• There is no common definition of food allergy (as opposed to sensitivity or autoimmune disorder) and there should be.
• Despite elimination diets being the main treatment at this point in time, there is only one study of their effectiveness.
• Food allergies affect more than 2 percent but less than 10 percent of population.
• Breastfeeding, hypoallergenic formula, and probiotics can all help allergic infants have fewer symptoms.  Breastfeeding has the strongest effect, and there is a positive effect of maternal dairy product elimination for dairy allergic infants.
• There is no evidence of  any effect of maternal elimination diets during pregnancies.  (So you can stop feeling guilty about that peanut butter fudge ripple ice cream cone you kept craving.)
• The Top 8 Food Allergens = 50 percent of reactions (as opposed to 90 percent, which you will often read). This means people with “weird” allergies, like barley or celery, are a lot less “weird” than their doctors may lead them to believe. 

Chafen JJ, et al. Diagnosing and managing common food allergies: a systematic review. JAMA. 2010 May 12;303(18):1848-56.

Screen shot of the new Ap from Vistadec Inc.

I’ve been wanting this ap to be created for some time.  Now I can’t wait to try it out.

According to the manufacturer, you should be able to scan barcodes using your smartphone camera, and the program will have a personalized allergy alert for you. 

It is unclear if the app will search for less common allergens, or only the Top Eight plus sesame.

For more information, see My Food Facts.

(Now if only they could link this to the handheld scanners already in the grocery store…)

A word of caution.  One of the many, many brands was actually given to us by the GI clinic at our local children’s hospital.  The bottle said it was soy free.  The nurse had researched it and called the company who swore that it was soy free.  Gave it to my daughter, she had a reaction.  I called the company.  They swore that their Vitamin E was not based on soy, and after much questioning they gave me the name of the company that supplies their Vitamin E.  Five minutes on google established that the supplier’s Vitamin E was in fact made from soy.   I called the vitamin company back and told them this and they said “Well, we can’t keep track of all the ingredients from all of our suppliers.”  REALLY??  You can’t??

Sometimes no matter how much we research a product, it is not enough.

However, I am happy to report that we’ve found a new allergy free kids vitamin that actually seems to be, well, allergy free.  I can’t guarantee that it will work for everyone, but so far so good with us.  The only problem with them is they have no iron in them.   For that we use Kirkmann capsules — they make tiny, easy to swallow ones that are only 5 mg of iron.

Yummi Bears Organics — free of top 8 allergens, GF/CF, and no coconut or palm oil!  Also, they use vegetable based food coloring — may not be appropriate for folks who are allergic to those veggies, but good for kids who are sensitive to dyes.  Best of all — my kid actually likes them! 

http://yummibearsorganics.com/

1 pint cherry or grape tomatoes, sliced in half

2 cups fresh or frozen (thawed) corn, off the cob

1 Tablespoon minced fresh cilantro (or if you don’t have any, substitute parsley)

5 slices bacon, cooked until crispy and crumbled

juice of 1 lime

1 clove garlic, minced

2 teaspoons olive oil

a few grinds of black pepper

Toss together all ingredients.  Serve immediately.  Or, if you want to make ahead, toss together and refrigerate everything except the bacon overnight and make and add the bacon before serving.

1 Tablespoon olive oil

3 red potatoes, diced

1 spring onion, white and green parts, sliced thinly

1 clove garlic, minced

1 cooked chicken breast, cubed

1 lb asparagus, snapped into 2-inch lengths

juice of 1/2 lemon

1/2 teaspoon thyme

salt and freshly ground black pepper

Heat olive oil over medium high heat in large skillet (I used nonstick, but a well seasoned cast iron pan would also work.)  Add potatoes and spread into an even layer.  Saute until golden around the edges, about 15 minutes.  Stir in white part of onion and garlic.

While the potatoes are frying, prep the vegetables and chicken breast.

Pour 1/4 cup water into the pan and cover with a loose lid.  Allow potatoes to steam for 5 – 10 minutes until tender.  Add chicken, green part of onion, asparagus, lemon juice, and thyme.  Cover again and steam for 3-5 minutes, until chicken is warm through and asparagus is bright green and toothsome.  Add salt and pepper to taste.

3/4 cup fresh orange juice (about 3 oranges)

1 12-ounce package fresh cranberries, washed

1 Tablespoon grated orange zest (Grate an orange before squeezing.)

Combine sugar, orange juice, and cranberries in a saucepan.  Bring to a boil over medium-high heat, stirring occasionally.  Reduce heat to medium and simmer until cranberries pop.  (About 10 minutes)  remove from heat, stir in orange zest.  Cool completely.  Serve chilled or at room temperature.

Can be made up to three days ahead and stored, covered, in the refrigerator.

Norman Rockwell

You don’t have to “make do” this Thansgiving.  You can have a fabulous dinner with not too much work, while still avoiding your allergens.  Now that’s really “freedom from want.”

Thanksgiving Dinner Menu

Butternut Squash Soup

Sage and Shallot Roasted Turkey

Mashed Potatoes

Wild Rice with Butternut Squash, Leeks, and Corn

Green Salad with Diced Granny Smith Apples, Dried Cranberries, and Pumpkin Seeds

Steamed Green Beans Tossed with Caramelized Onions

Mini Corn Muffins with Maple Butter (a whipped maple syrup spread that is dairy free)

Cranberry Sauce

Apple Crisp – toss in 1/2 cup of dried cranberries for some festive color

5 – 6 fresh sage leaves

1/4 cup Italian parsley

1 teaspoon salt

few grinds of black pepper

2 tablespoons olive oil, divided

Your turkey of choice

1 onion, peeled and split in half

1 apple, cored and cut in quarters

Mound first five ingredients together on a cutting board.  Using a large chef’s knife, mince together all ingredients until finely minced.  Drizzle 1 tablespoon olive oil on top and mince a few more times to incorporate and turn mixture into a thick paste.

About one hour before you put the turkey in the oven, carefully lift the skin on the breast and use your fingers to gently create a pocket of air between the skin and the breast meat.  Stuff herb mixture under skin.  Let turkey rest so salt can carry flavors into the meat.

Place onion and apple into cavity of turkey.

Roast turkey using your favorite technique (I like Alton Brown’s) or follow roasting instructions on package.

When temperature in thigh reaches 165 degrees, remove from oven and let rest for 15 minutes before carving.  Remove and discard apple and onion from cavity.

2 teaspoons coarse kosher salt

3 cups peeled cubed butternut squash (from 11/2-pound squash)

5-6 cloves garlic, peeled

3 tablespoons olive oil

1 1/2 cups finely chopped leeks (white part only)

1 1/2 cups frozen white corn kernels, thawed

1 tablespoon chopped fresh Italian parsley

Preheat oven to 350°F. Oil rimmed baking sheet. Toss squash cubes, garlic and 2 tablespoons oil in a 9 by 13 baking pan.  Roast until squash begins to brown around the edges, stirring occasionally, about 45 minutes.

While squash is baking, rinse rice in strainer under cold water; drain. Bring 6 cups water and 2 teaspoons coarse salt to boil in large saucepan. Add rice; bring to boil. Reduce heat; simmer uncovered until rice grains begin to split and are tender but still slightly chewy, about 45 minutes. Drain.

Heat remaining tablespoon of oil in a large saucepan over medium heat.  Add leeks and 3/4 cup water; simmer until leeks are tender, about 7 minutes. Fish out garlic cloves from squash and smash them into the leek liquid with the back of your spoon against the side of the pan.  Stir.  Add corn; simmer 2 minutes longer. Add rice and butternut squash; simmer until heated through and liquid is absorbed, about 4 minutes. Stir in parsley.  Season with salt and pepper. Transfer to bowl and serve.

(The rice and squash may be cooked ahead of time and refrigerated overnight.  It makes sense to roast a double batch of squash and then use the extra to make butternut squash soup.)

Adapted from a recipe by Nancy Oakes and Pamela Mazzola, from Bon Appetit, Nov 2008.

Not much specifically, butthey have a lot to say about health insurance, which affects all of us, especially those of use with higher health care needs.  Unfortunately, trying to figure out what all the political rhetoric actually means can be difficult.  I’ve turned to The Urban Institute, a non-profit, non-partisan research institution for an in-depth analysis of how the different plans will play out.  I’ve highlighted the information that is relevant to those of us living with and managing chronic illnesses, such as food allergies.  (If you’d like to read the full text of the Urban Institute report, see the link below, or check out each candidate’s web site for the full text of their health plans.)

The bottom line:

Sen. McCain’s health care plan would “make insurance less affordable and accessible for those with high health care needs” according to The Urban Institute.  The McCain plan would require more people to purchase insurance in the “non-group” market — that is, insurance that is not provided by an employer.  For people with a chronic illness, such as food allergies, this is potentially a problem.  Most states allow non-group insurers to deny coverage to people who are considered to have a high risk status (as in, having a known chronic illness.)  Sen. McCain proposes to solve this problem by funding state-sponsored “high risk pools” — insurance for those who are unable to find coverage in the private market.   However, about a third of all states do not have high-risk pools, so this option would simply not exist for residents of these states.  For residents of states with high-risk pools, high-risk insurance may simply be unaffordable.  McCain’s proposed funding for this system is not enough to cover the projected costs.

Sen. Obama’s health care plan is clearly better for people managing food allergies.  It would increase health insurance coverage so that all children in the United States would be covered.  Sen. Obama’s plan would the plan would prohibit insurance plans from denying coverage to applicants based on health status — meaning that people with chronic illnesses, such as food allergies, could not be denied health insurance because of their illness.  Sen. Obama’s plan would also make insurance more affordable for people with chronic illnesses, since it would require insurers to pool the risk of all the insured, rather than segment them into higher-risk or lower-risk pools.  (See below more my attempt to explain risk segmentation in English.)  In short:

“The Obama plan would ensure that every American citizen had a guaranteed source for purchasing or otherwise obtaining health insurance coverage, a situation that does not exist in the vast majority of states today.”                

  –The Urban Institute:  An Analysis of the Obama Health Care Proposal (with my emphasis added)

In addition, Sen. Obama’s plan focuses on the management of chronic conditions as a key to keeping health costs down and improving health outcomes.  (It’s a no-brainer to those of us who are managing chronic conditions that we spend more on health care.)  He proposes increased funding for research and education on chronic diseases.  Since allergies (food and environmental) are the most frequent chronic illness in children (according to the Allergy and Asthma Foundation), we can hope that this agenda will translate into more funding for fighting childhood allergies.

What is risk segmentation and why should I care?

Insurance works by pooling risk — you get enough people together and each of them pay a little bit of money into a pool, and then if any one of them needs the money (because an anvil falls on their head, for example, and they need to go to the hospital) the cost is spread around.   The way insurance should work is that those who are less likely to need a payout at any given time keep paying into the pool, because at some point in them they may become more likely to need the money.  (You never know when you might get hit by a falling anvil.)

The McCain plan would create a system of market segmentation in which the people least likely to need a health insurance payout (young, healthy people without chronic illnesses) would be put in a separate “segment” or risk pool and charged differently than those who are more likely to need a payout (older people and/or people with chronic illnesses.)  Some people who are very likely to need payouts from their insurance would not be able to buy it at all. 

Car insurance companies do this in a way — they raise your premium after you have an accident, if it is your fault.   If you have too many accidents or speeding tickets, you might get dropped from your insurance carrier.  But health insurance is different -  it is not risky behavior or poor decisions on your part that cause you to have food allergies.  Imagine if every time you needed to buy an epi pen ($110, with coverage!), your health insurance went up.  Imagine if your child was hospitalized for three days and the hospital bills were $45,000 (a not unreasonable amount these days) — and that the next time your health insurance came up for renewal, your premiums doubled.  Or your family was dropped from coverage and you were told to try to get insurance from your state’s high-risk pool. 

Risk segmentation is a very bad idea for those of use who are managing chronic illnesses.

So if I or someone I love has food allergies, who should I vote for?

No question about it, you should vote for Obama.  His plan is much more likely to ensure that you keep your health insurance, and that it remains affordable, whether or not you need it.   It is also more likely to translate into increased funding for research on food allergies, education about allergies, and a revamped health system that focuses on managing chronic disease.

Can you immagine an America where every child is covered by health insurance?  I can’t, actually.  But I’d like to live to see it.  

Run, don’t walk to your local polling place this year.  Don’t forget your epi pen. 

Sources:

The Kaiser Family Foundation:  Health 08

The New York Times:  On the Issues:  Health Care

The Urban Insitute analysis of 2008 health care proposals

Association of Health Care Journalists

Asthma and Allergy Foundation: Allergy Facts and Figures