Posts Tagged ‘cereal’

When it comes to making bread and cakes, wheat has some remarkable cooking properties that nothing else

can match. Its characteristic proteins, called gluten, form very strong elastic threads. These make a

stringy dough that can be stretched and stretched as the bread rises. As a result, the bubbles of gas

given off by the yeast or baking powder are all embraced by the dough, giving an open, airy consistency

to the finished product.
Have no illusions – without wheat flour you cannot make a crispy baguette or a well-risen cottage loaf.

If you are able to eat rye, then rye flour makes a pretty good substitute, because it also contains

gluten, though not as much as wheat flour. But a gluten-free diet excludes rye too (see p. 177), and

then baking definitely becomes a challenge.
Even on a gluten-free diet, however, you can still make several perfectly edible, even delicious, types

of bread and cake. The secret, especially with bread, is to accept that the texture is going to be

different from wheat-based bread, but to add enough interesting flavours to give the finished product

its own special character. The gluten-free bread you make at home will taste vastly better than the

pale and pappy commercial substitutes – and at a fraction of the price.
Wheat-free and gluten-free bread tends not to keep as well as ordinary bread, so make a batch of small

loaves and freeze some of them. You can slice them before freezing, then extract and defrost a few

slices at a time, as needed. Bread that is not frozen should be kept in a plastic bag in the

refrigerator. Even when kept in this way, the bread gets rather dry and tough after a few days, and

will benefit from being toasted. Try spreading it with butter, margarine or solidified olive oil (see

page 182) before putting it under the grill – this revives bread far better than ordinary toasting.
Pastry-making without wheat is also a challenge (see p. 180) but cakes, biscuits and other sweet items

are much less of a
problem. As long as you accept the limitations of non-wheat flours, cakes can be made perfectly well

using gluten-free flours. With the right culinary tricks, you can even make a light fluffy sponge (see

pp. 180-81).
To thicken sauces and gravy, you can use cornflour or any other non-wheat flour.
If you have an allergy or intolerance to other foods, besides wheat, the recipes here can be adapted

accordingly. For example, commercial egg replacers (see p. 186) can be used in place of eggs, and milk

substitutes (see p. 183) can replace cow’s milk.
Wheat-free diets
This section is for people with an allergy or intolerance reaction to wheat. Those with coeliac disease

should read the section on gluten-free diets.
In devising a successful diet for yourself, you need to take account of two factors:
1 How sensitive are you? If you have a true allergy (see p. 62) to wheat, you may be very sensitive and

need to avoid even the tiniest amount of wheat. But if you are just intolerant of wheat (see pp. 74-6),

you probably won’t react to such small amounts. so you don’t need to be so careful.
2 Are you sensitive only to wheat, or do you also react to related cereals, namely rye, barley and

oats? Some people have to avoid these as well, because of cross-reactions (see p. 14).
Those who are highly sensitive to wheat and have cross-reactions to related cereals, need to follow the

same kind of diet as the most sensitive coeliacs (see Gluten-free diets). Ready-made gluten-free foods

(such as bread and biscuits) can be useful, and they should be safe for you, unless you are

ultra-sensitive.
Those who don’t have any cross-reactions to related cereals can tolerate the following:
•    rye bread and rye crackers, as long as they are 100% rye
always double-check. If you buy rye bread from a local bakery, and it is unlabelled, make sure the

staff understand that you must always have 100% rye bread. Ask them to tell you if they ever change the

recipe – and jog their memories about this from time to time.
•    beer – as long as it is brewed using barley. Most is, but watch out for German Weissbier, which

is made from wheat.
•    oatcakes, as long as they don’t contain wheat flour or bran. Check the label carefully.
Gluten-free diets
A gluten-free diet is more restrictive than a wheat-free diet, since gluten is also found in rye,

barley, triticale and spelt. All these must be carefully avoided.
At one time, this list would have included oats as well, but new research suggests that the proteins

found in oats, called avenin, are sufficiently unlike gluten to be safe for many coeliacs. If you have

coeliac disease, you must have medical approval before eating oats. Only those who are healthy and

doing well on a gluten-free diet should try oats, and they should not eat more than one small serving

(less than 50g/13/4oz) per day. It is vital that the oats are grown, harvested, transported, milled and

packaged separately from all wheat to avoid contamination. See your doctor regularly for check-ups (and

if possible a biopsy) to check that the oats are not causing problems.
Various flours are used to make gluten-free breads, including
flours derived from rice, potatoes, soya beans and buckwheat (not
a true wheat). These are sold in health-food shops, and can also
be bought by mail order. For gram flour, try Indian groceries. There
are also special gluten-free bread mixes available in both health-
food shops and pharmacies, but these almost always contain
soya, and it is best to avoid eating too much soya (see page 71).
coeliacs who are extremely sensitive to gluten, and have to
avoid all trace of it, should be very careful about ready-made food.
These are just some of the unexpected sources of gluten:
•    Thickeners and stabilisers sometimes contain traces of gluten. These additives are very widely

used in ready-made foods.
•    A number of food additives (including caramel, citric acid, dextrin, mono- and di-glycerides,

gum base, malt, malt flavouring, maltodextrin, maltose, MSG and vegetable gum) are manufactured from

wheat, barley or oats. Although the amount of gluten/avenin they contain is extremely small, it can

affect a few coeliacs.
•    Barley enzymes, used to make rice milk, some brands of soya milk, soy sauce and miso, can leave

minute traces of gluten in the finished product. Blue cheese can also contain minute traces of gluten

(see p. 174).
•    Whisky and gin – both grain-based spirits – can contain gluten. So may distilled white vinegar.

These will only affect the most sensitive coeliacs, whereas beer must be avoided by all coeliacs, since

it is made from barley.
•    Composite ingredients in ready-made food are covered by the 25% rule (see p. 174), and

frequently contain wheat.
•    Wheat flour may be used as an aid to food preparation, leaving tiny residues in the food (see

p. 174).
•    Non-wheat flour may be delivered to the factories, or transferred from one area to another,

through hoppers or vacuum tubes that have previously been used for wheat flour. Very low levels of

contamination can occur in this way, sufficient to affect those coeliacs who are extremely sensitive.

This is one problem with gluten-free foods (see below), unless they are made in dedicated gluten-free

factories.
•    Products labelled ‘gluten-free’ may not be suitable for the most sensitive coeliacs. Testing

for very small amounts of gluten is difficult, and the international standard set by the FAO/WHO (not

more than 200 parts per million) is dictated by what can be accurately measured, and therefore policed.

Many countries (e.g. Sweden and the United States) feel that the permitted level of gluten should be

lower, and have set their own standards. These higher standards can be achieved by careful control of

the production methods.
There is a great deal of useful information about gluten on the
Internet, but there is also some very misleading information on one
particular website. It is advisable to consult several different sites.
Wheat-free baking powder
Some brands of baking powder contain a little wheat flour. You can make a wheat-free version by mixing

60g (2oz) sodium bicarbonate with 125g (41/2oz) cream of tartar and 60g (2oz) of a non-wheat flour.

Sieve together very thoroughly.
Brown bread
This mixture of buckwheat and potato flour makes a light-textured loaf that also toasts well.
PREPARATION TIME: 15 minutes, plus about 1 hour rising time
COOKING TIME: about 35 minutes
MAKES: 1 large loaf
250g (9oz) buckwheat flour
250g (9oz) potato flour 1 tsp salt
1 sachet easy-blend yeast
25g (1oz) butter
1 tbsp black treacle 1 large egg, beaten
Mix the flours, salt and yeast in a large bowl and rub in the butter. Dissolve the treacle in 225ml

(8fl oz) hand-hot water. Add this and the egg to the flour, and mix to a soft dough. Transfer to a

buttered 900g (21b) loaf tin, wrap in a polythene bag and leave in a warm place for about 1 hour – or

until the mixture has risen to the top of the tin.
Bake in a preheated oven at 220°C/ 425°F/gas mark 7 for about 35 minutes until risen and firm to the

touch. Remove from the tin and tap the base – it should sound hollow. If not, return to the oven for a

further 5 minutes. Cool in the tin for 10-15 minutes.
Variations: many different kinds of flavourings can be added to this bread. Try seeds such as poppy

seeds, mustard seeds, caraway seeds and onion seeds (Indian stores usually stock these with their

spices). Sunflower seeds and sesame seeds – either plain or lightly toasted – are also good. A

combination of black olives, sun-dried tomatoes and a pinch of mixed herbs makes a Mediterranean -style

bread.
Seeded rice bread
This makes a delicious, ‘nutty’, textured loaf that is yeast-free as well as wheat-free. It toasts

quite well.
PREPARATION TIME: 30 minutes COOKING TIME: 40 minutes MAKES: 1 small loaf
150g (5′12oz) brown rice, well rinsed
100g (31,2oz) rice flour 100g (3V2oz) fine oatmeal
1 tsp wheat-free baking powder
1 tsp salt
50g (13/4oz) sunflower seeds
25g (1oz) linseed
1 large, slightly under-ripe pear. peeled, cored and coarsely grated
2 large eggs, beaten
2 tbsp vegetable oil
4 tbsp buttermilk, live natural yogurt, milk or milk substitute
Cook the rice in plenty of boiling water for 15-20 minutes until tender. Drain thoroughly and cool

slightly.
Preheat the oven to 200°C/400°F/gas mark 6.
Combine all the ingredients in a large bowl, then transfer to a well-oiled 450g (1 lb) loaf tin and

bake for about 40 minutes, until slightly risen and golden, and firm to the touch. Cool slightly, then

turn out onto a wire rack and leave until completely cold. Serve cut into thick slices.
Banana loaf
This semi-sweet bread is yeast-free as well as gluten-free. It is good for packed lunches – and it

toasts well.
PREPARATION TIME: 10 minutes COOKING TIME: about 1 hour MAKES: 1 large loaf
4 medium ripe or under-ripe bananas 300g (10′,12oz) brown rice flour, sieved 100g (3112oz) butter,

softened
2 tbsp wheat-free baking powder 2 large eggs
225ml (Bfl oz) milk or soya milk
Butter and line the base of a 900g (21b) loaf tin. Peel and cut up the bananas and place in a food

processor with the remaining ingredients. Blend thoroughly, then transfer the mixture to the prepared

tin Bake in a preheated oven at 180  350°F/gas mark 4 for about 1 hour until risen and firm to the

touch. Cool in the tin then turn out onto a wire rack and leave to cool completely.
Rich herb bread
This is useful for those who have to avolo yeast as well as wheat/gluten.
PREPARATION TIME: 20 minutes COOKING TIME: 30-40 minutes MAKES: 1 small loaf
1108 (4oz) gram or chickpea flour
1 tsp syrup or honey
2 tbsp olive oil
1 tsp salt
1 unripe pear, peeled and grated
200m1 (7fl oz) boiling water
2 eggs
V2  onion, finely chopped
fresh herbs (thyme, tarragon or marjoram)
Mix the first five ingredients, then pour on the boiling water. Separate the eggs, beat the yolks

thoroughly and add to the flour mixture when It has cooled, along with the onion and herbs. This

mixture should now be the consistency of double cream. If too thick, add a little more water.
Whisk the egg whites until they will stand in soft peaks. Carefully fold them into the flour mixture.

Pour into a well-greased loaf tin and cook at 180 - C/ 350°F/gas mark 4 for 30-40 minutes.
Seeded rice bread    Pressed prune and walnut bread
Crispy millet baps
Tasty and filling, these are popular with children. They make no pretence to be bread but are an

excellent substitute for breakfast toast or a lunchtime sandwich. They are free from yeast, milk and

eggs, as well as wheat.
PREPARATION TIME: 30 minutes COOKING TIME: about 20 minutes MAKES: about 20 small baps
225g (Boz) millet seeds
1 tsp salt
150g (5′,12oz) peanut butter (or cashew, pecan or another nut butter)
1 tsp sesame seeds, toasted until golden
oil for frying
Wash the millet and soak overnight. Wash again to remove the starch, drain and add 600ml (1 pint) water

plus the salt. Boil over a low heat for 20 minutes, or until the water is absorbed.
While still hot add the nut butter and sesame seeds. Mix together well using a potato masher to break

up the millet. Take egg-sized lumps of the mixture, roll into a ball between the palms of your hands,

then squash into a flattish shape. It is vital to do this while the mixture is still warm.
Fry the baps in oil over a low heat, for about 20 minutes, or until the outside is golden and crunchy.

(They can also be frozen, and then fried from frozen, for a quick meal.) Serve with fruit or a salad.
Savoury spiced pancakes
This variation on a traditional drop scone makes a good substitute for bread. The pancakes are

delicious served warm from the pan. When cold, they may be reheated in a moderate oven.
1008 (3112oz) gram flour
1008 (3 72oz) rice flour
1 tsp wheat-free baking powder
1 tbsp ground cumin
large pinch of salt
1 large egg
300mi (112 pt) coconut milk
vegetable oil for frying
To serve:
Skinned and chopped fresh tomato mixed with a little freshly chopped coriander, or fried mushrooms with

chopped spring onion and parsley moistened with a little crbme fraiche.
Mix the dry ingredients together in a bowl then beat in the egg and coconut milk to give a thick

batter. Set a large non-stick frying pan or griddle over medium heat. Generously oil the surface of the

pan then drop well-spaced tablespoons of the mixture into the pan.
Cook until the edges of the drop scones start to form bubbles and the base of each is golden, then

carefully turn and cook on the second side until golden. Keep warm, covered with a clean tea towel,

while you make the rest.
Serve warm, spread with butter or topped with one of the savoury mixtures.
Variations: for sweet drop scones omit the cumin and add 25g (I oz) caster sugar and either a sweet

spice such as cinnamon, or the finely grated zest of 1 lemon or orange.
Pressed prune and walnut bread
Based on a traditional Spanish recipe, this is delicious served with cheese, or as a snack on its own.
PREPARATION TIME: 10 minutes, plus overnight COOKING TIME: 45 minutes MAKES: 1 x 18cm (7in) loaf
500g (1 lb 2oz) ready-to-eat pitted prunes 100g (3%2oz) walnut or pecan halves 50g (13/4oz) brown rice

flour
1 large egg, beaten
Place all the ingredients in a bowl and mix together. Press into an oiled 18cm (7in) sandwich tin,

cover with oiled foil and cook in a preheated oven at 170°C/ 325°F/gas mark 3 for 45 minutes. Place a

heavy weight on top and leave until completely cold before unmoulding. Serve cut into thick slices

using a serrated knife.
PREPARATION TIME: 25 minutes MAKES: about 27
Walnut macaroons    Lemon surprise pudding
Millet tabbouleh
Tabbouleh is a salad from the Middle East that is traditionally made with cracked wheat. Millet makes a

very tasty wheat-free alternative. This dish can be useful for packed lunches.
PREPARATION TIME: about 40 minutes MAKES: 4-6 servings
175g (6oz) millet 7 tbsp olive oil
3 tbsp lemon juice
3 tbsp each freshly chopped mint and
flat-leaf parsley
2 spring onions, finely chopped
salt and pepper
Place the millet in a saucepan with 1 tbsp oil and cook over medium heat, stirring, for 2-3 minutes

until lightly toasted. Stir in 350ml (12fl oz) boiling water and simmer uncovered for about 20 minutes

until the water is absorbed and the millet seeds are just cooked. Transfer to a bowl, stir in the rest

of the oil and season generously. Stir in the lemon juice and fork it through the mixture. Leave to

cool, then add the herbs and spring onion and stir well.
Variations: add other finely chopped ingredients such as tomato, red pepper or dried apricots.
Wheat-free flan pastry
Make a flan as suggested below, or chill the pastry then grate it roughly over a savoury or sweet pie

filling. For a savoury pie, the grated pastry can be mixed with grated cheese.
PREPARATION TIME: 15 minutes, plus 30 minutes freezing
COOKING TIME: about 20 minutes MAKES: 1 x 20cm (8in) flan case
125g (412oz) fine cornmeal (maize flour) 50g (13/4oz) gram flour
25g (1 oz) arrowroot powder
25g (I oz) ground almonds
75g (23/4oz) butter or baking margarine 1 egg white
Mix the dry ingredients together in a bowl then rub in the butter. Mix to a soft dough with the egg

white. Press the pastry evenly into a 20cm (8in) fluted flan tin and set in the freezer for a minimum

of 30 minutes.
Preheat the oven to 200′C/400′F/gas mark 6 and cook the flan case towards the top of the oven for about

20 minutes, until lightly golden.
Variation: for sweet pastry, add 25g (I oz) caster sugar
Rich cheese biscuits
These crisp biscuits are good to serve with drinks. Store them in an airtight tin.
PREPARATION TIME: 20 minutes COOKING TIME: about 25 minutes MAKES: 20 biscuits
55g (2oz) soya flour
40g (1 V2oz) potato flour
40g (I Y2oz) rice flour
115g (4oz) butter, softened
1158 (4oz) Cheddar cheese, grated
1 large egg, separated
2 tbsp seeds such as celery or poppy
Mix the flours together in a bowl, then work in the butter, cheese and egg yolk to give a firm dough.

Roll into 20 balls. Lightly whisk the egg white and turn the balls in it until lightly coated, then dip

in the seeds to coat lightly.
Space the balls well apart on baking trays and press down firmly to flatten. Bake in a preheated oven

at 200°C/400 T/ gas mark 6 for about 25 minutes until golden. Cool slightly then transfer to a wire

rack. Leave until cold and crisp.
Whisked sponge cake
This cake’s lightness lies in the whisking. A trail of the mixture, falling from the whisks, should

remain visible for at least 30 seconds. Then it’s time to add the flour.
PREPARATION TIME: 25 minutes COOKING TIME: 25-30 minutes MAKES: 1 x 23cm (91n) cake
75g (2314oz) gram flour
50g (13/4oz) cornflour
4 large eggs
125g (4 V2oz) caster sugar
50g (13/4oz) butter, melted
To serve:
jam or lemon curd
whipped cream (optional)
caster sugar
Sift the flours together. Butter a 23cm (9in) spring-release tin and line the base with greaseproof

paper. Using a handheld electric whisk, whisk the eggs and sugar in a heatproof glass bowl over a

saucepan of simmering water for about 10 minutes until thick and mousse-like.
Fold the flour into the egg mixture in 2-3 batches until completely incorporated, then fold in the

butter.
Transfer to the prepared tin and cook in a preheated oven at 190′C/375′F/gas mark 5 for about 25

minutes until risen and golden. Cool slightly then remove from the tin and cool on a wire rack. When

cold, split and fill with jam or lemon curd, and whipped cream if wished. Dust with caster sugar.
Walnut macaroons
These biscuits are good with coffee. Store in an airtight container. If you want, only decorate half of

them with walnut halves, then sandwich together with the other halves using coffee-, chocolate- or

orange-butter cream, or whipped cream. Do this just before serving.
PREPARATION TIME: 15 minutes COOKING TIME: about 45 minutes MAKES: 24
rice paper
2 egg whites
100g (3112oz) golden icing sugar
1008 (3 Y2 oz) walnut pieces, finely
chopped
grated zest and juice of 112 small unwaxed
lemon (if waxed, wash thoroughly in
hot water)
24 walnut halves
Line a large baking tray with rice paper. Whisk the egg whites in a heatproof glass bowl until stiff.

Stir in the icing sugar, chopped walnuts, lemon zest and juice, and stir over a saucepan of simmering
water for about 10 minutes until the mixture is slightly stiffened. Drop well-spaced spoonfuls of the

mixture onto the rice paper and top each with a walnut half.
Bake in a preheated oven at I 50′C/300′F/gas mark 2 for about 45 minutes. They should be risen but

still slightly chewy. Cool on the tray, then trim away the excess rice paper.
Lemon surprise pudding
The surprise is in the two layers. You end up with a creamy lemon sauce topped with a delicate sponge.
PREPARATION TIME: 20 minutes COOKING TIME: about 45 minutes MAKES: 4-6 servings
50g (1314oz) butter
125g (4 Y2oz) caster sugar
2 large eggs, separated
25g (1 oz) cornflour, sieved
25g (1oz) fine cornmeal (maize flour), sieved
finely grated zest and juice of 2 unwaxed lemons (if waxed, wash thoroughly in hot water)
250m1 (9fl oz) milk To serve:
icing sugar
Cream the butter and sugar with 1 tbsp hot water until pale and fluffy. Beat in the egg yolks followed

by the flours. Slowly stir in the lemon zest and juice, and then the milk. The mixture may appear to

have curdled but this is normal.
Whisk the egg whites to form soft peaks, then fold into the lemon mixture. Transfer to a 1 litre (13/4

pint) ovenproof dish and set in a roasting tin. Pour hot water from a kettle around the dish and cook

in a preheated oven at 180°C/350°F/gas mark 4 for about 45 minutes, until risen and just firm to the

touch. Dust with icing sugar and serve immediately.
Apricot and apple Eve’s pudding
This wheat-free Eve’s pudding can be varied by changing the fruit. Try peaches, strawberries or

blackberries instead of the apricots.
PREPARATION TIME: 30 minutes COOKING TIME: about 1 hour MAKES: 4-6 servings
400g can of apricot halves in juice
2 medium cooking apples, peeled and thickly sliced
50g (1314oz) caster sugar
Topping:
125g (472oz) butter, softened
125g (4 Y2oz) caster sugar
2 large eggs
125g (4V2oz) ground almonds mixed with
1 tsp wheat-free baking powder
50g (1 31ioz) flaked almonds
To serve:
pouring cream or whipped cream
Pour the juice from the can of apricots into a saucepan, add the apple and sugar and cook gently for

about 5 minutes, until the apple is softened. Remove from the heat and stir in the apricots. Transfer

to a 1 Iltre (13/4 pint) ovenproof dish.
In a separate bowl, cream the butter and sugar together until pale and fluffy then beat in the eggs one

at a time. Fold in the ground almonds and baking powder. Spread the almond mixture over the fruit and

sprinkle with flaked almonds. Cook in a preheated oven at 180°C/ 350°F/gas mark 4 for about 1 hour

until risen and golden and just firm to the touch. Serve with pouring cream or whipped cream.

Tony had suffered from hayfever since childhood but rarely took any medicines. Outside the grass-pollen season, he was fine, free of allergies and very fit. Then, when he was 35 he bought a run-down cottage in the country. The cottage was very damp and dirty.
The previous owner of the cottage, an elderly man, had died, and everything was much as he had left it. Tony moved in with his wife in late summer, and they began pulling out all the old carpets and furniture. Many of the windows would not open and there were dank musty cupboards and attics to be cleared. Dust filled the air – and Tony’s nose. He began to sneeze a little and within a few days he had a strange and unfamiliar feeling of tightness in his chest. During the following weeks, harvesting began in the surrounding fields, with several huge combine-harvesters working away all day and night. Tony noticed that, when out of doors, his eyes began to stream and the tightness in his chest became more noticeable. A few more days passed, and Tony found it harder to breathe, so he reluctantly went to see the doctor. The diagnosis was asthma. Skin-prick tests showed that Tony had allergic reactions to house-dust mite and moulds.
Tony’s case shows how someone who is already sensitised to an allergen – pollen in this case – may be vulnerable to developing new sensitivities, and new symptoms. It was almost certainly the dust mite and mould spores in the cottage that sparked off the trouble, followed by the mould spores from the cereal leaves, dispersed during harvesting.
For people with a tendency to allergies, the dangers of heavy exposure to potential allergens are something to bear in mind. It is surprising how many people with asthma had their first major attack while away from home, sleeping on an old sofa or in a friend’s dusty spare room. The dose of dust-mite allergen that you get from an ancient mattress or eiderdown can be massive.
Managing your allergy symptoms
As well as avoiding the development of new allergies, you need to manage your existing symptoms, and make sure that they interfere with your life as little as possible. For this you need good information and advice, support from your doctor, optimal drug treatment, and careful avoidance of your allergens.
Quite often people have all the information and drug treatment they need, but they still don’t stay on top of their health problems. There can be two distinct reasons for this: either they are not wholehearted about wanting to be well (ambivalence) – or they have never really accepted that they are ill (denial).
Ambivalence
Sometimes being ill has certain benefits – or being entirely well has certain disadvantages. Our state of health determines how people treat us, especially within the family, and the expectations people have of us. It may be comforting to be ill because others are more supportive then, or it may be less risky, because we are not forced to try things (such as sports or other physical activities) at which we might fail or look foolish. Being ill as a child often sets up a pattern for how we interact with the world, which revolves around caution, the comforts of familiarity, and holding back from new situations.
These habitual patterns can survive in the mind long after any real advantages have evaporated. Many people become stuck with a way of thinking and living where ill-health is a cornerstone of their existence. Doctors at the Chelsea and Westminster Hospital in London, who have developed a radical programme for treating atopic eczema (see pp. 46-8), have noticed this in their patients. ‘Old habits die hard and living with a little bit of eczema is a very tempting prospect for many patients, rather than clearing the skin completely…. As atopic skin disease begins for many in the first year of life, causing sometimes understandable alarm and despondency in the parents, the child learns how relevant their condition can be in their relationship with the external world, and with their parents in particular. Before they are able to speak, they have a powerful means of gaining parental attention which can have long-standing effects in the development of their personality. For some, to live without eczema is understandably a daunting prospect. This can be consciously appreciated and spontaneous-y referred to by some patients, while for others the issue will be buried from view, deep in their unconscious.’
If any of this rings bells with you, try to tackle the problem at source. Such mental blocks are not immovable. Indeed, simply recognising that the block is there can start to change things for some people.
Others may need professional help to overcome these longstanding habits of mind. Counselling or cognitive therapy can be very valuable, and your doctor may be able to help in locating a suitably qualified person for this.
Denial
At the opposite end of the spectrum are those who want to deny that they have any kind of health problem. Often these people cannot quite accept that they have a long-term disease, such as eczema or asthma, so they forget to take their drugs, apply creams to their skin, or carry their inhalers. Ironically, these people frequently wind up having far more trouble with their allergies than they need to, and a very poor quality of life, simply because they neglect preventive treatments.
To be really well, you first have to admit that you do have allergies, and then sort out your conflicting feelings about what this means. Again, counselling, cognitive therapy or some other kind of psychotherapy can be helpful.
Dealing with doctors
The decisions that your doctor makes about your treatment are ones in which you should be fully involved. Quite a few allergy patients don’t feel happy about their doctor’s treatment plan, but they never say so to the doctor’s face.
The usual pattern is to accept what the doctor prescribes without any argument, but then halve the dose of tablets, or only put the cream on once a day instead of twice, or not use the Inhaler at all. Some people stop and start their drugs in a random way because they never quite make up their minds about whether drugs are a good thing or not.
This approach to allergies invariably leads to worsening symptoms. The risks are greatest with complex problems such as
atopic eczema or chronic sinusitis, where a vicious circle can easily be set up if the disease is not brought under control, and for those with a life-threatening condition such as asthma. In the case of asthma, neglecting preventative treatment can be fatal.
It is far better to say what you think in the surgery, and discuss any misgivings you may have about drugs with the doctor. That way you can agree on a treatment regime that you are prepared to stick to – which may or may not involve drugs. Most doctors would far prefer a little plain speaking at the outset to having a patient who is half-hearted about following the treatment plan and never really improves.
A more serious form of communication breakdown occurs when a doctor stops believing what a particular patient says. This usually occurs because the doctor has decided that some or all of a patient’s symptoms are due to psychological rather than physical causes. (This is far more likely to happen to those with intolerance or unusual forms of allergic reaction than to those with classical allergic diseases.) Sometimes doctors say what they think, but often they don’t – they just start treating the symptoms in a different way, or acting impatiently, or saying rather puzzling things that leave the patient trying to guess what is going on.
If you find yourself in such a situation, the main thing to do is stay very calm and be very rational. Getting upset, or challenging the doctor’s opinion in a manner that seems at all aggressive, instantly confirms the ‘psychological’ diagnosis. Unfortunately, insisting firmly that the symptoms are not psychological also confirms the diagnosis as far as many doctors are concerned (see p. 237) which can be extremely frustrating. To begin with, deal with the situation by informing yourself about your illness. Be tactful and patient but persistent with the doctor, trying all the time to keep the relationship pleasant and the channels of communication open. If, after giving it a fair try for some weeks or months, this approach isn’t working, you should look into the possibility of changing doctors (see p. 88).
Emergency alerts
An emergency alert bracelet or pendant should be worn by anyone who:
• is allergic to latex rubber, or to drugs such as penicillin
• has a severe allergy to insect stings
• suffers from exercise-induced anaphylaxis, or anaphylactic shock as a result of food allergy
• has very severe asthma attacks.
Key information is engraved on the bracelet, along with a telephone number which gives medical staff access to a computer database containing vital medical data about you. This valuable service is provided by a non-profit-making company called Medic Alert.
As everyone knows, a little knowledge is a dangerous thing. You can use the information in this book to help yourself, but it’s important to remember that there is no substitute for the comprehensive understanding of the human body that your doctor gained during many long years at medical school. Always check with your doctor before changing your diet, stopping your drugs, practising breathing exercises, taking a non-prescription medicine or trying any other experimental treatment.
The information about disease, diagnosis and treatment in this book falls into four categories:
• basic information about the disease that no doctor would disagree with
• the findings of new research, or research that has not become widely known, but which falls within the accepted medical model of the disease concerned. Your doctor may not know about some of this research (there is a terrifying amount of new information bombarding doctors every week, and no one can keep up with it all) but he or she won’t find it unbelievable.
• evidence from research that is entirely valid, but which is widely ignored or dismissed because it falls outside the accepted medical model of the disease concerned (see pp. 86-7)
• information based on the repeated observations of doctors, or of patients – this does not amount to scientifically valid evidence, but it’s included here if it seems plausible and if it could be useful to some readers.
You should be able to tell, from the context in which it is presented, which category any item of information falls into. When talking to your doctor about items that belong in the last two categories above, be prepared for a certain amount of scepticism or possibly outright dismissal.
The important thing to ask the doctor is if there is good reason why you should not try the suggested measures, in addition to your usual treatment – is there any risk involved, given your particular state of health? Make it clear that you want to try the additional treatment with an open mind and will drop it if it is not helping. Ask for the doctor’s help in assessing the effects of the treatment objectively.
Managing asthma
Of all the diseases described in this book, asthma is among the most difficult to live with, especially severe asthma. Learn to recognise asthma symptoms before they get out of hand, and take immediate action.
Studies of patients who die from asthma attacks find that the deaths could, in almost all cases, have been prevented. Factors contributing to fatal attacks include:
• heavy exposure to allergens just before the asthma attack
• cigarette smoking
• failure to use preventer drugs
• repeat prescriptions for inhalers being given without the patient seeing a doctor
• delays in seeing an asthma specialist
• depression in the asthmatic leading to neglect of treatment.
For the day-to-day management of asthma, you should have a written management plan prepared by your doctor or asthma nurse.
This should tell you how often to take your drugs under normal circumstances, and what to do if your symptoms change or you develop a cold or chest infection. The actual brand names of your drugs (or the colour of the inhaler) should be included on the management plan. Assuming you have a peak-flow meter – and you really should have one –specific peak-flow values should be included on your management plan, with instructions for how to respond if your peak flow falls to these levels.
Your plan should tell you how to recognise a severe attack coming on, and what to do at the various stages of the attack. (This personal management plan is specifically geared to you or your child. Although pp. 100-101 give generalised advice, your own plan is invaluable.)
Be sure that you know exactly how the advice in the plan relates to the sort of real-life situations you experience. No matter how good your plan, real life can sometimes be far more complex than anyone anticipates, so there may be times when it is difficult to know what to do. When this occurs, make a note of the situation, and the reasons why you are unsure how to implement the plan. Call your doctor immediately if your asthma is getting worse, and get the asthma attack under control. Save your notes and, at the next opportunity, check with the doctor what you should have done in those circumstances. This will help you to build up your detailed knowledge of how to manage your asthma, or that of your child.
Research shows that asthmatics can, with training, develop a greater awareness of how narrow their airways are – this helps you to detect worsening asthma before things get too serious. You can train yourself in this art by guessing what your peak flow will be and writing your guess down before you use your peak-flow meter (see right) each day. Over a period of weeks, you should find your guesses getting closer to the true value.
A key part of asthma control is having everything with you that you need in case of an attack. It’s tedious, but you have to do it. You should take your reliever inhaler with you wherever you go. Those with severe asthma can also benefit from carrying a collapsible spacer (ask your pharmacist or see p. 255 for contact details of suppliers).
For a long day out, or a stay away from home, check that you also have:
• your management plan
• your peak-flow meter
• your preventer inhaler
• steroid tablets, if you sometimes need these
• your doctor’s phone number.
A little lateral thinking may be needed regarding the problem of carrying all this kit around. One asthmatic friend of mine carries his inhalers in a trendy-looking camera bag that goes everywhere with him. Mothers of asthmatic children have solved the problem by making an ‘inhaler pouch’ from a sunglasses case and attaching it to a favourite belt or by enlarging the pocket in a teenager’s jacket to accommodate inhalers.
Anyone with severe allergies to food or insect stings should take similar steps, so that carrying their auto-injector everywhere is a simple matter.
Peak-flow meters
A peak-flow meter can detect narrowing of your airways – the beginnings of an asthma attack – before there are any obvious symptoms. It measures the maximum speed at which you can force air out of your lungs. The signs of worsening asthma include:
• a morning reading which is less than 75% of the evening reading
• average readings less than 75% of your best-ever reading. (If they get to less than 50% of your best reading, this is a severe and possibly life-threatening attack.)
To use a peak-flow meter:
• push the pointer to zero and hold the meter horizontally
• keep your fingers away from the scale and the pointer
• breathe normally before you start
• stand up and take a deep breath, but don’t puff your cheeks out and don’t hold your breath before you blow
• seal your lips tightly around the mouthpiece
• blow hard into the meter, as if blowing out candles on a birthday cake; don’t move your tongue while doing this
• repeat three times, and record the highest reading of the three.
You must learn how to use a peak-flow meter from your doctor or asthma nurse, who should also check your technique regularly – it is very easy to get into bad habits.