Allergy: Selecting the Right Food
Allergy: Selecting the Right Food
An avoidance diet is for people who already know what food or foods affect them, and simply need to
avoid those foods. A diagnostic diet is for those whose symptoms suggest that they might be suffering
from food sensitivity of some kind, and who cannot be diagnosed by indirect methods such as skin tests,
because true food allergy is not involved. A diagnostic diet is intended primarily to show whether or
not food is causing the symptoms.
The diagnostic diets themselves fall into two basic categories. Firstly, there are diets that, by a
process of elimination, identify a particular food (or foods) as a cause of symptoms. Called
elimination diets, these are used to diagnose idiopathic food intolerance (see p. 74) and certain other
kinds of sensitivity reactions to particular foods. An elimination diet is purely diagnostic - simply a
means to establish which foods are at fault. To this end, all commonly eaten foods are avoided at the
outset, and each food is then tested individually. Once an elimination diet is complete, the
information gathered is used to establish a suitable avoidance diet. For example, if milk, wheat and
oranges caused symptoms during the testing phase of the elimination diet, those foods are all avoided
in future.
Secondly, there are specific diagnostic diets, which are a great deal simpler to carry out than
elimination diets. A specific diagnostic diet aims to reduce the intake of a particular substance that
is found in certain foods. The substances concerned -histamine or nickel, for example - are known to
cause particular symptoms in susceptible people.
A specific diagnostic diet simply cuts out all the foods that contain large amounts of the substance
under suspicion. If this diet alleviates the symptoms, and does so consistently, it is plausible that
the substance concerned is indeed the culprit. However, the diet should be stopped and then started
again, preferably several times, to check the response. Once the sensitivity is confirmed in this way,
the avoidance diet which follows is basically the same as the diet used for diagnosis.
Note that there is no agreed terminology for these different kinds of diet, and the definitions given
above will not necessarily be followed in other publications. You may even come across ‘elimination
diet’ being used to mean ‘avoidance diet’, which is particularly confusing. If you are consulting other
sources of information, check the context carefully to see what meaning is intended.
There is one odd man out in this chapter - the diet to protect against asthma, described on pp. 206-7.
It is neither an avoidance diet nor a diagnostic diet, but a health-promoting diet of the kind commonly
advocated to combat other widespread conditions, such as cancer and heart disease. In fact, it has a
remarkable number of similarities to diets that reduce the risk of these other diseases.
The anti-asthma diet is immensely healthy, whereas many avoidance diets carry a risk of malnourishment.
An allergic individual following any kind of restrictive diet - especially a child - should be
medically assessed for the possible risks. That is why it is important to talk to your doctor before
starting any dietary treatment or investigation. A referral to a dietician or nutritionist may be
necessary, and your doctor can arrange this.
When malnutrition does occur as a result of self-treatment, there are often very complex factors at
work. One potential hazard with dietary treatment is that psychological problems can easily become
entwined with obsessions about food. Eating can be a potent form of self-expression, or a way of
exerting control over oneself and others. Many doctors have seen patients who are mistakenly convinced
that food sensitivity is at the root of their health problems, or those of their children. In some
cases, no amount of objective evidence to the contrary will deflect people from such beliefs.
A few people with mistaken beliefs of this kind impose very restrictive diets on themselves - or
sometimes on the whole family. The food rules that they establish may be a way of limiting contact with
the outside world, avoiding other problems and issues by making diet the central focus, or simply
making demands on other people’s time and attention.
The current fad for identifying ‘food allergy’ using very dubious diagnostic tests (see p. 93) will
probably send many more psychologically vulnerable people down this route.
Another unhelpful trend in the dietary field is the wholesale (and usually ineffective) use of
vitamins, minerals and other supplements for a great variety of diseases, including allergy and other
forms of sensitivity. It is important to realise that none of the sensitivity diseases described in
this book has nutritional deficiency as its primary cause, so supplements are not a major part of
treatment in most cases. For the majority of people with some kind of sensitivity disease, a supplement
will make only a small difference, if any. However, it is true that, with some sensitivity problems,
certain supplements may be helpful to certain individuals. The use of Vitamin C in asthma (see p. 207)
is one example of this, and there are some other instances mentioned in Chapter 2.
Generally speaking, it is better to get the vitamins, minerals and other nutrients you need (such as
antioxidants) from food, not from tablets. Studies of adult-onset asthma have shown that only natural
Vitamin E protects against the disease: supplements have no effect.
Many vitamins and minerals, along with various plant and animal extracts, are now referred to as
nutriceuticals - in other words, substances that are classed as nutritional supplements for legal
purposes, but are being marketed as if they were medicinal drugs (pharmaceuticals). Many doctors are
concerned about this, if only because of the duplicity involved. These substances can be sold freely to
the public only because they are, in theory, nutritional supplements, yet they are actively promoted to
the public as if they were drugs.
The marketing is usually indirect, to avoid falling foul of the law, but very effective nonetheless.
Advertisements for the product avoid making any medicinal claims, since these would be unlawful, and
just speak vaguely of ‘health-giving properties’. The specific medicinal claims are made in magazine
articles (which often appear right beside the advertisement), penned by journalists who have been
supplied with a great many ‘facts’ - actually unsubstantiated claims -by the manufacturer of the
supplement. These claims are reproduced uncritically, so the journalists are simply acting as
mouthpieces for the manufacturer. There is no law preventing this.
This is a ruse that circumvents important laws intended to protect consumers from misleading
advertising. Few of these products are likely to be damaging - although there are concerns about some,
especially beta-carotene supplements (see p. 207). What matters here are the large amounts of money
being made from products that frequently have few benefits for those who take them.
What exactly is in ready-made food? People with food sensitivity, especially those with severe food
allergy or coeliac disease, need a simple answer to this question, but frequently they don’t get one.
Research among food-allergy sufferers has found that, in the course of a year, half of them
inadvertently eat the food they are trying to avoid, owing to a lack of information about ingredients.
Restaurants and canteens are responsible for many of these accidents, and most of the fatalities (see
p. 111), but packaged food also plays a part.
Unfortunately, many food ingredients that are potentially allergenic, such as milk and eggs, appear in
packaged food without this being stated on the label in everyday language. The information is usually
there somewhere, however – you just need to know what words to look for.
Decoding food labels
The problems with food labels fall into two general categories:
• some of the ingredients are described using technical terms. These are usually specific
constituents of the original foodstuff e.g. lactalbumin, one of the proteins found in milk.
• some manufactured ingredients can be made from different starting materials. So an item such as
‘edible starch’ could be made from either wheat or maize (corn), while ‘hydrolysed protein’ could be
made from soya, maize or yeast, sometimes with wheat added.
One day, no doubt, manufacturers will realise what a burden this type of obscure labelling imposes on
their allergic customers and will start using plain language. In the meantime, food-allergy sufferers
just have to learn all the terms that may be used for their culprit food or foods.
Labels used in health-food shops and delicatessens are another matter altogether. Here the problem is
with exotic-sounding items, such as kamut, which is actually an allergenic food (wheat).
Maize (Corn)
Items always made from maize: cornflour, cornmeal, cornstarch, dextrose, polenta
Items sometimes made from maize: baking powder, cereal starch, edible starch, food starch, glucose
syrup, hydrolysed protein, hydrolysed vegetable protein, malt, malt flavouring, modified starch,
modified food starch, starch, textured vegetable protein, vegetable gum, vegetable protein, vegetable
starch
Note that the gum on envelopes and stamps is sometimes made from maize, and that many medicines contain
cornstarch.
Eggs
Items always made from eggs: ovalbumin
Items sometimes made from eggs: lecithin (In fact this is rare in foods – lecithin is usually derived
from soya. Only in pharmaceuticals is lecithin likely to be derived from egg.)
Terms used for egg on cosmetics and toiletries: Ovum
Fish
Be very cautious when travelling. The use of fish meal as an ingredient of spicy sauces is common in
Southeast Asia, and in some parts of Africa. The strength of the spices may make the flavour of the
fish undetectable.
Milk
Items always made from milk: casein, casemate, lactalbumin, whey
Terms used for milk on cosmetics and toiletries: Lac
If you see the term ‘dairy-free’ on standard packaged foods, you can safely assume that the contents
are free from goat’s and sheep’s milk, as well as cow’s milk. But be more wary with homemade or locally
produced foods labelled ‘dairy-free’ - some
people think that ‘dairy’ refers only to cow’s milk.
Parev or pareve is a term used for kosher (Jewish) food that contains neither milk nor meat. However,
there can be contamination with traces of milk.
Lactose is a sugar produced from milk, and while it is not allergenic itself, it may contain a trace of
allergenic milk proteins. The amounts involved are tiny, and will only affect the most sensitive
individuals.
The label ‘non-milk fat’ sometimes misleads people if they just glance quickly at labels. The fact that
a product contains non-milk fat does not, of course, mean that it is entirely milk-free -remember to
look for all the synonyms of milk (see above).
Nuts
Items always made from nuts: frangipane, marzipan, praline
Standard packaged food will almost always include the nuts by name, but if you are buying other food
(e.g. from a stall selling home-made food) watch out for the above names.
Be very cautious about unrefined nut oils (see p. 110). Almond essence may be produced chemically, in
which case it is safe, but some is made from real almonds and could be allergenic.
Terms used for nuts on cosmetics and toiletries: Prunus, Juglans, Bertholletia, Corylus
Peanuts
Items always made from peanuts: arachis oil, groundnut oil satay sauce
Unrefined peanut oil should be avoided. This is not much used, and unlikely to be encountered except in
Indian and Oriental cooking. Most groundnut oil sold in Britain and Europe, or used in packaged foods,
is refined and considered safe (see p. 110).
Alternative names: arachide, beer nuts, cacahuete, earth nuts, goobernuts, groundnuts, monkey nuts
You are only likely to encounter these names on imported food, or when travelling. Always be very
careful with Indian or Southeast Asian food, where the use of peanuts is very common and often not at
all obvious. Avoid chocolate from Poland, which often contains peanuts that are not declared on the
label.
Items sometimes made from peanuts: hydrolysed vegetable protein. (The usual source is soya or wheat,
but some is derived from peanuts.)
Terms used for peanut on cosmetics and toiletries: Arachis hypogea, Arachis oil
Sesame
Items always made from sesame or containing some sesame: gomashio, halva, hummus (houmus), tahini, the
drink Aqua Libra
Alternative names: ajonjoli, berme, gingelly, teel, til, simsim
Check carefully for sesame in any food from a health-food shop or a stall selling home-made food, and
in foods from the Middle East, or Chinese packaged food (e.g. stir-fry oils). Sesame oil is always
unrefined and therefore allergenic (see p. 110). Watch out for contamination by traces of sesame in
bakeries and delicatessens where goods are sold unwrapped.
Term used for sesame on cosmetics and toiletries: Sesamum indicum
Shellfish
Items sometimes containing shellfish: curry paste, fish sauce and other sauces/pastes used in Southeast
Asian cooking
Standard packaged food should mention shellfish specifically, but you may need to read the label
carefully. Be cautious about bottles of imported sauce, and home-made or takeaway food.
Soya
Items always or usually made from soya: miso, soy sauce, textured vegetable protein, tofu, vegetable
protein
Items sometimes made from soya: hydrolysed protein, hydrolysed vegetable protein, lecithin, vegetable
gum, vegetable starch Changes in ingredients
Unfortunately, the ingredients of a product can change without any obvious warning on the label, or any
change in the packaging. You should always check the label in detail, every time - even on foods that
you have eaten before without any trouble.
Wheat
Items always made from wheat: bran, flour, graham flour, hard flour, strong flour, wholemeal flour
(there are non-wheat brans and flours, of course, but the words ‘bran’ or ‘flour’, without any
qualification, usually mean wheat)
Regional names for particular types of wheat: bulgur or bulgar wheat, Chilton, couscous, dinkel, durum,
einkorn, farro, fu, kamut, semolina, spelt, triticum, triticale (a hybrid of wheat and rye)
Items sometimes made from wheat: baking powder, cereal binder, cereal filler, cereal protein, cereal
starch, edible starch, food starch, hydrolysed protein, hydrolysed vegetable protein, modified food
starch, modified starch, starch, textured vegetable protein, vegetable protein, vegetable starch.
Assume that bread, crispbread, pastry, pasta and noodles are made from wheat, unless definitely
labelled otherwise (and read the label in detail too, because a little wheat is often added to items
such as rye bread and rye crackers).
Note that buckwheat is not wheat at all - it is not even a cereal. Nor does it commonly affect
coeliacs, as is sometimes claimed, though a few coeliacs may develop an intolerance reaction to it,
through eating it very regularly.
For more information on avoiding gluten, see p. 177.
Yeast
Items usually made from yeast: leavening
Items sometimes made from yeast: hydrolysed protein, hydrolysed vegetable protein
Labelling loopholes
Manufacturers do not have to include on the label:
• Any ingredients used in an earlier manufacturing process e.g. yeast used to make bread for
breadcrumbs, wheat flour added to spices or mustard powder during the grinding process, or bread used
to innoculate blue cheeses with mould -this can leave minute traces of gluten in the cheese.
• Residues left by substances used during processing, such as wheat flour used to dust processing
lines or prevent dried fruits from sticking together. Manufacturers do not need to declare these
residues on the label because the substance serves no function in the final product and is present in
amounts that are considered insignificant. The vast majority of those with coeliac disease or food
allergy will tolerate such microscopic traces, but the most sensitive individuals may not. Some
coeliacs are even affected by food additives manufactured from cereals (see p. 177).
• The individual constituents of a composite ingredient (such as salami on a pizza), if that
composite ingredient makes up less than 25% of the finished product. This is called the 25% rule. As
from November 2005, this is all set to change, thanks to the European Parliament. The contents of a
composite ingredient like salami will be listed in full. A few composite ingredients with officially
defined contents (such as jam, or chocolate) can be listed just as ‘jam’ or ‘chocolate’ if they make up
less than 2% of the product. Likewise herb mix or spice mix, if less than 2%. But there are certain
items that must always be listed if they are anywhere in the product, and however small the amount.
They are: milk, eggs, tree nuts, peanuts, sesame, mustard, celery/celeriac, fish, crustacean shellfish
(shrimps, prawns, crab etc), soya, wheat and all other cereals that contain gluten. Sulphur dioxide and
sulphites must be listed if more than 1 Oppm. This list will be reviewed from time to time.
`May contain’ labels
Labels reading ‘May contain nut traces’ are springing up like weeds on packaged food. Similar labels
relating to sesame, milk and eggs are also starting to appear.
Allergy sufferers, suddenly unable to eat foods that they formerly enjoyed, feel very frustrated about
this development. Many suspect that these labels are often just a defensive tactic - warning off
consumers with food sensitivity when the chance of the food containing the allergen is actually very
small. The danger is that some allergy sufferers may stop taking the labels seriously. Teenagers, in
particular, are increasingly dismissive of ‘May contain’ labels, and this is a huge worry for parents.
Could the need for ‘May contain’ labels be eliminated altogether with more careful factory procedures?
The problem here is that, with nuts, perfect cleaning of production machinery is extremely difficult.
Most machines have nooks and crannies in which a nut from one production process can become lodged,
only to free itself later during the making of a non-nut product. It is quite possible that someone
could encounter a whole nut, or substantial pieces of nut, in a non-nut product. That is why no one
with nut allergy, even if it is relatively mild, should disregard ‘May contain nut traces’ labels.
Some makers of confectionery and biscuits have now set up dedicated nut-free production lines, with
stringent precautions to avoid any possibility of contamination. This allows them to market products
that are guaranteed nut-free. If you cannot purchase these locally, you may be able to order them by
mail or over the Internet (see p. 255).
Note that packaged foods that have been produced on nut-free production lines in the past can be
switched to different production lines, that necessitate a ‘May contain nut traces’ label.
In some cases, a product is manufactured in two separate places, one of which is nut-free, while the
other is not. Consequently, the same product may sometimes be sold with a ‘May contain’ label and
sometimes without. Don’t disregard these labels, however illogical they might seem.
Packaging errors
As most people with food allergy are now aware, ready-made foods sometimes go out in the wrong
packaging. Alarming cases that have occurred in recent years include hazelnut yoghurts labelled Toffee
Yoghurt, and Vegetable Bake (containing nuts) sold in packets intended for Vegetable Lasagne (no nuts).
Manufacturers are increasingly aware of the hazards and when mistakes are discovered, allergy
information websites and organisations such as the Anaphylaxis Campaign are quickly informed, so that
they can alert allergy sufferers.
Belonging to such an organisation (see p. 255), and/or checking websites regularly, is definitely
recommended for anyone with food allergy. However, you should bear in mind that no information service
can protect you completely from this hazard. The odds against it are high, but one day you might just
be the unlucky person who first discovers a packaging error by suffering an allergic reaction. To
protect yourself as far as possible:
When is a nut not a nut?
Those with nut allergies often worry about eating nutmeg and coconut. In fact, allergic reactions to
these are rare. People with nut allergy are no more likely to react to nutmeg or coconut than anyone
else.
Tiger nuts or chufa nuts are not nuts at all, but the roots of a sedge plant – they are most unlikely
to cross-react with true nuts.
Peanuts, botanically speaking, are not true nuts at all. They are legumes (pulses). There can be
cross-reactions with soya and/or lupin (proceed very carefully with this novel food ingredient) but
reactions with other pulses are rare. Cross-reactions with tree nuts such as almonds and Brazils are
quite common however (see p. 15). Many people with peanut allergy can in fact eat tree nuts, but they
should be aware that a cross-reaction could develop at some stage.
Because cross-reactions between tree nuts are so common, doctors tend to speak simply of ‘nut allergy’.
However, it is possible to be allergic to one type of tree nut, without being allergic to others.
• always check that the food in the packet looks like the photograph on the packet
• double-check, when you serve the food, by noting the conspicuous ingredients of the meal
(carrots, for example), and ensuring that they are indeed on the list of ingredients – any discrepancy
should make you suspicious
• note the smell and appearance of any ready-made food, before you taste it. Do this even for
very simple things such as flavoured yoghurts
• only have a very tiny mouthful at first, and if you have any tingling of the lips or other
symptoms, however mild, stop eating immediately (this is helpful for true food allergy only, not for
coeliac disease)
• be especially cautious about vegetarian food if you are allergic to nuts or soya.
Latex in food
Those with latex allergy may react to very small traces of it in food. This sometimes occurs with
packaged food or restaurant food that has been prepared by workers wearing latex gloves. On one
occasion a highly allergic individual reacted to a water glass that had been handled by someone wearing
latex gloves. The amounts of latex involved are minuscule, and only affect those with severe latex
allergy. However, there is a strong case for workers handling food to wear non-latex gloves, especially
with the rise in cases of latex allergy.
There are also reports of people with latex allergy reacting (usually very mildly) to cold-seal
adhesives in food
wrappers, such as those used for ice cream. The reaction only occurs if the wrapper actually touches
the lips or mouth.