A dietitian shares her top tips for how to manage food allergies that she uses with her clients and her own anaphylaxis food allergy.
May is both Food Allergy Awareness Month and Celiac Awareness Month, so it’s a great time to discuss how to manage food allergies. It’s an important topic for me personally, because while I am gluten-free due to an IBS-related gluten sensitivity, I also have a very severe, anaphlyaxis-inducing tree nut allergy.
I’ve put together my top tips for how to manage food allergies below. These are tips that I use in practice in my every day life and that I also use with my food allergy clients.
1. Ask for help.
If you have a food allergy, especially if it’s new, don’t be afraid to ask for help. Learning how to manage food allergies can be quite a lifestyle change, so look for a registered dietitian who specializes in food allergies and can work with you locally or virtually as an online dietitian to help you adjust to your new lifestyle. Ask your physician or your allergist if they have any additional resources, or if they can refer you to an expert that can spend a little more time with you to help you more confidently navigate living with a food allergy and making sure your nutritional needs are being met.
An often overlooked concern with food allergy patients is mental health. Between traumatic near-death experiences, validated fears of offending foods, and trying to navigate food-based social settings with food allergies present, stress and anxiety can be all too common in food allergy patients. It’s important to work with healthcare providers to ensure there’s a balance between being vigilant of your food allergies and being hyper-vigilant, obsessive, and overly restricting (1). If you feel you fall in the latter category, please don’t hesitate to reach out to a mental health professional or ask your physician for a referral.
2. Read labels. Always.
Reading labels is imperative when you have any type of food allergy. Food labels are required to declare if a product has any of the top eight most common food allergens in the United States (fish, shellfish, wheat, dairy, egg, soy, tree nuts, and peanuts). If it’s a food that’s source is ambiguous, like lecithin, a company is required to state soy lecithin or lecithin (soy). Alternatively, they may also state at the bottom “Contains soy, milk, wheat ingredients” (2).
While many brands do also state products may contain other allergens, due to potential cross-contamination and not being produced in a dedicated allergen-free facility, it is not required for labels to disclose “may contain” allergens. If a brand doesn’t make it clear if the product was produced in a dedicated ____ allergy-free facility, don’t hesitate to call the customer service line to find out.
Also? Even if it’s a product you’ve been consuming for years, still always read the label. Even products you’ve been using for years can change their ingredients and formula. Make reading labels habitual, something that you do on autopilot. I honestly do it so seemlessly as part of my daily life that I often don’t realize I’m doing it until I see a problem ingredient. This happened in high school, when a granola bar I’d been consuming for years suddenly changed their recipe to include hazelnut and pecan flours. It happened again as a young adult, when a store-bought chocolate chip cookie I’d been consuming for years suddenly started adding chopped pecans as an ingredient. Fortunately I didn’t consume those items, but the only reason I didn’t is because I still read every single nutrition label and ingredient list out of habit.
Oh, and reading labels doesn’t just apply to food. Check ingredients in anything from lotions, skincare products, bath products, hair products, candles, natural cleaning products, and more. Common food allergen ingredients I see in some of those products include (but aren’t limited to) tree nuts, gluten, dairy, and soy. Check out this site to see a list of other commonly encountered items that are not required to disclose common allergies (including prescription and over-the-counter medications, pet food, alcohol, etc.)
3. Consider making your whole house allergy-free.
This tip can be a little harder to implement, but especially if you have young kids with food allergies at home, I strongly recommend the entire home being a safe zone where the food allergen-containing foods don’t even get through the door. The combination of being treated no differently at mealtimes (i.e. “this is what everyone is having for dinner, except Lindsey, she can’t have this and has to be different”) in combination with the safety and mental security of knowing everything in the house is allergy-safe makes an enormously positive difference in the mental and physical well-being of the allergic individual. They’ll still be reading every food label out of habit, but it can be a huge help in helping promote allergy awareness, over obsessive, paralyzing fear – not to mention it greatly increases safety and reduces the risk of cross-contamination at home.
4. Ask a gazillion questions – it’s okay.
Whether you’re dining out at a restaurant, a friend’s house, at your in-laws, or your coworker is offering you homemade cookies, you’re going to have a lot of questions to ask to see if you feel safe eating that food, and that’s perfectly okay. An important step in learning how to manage food allergies is learning how to speak up and ask questions to keep yourself safe.
There may be other diners who roll their eyes. There may be family members who are offended that you’re asking so many questions. But ultimately, with a food allergy you are putting your life in the hands of whoever prepared your food, so you need to ask the questions you need to in order to feel safer taking that risk.
Some of my top suggestions?
- Call restaurants ahead of time, during slow hours, to ask the questions you need to see if they’re able to safely accommodate you and your food allergy. If they’re not, find another restaurant that you feel safer dining at.
- Coordinate a menu together with friends and family members. They may not understand all of the food sources gluten is found in, or may have a hard time remembering both of your food allergies. If they’re open, offer to help create a menu together. It can be a great way to explain why different foods do and don’t work for you.
- Offer to bring a dish everyone can enjoy. Whether it’s a filling side dish, like a grain- or bean-based salad, or a safe dessert you know everyone will enjoy, this is one of my favorite ways to ensure I’ll have at least one option.
- Bring snacks. Pretty much every time I’m going out of town and am unsure what my options will be or if visiting anyone who isn’t my immediate family, I bring snacks. If I don’t have to use them, that’s fine. But if there’s nothing safe I can eat, I know I at least can rely on things like fruit, seeds, and safe granola bars I have stashed away for emergency.
If you find a restaurant is annoyed by your questions and isn’t taking you seriously – don’t dine there. There are restaurants that take food allergies much more seriously, so give your money to them. I know it’s a little trickier when a family member isn’t taking you seriously, but there may be a point where you have to let them know the severity of your allergy. One of my good friends has an analogy that keeping the allergy food near your loved one with an allergy is like pushing them into a busy interstate with little more than a, “good luck!” If you are having reactions every time you visit, you may need to let them know that you won’t be able to continue to visit and enjoy meals with them if they’re constantly going to be putting your life on the line.
5. Always carry.
Your emergency meds, that is. 😉 If your doctor has prescribed a potentially life-saving emergency medication like an epinephrine shot like EpiPen, carry it on you at ALL times. In fact, it’s actually often recommended to carry two EpiPens. One study showed 88% of kids were fine with one dose of epinephrine, but 12% of kids needed two doses (3). It’s absolutely worth it to carry two if it can mean a life saved.
If you have older kids, see if you can get a doctor’s note to let them carry it on them in their backpack at school (I carried mine on me at high school because we had a large campus and it could take ten minutes to get to the nurse’s office, which is valuable time when your life is on the line).
Travel a lot? Can’t hurt to get a note from your doctor explaining what your EpiPen is and that you’re medically required to carry it. One time we were traveling internationally with a group and had a layover at the Frankfurt airport. My now-husband and I got separated from the group and nearly missed our flight because they were questioning my EpiPen, what it was, and from the gestures they were making, I can only assume they thought I was going to use it to stab a pilot in a neck. Fortunately an employee who spoke English arrived and was able to explain I intended no harm, just needed it in case of personal emergency!
6. Have a food allergy action plan.
Possibly the single most important thing you can do when learning how to manage food allergies is to have a solid action plan, or emergency care plan. Know how you react. Do you experience hives? Carry an antihistamine (like Benedryl) on you, if that’s what your doctor has recommended. Is it a life-threatening food allergy? Carry your EpiPens, or other emergency medication, with you at all times. When it’s constant, it’s a habit, and you’ll never find yourself in an emergency situation without an EpiPen on you.
Know that if you have a life-threatening allergy and you need to use your emergency epinephrine, you still may not be in the clear. It’s recommended to call 911 and be transported to the ER immediately after giving epinephrine and to be monitored at least four hours, because symptoms may return.
The Food Allergy Research and Education‘s Education Research Group has a Food Allergy & Anaphylaxis Emergency Care Plan that is a great tool to use to help you identify your own action plan/ emergency care plan, or develop one for your child (4, 5).
Practice using your expired epinephrine shots on an orange (it can semi-mimic the feeling of injecting into your thigh), or if your child is the one with a food allergy, have them practice. I still remember my family and I practicing using my expired EpiPens on oranges when I was growing up. There was an element of “oh, haha, weird, I’m stabbing an orange!” but far more importantly, I remember practicing like this actually helped me feel much more empowered and confident to know what to do if I was having a reaction and needed epinephrine and my parents weren’t around.
I think many epinephrine shots come with a “tester” fake shot now, that doesn’t actually inject, but it can help you practice where you would inject the epinephrine in your body, feeling the sensation of pressing your shot against your leg, and the sensation of waiting for the delayed release. I actually have had friends and past coworkers that, when learning of my severe allergy, want to practice with the tester pen too, because they want to feel confident they can help should an emergency arise. Side note: these types of people are total gems, and the best people! Keep them in your life!
Know your emergency action plan inside and out, because on the rare occasion you experience a severe reaction, you want your action plan to feel completely instinctual.
Have any other top tips of your own? Leave them in the comments, or share on social media and tag NTF (@nutritiontofit and #nutritiontofit). And if you liked this post, please share it!