Safe and Healthy Meal Planning for Allergic Families

Creating balanced, healthy family meals can seem challenging and even overwhelming at the best of times, but even more challenging if one of your children has a severe food allergy. This is a common problem in Canada, as it is estimated that as many as 1.3 million Canadians suffer from life-threatening food allergies, and these numbers are likely on the rise.

For those who have severe food allergies, the protein in particular foods is mistakenly identified by the immune system as being harmful. The first time someone is exposed to one of these proteins, their immune system responds by producing antibodies. As a result, the next time that person is exposed to that protein, antibodies and chemicals such as histamine are released causing a reaction in the body which could effect the gastrointestinal tract, the respiratory system, the cardiovascular system, or the skin. 

As a Registered Dietitian, I often counsel parents of kids with severe food allergies on how to ensure that their family meals are safe and free of harmful allergens, as well as healthy and tasty. Most of these parents not only worry about their kids avoiding their allergy triggers, but also about ensuring that their child eats a balanced and nutritious diet. After all, some of these kids have to remove entire food groups from their diets to avoid an allergic reaction.

So, how do you ensure that your allergic child doesn't miss out on key nutrients? And how do you protect them from their allergy triggers both at home and away from home? 

1. Know the key nutrients your kids are missing out on:

Unfortunately, some of the most convenient and healthy foods contain the most common allergens. Peanuts, tree nuts, eggs, milk, and fish are among them. Here are the important nutrients found in these foods and how to receive them elsewhere:

• Peanuts and Tree nuts (which include almonds, Brazil nuts, walnuts, hazelnuts, macadamias, pistachios, pecans, and cashews): Peanuts are actually part of the legume family (in the same family as peas and lentils) but the proteins in peanuts are similar to those in tree nuts and that's why peanut and tree nut allergies often go hand in hand. Peanuts and tree nuts provide a small amount of protein but the main nutrient is fat (both mono- and poly-unsaturated). Nuts also provide fibre, and many vitamins and minerals. Great alternatives are seeds such as sunflower seeds and pumpkin seeds for a crunchy snack, as well as hemp, flax, and chia seeds which can easily be added to smoothies, cereals, salads and yogurt. Sunflower or pumpkin seed butters and hummus provide great alternative spreads to peanut butter.

Note: Please keep in mind that if your child has a severe allergy to peanuts, tree nuts or seeds, make sure that you read the label carefully to ensure the allergic oils are not in the ingredients list, or better yet, make it yourself and use an oil that is not an allergen to your child!

• Eggs: Protein, dietary fat, and iron are all important nutrients found in eggs. You can find protein, fat and Iron in all forms of meat and poultry. Other high-protein foods include beans, lentils, fish, dairy, and soy (assuming you aren't allergic to them). Healthy dietary fat alternatives are avocado, vegetable oils such as olive oil and canola oil. But my favourite egg alternative is actually chia seeds! They provide protein, healthy fat, iron and even calcium! They can also replace an egg in baking. Combine 3 tbsp of water with 1 tbsp white chia meal and you have a great egg substitute!
• Milk (includes all dairy foods): Calcium and Vitamin D are the most important nutrients in milk and dairy. These nutrients help to ensure healthy bones and teeth among other health benefits. Soy, rice, almond, oat, hemp, potato and coconut milks are all possible substitutes for cow's milk. While the amount of protein in each of these milk alternatives varies compared to cow's milk, they are usually fortified with similar amounts of calcium and vitamin D. If you aren't dealing with a soy allergy (which is also a common food allergy), soy milk is the best option because it contains similar amounts of protein, calcium and vitamin D as cow's milk. Other calcium-rich dairy foods such as yogurt and cheese have alternatives made with soy, rice, coconut and more that you can usually find in health food stores. They may or may not be fortified with calcium and vitamin D, so make sure to double check. 
• Fish and shellfish: Fish and shellfish provide a good source of protein and some forms of oily fish such as salmon and tuna provide healthful Omega-3 fats (DHA and EPA), which are important for brain and eye health as well as for preventing heart disease and stroke. It is fairly easy to find protein alternatives to fish, however it is not so easy to find DHA and EPA alternatives. Some manufacturers are now fortifying foods with marine algae-derived Omega-3 (DHA), such as cereals, pastas, yogurts, milks, and juices. If you have a fish allergy, it is important that you read the label carefully to make sure that the Omega-3 source is coming from something other than fish oil. Marine algae is a safe alternative. When it comes to Omega-3 supplements, fish oil tends to be the main ingredient. As an alternative, vegetarian Omega-3 supplements which contain ingredients such as flaxseed oil or algae oil are safe. 

2. Read labels carefully

Having a severe food allergy means that you and your child need to be careful about food choices, not only at the grocery store, but also at school, at friends' houses or at a restaurant depending on where your child is eating.

• Parents must read food labels carefully when they are grocery shopping and teach their kids to read them properly too. Check food labels every time you shop. Food makers sometimes change their recipes or manufacturing process, therefore, "New and improved" could mean "risky and avoid."
• Stay away from food products that do not have ingredients listed on the package (such as in bulk food bins), or if you don't recognize an ingredient.
• If you are dining out at a friend or family members house or a restaurant, make sure that they are aware of your child's severe food allergy so that they can take the proper steps to avoid allergens or let you know of any potentially harmful ingredients.  

3. Avoid cross-contamination

Cross-contamination can occur in the manufacturing facility, at the grocery store, or at home. It occurs when a "safe" food picks up traces of an allergen from an "unsafe" food, usually from utensils or sharing of the same appliances. If you are reading a food label and notice that there are warning labels that the food may have been contaminated with your child's allergen during manufacturing such as 'may contain ...,' 'does contain...' or 'may have come into contact with...,' avoid that product just in case there has been any cross-contamination in the manufacturing facility.

Avoid buying foods from the deli counter as meats and cheeses are often cut with the same slicer. Also avoid buying food from bulk bins as someone could have used the scoop from a bin that contains allergens i.e. if you are allergic to nuts and buying flour, the scoop could have previously been used in a bin containing nuts.

4. Practice food safety

When you are preparing your meal at home, it is important that you practice food safety, as even the tiniest amount of food can cause a severe allergic reaction. Be sure to wash your hands often, using a liquid or bar soap, or commercial hand wipes (not hand sanitizer). Clean all surfaces such as counters and tables thoroughly with a household cleaner and wash your utensils, pots, pans and cutting boards well with dish detergent and warm water. To avoid cross-contamination when you are preparing your meal at home, always prepare the allergen-free meal first, cover it and keep it away from other foods and any splatter that might result from cooking with allergen-containing foods. 

5. In case of an emergency, always keep your EpiPen (epinephrine auto-injector) on hand

Although it is not always possible for your child to completely avoid their allergy triggers, they can be prepared by making sure they have easy access to an EpiPen at all times. EpiPen (and EpiPen Jr) are meant for people who are at risk of a life threatening allergic reaction.

Remember to always replace your child's EpiPen before it expires. If you think you may need a reminder, you can register for the expiration reminder service at EpiPen.ca. If your child ever needs to use their EpiPen, make sure that he is transported to a hospital immediately afterwards for observation. It isn't uncommon for a repeat attack to happen within hours after exposure. In fact, it's important that he remains within close distance to a hospital for the next 48 hours.