as either nut allergy or child friendly. So when our son announced “I feel hungry” followed by “We go in dat cafe, mummy?” at each eatery we passed, the pressure was mounting to find him some safe food, and fast.

Having read a favourable review from another nut allergy family on TripAdvisor, I was relieved to spot Il Lamparo. Never mind that there wasn’t another customer in sight and they were still hoovering and laying tables, we approached the lady at the doorway. I explained that my son had a nut allergy (mentioning no “amendoim” or “fruta seca” whilst waving my freshly laminated translation card). Her initial response was to apologise and say her manager wasn’t there. Cue: “I feel hungry mummy. We go in dis cafe?”.

Whilst in the UK, this exchange would have made us try elsewhere, I put it down to the language barrier (and particularly my woeful lack of Portuguese). So I tried my lines again and handed over the translation card. She disappeared to talk to chef and returned to tell us all was fine. Still feeling slightly uneasy, we took a seat (as they finished hoovering) and placed our order.

Our waitress returned to ask to re-read the translation card several times and took it into the kitchen a second time to show the chef. The card doesn’t mince words and includes the line  “My child can die if he eats this food”. I figured that any restaurant that said “yes, come in” after reading the card was pretty confident of its ingredients and cross contamination controls.

After we ordered D burger and fries, the waitress came back from the kitchen to say the burgers had been made earlier that day (i.e. when the kitchen wouldn’t have been on heightened alert for the presence of nuts), so would we like to choose something else? She recommended the chicken and fries as a safe option (which incidentally came with Heinz ketchup in sachets). I think we relaxed a bit from that point on, as they were clearly aware about the need to avoid cross contamination.

Other possible eating options at the Marina

Later in the week, we had lunch at Figo’s Cafe on the Marina. We showed our waiter the translation card and he said they could make a meal for D. Although the children ended up eating the sandwiches we had with us, this would be one we would try again if we went back to Vilamoura.

It’s also worth mentioning that there is a both a Pizza Hut and a Costa Coffee on the Marina. We didn’t eat at either. However, for anyone else travelling to Vilamoura, being chains, it may be possible to research their menus prior to departure.

Four Seasons, Rua de Andorra, Vilamoura

After day 1, we tended to mainly eat in the hotel for the rest of the holiday. The hotel staff inspired confidence in the way they catered for D’s allergy. Each time we ordered food, I began the nut chat and was assured “yes, room 71”. D’s dietary requirements were known to all the staff. If they were unsure about an ingredient, they double checked with us. One time, we were asked whether he could have “óleo de girassol” (sunflower oil) and on another occasion whether the hot dog buns with a “may contain gluten and wheat” label were okay.

We had one hairy moment when a waiter brought a bowl of peanuts to our table with our drinks. That actually proved quite useful, as we were able to say to D “if that happens, you just say ‘no thank you’ and they take them away again”.

Aside from that one tiny incident, the service was all extremely reassuring.

In summary…

Travelling to Portugal and knowing zero Portuguese (I’m ashamed to admit not even hello, goodbye, please or thank you) threw us massively outside of our nut allergy comfort zone. We’ve reached the point in the UK, on home turf, of feeling confident (or as confident as you can be) in terms of supermarket shopping and in going to restaurants. The announcement on the flight, even though greatly appreciated, was a reminder that we are living with a serious condition. Deciphering Portuguese food labelling required extra concentration. Eating out, even with excellent service, felt like a leap of faith.

Monarch came good. The Four Seasons looked after us very well. We would have eaten again at Il Lamparo.

Am I glad we did it? Yes. Would we now holiday abroad again? Absolutely. Would we return to Vilamoura? Indeed. Just maybe not in rainy March…

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Severe allergies…

I’ve talked previously about how best to describe my son’s peanut allergy in conversation, so other people understand the severity. I’ve fallen into the habit of saying he is “severely allergic”, for fear that saying “allergic” might make the listener think “hmm, yeah, isn’t everybody these days” and saying “anaphylactic” might not be understood.

In recent months, I have read on several occasions that there is no such thing as a “mild” allergy: as any allergy has the potential to result in a severe allergic reaction. You can’t predict with absolute certainty whether an allergic person will have a mild or severe reaction on coming into contact with their allergen. They might have hives on one occasion, but anaphylaxis on another. So I am probably undermining the term “allergic” by qualifying it with the word “severely”. Simply saying “allergic” SHOULD be enough.

… and the allergy pretenders

Then I heard a story that left me somewhat aggravated and which also made me realise there is a need to spell out to people that, not only is my son’s allergy severe, it is also very “real”.

A friend of a friend said he had an allergy to chillies. One evening, whilst at a rugby club social, my friend realised a spicy dish had been taken to the “allergic” man’s table by mistake. She panicked, rushed over to warn him  … only to be met with a mumbled “erm, I think this will probably be alright” and then to see him continue eating it. Turns out, he was pretending to have an allergy, to make sure people didn’t serve him chilli-laden food.

I’ve also heard talk of people feigning allergies or intolerances to certain foods, so they don’t have to confess to counting their calories. Obviously, this all takes a far more worrying turn if someone is claiming an allergy to mask an eating disorder, and I am in no way qualified to pass comment on that. However, the woman who goes out for a meal with friends and, to save face when ordering a salad, pretends to have an intolerance? Unnecessary, unhelpful, and for goodness sake, how unassertive?

It would appear faux food allergies have been in vogue for some years, with the Washington City Paper reporting on the trend back in 2008.  The article quotes restaurant owner Jeff Black, who says of the “ingredient-averse” who feign an allergy:

“When people fake disease, it’s just like people who fake to get handicap plates… It’s ethically and morally wrong.”

Absolutely. So, why do diners do it? Is it an expression of control freakery where they otherwise don’t trust a restaurant to make a meal to their taste (or within their budgeted calorie allowance?). Is it a form of attention seeking, so that they are fussed over by the restaurant or receive sympathy from friends? Or is it simply a cowardly way of ensuring you get the meal you want, and these people haven’t realised the disservice they are doing to real allergic diners?

The problem of pretend allergies may even be rife amongst school children. It seems some parents are not above claiming that their child “can’t eat” something, when the truth is they “won’t eat” a certain food. During my recent spate of primary school tours (sussing out which were allergy savvy before my son starts this September), one headmaster stressed to me the need for a doctor’s letter confirming that D had a diagnosed allergy. Apparently, this proof is required so the school can differentiate the children with genuine dietary requirements from those who are merely picky eaters.

This approach is also recommended the School Food Plan, where the section dealing with allergies in the Q&A for headteachers states:

“Make sure that dietary needs are backed up with a medical certificate or letter from the doctor, so you ensure you are only altering your catering for those who are medically certified – or those who have special diets for religious or cultural reasons.”

I find the whole notion of pretend allergies quite incredible. It may seem like a harmless white lie, but the more allergy pretenders there are, the more catering establishments and the general public will be cynical about the claims of those with real allergies. So… men who can’t handle hot food, dieting ladies and pandering parents, please think twice before turning allergy pretender. It really doesn’t help those with the real medical condition.

Further information

Severe allergies

The Allergy UK site contains information on an allergic person’s chance of having anaphylaxis. It states this is:

“a little more likely in someone who has:

  • had a previous anaphylactic reaction
  • moderate-severe asthma
  • underlying cardiovascular disease”

Factors such as “exercise, heat, alcohol, the amount of allergen taken, and, for food, how it is prepared and consumed” can also influence the severity of the reaction. (For full details, see Allergy UK, Anaphylaxis and Severe Allergic Reactions).

Allergy pretenders

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This post was originally published as a guest post for Allergy Aware Kitchen, see Biography below.

My name is Louise and I have two children, a son (aged 3 ½) who has a severe peanut allergy and a daughter (almost 2) who, touch wood, has no known allergies as yet.

The first reaction

We discovered my son’s peanut allergy the hard way. When he was 20 months old he took a bite of a peanut butter cookie. It was the first time he had knowingly been given peanut. He suffered an allergic reaction that was immediate and severe. His lips puffed up and his eye swelled shut. His breathing became loud and wheezy.

Luckily, his grandmother, a retired nurse, recognised the signs of anaphylaxis and dialled 999. The early response paramedic arrived within minutes with the life saving adrenaline injection. However, when he was taken to hospital, the doctors became concerned that the swelling in his throat was not subsiding. They made the decision to induce him into a coma, so that they could insert a breathing tube, before his throat swelled closed. He spent three days in intensive care, on a life support machine, whilst the doctors waited for signs of a “trickle” around the breathing tube, which would show them that the swelling was going down.

Fortunately, he recovered well and by the end of the week he was back home playing with his Lego and watching CBeebies. You would not guess by looking at him what he had been through. However, then began our task of learning to live with a life threatening nut allergy…

How does a severe food allergy change your life?

My son’s peanut allergy impacts on all areas of our family life. That may sound extreme: I’m not saying it dominates. However, it does add an extra layer of organisation for everyday things. For example:

  • Wherever we are and whatever we’re doing, we always have to have my son’s emergency medication to hand. On entering the world of allergies, we had to learn how to recognise the symptoms of an allergic reaction and make sure that we know the drill for what to do in an emergency (including adminstering his “EpiPen” adrenaline auto-injector). The same is true for anyone who cares for our son: babysitters, nursery, school, his friends’ parents when he goes for a playdate. They all need to be trained in what to do.
  • We have to check EVERY food label for the mention of nuts. On doctor’s advice, we avoid all types of nuts. So, if a food label mentions “peanut” or any other type of nut in the ingredients list, then my son doesn’t eat that food. We also avoid any foods which have a nut warning label (for example, “may contain nuts” or equivalent wording).
  • Going out for the day? As well as carrying his emergency meds, I need to make sure I have some safe snacks too, in case there are no nut allergy friendly options when we are out and about.
  • Choosing a school? I need to find out which are food allergy savvy and check they have safeguards in place to protect allergic children and deal with a reaction, if it happens.
  • Booking a holiday? What’s the airline’s peanut policy? Do I need a GP’s letter to carry my son’s EpiPens onboard? Does the resort have a supermarket where I can buy safe foods? Where’s the nearest hospital? Do I know the emergency number for calling an ambulance and can I report “anaphylaxis” in the local language?

Saying that, despite his peanut allergy, as a parent, I want him to have as normal a childhood as possible. Yes, we have to be careful. However, I feel strongly that his allergy shouldn’t prevent him from going to, for example, parties, playdates and restaurants. Although it may require more planning and organisation, I don’t want him to be deprived of those experiences. We just have to figure out a safe way of achieving them.

Eating out with a nut allergy

Going to a restaurant can often feel like a fairly daunting prospect. As tourists in Keswick one lunchtime, the thought of going into a café or tea room and having the “nut chat” (the conversation with the manager where I ask if they can cater for my son) just felt too exhausting a prospect. We ended up buying supermarket bread rolls and a packet of ham and sitting on a bench eating a bland, makeshift picnic.

What would have made things easier for us that day? Maybe if we had spotted a chain restaurant which had a reputation for being allergy friendly, or if one of the cafes had a sign outside saying “Dietary requirements? Just ask!”? I’m sure that would have lured us inside and we might have forked out £10 a head, rather than a few pounds between us for bread and ham.

The perfect eating out experience?

One of our first attempts at eating out post peanut allergy diagnosis was at our local Pizza Express. Having explained about my son’s allergies to the waitress, she told me that one of the chefs had a severe nut allergy, having recently suffered anaphylaxis to some soft cheese which contained nuts, unbeknownst to him. Although you wouldn’t wish a food allergy on anyone, that was music to my ears. If anyone was going to “get” the need to serve my son a nut free dish, a nut allergic chef would.

So, short of there being a nut allergic chef, here are my suggestions for restaurants as to what would happen on an ideal visit:

  • No blagging! Firstly, I should say that if you genuinely CAN’T cater, please say! I’d much rather be told “we’ve got a tiny kitchen and there are nuts everywhere” than someone say “yeah, yeah, yeah… no problem” and then serve my son something that isn’t safe.
  • Website allergy info. Wherever possible, I will research restaurants online before venturing out. My eyes will light up if I see a statement along the lines of “Please talk to us about any food allergies, full information is available”. A downloadable allergy guide, detailing which dishes contain which allergens, is also extremely useful. Although this would only cover intentionally added ingredients and I would still need to talk to the restaurant about cross contamination, the fact there is an allergy guide hints that the restaurant is alert to its allergic customers.
  • A confidence inspiring greeting. On arrival at a restaurant, my stock opener is “my son has a severe nut allergy, is this something you can cater for?”. The most confidence inspiring response I can receive to this would be “Yes, many of our dishes have no nuts in the ingredients and we are well used to cooking for people with allergies. Come in, and I will ask the manager / chef to come and talk to you.”
  • Recommending a safe option. When we talk to the manager or chef, I don’t expect them to say that every item on the menu can be made nut safe (although obviously it would be fantastic if that were the case). I think it’s perfectly reasonable to tell me, for example, “these dishes are fine, but avoid anything made on the grill”, if that’s where there’s a risk. If we’re only offered one or two nut safe options, I am grateful… even if it means my son eating pasta and tomato sauce for the 50th time running.
  • Reassure me about cross contamination! After we’ve identified a nut free meal, I need some reassurance on how that will be prepared. It’s fine to tell me “we can’t guarantee that any food is 100% nut free”. One manageress explained that whilst there were nuts in the kitchen, these were kept in sealed containers and that my son’s meal would be prepared in a separate area. I was reassured. I’m happy if you tell me (1) there are no nuts in the ingredients and (2) you understand the need to use fresh pans and utensils and everyone will know that nuts must not come anywhere near this meal.
  • Then keep reassuring me… When we get to the point of placing an order, in the most confidence inspiring restaurants, the wait staff will tell me (before I’ve had a chance to ask!) that they’ve made a note of my son’s allergy on their pad. Once our order has gone into the kitchen, I’m really appreciative when our waiter comes back over to us and says something like “the chef knows about your son’s nut allergy and that the [tomato pasta] needs to have no nuts”.
  • Nut free desserts? When it comes to ordering dessert, if the waiter/waitress recommends a nut free option without me having to ask (or even comes over and says “I’m sorry, there are no nut free dessert options”), that makes me feel like the restaurant is on the ball and is still keeping my son’s allergy in mind.

Our experiences of eating out with a nut allergy have certainly varied. All too often, on entering a pub/restaurant/cafe, we’re met with an expression of raised eyebrows teamed with puffed out cheeks then a nervous comment which tells me they’re not willing to cook for my son. We then need to search for somewhere else or my son eats a packed lunch whilst everyone else tucks into a restaurant meal.

However, on those occasions where an eatery can provide a safe meal and their service does inspire confidence, I am incredibly grateful and will go home and sing their praises on Nutmums.com and social media. That nut allergy friendly restaurant will then become a regular haunt and the place I recommend when family or friends are thinking about arranging a get together.

How things might improve from December 2014

At present, if a prepacked food or alcoholic drink contains one of the top 14 food allergens (or an ingredient made from one of them), this must be declared on the label. The “top 14 allergens” include peanuts and, separately, nuts. At present, allergen information does not have to be provided for foods sold loose and when eating out. However, this is about to change.

On 13 December 2014, the EU Food Information for Consumers Regulation will require cafes and restaurants to provide information on food allergens. This could be done in writing (for example, on a menu or a blackboard) or the information could be given verbally by a member of staff. So, if I go into a restaurant, they should either be able to tell me which dishes contain nuts as an ingredient, or point me to where the allergen information is written down.

Whilst the new rules are an improvement in that restaurant staff will not be able to simply shrug and claim not to know what a dish contains, they unfortunately only cover ingredients which have been intentionally added to the recipe. They do not cover accidental cross contamination. So a restaurant will still be able to say “that pizza doesn’t have any nuts in the ingredients… but our kitchen is tiny and there are nuts everywhere!”. We will still have to have the “nut chat” on arrival, to seek some reassurance that they understand cross contamination.

Even without addressing cross contamination statements, the new regulations mean all cafes and restaurants are forced to think more about allergens, and therefore hopefully in turn become more allergy aware generally. I think a likely key factor in the legislation’s success is the extent to which consumers demand the allergen information to which they are entitled. If we report those restaurants who continue to meet requests for allergen information with a shrug and a “dunno”, then standards are likely to improve.

In summary? The new rules are a welcome step in the right direction to make eating out with an allergy a safer, and therefore more relaxing, experience.

Biography

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Children’s parties can be daunting events for parents of food allergic children. You might get lucky and have a trustworthy, clued up host, who happily agrees to make sure everything is safe for your child. Or you might have to prepare a replica party tea, minus allergens, for your child to take along. And if the worst comes to the worst, you can give the food part a miss altogether. But surely, when it’s YOUR child’s party, you can feel more relaxed, safe in the knowledge that you are in control of the food? Well, maybe not, if you are hiring a venue…

I read a blog post by a fellow allergy mum recently, which left me feeling terribly vexed. In short, she was investigating party venues for her son’s 3rd birthday. She asked a local museum, who offered children’s party packages, whether she could hire the space but provide her own party food. The museum’s response was that she would need “£2 million public liability insurance as well as references for 2 previous grade 1 listed venues that [she had] provided catering for”. Given this was clearly impossible, she provided the venue with some suggestions for safe foods for her child, and was met with the response that the museum could not provide catering on this occasion. (For the full story, see the post No dairy – no party? part 1 on the AllergyBabe blog.)

As well as feeling indignant at the injustice of a food allergic 3-year-old being denied a birthday party, I also wonder whether such policies could be discriminatory and open to legal challenge?

I’ve blogged in the past about whether it is possible to claim disability discrimination for a nut allergy. In short, the Equality Act 2010 (EA 2010) protects people from discrimination on the basis of certain “characteristics”, one of which is “disability”. In Wheeldon v Marstons, an employment tribunal, at a preliminary hearing, held that a chef’s severe allergy to nuts was a “disability” under the EA 2010. If this becomes settled law, businesses (as goods, facilities and service providers) could then also have a responsibility not to discriminate against someone with a severe nut allergy. In my view, this could force restaurants to “reasonably accommodate” nut allergy sufferers by providing at least one safe menu option and also, for example, make nightclubs reconsider their “no EpiPens” policies.

If a children’s party venue refuses to cater for a food allergic child, isn’t that also an example of disability discrimination? If you are “open for business”, don’t you have to be open for business to ALL? Take the example of the Christian B&B owners who turned a gay couple away from their guesthouse: if you are running a business you can’t apply discriminatory policies to pick and choose who you serve. In my view:

  • IF severe allergy is a legal “disability” under the EA 2010, then
  • A party venue that refuses to cater for a child on account of their allergies (or imposes impossible to meet criteria, having the same effect) amounts to disability discrimination.

Hopefully at some point someone will bring a test case against a restaurant/nightclub/party venue/similar and this point will be clarified for the food allergic community, so people will know the level of service they are legally entitled to expect.

I’m about to start researching venues for the Manchester Allergy Support Group children’s social event (more details to follow in the New Year). I will certainly report back as to any obstacles I come up against. However, if anyone else has encountered similar issues when trying to book a children’s party, do post a comment below – I would love to hear from you!