Allergic Living Summer 2012_CANADA by Allergic Living

HOW TO STOP TOXIC MOLD • GLUTEN’S LINK TO MIGRAINES ALLERGIES, ASTHMA & GLUTEN-FREE

Allergic Nanny Jo: My Allergies Require Discipline!

Living SUPER SUMMER RECIPES

TV’s parenting guru on allergy attitudes, food bullying and her new show

TURBULENCE OVER NUTS IN THE SKIES ‘I CAN REALLY BREATHE’ – THE JOY OF ASTHMA CONTROL

CELIAC & YOUR LOVE LIFE If your libido is lacking, gluten may be to blame

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contents ALLERGIC LIVING SUMMER 2012 • VOLUME 8, ISSUE 2

COVER STORY 16 This Allergic Life

TV parenting expert Jo Frost, aka Nanny Jo, is disciplined about controlling asthma and severe food allergies. BY GWEN SMITH

Features 12 I ‘Thought’ I Had Control Real-life stories of how four adults finally got to breathe freely.

BY CLAIRE GAGNÉ

24 Celiac & Your Sex Drive Allergic Living talks about a symptom that’s kept hushed up. LISA FITTERMAN

34 Flying Into Stormy Skies Inconsistent policies and bad treatment are driving foodallergic travellers nuts. BY GWEN SMITH

37 Currents CNRC experts on camping with asthma, handling a heat wave and soothing tiny noses.

48 What My Kids Taught Me As An Allergist She had all the medical training, but when her own son was diagnosed with food allergies, her world crumbled.

BY SARAH BOUDREAU-ROMANO

Return undeliverable Canadian addresses to Allergic Living magazine, 2100 Bloor Street West, Suite 6-168, Toronto Ontario M6S 5A5 Publication Mail Agreement # 41156507

CONTENTS

Environmental Allergies Notables 6

Editor’s Letter

Beach Party

29 Healthy Home

Picnic gear for the allergy-safe outing; our editors’ top sunscreen picks.

Got mold? We’ve got the scoop on how to rid it from your home. BY JENNIFER VAN EVRA

Road Trip! Snacks that are perfect for your summer car cruise.

10 Allergic Diva Pamela Lee tackles sensitive teenage skin.

11 Cool Finds The air purifier for your car; the nut-free e-book for your Kindle.

Columns 11 Ask the Dermatologist Dr. Sandy Skotnicki explains the health issues surrounding parabens.

20 Ask the Allergists Questions on: milk allergy and growth, mustard reactions, testing whether allergies are outgrown and when to worry about an insect sting.

23 Hot Topics 41-43 Allergy News Millions of us have food allergies; why the Amish don’t get asthma; and Canada’s first gluten-free certified product.

Laurie Harada explains what you need to know about the new food allergy labels, coming in August.

Allergy-Safe Food 52 Best of the Med

58 Our Story By jumping out of a plane my daughter showed me the importance of enjoying life, even with allergies.

Chef Simon brings an allergyfriendly, gluten-free twist to the deliciously healthy Mediterranean diet. With recipes from sesame-free hummus to spaghetti with capers and chicken wings. BY SIMON CLARKE

Living Gluten-Free 33 Celiac Expert Shelley Case shares her favourite gluten-free reads for summer.

45 Strawberries ’n Cream Watermelon Pops Strawberries and watermelon are paired for a tempting dairy- and gluten-free summer treat. The secret? Coconut cream.

ON THE COVER Photo by Jeff Newton Hair styling: Tab Salsman Makeup: Lindsay Lowe Shot on location near Los Angeles, California

BY ALISA FLEMING

45 ALLERGIC LIVING | SUMMER 2012

EDITOR’S NOTE | GWEN SMITH

Flying: Let’s Talk ome people are a pleasure to interview since they’re full of positive energy, good humour and can-do spirit. Jo Frost, who became famous as television’s Supernanny, is what we in the journalism biz call “a good talker” – lively, talkative, engaged in life. There she was, telling me all about her asthma and allergies and how she manages them while living in other people’s homes for her TV work. (See “This Allergic Life,” page 16.) Then quite inadvertently, I hit a nerve. I simply asked: How does she find accommodations for allergies these days? Her answer turned into a blistering tale of poor treatment on a flight when Frost asked a flight attendant if it was OK to ask people sitting near her in the first-class section not to eat nuts. Frost, who is severely allergic, was told absolutely not or she’d be asked to leave the plane. “It was like it was this self-indulgent fad, as if I’d invented it to maintain some kind of attention-seeking. It was absolutely awful,” said Frost. As it happened, I was already writing an article for this issue (“Flying Into Stormy Skies” page 34) about the growing chorus of unhappy tales when it comes to North American airlines and nut- and peanut-allergic passengers. Frost had another story in a recurring theme: customers feeling that many airlines are not on their side when it comes to accommodating nut allergies in particular (there has been some progress on peanuts). I can tell you from the personal experience of having a flight cancelled and being hurriedly put on a U.S. carrier’s plane (with no time to check allergy policies) that it is unsettling to see an allergen that can kill you being passed out to every other passenger at 35,000 feet. (In my case, it was peanut snacks.) I’m usually calm about not expecting a problem unless I eat an allergenic food, but I felt hyper-aware of the chomping all around me. How much residue was everywhere? What if I needed to use the washroom? The airlines are very attached to serving tree nuts as a premium snack. But come on folks – it’s a snack, alternatives could be considered. What about the health and safety of nut- and peanut-allergic travellers – most fatalities are caused by the ingestion of either of those allergens – and what about their comfort? Most of us in the allergy community aren’t even calling for outright bans, we’re just asking: could we forego these allergenic snacks on flights we’ll be on if we give you advance warning? It concerns me that we already have three studies about the issue of whether allergic reactions are happening in-flight and the answer is that, yes, they are. In a 2009 study, one in three of the reactions reported by passengers showed the symptoms of anaphylaxis, the severe form of reaction. Plus, there are numer-

6 ALLERGIC LIVING | SUMMER 2012

ous anecdotal passenger reports of reactions. It’s time all major airlines took a look at this issue, let’s not wait for a tragedy. Airlines still pride themselves on customer service, and with 17 million North Americans with food allergies and their family members affected, that’s a lot of passengers with the same issue. It’s time to open a dialogue about how we make this vulnerable population feel safe when they’re just trying to travel like everyone else. Allergic Living would like to get that conversation rolling. Tell us your stories of travelling with food allergies. Have you had a reaction? Felt at risk? Been asked to get medical clearance? We’re collecting these stories editor@allergicliving.com to share with select airlines. And meantime, my advice is to try to choose an allergy-aware airline when possible. To assist you, our editors have built a thorough resource – the “Comparing Airlines” chart at www.Allergicliving.com/airlines, which details the allergy policies of 12 airlines. I wish you safe journeys this summer. Just be sure to confirm accommodation practices ahead of time – and bring food, auto-injectors and lots of wipes.

Tell Us Your Views Online! Visit Allergicliving.com Facebook.com/Allergicliving and see us on Twitter.

Photo: GEOFF GEORGE

Gwen Smith Editor

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SUMMER 2012 VOLUME 8, ISSUE 2 www.allergicliving.com

Gwen Smith EDITOR

Giselle Sabatini ART DIRECTOR

Get the Best Coverage of Allergies & Celiac Disease

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Erin Stevenson WEBSITE COORDINATOR

Susan Clemens WEB FORUM MODERATOR EXPERT CONTRIBUTORS

Dr. Susan Waserman, professor, Division of Allergy and Clinical Immunology, McMaster University; Dr. Wade Watson, Professor of Pediatrics, Dalhousie University and head, Division of Allergy, IWK Health Centre; Dr. Paul Ehrlich, president, New York Allergy & Asthma Society; Dr. Scott Sicherer, chief, Division of Allergy and Immunology, Mount Sinai School of Medicine; Dr. Sandra Skotnicki, dermatologist, Sunnybrook & Women’s College Hospital and St. Michael’s Hospital; Shelley Case, RD; Laurie Harada, Executive Director, Anaphylaxis Canada CONTRIBUTING WRITERS & ARTISTS

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ALLERGY SHOTS

Beach Party We’ve got the fashionable picnic gear that’s just perfect for your allergy-safe or gluten-free picnic by the water. Have a fabulous day! –Jenny Kales

Picnic Perfect

Go Green

Crate and Barrel

Enjoy a family outing with the colourful Collapsible Picnic Basket from Crate and Barrel. The insulated bag folds flat for storing and is waterproof, PEVA-lined and PVC-free. $34.95 / 47 cm W x 29 D x 26.5 H. See www.crateandbarrel.com.

Retro Chic

Chill Out

The 1950s-inspired Picnic Cooler from Crate and Barrel may well be the coolest on the beach. Roomy and easyto-carry, this steel tote sports a locking handle, bottle opener, and chrome accents and shiny finish (reminiscent of a classic car). $62.95 / 36 cm W x 23 D x 30 H. See www.crateandbarrel.com.

Keep your favourite free-from foods cold (or hot) with Vacuum Insulated Food Jars from Thermos. The portable size is perfect for a picnic tote. With their sleek stainless steel designs and two convenient sizes, you’ll want to take these versatile jars everywhere. BPA free. $29.99/290 mL and $32.99/470 mL in stores. See www.homehardware.ca.

SUNNING SAFELY

GOOD SCENTS

KID FRIENDLY Delicate skin is shielded with Kids’ SPF 60 Moisturizing Lotion from Ombrelle, allowing kids fun in the sun with a formula that’s hypo-allergenic, fragrance-free and nut-free. This gentle waterproof sunscreen uses sunscreen filters that provide a strong defence against harsh UV rays. $17.99/250 mL in drugstores nationwide. See www.lorealparis.ca.

8 ALLERGIC LIVING | SUMMER 2012

You’ll love the eco-friendly Newberry Picnic Basket from Picnic Time. Tucked inside the lined, plaid interior of this willow carrier is a reusable dinner service for four, a corkscrew and salt and pepper set. Just add gourmet goodies. $129.95 See www.picnicworld.net.

SENSITIVE SIDE Keep the sun in check with Sensitive Skin SPF 60 Sunscreen from Vanicream. This PABA-free and non-irritating sun defence protects and moisturizes ultrasensitive skin without chemicals, fragrance or preservatives. Free of gluten and nut oils with UV blocking from zinc oxide. $29.99/ 113 g at www.allergycanada.com.

While lounging at the beach, protect your skin with Natural Very Emollient Sunscreen in Pure Lavender SPF 45 from Alba Botanica. This lightly fragranced, organic, UV-blocking formula soothes and moisturizes with natural elements like green tea extracts, aloe and chamomile. Plus, it’s waterproof, gluten-free, peanut-free and 100% vegan, with no parabens or PABA. $14.05/113 g. See www.canadaonly.ca.

ALLERGY SHOTS

ROADTRIP! Crank up the tunes and check out some of our favourite allergy-friendly, GF snacks for your summer driving adventure. –Jenny Kales

Hot Potato

Lentil Love

Chee-Cha Potato Puffs allergyfriendly air-puffed snacks are loaded with potato flavour and satisfying crunch. Plus they’re nutfree, gluten-free and dairy-free with no trans fats or GMOs. Enjoy six savoury varieties in a convenient new single serving size, including Sea Salt and Spiced Pepper and Smokey Barbecue. $1.25/20 g. In select stores and online. See www.cheecha.ca.

New this summer, Plentils from Enjoy Life Foods get their crispy texture and savoury flavour from a heart-healthy blend of lentils, rice and potato starch. Available in four taste-tempting varieties including Garlic and Parmesan and Dill and Sour Cream, Plentils are gluten-free and free of the top 11 most common food allergens. $4.29/113 g. In select stores as of June 2012. See http://plentils.com.

Tasty Twist

Gourmet Grains

Gluten-free Ener-G Wylde Pretzels are made from an appealing blend of potato, corn and rice flour for yummy taste and texture. A great takealong treat, they’re also free from dairy, wheat, soy, peanut, tree nut and egg. May contain sesame. $2.19/113 g in select stores, see www.ener-g.com.

A scrumptious spin on the traditional chip, Gourmet Brown Rice Crisps from Riceworks have a crisp crunch from being baked, and then fried in fat-free sunflower or safflower oil. Free of gluten, wheat, peanuts, tree nuts and eggs and made from a wholesome brown rice base. Five flavours including Salsa Fresca and Parmesan. Contains sesame. $2.99/ 156 g in stores nationwide. See www.riceworks.ca.

Cute Fruit Satisfy your kids’ craving for sweets with healthy Mini Bites from SunRype. These gluten-free, all-natural snacks have no added sugar or additives, and they are free from peanuts, tree nuts, soy, eggs and dairy. Convenient mini-pouches are just the right size for the car; choose from Strawberry, Mixed Berry and new Plus Veggie Raspberry Orange. $3.49/170 g in stores. For retailers, see www.sunrype.ca.

FREEZER BLAST Fun for kids of all ages, the Stealth Rocket Lolly from Chapman’s just seems to shout “Summer!” This allergyfriendly frozen treat has no artificial colour or flavour, plus it’s free of gluten, peanuts and tree nuts.

The 18-pack includes Peach, Lemon Lime and Grape flavours. $4.49/18 (75 ml) lollies. In stores nationwide; see www.chapmans.ca.

ALLERGIC LIVING | SUMMER 2012

Sensitive Solutions

ALLERGY SHOTS

the

allergicdiva to the rescue of teenage skin

Don’t let the fact that Sudocrem is marketed as a diaper cream deter your teen; it is great for eczema and acne, acting as a protective barrier and keeping moisture within the skin. Use it for trouble spots on the face and body. $7.99-$8.99/125 g at pharmacies. For ingredient questions: 1-877-957-2229

by PAMELA LEE y whole family is atopic. I wish that meant we stick to one subject at the dinner table, rather it means we experience the gamut of allergic disease: from asthma to hay fever, anaphylaxis to eczema. Adolescent skin problems have plagued my two boys, particularly Nick. His eczema-prone skin was awful when he was a baby, manageable while he was school-age, and has returned with a vengeance. Bits of him are dry and flakey; other bits are red, weepy and unbearably itchy. Add acne and the need for hygiene and finding suitable products becomes harder and harder for teens like him with sensitive, allergic skin. When looking for products for teenage girls or boys, it’s important to test a small area of non-sensitive skin to make sure the product will not cause a reaction, which can endure for weeks or even months. Reasearching this subject, I brought Nick along to a natural pharmacy that sold a range of beautifully packaged creams and lotions, hoping to find the right treatment. No such luck for him, as his skin is a difficult case, but following are products that have had success in treating or protecting allergic teenaged skin. Here’s hoping your teen will find his or her skin-care answer among them. As labeling law for cosmetics isn’t as stringent as for food, I’ve included phone numbers to call to check ingredients.

TIP: Ask a store whether it’s possible to get a small amount of a product to patch test – before you purchase a whole jar or bottle.

10 ALLERGIC LIVING | SUMMER 2012

British-based Simple passed the Allergic Diva skin challenge with flying colours and I’m sure it will work for your teen, too. Products in this wide and reasonably priced ($7.99-$17.99) line include Moisturizing Facial Wash and Vital Vitamin Day cream with SPF15. There are no dyes, perfumes or harsh irritants. Cleansing Facial Wipes are a convenient way to keep skin clean and moisturized after a workout. At retailers across Canada. 1-866-752-4602

The Seaweed Bath Company uses seaweed and natural oils in their products. Try their Wildly Natural Seaweed Powder Baths ($19.89 US/476 g) for a therapeutic soak when your teen’s having a flare-up and Wildly Natural Seaweed Butter ($12.89 US/56 g) as a spot treatment to soothe and heal irritated skin. Your teen can stash the butter in a purse or backpack to treat eczema as soon as it begins. Available at www.seaweedbathco.com. 1-877-317-3106

Teenage girls will love that Physician’s Formula’s new line for sensitive, red skin is clinically proven to make skin look healthier. It consists of: Redness Relief Cleanser ($12.97/142 g), Redness Correcting Moisturizer ($22.97/48 g), Redness Relief Moisturizer ($22.97/48 g), and Instant Skin Calming Spray, ($22.97/113 g). Available at Walmart. 1-800-227-0333

When you’re a teen, body scent is important. But harsh chemicals can irritate. Crystal Body Deodorants are made from mineral salts that prevent odour-causing bacteria by invisibly coating the skin. They cause no staining or residue. Available unscented in spray ($5.99/118 mL), roll-on ($5.99/66 mL), travel stick and towelettes. Available at www.thecrystal.com and at select drugstores. 1-800-829-7625 At VMV Hypoallergenics, hypoallergenic is a lifestyle. Your teen can send them skin patch test results and they’ll return a customized list of safe products. Red Better Flareup Balm ($50 US/25 g) and Red Better Daily Therapy Moisturizer ($34 US/120 mL) reduce redness, flaking and irritation. Skin The Bluff ($20 US) concealer hides breakouts. See www.vmvhypoallergenics.com. 1-212-217-2762

ALLERGY SHOTS

FRESH CAR SMELL hen pollen, smog and mildew get trapped in the small space of a car, that spells bad news for passengers with asthma or allergies. To the rescue: the Philips GoPure automotive clean air system, an affordable portable air purifier that boasts a three-stage air filtering process that eliminates harmful gases,

pollen, mildew, bacteria, smoke (never in the car!) and dust. It also removes that hazardous “new car smell” composed of toxic VOCs. The device mounts easily on a dash or seatback and the filter is a breeze to change. Just install and enjoy the ride. $199 US at Amazon.com. –Erin Stevenson

ask the dermatologist Dr. Sandy Skotnicki answers your sensitive skin questions. I’ve heard a lot about people with sensitive skin avoiding parabens. What is the issue with them?

Nut-free E-book Associate Editor Jenny Kales is well-known for her blog The Nut-Free Mom. Now Jenny has released a Kindle edition e-book called “The Nut-Free Mom: A Crash Course in Caring for Your Nut-Allergic Child”. It’s packed with terrifc advice and we highly recommend. $9.99 at Amazon.com

Parabens are the most commonly used preservative in foods and cosmetics. In beauty products, a preservative is used to help decrease the development of bacteria and fungus in your favorite cream or lotion. Any cosmetic or toiletry product that has a water component will need a preservative. Powders will not, and this may explain the heightened interest in mineral makeups. Contrary to what you’ll see on the Internet, the health concern with parabens is not a skin issue. Parabens are added so frequently because they are excellent preservatives, and because they cause a very low, low percentage of skin reactions, such as irritation or true allergy. Parabens are becoming increasingly controversial because they have been found in extremely small concentrations in some breast cancer tumors. Parabens can show an ability to mimic estrogen, the female hormone that plays a role in breast cancer. I must stress that this is a concern and has not been proven. The U.S. Food and Drug Administration has a policy statement on parabens that discusses their safety. (For more info, see: www.fda.gov and search “parabens”.) With skin care, there is a choice of chemicals that can be used to preserve a cream or lotion or makeup. Given that there are many preservatives that can do the job, many companies are choosing to avoid parabens until more studies are done on whether the estrogenic properties of parabens are a genuine health issue.

ALLERGIC LIVING | SUMMER 2012

‘I Thought I Had Control’ After years of strained breathing and missing out in life, adults with asthma discover the incredible freedom of disease management. by CLAIRE GAGNÉ

12 ALLERGIC LIVING | SUMMER 2012

Photo: KELLY KERR

s young as 4 years old, Eric Himan remembers not being able to catch his breath. At night, he would go see his grandmother – Himan was raised by his father and his grandparents after his mom died when he was very young. She would give him a “cough-syrup” type of medication and rub his back until he fell back to sleep. Himan’s father was in the military and when the boy was about 7 years old, the family moved to Hawaii. He clearly recalls stepping off the airplane and a lei being placed around his neck. “Within a minute I dropped to my knees because my chest hurt so bad,” he says. His family began screaming: “Get that lei off of him!” Today, Himan is 33 and an accomplished singersongwriter based in Tulsa, Oklahoma. He has seven studio releases under his belt and plays at bars and festivals across the country. Himan has always admired large, powerful voices – he’s a fan of Aretha Franklin and the Black Crowes – and his own voice is sweetly strong. But because of his asthma, getting his sensitive lyrics out with the strength and soul he wants is something Himan has had to work hard at; he pushes himself. His touring schedule is exhausting, and his asthma flares when he’s tired. Until recently, he would step

Eric Himan (left) is no longer singing the asthma blues; Kathy Anderson is back to cycling and all her sports.

away from his band in the middle of a show, hide, and take a puff from his inhaler. This changed however, when Himan learned his asthma could be better managed. “I thought it was under control,” he says. But he learned he was taking the reliever inhaler too often, and relying on it too heavily, especially to get through a performance. Himan’s situation is a common one. Many people “think” they have their asthma under control, until they learn what true control is. Sometimes that means seeing a specialist who teaches them that they’re reaching for the reliever inhaler too frequently. Often, patients are so used to symptoms – coughing at night, having breathing difficulty during exercise and even severe attacks that land them in the hospital – that they don’t even realize things could be better. This is why Dr. Paul Garbe, director of the National Asthma Control Program at the U.S. Centers for Disease Control and Prevention, says a key aspect to asthma control is “seeing a physician for the assessment of severity of your disease, so they can determine the right medications.” The next step is regular visits to that doctor so he or she can monitor your ability to control your disease by avoiding the triggers that bring on symptoms and taking your medications properly. As 60-year-old Kathy Anderson has learned, having lived with asthma for 58 years, asthma control is also a journey. Throughout her life, there have been many instances where she controlled her asthma, and just as many where asthma controlled her. Reflecting back on her childhood, she says, “it was a completely different disease back then.” She carried an “inhaler” – a seveninch glass tube with a hand pump on the bottom – with her to grade school, wrapped in a handkerchief and placed in a purse. “I had a permanent pass to skip gym class,” says Anderson, and as controller inhalers weren’t available back in the 1960s, she often took oral steroids. Her parents moved from Pittsburgh to Arizona when she was in the eighth grade, hoping the dryer climate would help, but even there she would land in the hospital twice a year. In one attack, both her lungs collapsed, and the doctors didn’t think she was going to make it.

Kathy Anderson ran into a perfect storm of bad health: a bacterial infection in her lung, exposure to a lot of mold on a trip, and she developed whooping cough. “I was pretty sick for five years.”

After college, Anderson moved to New Jersey and “this was when the medications started changing,” she says, and her hospital visits became infrequent. As she approached the age of 40, she became active, running and doing small triathlons. “I had 15 asthma-free years,” she says, “that coincides pretty much with the advent of the combined controllers.” Anderson is referring to medications that combine inhaled corticosteroids, which reduce inflammation, with long-acting beta-2 agonists, which open up the airways. But fast-forward to 2005, and Anderson’s asthma was thrown out of control in her mid-50s. Now living in Alaska, she experienced a “perfect storm” of health issues: she got a bacterial infection in her lung and then, to make matters worse, on a fishing trip she stayed in a damp lodge and was exposed to a lot of mold, her biggest trigger. That same year, she developed whooping cough. “I ended up pretty sick for about five years,” she says. Anderson’s asthma symptoms caused her lung to collapse regularly, and she had to abandon favourite activities: cross-country skiing, downhill skiing, running, kayaking and hiking. Her allergist sent her to see a specialist at National Jewish Health in Denver who treated the bacterial infection and prescribed Xolair, a medication that’s taken by injection for people with severe-persistent allergic asthma. Her symptoms have greatly improved, and she’s back to taking part in all her activities. Anderson credits modern medications for her asthma control. “Thank goodness for science, it’s made a tremendous difference in my life.” Modern medicine also gets the thumb’s up from Caitlin Harvey, a 27-year-old who lives just north of Montreal. Harvey was often sick with asthma as a child, and would visit the doctor’s office a few times a month for Ventolin treatments with a nebulizer. When she got older, she saw specialists at The Montreal Children’s Hospital, but the medication they had her on just never seemed to make a difference, and she gave up on it in her teens. “I thought I was doomed to spend my whole life waking up ALLERGIC LIVING | SUMMER 2012

coughing in the middle of the night or having someone haul me to the ER at all hours of the night because my rescue inhaler just never seemed to work,” she says. As a self-supporting college student, Harvey was prescribed a combination-drug Advair inhaler, but when she went to fill the prescription and saw the $100-plus price tag, she walked away. Aside from the cost, “I didn’t think it would actually work.” It wasn’t until Harvey was prescribed it again, this time covered under her soon-to-be husband’s drug insurance, that she finally started taking the medication. “I suddenly could breathe,” she says. Harvey stopped waking up coughing in the middle of the night, and she started exercising. Now the girl who was always lagging behind in gym class is a mother of three who takes karate classes and is enrolled in her first fivekilometre run. Her doctor has given her an asthma action plan, a set of written instructions that tell a patient when to increase the dose of their controller inhaler, or when it’s time to go to the hospital. Now Harvey self-regulates her asthma, increasing her dose when she feels a cold coming on, and whenever her symptoms are increasing. “It has been amazing,” she says. It’s this empowerment to manage asthma that Dr. Travis Stork, host of the U.S. television talk show “The Doctors” and a practising emergency room physician, believes is key in living with the disease in a healthy way. “Asthma is an illness that you need to get really good management of to prevent severe and potentially life-threatening attacks, and I think a lot of people may be naïve about what their triggers are. They might not realize that using their rescue inhaler two or three times a day means they don’t have the control they need,” he says. Stork grew up with asthma, but it’s the time he has spent in the emergency department that has really opened his eyes to the severity of the disease and the need for proper management. “For some people, asthma is just a nuisance, but for a lot of people it’s truly a life-threatening illness every day of their life.” Stork is involved in a travelling awareness campaign called The Asthma Express (the Asthma and Allergy Foundation of America and two pharmaceutical companies are partners on the project). He hopes the program will encourage people to really understand what triggers their asthma or their child’s, and to speak to a doctor about getting it under control. “For some, it may be as simple as allergen avoidance. For other people, it’s inhalers, for others, it’s a combination of medicines,” he says. “The relationship with your doctor is essential. You shouldn’t be short of breath every night before you go to bed; you shouldn’t be using your rescue inhalers five times a day. I think a lot of people are just living with poorly controlled asthma – but there are so many options out there.” Sarah Hendrickson, a 37-year old from Baltimore, feels her asthma has always been fairly well controlled – she took allergy shots as a kid and was able to play soccer as a child right through college. But recently she’s taken a next step forward: really focusing on asthma control as a lifestyle. “Healthy living is extremely important,” says Hendrickson. “It’s everything from diet, not smoking, not being around dogs that have a lot of dander, not being around cats and not being around triggers.” Hendrickson is allergic to grass and is 14 ALLERGIC LIVING | SUMMER 2012

Dr. Travis Stork of “The Doctors” TV show grew up with asthma, but it’s his time spent in the emergency room that has opened his eyes to the need for much better asthma management. “For some people, asthma is just a nuisance. But for a lot of people it is truly a life-threatening illness every day of their life.”

Dr. Travis Stork is a practising ER physician as well as TV host.

The Delias and sons Brandon and Jaxson.

FROM SICK BED TO SPORTS FIELD lisa and Michael Delia learned about asthma control not for themselves – neither has asthma – but for their son Brandon. The boy had had a dry cough since birth, but not knowing much about asthma, the couple assumed it was allergies or a cold. Then one night when Brandon was a little over a year, Elisa went to check on her son in bed and found him short of breath, his chest drawing in, and his lips turning blue. His parents rushed the boy to the emergency room, where he was diagnosed with the RSV respiratory virus, and admitted for 2½ weeks. It was after conversations with staff at the hospital that Elisa spoke to her family physician about asthma. She was given a prescription for a reliever inhaler. Still, Brandon would cough and have difficulty breathing, and for the next year, the family would travel back and forth to the emergency room. “He had an episode, we’d give him albuterol,” says his mother. “He didn’t have any maintenance drugs.” Getting a specialist involved was life-changing. Brandon was put on controller medication, and his family was given an action plan for how to manage his asthma. Brandon could even take part in sports without his parents’ constant fear of a severe attack. “We understood: if we give two puffs before he plays soccer, if we give two puffs before he plays football, he won’t drop dead on the field,” says Elisa. Brandon is now an active 9-year-old, who plays rugby, football, baseball and snowboards in winter. His younger brother, Jaxson, age 3, also has asthma. But when the Delias got Jaxson’s diagnosis, they were prepared. The boy is on controller medication and is also an active child. “We are a very outdoors family. It’s really unbelievable to be able to do all of these things,” says Delia.

extremely sensitive to harsh cleaning supplies, which she avoids. She exercises regularly and feels that in doing so, her legs are stronger and her lungs are stronger. “I feel like if I am having a problem with breathing, when I run by people mowing the lawn, I feel like I can control it more because my body is stronger.” Hendrickson is training for her first full marathon in Chicago in October. She plans to cross the finish line with her arms above her head, reliever inhaler proudly in her hand. “I think if you have a focus on [controlling your asthma], and actually do what your doctor tells you to do, you can live and breathe normally,” she says. Recognizing that as a musician with asthma, he could help spread the word about asthma control, singer Himan recently offered his time to the American Lung Association and developed a public service announcement with the organization. But it was only through this collaboration that he ultimately learned that his own asthma could be better managed. After speaking with his doctor, he is now on Singulair, an oral medication for asthma and allergies, and takes his reliever inhaler with a spacer, which has made it a lot more effective. “I definitely can see a difference,” he says. Himan is now performing two hours straight, getting through concerts “fairly easily”, without losing his voice from needing to shout out whatever his lungs had left. Now that he’s in control of his asthma, his show can go on. Write to editor@allergicliving.com to tell us your asthma control story. Or share it at Facebook.com/allergicliving.

Visit Us at Allergicliving.com Get the latest breaking allergy, asthma and celiac news; share stories on the Forum; explore outstanding resources on school, travel and dining out issues and find great advice for keeping a healthy home. Plus, don’t miss our recipe database.

ALLERGIC LIVING | SUMMER 2012

FIRST PERSON

This Allergic Life with Jo Frost

Job: Parenting expert, TV’s “Nanny Jo” Lives with: multiple food allergies, environmental allergies and asthma Resides in: California

16 ALLERGIC LIVING | SUMMER 2012

Jo, first, what allergies do you have? I’m allergic to all nuts, peanuts, crustaceans and rye. I have asthma and that’s triggered by tobacco, severe changes in weather, pollen, strong household cleaning products, mold, animal dander, lilies. And with perfumes, anything very flowery is a problem for me. As Nanny Jo, we think of you coming to the rescue of parents with serious discipline problems with young kids. But that means going into other people’s homes. What challenges have you faced doing that? I’m really upfront with my allergies. So households remove all foods that could be dangerous for me. The main one is peanut butter – as you do love a peanut butter and jelly sandwich on this continent! The PB & Js are out, the kids can’t eat nuts, in some cases, parents do smoke, so I ask them if they can refrain from smoking around me.

Photography: JEFF NEWTON

We know her best as Nanny Jo on TV’s former “Supernanny” TV show. From 2004 to late 2010, Jo Frost brought order to households where parents had lost control by helping moms and dads learn parenting skills like discipline and follow-through. Nanny Jo’s firm, fair and always consistent parenting techniques (including the famous “naughty step” for timeouts) paid off in incredibly improved behaviour and closer bonds for the families on the show. But as viewers in almost 100 countries tuned in to see Frost bring peaceful resolution to another household gone wild, few realized that the world’s top nanny was having to do her own strict daily managing – of food, pet and environmental allergies. Jo Frost recently spoke to Allergic Living Editor Gwen Smith about how she juggles her busy lifestyle – which includes a new show for the TLC Network and a lot of travel – while keeping her asthma and serious allergies under careful control.

Pets get removed as well. A production company makes sure a house is cleaned before I go in it, in case there’s dog hair hanging around or cat hair all over. When you’re helping families for TV, how long are you in a home? Just over two weeks, and I’m in their home for about 16 hours a day. Honestly though, [allergy accommodations] have never been an issue. I’ve been in my career as a parental expert for 25 years and have to say, I’ve been incredibly embraced by the American public. The families know I’m trying to help, so I’m given a lot of love. When I say, “I know the kids love peanut butter but I’m allergic to it and I want to be able to kiss and cuddle your kids freely, ” they’ll say, “we want you hugging and loving our kids as well.” I’ve had a couple of occasions where the kids have gotten upset because the pets had to go to a friend’s house. But I say, “Nanny JoJo has a severe allergy so that if I’m near the animals, they will make me very ill, and I’ll end up in the hospital”. And then they say, “oh no”. You talk to the children and they’ll say, “OK then Nanny Jo-Jo”. Outside of your work, how do you find accommodations for allergies these days. I have to say that overall, this country [the United States] lacks a compassion for those with severe allergies. Where do you feel that the most? I am somebody who’s tried very hard to have management of this [asthma and allergies] with the correct medications and awareness. My most unfortunate experience with my allergies has been with American Airlines. [She mentions good travelling experiences with both United and Virgin Airlines.] My unfortunate experience was that I was met with a crew who had zero empathy toward my condition. When I offered as a solution that I could ask other passengers personally if they would refrain from eating nuts, they told me: “You cannot do that,” and that if I did they would have to get security to take me off the plane. At that point I had passengers who overheard and came up to me saying, “we totally understand and don’t worry, we won’t be eating nuts.” The crew then said the only way I could fly on this aircraft was if I was to give up my first-class ticket and sit in the back cabin, as they wouldn’t be serving nuts there. It was like it was this selfindulgent fad, as if I’d invented it to maintain some kind of attention-seeking. It was absolutely awful. I was on my way to visit a family, who desperately needed help. I didn’t want a family to suffer as result, so I gave up my seat to this man [in economy]. We swapped seats. There was this lady with her daughter who said, “you’ve got the patience of a saint”. But the crew continued gossiping about me in the front cabin. They looked at me as if I thought I was entitled. I’m just looking to be treated like anyone with a severe allergy: with dignity and compassion. I felt that this situation had been handled appallingly so I asked if I could see a customer service representative once I got the gate. I told them this story. They listened, and I got a lot of sympathy and they said it was unacceptable, they apologized on behalf of the Allergic Living asked American Airlines whether they would follow up with Jo Frost regarding this flight. The airline responded: “AA Customer Relations is looking into the information provided by Ms. Frost, and will do their best to address her concerns.”

crew, and said they would follow up. But I’ve still yet to hear from them, and that was over three months ago [as of late May]. I’m a very solutions-oriented person, but I was met with this defensive attitude. It was: “no, no and that’s our policy, and no.” If you had the chance to speak to an airline CEO on this topic, what would you say? I would say that I do understand that they want to accommodate light snacks on a flight. But I would really urge them to look at the many alternatives that there are as snacks. We’re talking about anaphylaxis here. If we can become more aware in public places: airplanes, schools and with the labeling of products, maybe we can get North America to look differently at those who have life-threatening medical conditions like anaphylaxis. We should look to prevent situations. We’re spending billions of dollars dealing with issues in the aftermath rather than looking at how we prevent. Have you experienced anaphylaxis? Yes, I have. The worst I’ve dealt with left me in hospital for a couple of days and my blood pressure went really low. [This incident happened two years ago, brought on by a restaurant meal.] I had been told, very confidently, that were no nuts in a particular meal, and there were. It left me never in the same place again. I have allergies and asthma management under control; I carry an EpiPen, I have my inhalers for my asthma, which I take. What has changed is my ability to trust those who may not be fully informed. You have to read between the lines. [At a restaurant] if they say, “I think so,’ that is not – “I know so”. Now in a restaurant, I ask: “Are you sure?” and “Can I see the chef?” because I have to be in control of my life and responsible for my life, so I will do what’s necessary to do that. I don’t see myself as a sufferer and I don’t see it as a disability. I just know there are certain things that I can’t do. For instance, I would love to go horseback riding, but I can’t; it’s life or death. [As a child, Frost had a very bad reaction to horses that required emergency treatment.] So there are things you can do and things you can’t. For instance, I waterski and cycle, things like that. I’m not surprised to hear your attitude, as you always do seem like a positive person. I think it’s a mindset. From a very young age, I had eczema, allergy and asthma, and I was raised [in England] by parents who didn’t see this as a handicap. I was incredibly involved in sports. I had asthma, but I ran the 100-metre sprint at school and played nationally a game called netball – similar to basketball – I did the long jump. I still cycle and love swimming. You say that I sound confident as a grown woman, but it does start young. It’s important for parents of allergic children to recognize the seriousness but to keep your explanations really simple and to teach your children to make decisions that impact their quality of life and the safety of their life. Tell us a little about your new show for the TLC Network. People know me for dealing with [children’s] unruly behaviour, discipline, implementing rules and following through. But the idea with my new show for the TLC Network is to take the focus to the whole family and how we how we can become more mindful as a ALLERGIC LIVING | SUMMER 2012

FIRST PERSON family and help and support each other more. We’ve got women working, blended families, adoption, families in the military. Then we’ve got 21st century issues like bullying, teens and technology and girls, self-image and what’s portrayed in the media. I have the opportunity to stretch at TLC, which is amazing. Helping is what I’m really passionate about. I feel very blessed that we have families courageous enough to have me come into their homes and talk about their issues and do that with a couple of cameras and sound guys. If it wasn’t for those families, we would not be helping millions around the world. It’s very empowering when families realize that. It’s an emotional journey but it’s very fulfilling for everybody. When does the program begin airing? We’re looking at the show coming out before the end of the year. So exciting times! And I would love for families to come forward with issues like dealing with asthma or food allergies. If I’m able to help families who do reach out, then I’m able to extend that to a much wider base of families who have these conditions. [*If you would like to apply, see the note at the end of the article.] You mention bullying. Two U.S. studies show that about one-third of kids with food allergies have faced teasing or bullying, including having allergens waved in front of them. What’s your advice for families in such circumstances? Bullying is bullying and all forms of harassment have to be taken to a school authority to take care of that. Bullying that involves peanut or another food that a child is allergic to is a life-threatening situation and we need teachers to be more aware of this. We need for our children to feel they can go to the adults, who can be trusted to take care of this. If we leave children feeling that things will not be handled, then children try to handle it themselves, in the best way they possibly can. That’s an enormous amount of stress and pressure on a child who actually doesn’t know what to do to make things better. If you’re waving [a food allergen] around, it’s bullying. There needs to be open dialogue at PTA meetings and parents and teachers coming together to understand the importance of it, as we would in any case where there’s bullying and harassment. What would you say to a teen refusing to carry an autoinjector or asthma inhaler for fear of seeming ‘different’? I hope to get the opportunity to deal with this on the new show because there are a lot of teens who feel that it’s not cool to carry an EpiPen or asthma meds. I would really talk to that teenager about responsibility and being accountable for your own life. For parents, it’s about talking to your child on a level of gaining more maturity and understanding of the condition they have. Give them information to read; the more they know, the more it’s in their own hands. It will give them the confidence to brush off what somebody else is saying. Empower them, let them know that their medication is there as a backup plan, not as a hindrance. Which is harder: managing allergies or getting toddlers prone to tantrums to behave? Both are challenging and in order to manage either requires knowing what is happening and how to handle the circumstances and 18 ALLERGIC LIVING | SUMMER 2012

“Talk to your child on the level of gaining more maturity about the condition they have. Empower them, let them know that their medications are there as a backup plan, not a hindrance.” what’s the plan, so that you’re feeling in control in those circumstances. As a parent, you’re in control in terms of how you choose to raise your child and we hope you do the best that you possibly can. As a person with allergies, you aim for control and you do hope that the rest of the world catches up in terms of understanding and compassion so that we will start to see food ingredients on restaurant menus and better accommodations on airlines. Do your staff or friends know what to do for you in an allergy emergency? Yes. My executive assistant Cynthia knows how to administer my auto-injector and so does my significant other. In my very close circle, nobody eats peanuts, nuts, nobody has the enjoyment [laughs] of eating lobster or crab. I joke with Darrin [her boyfriend]: ‘If you’re going out with the lads after basketball, go for a Thai [meal]. He would love to own dogs, but sorry, no dogs. I often say, “I’m going to buy you a big tortoise”. [laughs] Note: To have your family considered for Jo Frost’s new show on TLC, keep an eye on www.jofrost.com or @jo_frost on Twitter for details on how to apply.

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EXPERT ADVICE

DR. WASERMAN

DR. WATSON

ask the

allergists Q

My daughter is allergic to milk. She was diagnosed as an infant and put on Nutramigen, and then soy milk, and for the past few years has been drinking almond milk. Given our family’s genetics, she should be tall, however, despite being in the 60 percentile her first year, she has fallen to the 20 percentile at 5 years old. Are kids who do not get calcium via cow’s milk more likely to be short? Should she be taking a supplement? DR. WATSON

Growth in childhood is a general measure of nutritional status and health, so any change of more than two major percentiles (for example 50th and 25th) should warrant a review by your physician. What you have not indicated is how quickly her growth changed at her doctor’s check-ups.

20 ALLERGIC LIVING | SUMMER 2012

In terms of calcium, there are published guidelines at each age. It should be easy to calculate your daughter’s intake at least from the almond milk, since that will be on the label. Also look at other foods she eats to see if they are calcium-rich. Examples include salmon, tofu, rhubarb, spinach, white beans, baked beans, broccoli, peas, brussel sprouts and sesame seeds. Calcium intake on its own does not directly affect growth, but may affect bone development. Is your child getting the appropriate calories to allow her to grow? I would keep a diary of exactly what foods she is eating and request a review by a dietitian to see if there are any deficits. If that’s not an issue, then reviewing other reasons for her slow growth with your doctor would be the next step.

After a couple of reactions, my 8year-old daughter has just been diagnosed as allergic to mustard seed. I was expecting maybe nuts, but mustard? Any tips for what foods she’ll need to avoid?

Mustard is present in many packaged foods. It is resistant to heating and processing, and can therefore appear as a “hidden” ingredient. Foods to watch for that may contain mustard seed include sauces, marinades, dressings, deli meats, dips and spreads, relish, chutney and pickles, spices, flavouring, and seasoning, and sometimes canola oil. Mustard is also a well-known condiment used on hot dogs, hamburgers and sandwiches, so be careful at fast-food establishments.

Our youngest has just turned 2 and shows signs of pollen allergies. His nose either runs non-stop –

THE TOP 11 FOOD TRIGGERS These foods cause most serious food allergy reactions. • Peanut

• Soy

• Shellfish

• Wheat

DR. WASERMAN

• Tree Nuts

• Sesame

Yes, mustard can cause allergic reactions. As of this August, mustard will be added to Health Canada’s list of “priority allergens” – which means it will have to appear on food labels.

• Milk

• Mustard

• Fish

• Sulphites

• Egg

(food additive)

Photo: EDITH HELD / Corbis

Dr. Wade Watson and Dr. Susan Waserman consider milk allergy and height, mustard’s priority status, testing for outgrowing, and when to worry about a sting.

and this doesn’t appear to be a cold – or it’s plugged. Are there antihistamines for little kids? DR. WATSON

Pollen allergies are rare but not impossible in a 2-year-old. It takes several seasons of pollen exposure to develop an allergy to pollen. Typically, triggers at the age of 2 are allergens present daily, such as pets, house dust mites and molds. In any case, there are antihistamines available at your pharmacy. The ideal antihistamine for any child (or adult) should work quickly and not cause sedation. There are two liquid preparations you can find easily: Claritin (loratidine) and Aerius (desloratidine). Reactine (cetirizine) liquid is apparently coming back to the market soon as well. Try to avoid the older antihistamines as they affect brain function. One dose of an older antihistamine has the same effect on the brain as a blood alcohol level of 0.10 percent. Another treatment that may offer relief is using saline nose drops to remove mucus. If there are persistent symptoms, you should talk to your allergist about spe-

cific testing to guide you about avoidance and prescription treatment options.

When we came home from a trip, my 18-year-old son reported that he’d been stung by a hornet and had had a big welt. He also had felt a little dizzy and his throat and tongue felt weird. Does this sound like an allergy? DR. WASERMAN

His symptoms of dizziness and a weird feeling in his throat and tongue after an insect sting do sound like an allergic reaction. Speak to your doctor about seeing an allergist. The diagnosis of allergy to stinging insects, known as venom allergy, is made with allergy skin testing or blood tests. Depending on the results, your allergist will decide on whether or not to start allergy injections, a treatment which helps to build tolerance to the venom of the stinging insect. I recommend these shots for anyone with a diagnosis of stinging insect allergy and a history of a systemic venom reaction, since they’ll increase your protection level by up to 98 percent.

While waiting for your son’s allergy assessment, he should carry an epinephrine auto-injector in case of another sting. Speak to your family doctor about a prescription.

My daughter is 4 years old and was diagnosed with a peanut allergy before her third birthday after experiencing a rash around her mouth. Her RAST blood test for peanut showed an antibody level of 4.85, then she was retested a year later with a result of 3.82. Her allergist has suggested a food challenge in a year if her test result drops below the 2 level. But it’s my understanding that the blood test results do not indicate the severity of an allergy, but the probability that an allergy exists. So how is a dropping number indicative of outgrowing an allergy? DR. WATSON

You ask an important question. For making a diagnosis of food allergy, skin tests are a very sensitive way of confirming that a food implicated on history is indeed the culprit. RAST or ImmunoCAP

EXPERT ADVICE

Food Allergy Symptoms

levels have been studied for their ability to identify the risk of having a reaction to a given food. Different levels indicate different risks for having a reaction. Levels two or lower suggest that there is a greater than 50 percent risk of not having a reaction. Most allergists agree that since the risk of having a reaction is lower than 50 percent, the possibility of a successful food challenge makes it worth recommending it to families. Challenges are done with medical supervision and epinephrine on hand, in case it’s needed. To most parents, that chance of success will merit serious consideration: one less food to worry about is very freeing for families.

Not everyone will get all symptoms, and severity varies.

Is it true that food allergies to shrimp or peanuts get worse with every accidental exposure? I had my first bad reaction to shrimp at 25 years of age, and this concerns me. DR. WASERMAN

Although I hear this often, there is very little evidence in the medical literature to support this notion. A severe reaction at one time does not necessarily mean that the next one will be worse. The severity of a reaction is unpre-

Asthma Basics Allergic asthma is a chronic inflammatory disorder of the airways and is triggered by allergens such as animal dander, dust mites, pollen or mold. Some people also have non-allergic asthma, set off by irritants including cigarette smoke, pollution and chemical fumes. Not everyone will get all symptoms, and not every asthmatic will wheeze. The Symptoms • Chronic coughing • Shortness of breath • Wheezing • Tightness in the chest • Shallow, rapid breathing • Breathing difficulty at night, causing sleep disturbance • In a severe attack, the person will find breathing very difficult; he may have trouble speaking or concentrating; and he may have a bluish tinge to the lips and face

22 ALLERGIC LIVING | SUMMER 2012

• • • • • •

Tingling in the mouth Swelling of the tongue and throat Itchy skin, hives or skin redness Breathing difficulty, wheezing Abdominal cramps Vomiting

• Faintness due to a sudden drop in blood pressure • In a severe anaphylactic reaction, the allergic person can lose consciousness and is at risk of death

Anaphylaxis This is the serious form of food allergic reaction, involving one or more of the body’s systems: the respiratory tract, the gastrointestinal tract, the skin and the cardiovascular system. Anaphylaxis can lead to a loss of consciousness or even death. It can come on swiftly, and is a medical emergency. It is essential that those with food or sting allergies carry an epinephrine auto-injector (known by the brands EpiPen® or Twinject®). –Staff Reviewed by Dr. Susan Waserman

dictable and potentially influenced by many things including patient age, amount of exposure to the offending allergen, state of health of the person at the time, including the presence of infection and medications, and exercise. And that’s just to mention a few of the possible factors. In any case, an epinephrine auto-injector goes a long way towards decreasing anxiety.

My son who’s 4 has recently been diagnosed with asthma. I’m finding that using the nebulizer and mask is challenging with an energetic child. Have you got any tips? DR. WATSON

I agree with your son. If I were 4 years old I would not want to be tied up for seven to 10 minutes attached to a machine. There are many more interesting things to do! The number of times I have recommended a nebulizer as a home management tool for asthma in the last 20 years would be fewer than 10. Certainly in the last five years it would be one time, and that was a child less than one year of age. Medications available by nebulizer are also available by puffer. There are holding chambers with face masks that are available, which are used with the puffer to effectively administer the medication. They work very well in delivering medications to your child’s lungs. This is less time consuming and it should be easy to teach to a 4 year old. I can’t think of any pre-schooler who refused to use the holding chamber, especially if they were told it would be faster. I would speak to your doctor about making that change.

My child is allergic to both peanuts and soy. Is that common and how are the two connected? DR. WASERMAN

Both peanut and soy are part of the legume family, which also includes peas, beans, chickpeas and lentils. How often these two food allergies co-exist in the same individual is not really known. However, they are connected. In experiments, scientists have seen cross-reactivity or similarity between some of the peanut and soy proteins, which means that the antibodies that recognize peanut protein and cause an allergic reaction can also recognize soy. However, despite this similarity, the majority of peanut-allergic individuals do not have soy allergy, and vice versa. It is also important to remember that allergyprone people may just develop allergy to multiple foods, even if the foods are not related.

Dr. Wade Watson is a pediatric allergist and Professor of Pediatrics at Dalhousie University. He is also the head of the Division of Allergy at the IWK Health Centre in Halifax. Dr. Susan Waserman is an allergist and Professor of Medicine in the Division of Allergy and Clinical Immunology at McMaster University in Hamilton, Ont. She is also a past president of the Canadian Society of Allergy and Clinical Immunology.

To submit a question, write to editor@allergicliving.com. Write “Ask the Allergists” in the subject field, keep your question brief and include an e-mail and phone number.

HOT TOPICS

CLEAR LABELS AT LONG LAST

Navigating the grocery store promises to be easier as Canada’s new allergen regulations take effect this summer. by LAURIE HARADA

hey’ve been years in the making, and this summer people with food allergies will finally see ingredient labels that make identifying which foods are safe to eat an easier task. New legislation for the labeling of food allergens, gluten sources and added sulphites will come into force August 4, 2012. This much-anticipated law will improve the lives of approximately 2.5 million people in Canada with self-reported food allergies and an estimated 1 in 133 persons in affected by celiac disease. While this is a huge step forward, there are things that consumers need to keep in mind. Here are a few of the highlights of the new regulations and what they mean for people with allergies. (For more information, visit Health Canada’s website – www.hc-sc.gc.ca. Type “allergen labelling” in the search field.)

MUSTARD IS IN The new regulations encompass ingredients known as “priority allergens”. This has historically included peanuts, tree nuts (e.g. walnuts, pecans), egg, milk, sesame seeds, soybeans, wheat/triticale, crustaceans, fish and shellfish. Those who are managing an allergy to mustard will be happy to know that it has been added to the list of priority allergens and is included in this legislation.

PLAIN LANGUAGE Under the new law, manufacturers must specify food allergens in plain language, rather than only using scientific terms. This will make it easier and often quicker to decide whether a product is appropriate for an allergic consumer. As one egg-allergic consumer notes: “I’m looking forward to seeing the familiar word ‘egg’ on those

Law will make it easier to spot allergens.

chocolate Easter bunnies that list ‘albumin’ as the main ingredient for the bunny eye.” There are two ways you can see this on the packaging: The common name could appear in brackets after the scientific term in the ingredient list. For example, the list would read: “ovalbumin (egg)” or “casein (milk)”. Or, if only the scientific term is shown in the ingredient list, the common term must be noted in a “Contains” statement after the ingredient list. For example: “Contains: egg” or “Contains: milk”. If manufacturers choose the second option, they must declare all priority allergens in the product in this “Contains” statement. While this statement will make it easy for someone to scan a label for allergens, consumers should read all ingredient information, starting with the ingredient list, in order not to miss something.

EVERYTHING DECLARED In the past, allergens could be “hidden” in products under the terms “seasoning” or “spice”. Under the new regulations, manufacturers are still not required to list all

ingredients of seasonings and spices, but if they contain a priority allergen, it must be declared. For example, if milk is an ingredient in the seasoning of potato chips, or mustard is used in the spice of a salad dressing, you will see that declared.

NOT COVERED One of the greatest sources of frustration for allergic consumers has been the proliferation of precautionary labels such as “May contain [allergen]”. With almost 30 different ways of saying “may contain” (e.g. “made in a facility that processes nuts”), consumers often take risks, trying to estimate the likelihood of an allergen being present in a product. While Health Canada is recommending that manufacturers use a single statement – “may contain” – there will still be variations since the choice of wording for a precautionary statement is left to the discretion of the company. Our advice: heed the warnings and don’t take a chance! Over the years, we have also seen growth in products with “free-from [allergen]” claims. Though manufacturers’ claims are expected not to be misleading or deceptive, “free-from” claims are not included in the labeling regulations. Consumers should not rely solely on these types of statements, but should carefully read ingredient lists as usual, and call manufacturers directly when they have questions. Both precautionary warnings and free-from claims are put on a package voluntarily; they are not required by law. The new regulations will help to ensure that the food industry labels pre-packaged foods in a way that will help consumers make informed decisions about products that are safe for them or, alternatively, which ones could potentially cause an allergic reaction. It’s only through the interaction and collaboration of government, industry and consumer groups that we’ve been able to make this progress. Anaphylaxis Canada is proud to have played an instrumental role in getting this legislation passed. We could not have done it without the support of many allergic consumers – who made their views known. We still have a way to go, closing gaps with voluntary statements and free-from claims, but the community’s past achievements have laid the groundwork for future success. Laurie Harada is Executive Director of Anaphylaxis Canada, www.anaphylaxis.ca. ALLERGIC LIVING | SUMMER 2012

Celiac &Your

Love Life Is your sex drive lacking and passion fading into the past? This could be a symptom of celiac disease. by LISA FITTERMAN

hil Zimbardo wants to talk about sex. More precisely, he wants to talk about the utter misery of losing interest in it. As a life-long lover of women, he was at a loss when it happened to him, a Dr. Phil, a prominent psychologist more used to seminars on mental health than dealing with his own, an author and speaker – a guest, even, on the TV talk show hosted by that other Dr. Phil. In his early 70s, Zimbardo was hit by a perfect storm of symptoms that included extreme fatigue, a bloated belly, constipation and the constant, embarrassing need to pass gas. Zimbardo knew it wasn’t just age-related, and his doctors were mystified. Maybe it was irritable bowel syndrome, they suggested, or excessive gas syndrome, which seemed little more than a catch-all term for a condition they couldn’t fix, no matter how many colonic treatments and anti-flatulence medications he was prescribed. As his body betrayed him, Zimbardo grew depressed to the point that he lost interest in all things sensual and sexual. This was astounding since he’d always adored women: gorgeous, plain, curvy and not. Sex with his wife of nearly 40 years had become something he did out of duty; he “serviced her,” pretending to enjoy it because he was not able to be a full and willing participant. At the same time, he was aware that he was a faker, a guy who was crumbling on the inside as everything

24 ALLERGIC LIVING | SUMMER 2012

he had taken for granted about himself – his wit, his sexuality and his very masculinity – was erased. It was sheer torment. Then a friend suggested that Zimbardo might have what she’d just been diagnosed with: celiac disease, an autoimmune condition that affects an estimated one in 100 people in North America. He had a vague idea of what it was – the body’s virulent reaction to gluten, a protein in wheat, rye, barley and many oat products, which damages the villi, the small, fingerlike projections in the wall of the small intestine that help nutrients pass into the body. In turn, this compromises or prevents the absorption of important nutrients such as vitamins, phosphates and minerals. “What do I have to lose?” he asked himself. Zimbardo made an appointment with a gastroenterologist, got his blood tested for the antibodies associated with celiac disease and then later had an intestinal biopsy to confirm the diagnosis. All of a sudden, he had a reason for his constipation, tiredness, gas, depression and the resulting sexual dysfunction, and a way to turn things around: eliminate gluten from his diet. “No one talks about the sex part in celiac disease,” says Zimbardo, now a professor emeritus at Stanford University in California. “No one tells you that your sex drive can shut down and that your very manhood can be challenged. As a psychologist, I’m always analyzing behaviour and I just could not understand what has happening to me until I was diagnosed.”

ALLERGIC LIVING | SUMMER 2012

He has a point. People often find it hard to talk about sex, period, never mind how it relates to celiac disease. While the symptoms associated with the disease run the gamut from diarrhea and stomach cramping to osteoporosis, weight loss and weakened tooth enamel, it’s as if any discussion of the S-word has been shoved behind closed doors, to be whispered about, if at all. With the digestive distress before a gluten-free diet is adopted, “you’re probably not going to feel really sexy, and you wonder if you’ll ever get your sexy back,” says Alice Bast, founder and president of the National Foundation for Celiac Awareness (NFCA). “Even after people are diagnosed, they don’t ask their doctors about something as simple as kissing,” she says. “But it’s a real concern. What do you do if the person you are about to kiss has just eaten gluten?” Last year, Bast asked that question of a panel of specialists at the International Celiac Symposium in Oslo, Norway. “They were, like, ‘what?’”she recalls. “I said: ‘kissing’. They didn’t know what to say because they’d never dealt with this before. But people do ask filled out anonymous questionnaires that asked things such as me. They ask me all sorts of things they won’t ask their doctors.” how often they had intercourse, if they experienced any pain durA 5-foot, 9-inch dynamo who weighed a mere 100 pounds ing sex and if they had problems reaching orgasm. After 12 when she was diagnosed 18 years ago, Bast started the NFCA to months of living gluten-free, they filled the questionnaire out educate people and provide a forum for people with celiac disagain. To better interpret the data, their answers were compared to ease. She says people ask her many questions when it comes to those of 51 people without the disease. celiac disease and their sex lives. Like The results were clear. The people with whether semen can contain gluten, and if untreated celiac disease had “significantly” the sex drive is affected by vitamin, horless intercourse than those in the control mone imbalances and plain old gas. (The group, and fewer of them were satisfied with answers: probably not and absolutely.) their sex lives. And after 12 months of treatMindful of the panel’s confused response ment, their sex lives had improved in every to what she considered a simple question, way – a lot. While Ciacci has no plans to do a Bast and her NFCA colleagues put together further study, a few experts such as Dr. Peter a short video called “Sex and the Celiac.” It’s Green, the founder of the Celiac Disease about how sneaky, undiagnosed celiac disCenter at Columbia University, are aware of ease could be “fixing your funk” or “making the issues around a healthy sex life with celiyour mojo a no-go.” With about 5,000 ac disease. He isn’t shy about asking his online views to date, it’s a bona fide hit. And patients how often they’re having sex, espeit has common sense advice for people who cially when issues of fertility are involved. suspect they have the disease: make an Sheila Crowe, a gastroenterologist and appointment with a physician pronto. medical professor at the University of Phil Zimbardo: transformed by diet “When in doubt check it out,” Bast says in California, San Diego, acknowledges there is the video. “If your libido is lacking, take the celiac symptom too little data about sex lives and celiac disease, and that gastroenchecklist and get your sexual side back in the game.” terologists are not trained to think about sex when they are checking out symptoms such as constipation or diarrhea. “We’ll ask about genital health and urinary function, about menstrual mid all the research into celiac disease, from its cycles and cramps and infertility – but sexuality? It’s not on my provenance to possible treatments, Allergic Living radar screen,” she says. “Maybe it should be. Maybe the average was able to find only one small study that has gastroenterologist should be asking about sexuality as a matter of focused on the level of sexual satisfaction among course.” people with the condition. Published in 1998, it At the same time, she cautions that talking about sex drive was conducted in Italy, the land of love and pasta, and it involved means having to overcome social mores and fears, and to delve 55 patients with celiac disease: 24 men and 31 women between the into an issue that may be caused by a myriad of physical and psyages of 18 and 65. chological factors, including depression. With undiagnosed celiac “Sometimes, I heard women complaining about troubles in disease, notes Crowe: “People are fatigued. They lack energy, they their sex lives and sometimes, they would speak of how sex had may be underweight, which affects endocrine function, and they gotten better after changing to a gluten-free diet,” says lead may suffer depression due to it all. Women may stop have having author Carolina Ciacci, a gastroenterologist and professor of their periods. Any chronic illness can impact our sexuality. We all medicine at the University of Naples Federico II. “It was clear that need to be aware that it’s not as simple as: ‘Not tonight, dear, I have a study was merited.” a headache.’” Before they embarked on gluten-free diets, the participants

“No one talks about the sex part in celiac disease,” says Phil Zimbardo, a prominent psychologist and professor emeritus at Stanford University. “No one tells you that your sex drive can shut down and that your very manhood can be challenged.”

26 ALLERGIC LIVING | SUMMER 2012

Green and Crowe stress that specialists should be more sensitive to these issues. Recently, for example, a woman in her 30s was referred to Crowe for an opinion on her celiac symptoms. The woman asked point blank if she could have sex with her husband after he had eaten food containing gluten. “It was the first time I had ever been asked,” Crowe says with a laugh. “I told her that what her husband eats isn’t going to cause problems since gluten has to be ingested into your body.” When it comes to kissing, Crowe says there isn’t scientific evidence that enough gluten would be left in the mouth to cause a problem for the partner with celiac disease. But Bast of the NFCA counsels caution all the same. No matter how unromantic it seems, she recommends being careful about kissing and having your partner brush and rinse. It’s better to be safe than sorry.

hile Bast doesn’t like to dwell on how she felt before being diagnosed with celiac disease, she acknowledges that sex was the last thing on her mind. “I thought that I had cancer and was dying. Everywhere we went, my life revolved around eating a minimal amount of food and trying to stay out of the bathroom,” she says. Even after she was diagnosed, change didn’t happen quickly because she was so malnourished and had been through so much, including multiple miscarriages and a stillbirth. In fact, when it came to sex, the change was so imperceptible, she didn’t even realize that after years of avoiding intimacy, she had begun to enjoy it again. It was a subconscious thing more than anything, some-

thing that somehow seemed normal again, from the act of putting her arms around long-suffering, patient husband and – gasp! – initiating an encounter. “Once I had the diet down, I got it all under control,” Bast says. “When I began to talk about it with others, I realized that I wasn’t alone.” In San Francisco, Zimbardo cut gluten from his diet and started taking anti-inflammatories and probiotics in order to get his gut’s flora back into shape. It took a year to undo the damage and get his mojo back, both sexual and otherwise. Now 79, he and his wife will celebrate their 40th anniversary on August 10 by renewing their wedding vows at the same Stanford University church where they married, and in the presence of their three children and grandchildren. Zimbardo shudders as he recalls losing his sexual drive and sense of self as his body changed, as his belly grew, as he burped and passed gas as food failed to pass properly through his intestines. He has a message for those suffering from symptoms: Get thee to a doctor because the first thing you want to do is look at the distinct possibility you have celiac disease. “Changing my diet was nothing short of transformative,” he says. “Now, I can’t wait to be 80. “I get impatient with people who say, ‘Oh my God, you’re still doing it.’ Of course I am! And I plan to do it as long as I can. Sex should be a central part of your life, no matter your age.” To share your views on this article, write to: editor@allergicliving.com The NFCA’s video can be viewed on Youtube.com; search Sex and the Celiac: The Movie.

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HEALTHY HOME

so when you find it, the first thing you need to do is pinpoint the moisture source and stop it. “The key to mold control is moisture control,” says Laureen Burton, a chemist and toxicologist with the Indoor Environments Division of the U.S. Environmental Protection Agency. “People think, ‘I don’t even need to look at where this came from because I’ve wiped it up.’ But if you don’t fix the moisture, that mold will be coming back.” So where to start sleuthing? Chances are, there’s one of a few usual suspects at work: a leaky roof or siding, cracks in the home’s foundation, clogged or broken rain gutters, improperly sealed windows, inadequate insulation, a plumbing leak, a seeping washing machine or refrigerator, high indoor humidity or condensation. Sometimes the source is easy to pinpoint, like a sweaty pipe under a kitchen sink, pooling water near a foundation or a beaten-up old skylight. Other times, you may smell mold but have no idea where it’s coming from; in those instances, you may need to call in the pros.

HOW TO CLEAN UP

GET A HOLD ON MOLD

If you’ve got allergies or asthma, mold in the home is bad news. Fortunately, Allergic Living’s handy how-to guide will spare you from the spores.

Photo: KATE KUNZ / Corbis

by JENNIFER VAN EVRA t’s the houseguest you never want – and one of the toughest to send packing. Especially in damp climates, indoor mold is one of the most common and stubborn problems – and for people with allergies and asthma, breathing in those microscopic spores day in and day out can spell serious trouble. Whether it’s lurking around window

You’ve cut off the moisture source, put the mold on notice, and now it’s time for the clean-up. But how you do that depends entirely on where you find the mold and how much you have. The Canada Mortgage and Housing Corp. recommends an assessment by professionals if you have an area of mold larger than a 4x8-foot sheet of plywood. The agency says homeowners can take on what it defines as “moderate” mold (three or more patches, each smaller than a square metre) with precautions that include sealing off the affected area and wearing protective gear, but you may still want an outside opinion. If tackling a moderate or smaller area of mold yourself, you’ll want to follow a few key steps.

• Out With The Mold ledges, spreading under basement carpets or seeping through drywall under that leaky sink, it’s got to go. So how to tackle this growing problem?

WHERE’S THE WET? There’s no point in trying to get rid of mold until you figure out where it’s getting its food. Mold can’t grow without water,

Many think that spritzing mold with a chlorine bleach solution will do the trick – but bleach can be problematic for people with asthma, and even dead mold can trigger reactions in those with allergies. Also, you could end up adding even more moisture to the area and actually promoting mold growth. Same goes with painting or caulking over: it will only come back. So what’s the real solution? Small amounts of ALLERGIC LIVING | SUMMER 2012

HEALTHY HOME

• Its Right Place Molds love to set up shop in new locales. That’s why it’s especially important that, during the clean-up process, you prevent them from travelling to other areas of the home where they can find moisture and get growing again. For jobs that require more than wiping off, use tarps or plastic to seal the area so the tiny spores can’t spread. Also make sure

Big jobs call for experts in protective gear.

that any nearby air ducts are sealed and that the heating or air conditioning systems are off; otherwise you run the risk of blasting spores into other rooms. If you’re removing any moldy materials, just make sure to bag them up before you traipse them through the house; and once the affected area is dried out, give it the onceover with a HEPA vacuum, then discard the bag. If you think you might have mold in your air system, spend a little extra and have your ducts cleaned.

• Protect Yourself Remember that mold can trigger symptoms even in people who don’t have allergies, so Dr. Ginger Chew, an epidemi-

MOLD: NOTHING TO SNEEZE AT olds are fungi that exist almost everywhere in the outdoors – and inside, they’re a common component of household dust. But mold can become a nightmare when there’s a large amount and it’s busily forming colonies in your home. Like any pollens, dust and other airborne allergens, mold can cause a host of reactions in people who are sensitized, from itchy, watery eyes to sinus problems to full-blown asthma. But according to Dr.

30 ALLERGIC LIVING | SUMMER 2012

Ginger Chew, an epidemiologist with the U.S. Centers for Disease Control and Prevention, besides triggering allergic reactions, molds can also cause breathing problems and other irritant effects in people who are not allergic. In rare circumstances some molds can be infectious or toxic; and as they are growing, these spores can produce microbial volatile organic compounds, or mVOCs, which can trigger the same kinds of reactions as VOCs

• Wash It Off You’ve conquered the mold – but like any formidable opponent, it’s going to do its best to come back. That’s why it’s especially important that, when you’re finished, you wash the clothes you were wearing, and hop in a shower to send all those mold spores down the drain. “Washing the mold spores from your hair is a good idea, because if you don’t, they can be transferred to your bed, or the sofa, or the child’s bed,” says Chew, who emphasizes that surfaces don’t need to be wet for mold to grow. In fact, even a mattress with a tiny layer of moisture can be enough to kick start a

that off-gas from paints and other household chemicals. Those tiny VOCs can hitch rides around your home – and even slip right out of wall cavities and into your home. “VOCs can permeate through porous surfaces very easily because they are volatile,” Chew explains. “And a lot of the things we think are non-porous really aren’t – like drywall.” So how much exposure to these homewreckers is OK? There are guidelines and international standards, but Chew says levels that are deemed “safe” can still pose serious problems for those with mold allergies or sensitivities – and an individual’s

condition can get worse with prolonged exposure. “People who are allergic or have asthma mount a quicker and more intense immune response and become sensitive to even smaller concentrations. So it’s a moving target,” says Chew, who explains that the irritant-type reactions (such as pneumonitis or lung tissue inflammation) are usually associated with people who get big hits of mold on the job, and on a regular basis. But if a family keeps having to re-caulk a moldy bathtub or is ignoring a mold problem altogether, “it can also be happening in a home.”

Photo: EPA, courtesy of Chin Yang, Ph.D.

mold on hard surfaces such as tile can be wiped off with basic detergent and water, or in more serious cases with a non-toxic mold cleaner, then carefully dried to prevent regrowth. You can do the same for more porous materials like drywall – so long as the mold is limited to the surface, and hasn’t made its way right through. Once mold has set up shop in the nooks and crannies of carpets, ceiling tiles, drywall and other materials, there’s a good chance the affected areas will need to be scrapped – although steam cleaning and allowing fabrics to dry completely can save carpets and upholstery. And if you think you only have a spot of mold near a baseboard, and then peel back a piece of wallpaper or wood paneling and see it’s coated in black, your DIY spirit should take a back seat and let the professional mold remediators take over.

ologist with the U.S. Centers for Disease Control and Prevention, recommends that anyone doing the removal always protect themselves with an N95 mask, gloves and goggles. Those with allergies and asthma should avoid the affected area altogether – especially kids. “It’s a case-by-case thing, but for a major rip-out of a moldy sink or cabinet, for example, I think allergic or asthmatic children should be as far away as possible,” she says. “And you’ll probably want to cover the furniture, because wherever the spores land, even if it’s dry at the time, given enough moisture and nutrients they could start growing there, too.”

HEALTHY HOME

If you could see the air in your home,

you’d hold your breath!

new colony. “It can be just a thin layer of moisture that is invisible to the human eye. That’s one of the reasons that mold grows on walls, especially in climates where you have a big difference between the temperature inside and out,” she says.

The Check-Up Mold can reappear if the dampness isn’t quite completely eliminated, and sometimes when homes go from being improperly sealed to airtight, moisture can get trapped in unexpected areas. Burton recommends that, after any renovation or remediation, homeowners keep their eyes and noses peeled, and act quickly if they notice any signs of moisture or mold. Still, she emphasizes that most often, the pesky fungi simply take full advantage of human neglect. “Usually it comes from someone not dealing with the problem when it started. They had a leak, they patched it, put the wall back up and it was still leaking in behind. Or they had an issue and just painted over it. I can’t think of a story I’ve heard that didn’t start with a moisture problem that could have been controlled from the beginning,” Burton says. “The biggest thing is: once you find it, you fix it.”

had hopedat that the Breathe would with our “IWe was skeptical first, butEZnow it’s been overhelp six months allergies as allergy meds only help to No a limited extent. and my boys are doing better than ever! allergies from Further, I have consistently suffered from a chronic, the weather, no wheezing or coughing just two small hacking cough for a long time. Since our EZ Breathe has boys of energy and life.not I’m experienced thoroughly convinced beenfull in operation I have even onethat severe my boys’ lungs not irritated by floatingMoreover, particles that attack and myare cough has disappeared. the would cause them to become sick and I owe that musty normally smell in our basement has been completely eliminated. EZEZ Breathe a great investment! clean air to my Breatheissystem!” – S. Danielson - EZ Breathe Customer

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Want to nip that growing problem in the bud? Here’s some helpful advice: • Clean up any leaks or spills right away. If moisture is removed within 24-48 hours of appearing, mold is unlikely to grow. • Check your roof and repair or replace it immediately if you detect a leak; also repair any cracks or openings in your siding, and make sure your rain gutters are clear of debris and functioning properly. • Make sure the ground around your home slopes away from the building, not toward it.

EZ Breathe asthma and allergy advantages • Removes harmful triggers: pollutants, mold spores, pet dander, etc.

• Properly insulate your walls; this will help keep condensation from forming on your interior walls. • If you see condensation around windows or on walls or pipes, dry the wet surface and reduce the moisture source. If you have condensation, it could be a sign of high indoor humidity.

• Maintains healthy humidity levels (below 50%) • Reduces irritating airborne particles • Creates whole home air exchange

• Keep indoor humidity low, ideally between 30 and 50 percent. You can find humidity meters at most hardware stores. Low Moisture, Clean Air, Healthy Home. C

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CELIAC EXPERT | SHELLEY CASE

HOT SUMMER READING

A lazy day in summer is a great time to brush up on celiac disease and the gluten-free diet. Let me share some of my favourite books. Celiac Disease for Dummies by Dr. Ian Blumer and Dr. Sheila Crowe This is an easy-to-read book written for those with celiac disease and their family members. It has practical information including symptoms, diagnostic tests, associated conditions, complications, treatment, nutritional considerations, alternative and complimentary therapies, research about potential new treatments, and more. Real Life with Celiac Disease: Troubleshooting and Thriving Gluten Free by Melinda Dennis, RD and Dr. Daniel Leffler Health professionals and those with celiac disease will find this book, which features a wide variety of topics about celiac disease, gluten sensitivity and the gluten-free diet, highly informative. It includes case studies from the authors (from the Celiac Center at Boston’s Beth Israel Deaconess Medical Center) and more than 50 celiac experts, along with recommended treatment options and lifestyle changes. Complete Gluten-Free Diet and Nutrition Guide by Alexandra Anca, RD and Theresa Santandrea-Cull Dietitian Alexandra Anca teamed up with baking instructor Theresa SantandreaCull to produce this informative guide

that features an overview of celiac disease and detailed information about the gluten-free diet: foods allowed and to avoid, shopping tips, substitutions, healthy eating, a 30-day meal plan and over 100 recipes with nutritional analysis. People Before Profit by Ken Koopman This is a heart-warming story of a true entrepreneur, Bob Moore, founder of Bob’s Red Mill. Starting out from humble beginnings, Bob and his wife Charlee persevered through numerous setbacks, including a fire that destroyed their first mill, and rebuilt Bob’s Red Mill into the well-respected international whole grain company it is today. With passion, yet humility, strong ethics and faith, Moore’s story is truly inspiring and is a must-read. Easy Gluten-Free: Expert Nutrition Advice with More than 100 Recipes by Tricia Thompson, RD and Marlisa Brown, RD Written by celiac expert dietitians, this book features information about glutenfree ingredients, label reading and nutrition strategies. It includes a 28-day meal plan and recipes with nutritional analysis. The recipes are divided into: quick-and-easy (less than 30 minutes) and creative (special dishes), and many of the recipes are made with whole grains and flours.

The Definitive Gluten-Free Guide Here’s what you’ll find in the new Gluten-Free Diet: • • • • • • •

Detailed food and ingredient information. Creative ideas for meals and snacks. Gluten-free recipes with nutritional analysis. Prevention of cross-contamination advice. Practical strategies for healthy gluten-free living. Tips for eating out. Breaking news about oats, including position statements from organizations around the world.

Gluten-Free Diet: A Comprehensive Resource Guide by Shelley Case, RD Of course I’m biased, but had to include it! See my advertisement below for complete info on the book. 1000 Gluten-Free Recipes by Carol Fenster I love all the cookbooks by gluten-free culinary expert Carol Fenster. But this is my favourite since it’s loaded with a range of delicious recipes using common ingredients that the whole family will enjoy. Many of the recipes are conveniently highlighted as quick-to-make or vegetarian. Whether you are on a gluten-free diet or not, I highly recommend. Complete Gluten-Free Cookbook by Donna Washburn and Heather Butt These home economists have developed recipes that are easy to follow and use a variety of nutritious gluten-free flours, nuts, beans and seeds. There are wonderful recipes for appetizers, salads, soups, side dishes and entrees. However, it is the extensive number of delicious breads, quick breads and desserts, along with a section on bread machines, that makes this cookbook a real winner. Everyday Gluten-Free Slow Cooking by Kimberly Mayone and Kitty Broihier, RD The authors have developed 140 flavourful recipes for breakfast, lunch and dinner using whole grains and other common ingredients. More than 100 of the recipes are dairy-free or can be adapted using substitutions.

Shelley Case, RD, is an international celiac nutrition expert, consulting dietitian and the author of Gluten-Free Diet: A Comprehensive Resource Guide. For more information and articles, see www.glutenfreediet.ca.

Order your copy today. www.glutenfreediet.ca

• New food and GF labelling regulations in the U.S., Canada, Europe and Australia/NZ, as well as the international Codex Alimentarius. • Over 3,100 gluten-free specialty products listed by company name, product name and package size. • Directory of more than 270 U.S., Canadian and international companies, with manufacturers of GF products, GF bakeries and GF stores & distributors. ALLERGIC LIVING | SUMMER 2012

Stormy Skies Inconsistent allergy policies are leaving travellers stressed and angry. What can be done? by GWEN SMITH

34 ALLERGIC LIVING | SUMMER 2012

Photo: (plane) iStockphoto.com / MARCHCATTLE

r. Brett Greenberger vividly recalls the dream vacation that imploded. Three years ago, the Baltimore psychiatrist and his wife Emily, a social worker, planned a Caribbean getaway for the family – including their three kids and his parents. Since their daughter Lily, then 5, has serious allergies to peanuts and nuts, the couple researched staying in a condo on the Leeward Island of St. Kitts, figuring they could do their own cooking and ensure the food was safe. They looked into flights. The times worked well with American Airlines, which doesn’t serve peanuts, so the next step was to inquire whether nuts would be served on these particular routes. “We were assured they would not be,” says Greenberger. So they booked the seats and prepaid the condo. On their travel day, the flight from Baltimore to Miami went well. The family checked in at the ticket counter in Miami – just to confirm that nuts wouldn’t be served on the flight to St. Kitts. The first hint of trouble came when a supervisor responded that this was up to the crew. When the Greenbergers headed to the entranceway of the plane and began to speak to a flight attendant about Lily’s allergies and previous assurances, she told them that nuts were being baked in the front ovens to be served in first class. The couple immediately noticed the strong aroma. Next, the pilot and gate supervisor were there, telling them that the snack service could not be changed and further, the pilot felt their child and her serious allergies presented a flight risk to the whole plane. With Lily now sobbing, the Greenbergers say they were not allowed to board. So could they get another flight? Not to the Caribbean. The airline’s representatives said they could fly them elsewhere but heated nuts would be served in first class on all St. Kitts flights. “Multiple people from the airline said there would be no issue with nuts, then one individual and the pilot made the decision not to accommodate or problem-solve in any way. It was just not fair,” says Greenberger. These are turbulent times for travelling with peanut or nut allergies. On the upward bounce, some North American airlines are taking positive steps forward. JetBlue and Southwest Airlines often receive positive reviews for allergy awareness, and Canada’s WestJet has become the shining star of food accommodations. (WestJet doesn’t serve peanut or nut snacks and, to reduce residue, its crews will make an announcement asking fellow passengers to refrain from eating nut or peanut snacks. It also stocks EpiPens.) But on the stomach-flipping downward bounce, the negative stories and tales of inconsistent promises about allergy accommodations abound. In Allergic Living’s view, they are becoming more frequent. One of the big problems is that some airlines’ own staff seem unaware of their employer’s exact policy on food allergies. In a 2008 study from the University of California at Davis, researchers phoned U.S. airlines three times and asked the same questions, including: “Would you be willing to remove peanuts or tree nuts from a flight?” Airlines responded consistently only 31 per cent of the time. Anecdotally, this situation persists with some carriers. On board, it’s the same: some cabin crews will make accommodations such as serving alternative snacks and making an announcement that there is someone on board with a nut or peanut allergy. But customers often don’t realize that, at most airlines, these are the actions of an individual crew, not a policy you can rely on. In a tough economic climate, huge carriers like United and

One of the big problems is that some airlines’ own staff members seem unaware of their employer’s precise policy on food allergies.

If you’ve been promised an accommodation, mention it to airline agents.

American Airlines have also become attached to the prestige value of heated tree nuts (usually almonds and cashews) to attract the high-paying customers in the first-class section. “The warm nuts are something we can offer the premium passenger to make the travel experience better and to help differentiate our product,” says American’s spokesman Ed Martelle. While food allergy consumers need airlines to be overt about their policies regarding peanuts and nuts especially – since they are common snacks and potent allergens – some U.S. airline websites offer only a generic allergy statement that’s more a liability disclaimer. Offering consumers adequate information is helpful – and cost-effective. Case in point, the Greenbergers wound up with a full refund on their seven flights. *** The idea of changing the nut snack culture of the skies and reducing the risk of reaction at 35,000 feet often seems like a no-brainer to those living with food allergies. But there are those who strongly object, and not just those who like nut snacks. From the peanut grower to the big confectioner, there are lobby groups that say there’s no proof that peanuts or nuts in an airline cabin cause severe reactions. This came up in late 2010, when the U.S. Department of Transportation (DOT) proposed banning the serving of peanuts on planes. DOT backed away from such a ruling because of a law, passed by Congress in 1999, which demands a peer-reviewed study that shows “severe reactions by passengers to peanuts as a result of contact with very small airborne peanut particles” before any peanut-restricting edict can be issued. But on a smaller scale, there is, in fact, evidence of risk. Three studies have examined air travel and found that, based on passenALLERGIC LIVING | SUMMER 2012

gers’ reports, there have been peanut and tree nut reactions. In the University of California study of 471 people known to have severe peanut, nut or seed allergies, almost 10 percent reported experiencing a reaction. Of significant concern in a 2009 study from the University of Michigan was that one-third of the reactions were consistent with anaphylaxis. Dr. Matthew Greenhawt, an allergist and author of the Michigan research, says that a more rigorous study “would require diligent in-flight assessment of how peanut or tree nut particles may distribute within a pressurized cabin, how different cabin configurations may alter this, and how these dynamics may be affected by different aircraft models.” That’s tough data to come by, since the airlines haven’t been open to that kind of aircraft scrutiny. Greenhawt says that while proof beyond self-reporting is ideal, “the passenger reports continue to pour in and should not be dismissed.” Organizations like the Food Allergy & Anaphylaxis Network, Anaphylaxis Canada and Allergic Living receive e-mailed accounts of reactions on flights. While most of them are mild, all of them are troubling when at such a distance from a hospital. *** It’s interesting that while sectors of the food industry raise doubts about the seriousness of allergy risks, Allergic Living actually sees an increase in allergic passengers being questioned about whether they are “fit to fly” – the airline term for being healthy enough for air travel. In the Greenbergers case, “it was like Lily was the perpetrator of the problem,” says her mother. (It should be noted that Martelle says American’s view is that “there are discrepancies between what the Greenbergers are now saying and what they said during the event.”) Anne Thompson, co-founder of Illinois’ MOCHA food allergy support group, relates that her son Andrew almost lost his seat due to his peanut and nut allergies. Last year, the high school student and his rowing team were heading to a big regatta. Andrew checked in with United at O’Hare International, just to confirm that no peanuts would be served (that is United’s policy). The ticket agent was concerned, since the airline “couldn’t guarantee” there would be no nuts in the cabin. The teen phoned his mother in a panic – the agent said she might not let him board. He was allowed on – but by no means was it a given. After the Canadian Transportation Agency (CTA) declared nut and peanuts allergies a disability when it comes to flying, Air Canada instituted a policy in late 2010 in which a passenger may request a “buffer zone” of three nut-free rows. But to qualify, you need to get a doctor to fill out a “fitness to travel” form, which the airline keeps on file. There have been a high-profile incidences of Air Canada’s staff telling allergic passengers that they can’t board as they don’t have a fitness form – clearly a misinterpretation. The new policy says you need the medical form if you want to request the allergy buffer zone, but not if you simply wish to take your seat. Also flying out of O’Hare last fall was Amy Wicker and her family of four. Wicker told United flight attendants on the Phoenixbound flight that her daughter has severe tree nut and peanut allergies. She’d done this in past and found crews willing to change snacks or make an allergy announcement, but this time she was told that nuts for first class were being heated in the front and rear galleys. When she asked if an alternative could be served, the reply was: “If you don’t feel comfortable flying, you’re welcome to get off the plane.” Appalled that a snack seemed to trump a child’s health, Wicker gave her daughter a pre-emptive dose of Benadryl 36 ALLERGIC LIVING | SUMMER 2012

The teen phoned his mother in a panic. The agent might not let him board because of his allergies; he might miss his competition. He was allowed on, but it wasn’t a given. for a tense, three-hour flight. All the gut-wrenching over whether people with allergies will be “allowed” to fly, makes Clowes’ blood boil. After taking a flight where nuts were being heated, Clowes, the founder of Allergymoms.com and a columnist for this magazine, asked the family allergist whether that environment was safe for her son, who’s highly allergic. While Greenhawt’s view is that such warming poses little risk for airborne reactions, Clowes’ allergist counseled not to chance it in her son’s case. As the family had already booked flights with American out of Pittsburgh, she phoned the airline’s disability desk to see if it was possible to forego heating the nuts. At first she was advised to just ask at the gate. When Clowes pressed for a firmer answer, “he said, ‘I don’t know if your son can fly, I’m going to require a letter from your doctor that says he’s safe to fly.’ I said: ‘I’m going to require you to put that in writing.’” Clowes blogged about the incident, generating 10,000 views. The airline got in touch with a solution: the family was put on an early flight where nuts wouldn’t be served. Wicker’s experience got her fired up about the rights of allergic travellers. The former TV reporter has now launched Allergysafetravel.com and has begun speaking to senior U.S. airline officials about the need for accommodations. She and Thompson are both of the view that some of the big airlines simply may not be informed enough about the issues that passengers with serious allergies come up against the nut-snack culture in our skies. American, for instance, moves about 250,000 passengers every day. With that kind of traffic, it’s hard for food allergies to get on the radar. “This should come down to people working together,” says Wicker. “This is a big and growing issue. What can we do to work together? I think the solution is there.” The big airlines need to hear reasoned arguments and hear more about the demand for change. “We don’t always advocate for this health condition in a very serious way,” says Clowes. Her blog post generated hundreds of messages about reactions or bad treatment, “but people are not reporting incidents. Write to the airline; file a complaint with DOT or [the CTA] online. The form takes five minutes.” Even the Greenbergers, who salvaged their vacation by driving to Disney World, are hopeful about the outlook for more accommodations in the air. “The generation of people with food allergies is growing up and they’re going to be the business people of the future,” says Brett Greenberger. “Those are the customers who matter to the airlines.” our “Comparing Airlines Chart” for the policies of 12 airlines. Â • See www.allergicliving.com/airlines • Gluten-free meals on the airlines: to eat or not to eat? www.allergicliving.com/planefood

CANADIAN NETWORK FOR RESPIRATORY CARE SPECIAL SUPPLEMENT • SUMMER 2012

BREATHE EASY WHILE CAMPING BY JACLYN LAW

Camping is a great way to connect with nature and enjoy Canada’s rugged beauty. But if you or your child has asthma, you may feel anxious about prolonged exposure to the great outdoors. You can manage asthma and spend quality time under the stars – but it takes careful planning. “Choosing where and when you go definitely needs to be pre-planned,” says Julie Gaalaas, a Certified Respiratory Educator (CRE) in Camrose, Alberta. Your asthma should be well controlled before your trip; if not, refer to your asthma action plan for directions on

Camping near a beach is one way to avoid pollen triggers.

increasing your controller medication. “While you’re camping, I recommend doing a symptom diary or monitoring peak flows so you know how you’re responding to your environment,” says Gaalaas. Seasonal allergies can worsen asthma, so camp when your allergens are typically lower: tree pollen is airborne in spring, grass is most active in early summer, and ragweed causes misery in late summer and early fall. Check the

pollen count and the weather forecast before you go. (Damp conditions mean less tree, plant and grass pollen, but possibly more mould.) When picking a destination, keep in mind that beaches have less tree pollen than forests, and a beach, concrete pad or trailer helps with grass avoidance. Sites with showers will enable you to rinse off pollen before bedtime. See Smart Camper’s Tips on page 38

Your Asthma in a Heat Wave Heat waves are sticky and uncomfortable for everyone, but they can cause extra trouble for people with asthma. “Heat and humidity can play a role in your asthma control,” says Carolyn Savage, a Certified Respiratory Educator in Portland, Ontario. One reason is that hot, humid air often contains

more outdoor air pollutants, which aggravate the airways and cause inflammation. This leads to asthma symptoms, explains Savage. Those prone to symptoms when exercising will want to be mindful during a hot spell, and perhaps turn to an indoor activity. Staying hydrated is especially important during a

heat wave: when you don’t drink enough water, your whole body feels it. “The heart has to work harder to pump the oxygen and nutrients to the body. Breathing can become faster as a helper to the heart,” says Savage. To help control your asthma during the summer, avoid your triggers, use your inhalers as

you’ve been directed, and check the Air Quality Health Index (www.airhealth.ca) daily – a value of seven or above is high, but everyone responds differently, especially those with asthma. “Decrease outdoor activity, keep your reliever puffer handy, and follow your asthma action plan,” says Savage. “These actions will help keep your breathing in good control during the heat of the summer.” –Jaclyn Law

ALLERGIC LIVING | SUMMER 2012

SUPPLEMENT

THE ASTHMA EXPERT With Dr. Harold Kim, Allergist

• A couple of weeks before your trip, clean and air out your tent (remove mould with a non-toxic mould removal product or mild bleach solution). Wash sleeping bags, sheets and blankets. • Do activities in the afternoon, when there’s less pollen, and keep your tent zipped so allergens don’t get in. On high-pollen days, consider visiting a nearby town. • Campfire smoke can irritate airways: pitch your tent upwind and don’t sit close to the fire. • Consider taking an antihistamine daily one week prior to and throughout the camping trip to help prevent allergic reactions. • Camp where you’ll have a cellphone signal. Know where the closest medical facility and pharmacy are, and have a list of your medications on hand. • Wear medical ID and carry your inhalers at all times, and your epinephrine auto-injector if one is prescribed (pack two injectors if emergency help is over 20 minutes away). • If your asthma worsens, refer to your asthma action plan for instructions. And if camping proves too challenging, don’t be a martyr – have a backup plan, such as decamping to a motel. Tips provided by: Certified Respiratory Educators Julie Gaalaas and Kristine Petrasko.

38 ALLERGIC LIVING | SUMMER 2012

hen it comes to allergies, often a newborn will start out with allergic eczema. Then a food allergy will occur. Then the child may develop asthma with allergic rhinitis. One of the great hopes is to have a treatment that may prevent this “allergic march”. For patients with allergic rhinitis, allergists will advise trigger avoidance, followed by therapies such as antihistamines and nasal steroid sprays. We may then turn to immunotherapy – allergy shots – to desensitize to the allergen. An important discussion has emerged as to whether childhood immunotherapy could halt the progression to asthma. A few studies are, in fact, showing this outcome. The European PAT study is the most important in considering the longterm effects of immunotherapy. Children in the study received either allergy shots to birch and/or grass allergens or standard medical treatment for three years. The researchers then followed up seven years later. In the group that didn’t receive immunotherapy, 45 percent of children developed asthma. In the group that had allergy shots, only 25 percent developed asthma. The children who got injections also had fewer nasal and eye symptoms. The significant difference in asthma emergence suggests we

could have a dramatic public health impact by simply using this readily available treatment. As we say in medicine, “more studies are needed,” but with PAT and other shorter-term studies providing valuable evidence, allergists and parents should more often consider the option of immunotherapy in childhood. We know it leads to excellent symptom control of allergic rhinitis – and we are learning that it could, over time, slow or even stop the allergic march to asthma.

ABOUT US The Canadian Network for Respiratory Care is a non-profit organization and registered charity that works to improve the lives of Canadians living with respiratory disease. We certify healthcare professionals as Certified Asthma and Respiratory Educators (CAEs and CREs). Our CAEs and CREs work to help patients with their asthma, COPD, allergies and smoking cessation efforts. For more information or to find a CAE or CRE near you, please see www.cnrchome.net or phone: 905-880-1092.

Photo: RICK CHARD

SMART CAMPER’S TIPS

Q. My son used to be great about tracking symptoms and using his peak flow meter. But now he’s 17, and has to be reminded repeatedly to do so. Do you have any advice? Lora Miller: As children grow older, parents can often make

Ellen Fleming Michaud

Trevor Shewfelt

Lora Miller

Q&A Certified Educators take your asthma and allergy questions. Send questions to: ask@allergicliving.com

Q. Grass pollen triggers my asthma. But I live on my own and need to mow the lawn. Any recommendations? Ellen Fleming Michaud: It would be best for you not to do the mowing, as cutting the grass distributes pollen into the air. However, as this is not an option, I strongly recommend that you wear a mask with HEPA filtration to block out dust, pollen, and mould (these are available at most hardware stores). After mowing, take a shower to remove any pollen and change into fresh clothing. Taking a non-drowsy antihistamine daily during allergy season can also help. Speak with your allergist about whether you could be a candidate for allergy shots and ensure that you take your asthma controller medicines (inhaled corticosteroids) daily. Your blue rescue inhaler should be available to you at all times. Q. A month ago, my 6-year-old had an asthma attack and we had to go to the hospital. Our doctor then changed controller inhalers and increased the dosage, but now my daughter’s symptoms seem worse. Could this be the wrong medication for her? What should we do? Trevor Shewfelt: It’s possible it’s the wrong medication, but

the more likely reason is incorrect inhaler technique. Inhalers are surprisingly difficult to use properly. I suggest getting your pharmacist to watch your child use her new inhaler. He or she will be able to help her with the correct technique. If the inhaler is the spray type with the pressurized canister, ask your respiratory educator or pharmacist about a spacer device. A spacer can make it much easier to get the medication deep into her lungs where it does the most good. Also, I would suggest visiting the Children’s Asthma Education Centre website (www.asthma-education.com) for demonstrations on using an inhaler.

more of an impact on their kids by giving them ownership of decisions regarding their health. In this case, I would ask your son why he is no longer monitoring his peak flows. If his response makes you think he is becoming complacent with his asthma control, you could ask him what he might miss out on if he has symptoms – a paycheque from missed shifts at work or maybe the basketball championship game. If he starts to see that his health is linked to things that he values, he will find his own motivation to keep his asthma under control. Q. We have identical twins and one has just been diagnosed with asthma. Is his twin equally at risk of developing it? Ellen Fleming Michaud: If having asthma was based solely on

genetics, identical twins would be equally at risk of developing it. However, studies show the odds of identical twins both developing asthma are about 60 per cent. It is nearly impossible to predict whether your other child will inherit the disease, as there are environmental factors that come into play, such as exposure to air pollution, cigarette smoke and dust mites. Diet and exercise may even have a role. My advice: closely monitor your child for signs or symptoms of asthma and speak with your family physician about whether to have a spirometry test performed. Q. I’m going to be a bridesmaid at an August wedding. Since ragweed is a bad asthma trigger for me and the wedding is bringing on stress, what can I do to prepare? Trevor Shewfelt: Start with regular exercise, a good diet and lots of sleep. These will help you deal with stress. If you have a controller inhaler, use it as prescribed in the months leading up to the wedding to keep your lung inflammation in check. Ask your respiratory educator or healthcare professional about starting an antihistamine like loratadine (Claritin) a week before the wedding to lessen symptoms from ragweed. You might also ask about an omega-3 and/or vitamin D supplement, as both can reduce lung inflammation. Finally, you could speak to your doctor about taking a leukotriene inhibitor like montelukast (Singulair), in addition to your controller medication to further reduce inflammation. Q. My son is starting Grade 1 this fall, when should we start increasing his asthma meds to be ready for school? Lora Miller: I recommend marking your calendar a full two weeks prior to a risky season that will affect asthma symptoms, and start taking or increasing inhaled corticosteroids at this time. The so-called September spike for asthma is one issue, but there are other risky times as well. Taking action two weeks ahead of a trigger season will help to minimize reactions.

Ellen Fleming Michaud is a respiratory therapist and CRE in Renfrew County, Ont. Trevor Shewfelt is a pharmacist and CRE in Dauphin, Man. Lora Miller is a respiratory therapist and CRE in Camrose, Alta.

ALLERGIC LIVING | SUMMER 2012

Food Allergies:

Avoidance Alone Isn’t Enough BY SUZANNE MURPHY

Many children with asthma also have food allergies and as a Certified Respiratory Educator, I often talk to families about prevention and being prepared for a food allergy reaction. I am alarmed by the number of parents who do not have an epinephrine auto-injector for children at risk for anaphylaxis. These families rely on being able to avoid allergens as a prevention strategy. That is dangerous. Children with uncontrolled asthma who are exposed to a food allergen are at an increased risk of death from an anaphylactic reaction. Asthma medication, such as Ventolin, can’t halt the breathing difficulties of an anaphylactic reaction. An experience with a 5-year-old patient of mine reinforces the point. The girl ate a piece of a store-bought cake that was labelled as free of her allergens. After a few bites, the girl’s face swelled and she had difficulty breathing. Her parents called 911 and gave her epinephrine while waiting for the ambulance. She made a full recovery. However, if the parents hadn’t had an auto-injector available, it may have ended differently. I encourage all families dealing with asthma and anaphylaxis to follow their asthma action plan, ensure that they have an auto-injector available at all times and know how to use it. Suzanne Murphy is a nurse and CRE at Credit Valley Hospital in Mississauga, Ont.

POLLEN QUICK TIPS • Close doors and windows, especially in the bedroom. • Avoid drying clothes outside as pollen will accumulate on the laundry. • Discourage kids from playing on freshly cut grass. If they can’t avoid, shower and change clothes afterward. • Take a non-drowsy antihistamine prior to activities like picnics, soccer and baseball games.

CNRC thanks GlaxoSmithKline for helping to make Currents possible through an educational grant. 40 ALLERGIC LIVING | SUMMER 2012

Parents’ Corner

Soothing Tiny Eyes and Noses BY INGRID BAERG

Kids with asthma often also have seasonal allergic rhinitis or pollen allergies, such as summer grass pollen reactions. The symptoms include itchy, watery eyes and a runny or stuffy nose, which can make kids feel miserable. Inflammation in the nose may Treating runny nose contribute to inflammation in the symptoms helps kids with asthma control. airways of the lungs. Therefore treating the nose is important in managing asthma, but doing so can be difficult at a young age. Here are some tips to get help you get it right. Nasal Sprays: Young children aren’t keen about a solution being sprayed up the nose. Use books, pictures or even a model of a nose to show kids the anatomy and what the spray does. Aim away from the bony middle part of the nose. Don’t expect immediate relief, since getting control of “stuffiness” or inflammation with a nasal corticosteroid spray can take several weeks. Be persistent. Eye Drops: Have the child lay the head in a parent’s lap or on a pillow. Do not place drops directly on the eye. Rather, gently pull the lower eyelid at the cheekbone, creating a pocket. Place the dropper as close to the pocket as possible without touching, and insert one drop at a time. Oral Medication: Non-drowsy antihistamines such as Aerius, Claritin and Reactine are the most appropriate as they have fewer side effects and last 24 hours. Benadryl should be avoided for rhinitis since it is sedating, and its effect only lasts four hours. Ingrid Baerg is a CAE and nurse at the Asthma Education Clinic at the BC Children’s Hospital in Vancouver. Photo: iStockphoto.com / IMGORTHAND

SUPPLEMENT

LATEST INFORMATION

NewsFlash If you suspect a food allergy, go for testing.

Food Allergy Affects 2.5 Million in Canada by CLAIRE GAGNÉ bout 2.5 million Canadians report having a food allergy, according to Dr. Ann Clarke, a leading researcher from McGill University’s divisions of allergy and clinical immunology and clinical epidemiology. The number is based on data

In Brief Bee Pollen Warning Canadian doctors are warning that bee pollen health supplements, which are rich in vitamins and minerals, have the potential to cause a life-threatening anaphylactic reaction in those with pollen allergies. Writing in the Canadian Medical Association Journal, the doctors described the case of a patient who, shortly after taking her second dose of the supplement, began to have anaphylactic symptoms including lip and throat swelling, diffi-

collected from almost 10,000 people who report at least one food allergy. That’s 7 per cent of Canadians, and considered a conservative estimate, since many who reported having a food allergy are excluded from the finding due to factors like the possibility of having outgrown an allergy, and confusion between milk allergy and lactose intolerance

cultly swallowing and shortness of breath. It is thought that these reactions can occur because bees collect a variety of pollens, including windborne spores like ragweed.

Asthmatic Seniors Research published in the Annals of Allergy, Asthma & Immunology found that only 53 per cent of U.S. asthmatics over the age of 60 took prescribed inhalers on a regular basis. The findings are significant, as the death rate for people with asthma over the age of 65 is 14 times higher than that of younger patients. “It is alarming that such a large percent-

or wheat allergy and celiac disease. Of concern to the researchers is the fact that many who reported having symptoms when they ate a particular food had not seen a doctor for diagnosis, and did not carry emergency medication. “If you have a reaction to a food and you’re not sure whether this represents an allergy, it’s necessary to see an allergist so they can do the proper testing to determine whether you have a food allergy,” Clarke said in a podcast interview with Anaphylaxis Canada. “If you do, you really need to strictly avoid that food and carry Dr. Ann Clarke of an epinephrine auto- McGill University injector.” An early look at the data suggests food allergy may be more common in households where the education level is higher, but Clarke, a researcher with the AllerGen network, says this needs further study before conclusions are made. While the 7 percent is considered a good estimate of the allergy picture in Canada, self-reported food allergy studies are known to find slightly higher prevalence compared to physician diagnosis, but the latter isn’t practical for a large scale study. Clarke says that, with so many affected, all Canadians need to be aware of the dangers facing those with food allergies. “They really need to know that food allergy is a real problem, and it’s not something that can be easily dismissed, because it can lead to a life-threatening event.”

age of older people with asthma are letting their disease go untreated, especially since this can lead to other health problems,” the study author said in a release. Allergic rhinitis, arthritis and diabetes were found to be more common in study participants with asthma than in those without.

Asthma Stats New data from the U.S. Centers for Disease Control and Prevention shows 25.7 million Americans (18.7 million adults and 7 million children) have asthma. Other key U.S. statistics include: Continued on page 42 ALLERGIC LIVING | SUMMER 2012 41

LATEST INFORMATION Continued from page 41 • 1 in 11 children have asthma; 1 in 12 adults have asthma. • black children are twice as likely to have asthma as white children. • 1 in 5 asthmatic children went to an emergency room for asthma in 2009.

3 Shots Only Researchers in Switzerland say they’ve found a way to reduce the number of injections needed for immunotherapy to just three shots. In the study, cat allergen was modified and injected directly into the lymph nodes. After three injections over two months, the patients who got injections gained tolerance to cat dander, while those on a placebo did not. Typically, immunotherapy injections are taken weekly or monthly over three to five years. The study, published in the Journal of Allergy and Clinical Immunology, had a small sample size and was meant to determine the safety of the shots.

Preventing Eczema A study has found that taking heat-killed bacteria in infancy may prevent eczema. Researchers in Europe looked at more than 600 infants who were at risk of eczema due to one parent being “atopic” – the tendency to be allergic. Ten per cent of those who took the bacteria in a solution from five weeks old to seven months old developed eczema, compared to 20 per cent of the group who got a placebo. The effect was greater in those children whose father was allergic. –C.G.

AMISH KIDS LESS ALLERGIC t has been known for a number of years that kids who grow up on a farm have fewer allergies and a lesser chance of developing asthma. Now new research is showing that there’s something about growing up on an Amish farm, specifically, that further increases protection against these diseases. Researchers compared kids who lived on farms in the Amish community of about 25,000 in Indiana with kids who lived on farms in Switzerland, as well as Swiss kids from cities. (The Indiana Amish community migrated from Switzerland about 200 years ago, so there is genetic similarity.) On the Amish farms, 5.2 per cent of the children had asthma and 7.2 per cent tested positive to skin prick tests for environmental allergens. The rate of asthma and allergic sensitization on Swiss farms was 6.8 per cent and 25.2 per cent. In the non-farm Swiss kids, rates were even higher: 11.3 per cent were reported to have asthma, and 44.2 per cent were sensitized to allergens. (Sensitization does not necessarily mean a person will have allergy symptoms.) Researchers did not have an explanation for the lower rate of sensitization in the Amish children, but said many families in the community live on working farms, all have horses that are used for transportation, many drink raw milk, they don’t have electricity in their homes and they have large families. –Claire Gagné For more on the “farming effect theory” see www.allergicliving.com/whyallergies

Leaders of the new group: John Lehr, Maria Acebal and Mary Jane Marchisotto

42 ALLERGIC LIVING | SUMMER 2012

he top two U.S. food allergy associations are joining forces to create one powerhouse organization seeking to improve the lives of people with food allergies. The Food Allergy & Anaphylaxis Network (FAAN) and Food Allergy Initiative (FAI) will unite under a new name and logo (to be announced shortly) and begin operating as one organization after they receive regulatory approval for the merger. The new organization will be led by John Lehr, who most recently was the president and CEO of CureSearch for Children’s Cancer. He is clear on the focus for the merged organization: “There are two things I’m most interested in. One is advancing research toward a cure, and I think there’s a lot that can be done on that front. Second is to make sure any child or adult who has food allergies is safe.” –Claire Gagné

Photo: AFP / Getty Images

Food Allergy Groups T Unite in Cure Hunt

Migraines Linked to Celiac by LISA FERLAINO aving chronic migraines could be a sign of celiac disease, according to a new study from researchers in New York. After studies in Europe showed a link between celiac disease and a high prevalence of migraine headaches, Dr. Alexandra Dimitrova, a neurological resident at Columbia University Medical Center, under the supervision of Dr. Peter Green from the Celiac Disease Center at that university, decided to investigate whether the same held true in the U.S. The researchers found that 30 per cent of the patients they studied with celiac disease reported chronic migraines (14 or more per month). For the study, the researchers analyzed the intensity and frequency of headaches of 502 people with celiac disease, gluten sensitivity, irritable bowel disease, as well as a control group. They also looked at daily habits, such as coffee and alcohol consumption. Those with celiac disease reported the most frequent and intense migraines. Since it often takes years before someone is diagnosed with celiac disease, migraines could be a clue: “I would test any patient not responsive to appropriate migraine medical therapy administered by a neurologist,” says Dimitrova. The good news is that both the European and U.S. research suggests that a gluten-free diet can reduce the number and severity of migraines. More work needs to be done, says Dimitrova, including a study in which diet and eating habits are looked at in-depth to determine the impact on migraines.

Chips Get First Gluten-Free Seal anada has its first officially certified gluten-free product: Lay’s potato chips. In order to obtain the designation, four facilities in Canada and one in Mexico were certified under the Canadian Celiac Association’s Gluten-Free Certi-fication Program. The chips, made by Pepsico Canada, for the most part have always been made without gluten, but now customers can be assured that Lay’s facilities and manufacturing processes have been verified by a third party. (Only one variety, Lay’s BarBQ Flavour, won’t bear the new CCA logo.) Paul Valder, the consultant developing the CCA’s certification program, says this is just the first of a number of certified products consumers will see over the coming months. The CCA is in discussions with a major retailer for certfying its private label line, and also in the gluten-free pipeline are: a national brand that makes crackers and cookies, a national bakery, and a generic drug manufacturer. –Claire Gagné

Texas Schools Go Allergy Friendly

Lobbying the legislature in Austin in 2011.

ood allergy advocates in Texas have scored a coup with the release in May of guidelines for district-level food allergy policies. The guidelines, which took involved consultations, were required in legislation that passed in June 2011. Getting such a bill through in Texas wasn’t easy, according to Mike Lade, vice-chair of FAAN’s board of directors and a member of the guidelines committee. “Texas is still the Wild West,” he says. “No local school district wants to be told, ‘Thou shalt do this.’” The guidelines contain information on everything from symptoms of a reaction to training for school staff, guidance on reducing the risk of allergen exposure, sample forms, action plans and more. They will be used as the basis of school district policies. –C.G.

When Can Kids Self-Inject? M any allergists expect children to take responsibility for recognizing signs of anaphylaxis and self-injection of epinephrine by ages 12 to 14, report the authors of a study that surveyed 88 American allergists. While the timing of when allergists expected the transfer of responsibility from parent to child to occur varied, many expected that, by the ages 9 through 11, children would be able to describe some anaphylaxis symptoms, recognize the need for epinephrine, and show they could self-inject using a trainer. By 12 to 14, 79 per cent of allergists said children should be able to selfinject epinephrine. In the study, published in the Annals of Allergy, Asthma and Immunology, allergists most often cited being able to self-inject with a trainer, being able to describe reasons to inject and having a high risk of anaphylaxis as factors for transferring the responsibility to the child. –C.G.

ALLERGIC LIVING | SUMMER 2012

deliciously dairy free no matter how you slice it

Daiya Wedges Same delicious experience in a whole new style! New Daiya Wedges are ready to just slice and enjoy, no cooking or melting required! Perfect on your favourite sandwich or as a bite-size snack, and still deliciously free of dairy (lactose & casein), soy, gluten, and other common allergens. With three new flavours — Jalapeño Garlic Havarti, Jack, and Cheddar — the only decision left is which one to slice into first!

dairy free

gluten free

soy free

Vegan

Pareve

NO DAIRY, NO GLUTEN | ALISA FLEMING

Photo: HANNAH KAMINSKY

Strawberries ’n Cream Watermelon Pops atermelon and strawberry have evolved to be one of my favourite fruit combinations. Plus, the riper the fruit, the sweeter the pops, so this cool recipe is ideal to enjoy in the heat of summer. Feel free to reduce the honey in the watermelon and strawberry blend if your fruit is particularly ripe, but be aware that the finished pops will taste a little less sweet once frozen.

Ingredients Fruit Layers

Vanilla Cream

• 1⁄4 lb (113 g) seedless watermelon flesh 1 (about ⁄2 cup of purée) 1 • ⁄2 cup (120 mL or 2.5 oz) fresh or frozen ripe strawberries, halved • 1 tbsp (15 mL) honey • 1⁄4 tsp (1.25 mL) fresh squeezed lime juice

1 • ⁄2 cup coconut cream* [see “Advice On” page 47] or full fat canned coconut* milk • 1 tbsp (15 mL) honey • 1⁄4 tsp (1.25 mL) vanilla extract continued on page 47

ALLERGIC LIVING | SUMMER 2012

NO DAIRY, NO GLUTEN | ALISA FLEMING Method

• Combine the watermelon, strawberries, 1 tbsp of honey and the lime juice in a blender. Purée until smooth. Pour into a glass measuring cup, and quickly rinse the blender jar. • Combine the coconut cream or coconut milk, remaining 1 tbsp of honey and the vanilla in the blender. Purée until smooth. • Pour the fruit blend into 4 to 6 pop 1 molds until they are roughly ⁄3 full. Freeze the pops for 30 minutes. • Remove the pops from the freezer,

and divide the vanilla cream among the pops to make the second layer. Freeze the pops for 30 minutes. • Remove the pops from the freezer, and pour the remaining fruit blend over the pops to make the third layer. Place the popsicle sticks into the pops, and freeze the pops for 1 to 2 hours, or until completely frozen. Makes 4 to 6 Pops Recipe Variations

• Quick Blended Cream Pops: For a super fast two-step recipe, skip the layers and simply blend all of the ingredients together.

Fill the pop molds and chill in the freezer for 2 hours or until solid. • Strawberry Cream Variation: For fruitier pops, blend two ripe strawberries into the vanilla cream before pouring it into the molds. *A Note on Coconut

Coconut is technically a fruit. While most allergists do not consider it a tree nut, if you are nut allergic, ask your doctor if coconut is safe for you. Alisa Fleming is the author of Go Dairy Free: The Guide and Cookbook for Milk Allergies, Lactose Intolerance and Casein Free Living, and founder and chief editor of the website Godairyfree.org.

ADVICE ON:

Substituting Cream in Dessert Recipes My go-to substitute for heavy cream in sweet recipes is coconut cream. Despite the name, coconut cream contains no dairy. It’s made purely from puréed coconut, but has a rich, creamy texture. Like dairy cream, coconut cream is high in saturated fat, allowing it to solidify at cooler temperatures. Thus, coconut cream can be whipped, and maintains a rich and creamy texture when frozen. Coconut cream is also surprisingly easy to locate; you’ll find it in the Asian foods section of most grocery stores under the guise of canned coconut milk. Coconut cream is simply the rich part of full-fat coconut milk. As the coconut milk rests, the cream rises to the top to form a very thick layer that can be scooped out like soft ice cream. In fact, the sign of a good canned coconut milk is one that separates into a watery base with up to threequarters of a cup of “stand a fork in it” cream on top. In warmer months, chill the coconut milk in the refrigerator for a few hours to assist in the separation. – Alisa Fleming

Coconut cream dessert

ALLERGIC LIVING | SUMMER 2012

48 ALLERGIC LIVING | SUMMER 2012

What My Kids Taught Me As

AnAllergist No amount of medical training could have prepared me for having children with multiple food allergies. by Sarah Boudreau-Romano

Photography: ANDREA MANDEL

can tell you exactly where I was when the field of allergy and immunology first stole my heart. I was in my first year of medical school sitting in an overly cool classroom taking notes as fast as any human hand could. My pathology lecture was just ending and immunology was up next. I rubbed my sore fingers and prepared to write down, verbatim, the next lecture. But shortly after my professor started to speak, I realized that I had completely stopped taking notes. I had allowed myself to be drawn into the story that she was weaving, a story of T cells and B cells and their physical and chemical conversations with each other. It was amazing. Little did I know that she was introducing me to a cast of cellular characters that would soon become not only important for me to pass my next immunology test, but also to complete my subsequent fellowship training and to my understanding of the mechanism of food allergy, an immunological disease that would affect three of my four children. In 2005, after completing a pediatric residency, I started my fellowship in the field of allergy and immunology at the

Childrenâ&#x20AC;&#x2122;s Memorial Hospital in Chicago. I had a 7-weekold baby boy at home so I was knee-deep in motherhood, but I was ready. I was excited to finally be seeing patients with the allergic and immunological disorders that I had been so interested in during medical school. These diseases, including chronic sinusitis, seasonal allergies, and immune deficiencies, were all challenging and interesting, but what drew me in the most was food allergy. There was something so cruel and senseless about a disease that denies a child a bakery cookie â&#x20AC;&#x201C; it made me want to break its code. As fellows, we were taught to take a detailed history of the allergic reaction from the patient and the parent, paying exquisite attention to what food was ingested, the timing of the ingestion in relationship to the symptoms and what symptoms occurred. Patient histories would often become complicated, a fusion of facts and feelings. We would then perform skin-prick testing with the suspected food protein and draw blood for the same allergen. Combining the history and the results of the testing, a diagnosis was made. We would review an allergen avoidance sheet with the family, explaining the importance of reading food labels, and discuss an emergency health-care plan, teaching the ALLERGIC LIVING | SUMMER 2012

families how to recognize and treat an allergic reaction. We provided them with a short list of support services and asked them to follow up in one year. It was a good system, at least as far as I knew. By the end of my first year of fellowship, we had twin boys (yes, we had three boys in 13 months!) and one of them, Gino, literally had hives on his skin only a few days after he was born. He would soon be covered in itchy, bleeding eczema and more often than not, vomit, so I made an appointment with an allergist. I provided her with a detailed history of my son’s reactions that was, of course, muddled with facts and feelings. His skin-prick test and his blood test to cow’s milk were both positive and the allergist told my husband and me that our son was allergic to cow’s milk. As this diagnosis fell from her lips, the same diagnosis that so often fell from mine, I experienced how it felt on the other side. It was a powerful blow. I was on the wrong side of this appointment, a side I never dreamed I’d be on. I was not the allergist that day, instead, I became the mother of a child with food allergy. After we reviewed the perfunctory literature, I got my one-year send-off and then, I panicked. I wanted our allergist to come back in the room. I had so many questions left to ask. But I was an allergist, so how could I have so many questions? I only knew one thing – that I needed more time with her. I felt alone and anxious. As a fellow, I’d never quite understood it when parents cried at the end of our appointments. The diagnosis and treatment was a matter of fact. You avoid the food and you avoid the reaction. But now, on the other side, I understood. It was about how in the world you were going to avoid the food and what on Earth would happen if you didn’t. I walked out of the office saddened that, previous to this appointment, I had not really known what food allergy families go through and devastated that I had to learn it like this. It felt like I was like starting over, both personally and professionally. When I walked into my house after the appointment, I went directly to the kitchen. I have always believed that our home should be a safe haven for my children, so I began my quest to rid the house of milk. I started reading labels. As I read every label on every box of food in my kitchen, I turned numb. I threw away pudding, cheese, sticks of butter, bags of chips and boxes of cookies until my cabinets and refrigerator were nearly bare. No one warned me how hard it would be to go back into my kitchen for the first time. After putting the boys to sleep, I went to the grocery store. As I wandered the aisles trying to find food without any milk ingredients, I noticed that my usually overflowing cart was sparse. I knelt on the ground to read the ingredients of a rice drink and caught a 50 ALLERGIC LIVING | SUMMER 2012

As a mom who’s “been there”, Boudreau-Romano wants to help with the issues facing allergy families.

glimpse of a pint of ice cream in another mother’s cart. A feeling that I rarely had felt in my life overwhelmed me. As I fought back tears, I realized what it was. Jealousy. I was truly jealous, deep to my core and then, immediately, ashamed. I wanted her cart. I wanted her convenience. I wanted pizza and ice cream, cheese sticks and yogurt. And I was ashamed that my desire for her food made me feel disdain toward her. No one told me that the grocery store could be this painful. When my head rested on my pillow that night, I remember a long pause in my breathing during which all of the costs of this diagnosis hit me. I could not believe this was happening. And for the first time that day, I actually let myself think about the unthinkable: my beautiful, sweet child could actually die from eating the wrong food. A wave of anguish swept over me. No one told me about this moment, either. It was several months later on a pretty summer afternoon when it nearly did happen. I was on call, so my parents were at our house helping with the boys. I was so excited to see the kids when I got home from work that I let them eat a little treat before dinner:

It was not even a minute after his first bite when my dad yelled out my name and carried Gino to me. When I took him in my arms, I felt his weight; it is the strongest memory I have of that moment. He was completely limp in my arms. I screamed for the EpiPen Jr. as he began to turn blue. homemade allergy-safe cookies. It was not even a minute after his first bite when my dad yelled out my name and carried Gino to me. When I took him in my arms, I felt his weight; it is the strongest memory I have of that moment. He wasn’t holding any of it on his own. He was completely limp in my arms. His colouring grew pale and grey, and he began to turn blue around his lips, so I screamed for the EpiPen Jr. Even though I can put teeny tiny umbilical lines into two-pound babies without a tremor, with my own child, I was shaking so much that I could hardly remove the gigantic gray cap from the EpiPen Jr. When I finally did, I jabbed it into his thigh with a thud and counted to 10. Gino began vomiting profusely, mucous was bubbling out of his nose, and he was turning more and more blue. I could feel myself losing him and I believed that he was dying in my arms - dying from a cookie. Specifically, it would turn out, not from milk, but from the egg in that cookie. Thankfully, the epinephrine began to work. His colouring returned and I felt an overwhelming sense of relief as he started to open his eyes again. That night in the hospital, I remember crying and clutching to Gino for dear life, and thanking God that I could. After this reaction, the list of foods Gino had to avoid due to serious reactions began to grow and grow until it included milk, egg, wheat, corn, oat, barley, grape, mustard, sesame, green pea, pinto beans, lentil beans, garlic, chicken, turkey, peanut, tree nuts, fish and shellfish. Gino’s twin brother, Milo, has severe allergic reactions to soy and egg. Our youngest, Lucy, had anaphylaxis to milk at four months old requiring two doses of epinephrine. I spent most of the first several years of life raising children with multiple life-threatening food allergies feeling woefully unprepared. I felt alone, scared and confused. I often think about why I felt this way and what could have been done to lessen those feelings. I feel that we, as allergists, need a better way to more thoroughly address the real-life issues that so often plague the lives of food allergy families. There must be a stronger link between food allergy families and the allergist’s office. What would this look like? Maybe it’s a mandatory second appointment with the allergist or a nurse, or a one-on-one family

meeting with a veteran food allergy family during which they share their favourite sources of information, recipes, tips and support services. Perhaps it’s a follow-up phone call the evening after a food challenge or group meetings run by the allergist’s office for his or her patients. Since the completion of my fellowship, I have not gone back to seeing patients in the clinic and I have struggled to find the best way for me to serve the food allergic community. In the future I would love to be a part of a follow-up appointment as both the allergist and the veteran food allergy mom, but until I can make this concept a reality back in the hospital or through consultation, I started a blog in an attempt to do this virtually. Through this blog I provide education and advocacy, first-hand experience and mostly, friendship. When I began to fall apart in this allergic life, it was with the support from my family, my medical colleagues, and other food-allergic families that I was able to be put back together again. I want to be one of the people who help to revive and strengthen other food allergy families. I want them to remember exactly where they were when their heart, once broken by food allergy, finally started to heal. Sarah Boudreau-Romano’s blog is Theallergistmom.com. Three of her four children are allergic to multiple foods. Their combined list is: milk, eggs, peanuts, tree nuts, soy, wheat, oat, corn, green peas, beans, mustard, sesame, fish, shellfish, grapes, cranberry and bananas.

ALLERGIC LIVING | SUMMER 2012

FOOD | SAFE EATING

52 ALLERGIC LIVING | SUMMER 2012

Bestof the Med The Mediterranean diet is splendid for good health. But as Chef Simon shows, the taste is fantastico, too. Recipes by Simon Clarke Photography by Chris Gonzaga

(Left) Spaghetti With Capers And Arugula; (right) Stuffed Grape Leaves, With Quinoa And Mint and Eggplant Hummus

ALLERGIC LIVING | SUMMER 2012

FOOD | SAFE EATING

Stuffed Grape Leaves, With Quinoa And Mint SERVES 6-8 Free of: gluten and all top allergens Ingredients

1 jar of grape leaves (about 30 leaves), drained 1 cup (250 mL) raw quinoa 2 cups (475 mL) vegetable stock [Look for allergen-free, GF brand] 2 cups (475 mL) tomatoes, diced 1 ⁄2 cup (125 mL) red onion, minced 1 ⁄2 cup (125 mL) currants 1 small bunch mint leaves, chopped 1 tbsp (15 mL) cumin 2 tbsp (30 mL) olive oil 2 tbsp (30 mL) lemon juice salt and pepper Method 1. In a medium saucepan, cook quinoa in

vegetable stock. Use medium heat until liquid is absorbed and quinoa is cooked through. Let cool. 2. In a large bowl, add cooked quinoa and remaining ingredients (except grape leaves). Stir well, and taste test seasoning. 3. Lay the grape leaves out on a flat surface. Place about 2 tbsp of filling onto the centre of each leaf. 4. Fold over one side lengthwise, then the other. Roll from the bottom to form a bundle. Each should resemble a short, fat cigar. 5. Continue until all the filling is used up. (A great job for involving the kids!) 6. Serve with our hummus and olives.

Eggplant Hummus SERVES 6-8 Free of: gluten and all top allergens (no sesame!) Ingredients

1 eggplant, halved lengthwise 1 14 oz (398 mL) can white beans, rinsed 4 cloves garlic, roasted 1 ⁄2 cup (60 mL) parsley, chopped 1⁄ 4 cup (60 mL) lemon juice 2 tbsp (30 mL) olive oil salt and pepper Method 1. Heat oven to 400° F. 2. Place eggplant halves onto a baking

sheet, cut side up. Roast 22-24 minutes until cooked through. Cool. 54 ALLERGIC LIVING | SUMMER 2012

Watermelon And Herb Salad

3. Scoop eggplant flesh into a food processor and discard skin. 4. Add all remaining ingredients. Pulse until smooth and combined well. 5. Place hummus in dipping bowl, and serve with gluten-free garlic toasts or vegetable sticks.

Warm Spaghetti With Capers And Arugula SERVES 4-6 Free of: gluten and all top allergens Ingredients

2 227 g packages rice or quinoa spaghetti* 1 two-inch thick slice of bresaola* or pancetta, diced 1 small red onion, diced 2 cups (475 mL) cherry tomatoes, halved 1 ⁄2 cup (125 mL) capers, rinsed 1 cup (250 mL) olives, pitted 1 cup (250 mL) purple basil 2 large handfuls of arugula 2 tbsp (30 mL) olive oil salt and pepper Method 1. Cook the pasta in salted water,

per instructions. Set aside.

2. Place bresaola or pancetta in a large

sauté pan. Cook 2-4 minutes over medium-high heat until golden brown. 3. Add onion and cook until translucent, about 3 minutes. 4. Place tomatoes, capers and olives into pan, sautéing and stirring 3-4 minutes. 5. Remove from heat. Add basil and arugula and cooked pasta to the mixture. Toss together well. 6. Serve in bowls, drizzle with olive oil and season with salt and pepper. *Notes

We used GoGo Quinoa spaghetti; bresaola is a cured beef product similar to pancetta. For vegetarian: omit meat and replace with ¼ cup (60 mL) olive oil.

Watermelon And Herb Salad SERVES 4-6 Free of: gluten and all top allergens Ingredients 1 ⁄2

watermelon 2 cups (475 mL) assorted tomatoes, chopped

1 cup (250 mL) cucumber, diced 1 avocado, diced 1 ⁄2 cup (125 ml) each, fresh basil, mint and chives, chopped ¼ cup (60 mL) fresh lime juice ¼ cup (60 mL) olive oil salt and pepper Method 1. Remove skin from watermelon and

dice the flesh. Place into large bowl, along with other vegetables and herbs. 2. In a measuring cup, stir together lime juice, oil and salt and pepper. 3. Pour dressing over salad, toss well, and serve. Note: Try contrasting colours and

Red Pepper Pockets SERVES 4-6 Free of: gluten and all top allergens Ingredients

4 large red peppers, halved, seeds removed 1⁄ 4 cup (60 mL) olive oil 1 small sweet onion, diced 4 garlic scapes or 4 cloves garlic, minced 2 ⁄3 lb (300 g) ground lamb* 1 cup (250 mL) kalamata olives, halved, pitted 1 bunch basil 1 cup (250 mL) dairy-free mozzarella shreds [or feta cheese if not dairy-free] salt and pepper

Method 1. Pre-heat barbecue on medium-high. 2. Rub outside of peppers with 2 tbsp

of the olive oil, and grill, skin side down, 6-8 minutes. Remove and set aside. 3. Meanwhile, in a large sauté pan, heat remaining olive oil over medium. Add onions and garlic and cook 4-5 minutes. 4. Add ground lamb to pan, and cook 6-8 minutes, stirring often. 5. Next, toss in olives, basil, salt and pepper and combine well. 6. Spoon mixture into pepper halves, top with non-dairy cheese shreds and serve. *For vegetarian: omit the lamb and 1

add 1 ⁄2 cups (350 mL) of diced zucchini.

shapes of tomatoes.

Red Pepper Pockets

ALLERGIC LIVING | SUMMER 2012

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Arielle Sodowick’s exhilirating dive in New Zealand.

OUR STORY

It’s Her Life As my dairy-allergic daughter proves her independence, I’ve had to learn to let go. by MELISSA SODOWICK

y 20-year-old daughter, Arielle, who was spending a semester in Australia and taking a side trip, sent me the link to her itinerary for New Zealand. “Extreme Adventures” appeared at the top of the page, followed by a list of activities on the tour. I held my breath as I read the descriptions, to the effect of: “Travel through river canyons at 100 kilometres per hour in a jet boat!” “Bring your courage along as we bungee jump over Queenstown!” “Fall out of a plane from 14,000 feet over magnificent scenery.” I stopped there. “Are you crazy?” I emailed back. “I hope these activities cost extra, and you can’t afford them.” “Everything is included except for skydiving,” she replied, inserting a smiley emoticon. Not only did I think she was nuts for considering jumping off a mountaintop attached to a rubber band or parachuting from a plane, but also for sharing this information with me. Having grown up watching me deal with her severe milk allergy, she knew I was wired to worry. When dining out, I’d interrupt while she was ordering, urging the waiter to check the dish’s ingredients before she

58 ALLERGIC LIVING | SUMMER 2012

had a chance to ask herself. Once the meal arrived, I’d lean over her plate to inspect the food for any trace of butter or cheese. But that anxiety was nothing compared to what I felt after Arielle, at age 16, had an anaphylactic reaction that required three doses of epinephrine and hours of monitoring in the emergency room. From that day on, whenever she was headed out to meet friends, I’d stop her at the door and ask where she’d be eating and if she had her medications with her. She’d glare back at me. “You can’t keep me in a bubble for the rest of my life.” *** She was right. Ultimately, I wanted what she wanted – for her to enjoy the same activities and freedoms as any teen. I worked on backing off, and reminded myself that she had always been careful: checking labels, alerting servers and managers to her allergy and passing up a food when she couldn’t be certain whether it contained dairy. With planning and proper precautions, she spent two weeks without incident in Provence through a high school exchange program. (Full disclosure: my husband and I followed her to France. We stayed

about 45 kilometres from her home base and never saw her, but felt reassured that we were only a car ride away in case of an emergency.) Arielle’s transition to college went smoothly, too. She found plenty of safe foods in the dining hall and learned to cook when she moved off campus in her sophomore year. When she pleaded with us to study business in Australia, it was hard to say no. *** Arielle texted us when she arrived in New Zealand and then five days later. “Just went skydiving from 15,000 feet! It was amazing!” My heart raced. I texted back: “OMG! U really did it!” Our exchange was brief, since she was on the road. She said she’d fill us in on the jump when she returned to Brisbane. Knowing she was now safe on the ground, I felt calmer. In the days that followed, I pictured my daughter falling through the sky in tandem with an instructor. I thought about her fearlessness. I considered that perhaps when you’ve experienced real fear – an itchy tongue that in seconds becomes something worse, like the tightening of your throat – you have fewer imagined fears. Or maybe you become determined to live life to the fullest, travelling halfway around the world, surfing, glacier hiking, bungee jumping and skydiving. Back in Brisbane, Arielle called us through Skype to video chat. After sharing the highlights from her trip, she asked, “Want to see the skydiving video?” We watched her take off on a twin-engine plane with a few of her travel companions. Then came the jump. Geared up in a silver jumpsuit, helmet and goggles, she went free-falling through clouds. In a close-up, she was smiling, exhilarated. Suddenly, I was overcome with awe as well as joy for her. I wondered if she could see me tearing up through the pixilation of long-distance video. Then I noticed Bon Jovi’s “It’s My Life” playing with the footage. I listened to the words: My heart is like an open highway Like Frankie said, “I did it my way” I just want to live while I’m alive ’Cause it’s my life. It was the perfect anthem for Arielle. Melissa Sodowick is a freelance writer who lives in Washington Crossing, Pennsylvania. To comment: editor@allergicliving.com.

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