Eating out with allergies: the ‘rules’

IMG_1611THERE I WAS, poised to press ‘publish’ on my next post: our top 10 allergy friendly places to eat from 2014. Finding safe spots is never easy, but over the past year we’ve clocked up a few favourites.

Then I realised I should probably preface this post with The Rules. They are the steps we take, and the key things we consider, whenever we eat out. I’m sure others will have more to add, but this is simply how we go about things. Here goes:

* I always ring and email in advance to check the manager and chef are aware, and in some cases we pre-order our meal. It starts as a sussing-out call – do they sound as if they know what they’re doing? If not, forget it. If they do, I’ll go into greater detail, stress that we need the food to be prepped free from cross-contamination, and find out what dishes are likely to be safe for Sidney to eat. I’ll usually summarise the allergies and what we’ve mutually agreed in an email before our booking date. If nothing else, it’s only fair to give a place advance warning where possible and to explain fully what we’re after.

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Check every ingredient – however obvious

* I go through every ingredient – flour, oil, gravy stock, even cheese – to ensure none is a ‘may contain’ product and we won’t unwittingly be fed, for instance, Grana Padano (contains egg) instead of Parmesan. The new EU regulations, requiring catering businesses to inform customers of the ‘Big 14′ allergens in their dishes, is a help, but only the start of a longer conversation to be had. It doesn’t require anyone to reveal risks of cross contamination, or even to guard against cross contamination, and, of course, if you’re dealing with an allergy outside the top 14 you’ll have more questions to ask.

* Upon arrival I always reiterate the ‘can you prep Sidney’s meal without cross contamination?’ spiel and make sure whoever is serving us is fully briefed.

* I prefer it if the manager on duty serves us directly and if we can at some point – either in advance or on arrival – have a conversation with the chef, too.

nandos_restaurant1

Even ‘safe’ chains need reminding

* If you find a safe chain, don’t automatically assume every branch is equally sussed – you’ll have to go through the same rigmarole in every branch, as standards can vary enormously.

* Similarly, if you find a safe place to eat, remind them of your needs every time you visit. Staff change, recipes change: you can never be complacent.

We always go for off-peak times – a midday lunch, for example, or a 5pm tea. Easy when the kids are small and it fits their routine, but it’s probably always best to aim for the quieter periods where possible: the start of a lunch or evening service is a good slot.

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Keep small hands busy

* Factor in a longer wait as allergy friendly food will often have to be prepped from scratch. I take sticker books. That may not work when he’s 15.

* Try to help a restaurant by spelling out what you can have, not just what you can’t. We’ve found some brilliantly accommodating places but eating out with allergies is about communication between you and the chef/manager. If meat and two veg is generally a safe option, or a simple tomato pasta dish, let them know so they can think up something that works for their kitchen. Make it easier for them – it’s not their job to guess what we need.

* Don’t feel pressurised into eating out. This one’s a biggie: it took me until Sidney was three to take the plunge. I needed to get to a stage where I was feeling more confident about managing Sidney’s allergies, and had a grip on exactly which foods he was allergic to. Other allergy parents can sometimes be a bit (well-meaningly) pushy about eating out – they do it, and are understandably keen to encourage others to do it, too,  but it has to be a step taken when you feel the time is right. Personally, I think it’s important to get there at some point: I wanted us as a family to be able to go out to eat, for Sidney to enjoy great food (I’m an OK cook but there’s a limit to my culinary capabilities), have a future with a full social life and, vitally, to hear us asking all the questions he will need to ask, and taking all the precautions he will need to take, as he gets older. I started out tentatively at one or two places on the recommendations of a fellow allergy Mum, whose opinion I trusted, and built my confidence from there.

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Decide whether nuts are a no-no

* Draw your own parameters. For me, the existence of nuts or eggs on a restaurant menu does not necessarily signify an automatic no-no. There’s been a lot of concern recently within the allergy community over Pizza Express’s decision to serve loose nuts. I don’t necessarily have a problem with that, but I will always ask how a restaurant manages cross contamination, and specifically in relation to dishes that give cause for concern. But don’t be swayed by others’ opinions – stay within your personal comfort zone. Ask all the right questions and expect all the right answers, otherwise…

* …my absolute rule of thumb is: if I’ve got any doubts, I don’t do it.

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Expect fruit for dessert

Other than all of that, puddings are generally fruit salad but that’s fine by me. Bread and breadsticks are usually a no-no (risk of cross contamination with nuts and sesame) so I bring some if I think they might be asked for. And if the rest of us might want to order dessert I bring a safe cake or chocolate treat for Sidney to have, too.

If that bumper list doesn’t make it obvious, going out for a meal these days is far from spontaneous. And if, like me, you favour skulking anonymously into a restaurant to hunker down without fuss, get used to never being able to do this ever again. You might as well amble in with egg cups in place of your bazinkas and a small entourage of limping otters for all the anonymity you’ll retain when eating out with allergies.

But it’s worth it.

Coming up next: Top 10 allergy friendly places to eat out 

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Preventing allergies – a Twitter essay

Unknown-1RIGHT NOW, as I type, many of the world’s top and absolutely bestest allergists and allergy experts are gathered in Houston for the American Academy of Allergy, Asthma and Immunology annual meeting. Later tonight, the UK’s Professor Gideon Lack will reveal the data from the long-awaited LEAP (Learning Early About Peanut Allergy) study into how best to prevent peanut allergy in young children.

In the run-up, I have been following the tweets from the great and the good gathered at the conference and the most amazingly informative string of posts has just come through from Canadian allergist Dr David Fischer. He calls it a Twitter essay on LEAP. Genius, and I felt it was worth sharing so I’ve pasted it below. (If you want to follow Dr Fischer on Twitter he’s @IgECPD and if you want to follow the conference tweets search the hashtag #AAAAI15.)

‘How we got to the leap study and what’s at stake': A Twitter Essay by David Fischer, MD

1. There are 2 known ways of inducing tolerance (ie preventing allergy) in children: high zone tolerance and low zone tolerance

2. The concept of low zone tolerance is that if you’re not exposed to something you can’t become sensitized/allergic to it

3. Concept explains why North Americans become allergic to animals they’re exposed to (cats/dogs) but not, say, Tasmanian Devils 

4. Original theory behind strict avoidance of food allergy introduction until older ages in children based on low dose tolerance theory

5. High zone tolerance is when large early exposures induce tolerance. This is the plan of the LEAP study

6. The problem with the low zone tolerance idea in the West is that the strict avoidance of these foods is impossible 

7. Most patients reacting to peanut have with 1st exposure, but it’s not their 1st. Traces in packaged food & skin exposure in homes problem

8. A few Physician groups put out warnings based on Strict Avoidance/Delayed Introduction. That timed with increase in food allergy rate

9. These Guidelines were reversed years ago, allowing for earlier introduction of foods to children…with the hope of it being preventative

10. An Aussie study has already shown that introducing cooked egg between 4-6 months of age appears to prevent sensitization to egg 

11. Dr Lack (LEAP study author) has already noted that the rate of peanut allergy in Israel (where peanut is 1 of the 1st foods) is lower

12. Lack feels it’s a race against time to induce oral tolerance to peanut before intermittent trace exposures (esp skin) induce allergy

13. What we find out today is whether we can literally PREVENT peanut allergies through early peanut introduction. Stay tuned

Note: I asked him if he would mind clarifying ‘intermittent’ in this context and he replied: “From a food perspective I would mean small exposures such as feeding a child foods that have ‘traces of nuts’ instead of nuts.”

So there you have it. Now waiting on that LEAP* data.

The LEAP trial took 640 children aged between four months and 11 months of age who were identified as high risk for peanut allergy (based on an existing egg allergy and/or severe eczema). They were randomly split into two groups – consumption or avoidance. Those in the consumption group were to consume a peanut-containing snack with three or more meals per week; those in the avoidance group were not to ingest peanut-containing foods, both until the age of five. Here is more on LEAP from the BSACI and the Anaphylaxis Campaign.

**UPDATE** And here we have it – feeding peanuts to young infants with heightened allergy risk dramatically reduces the odds that a peanut allergy will develop. Follow the links to the study findings in the New England Journal of Medicine, an article in the New England Journal of Medicine blog here, the Allergic Living report here and The Telegraph here. Worth noting that Professor Lack has stressed that infants showing early signs of peanut allergy (those with skin prick test reactions greater than 4mm) were excluded from the study and effects of peanut consumption in this group remain unknown. But this is properly groundbreaking stuff…

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Brave new world & breadsticks

DSC_0456NEWS that a posho West End restaurant has been forced to close its doors wouldn’t usually fill me with glumness. But, oh, how I am bemoaning the loss – temporary or not – of Locanda Locatelli.

The celebrated Portman Square hangout has been left homeless following a gas explosion in the five-star Hyatt Regency Churchill hotel that houses it.

And now its chef-patron, Giorgio Locatelli, says he may abandon the site and try to re-open elsewhere.

So why my gloom? Well, because a visit to Locanda Locatelli last year marked the beginning of a brave new world for us as a family. It’s where we ate our first meal out, fully catered for Sidney.

Now, clearly, I wouldn’t normally countenance a £30 a dish restaurant as the ideal place to take a toddler for lunch. But this meal was the ultimate gift to an Allergy Mama: organised behind my back, a surprise for my birthday from my Mum and husband, both of whom bravely took over the reins dealing with our complicated allergy requests and managing to sort a three-course meal for nine of us, where every single item on the table was safe for Sidney to eat.

EVERY. SINGLE. ITEM.

From the breadsticks to the homemade rosetta rolls – beloved of my childhood trips to Rome – the cicchetti and tomato pizzette brought out with our aperitifs, through the starters, main courses and even a specially prepared birthday cake, every single thing on that table was prepped free from cross contamination and Sidney-safe.

SIDNEY SAFE.

Breadsticks! DSC_0464 IMG_8676   IMG_8672 IMG_8680 IMG_8684 IMG_8686 IMG_8688 As a rule, and because I’m such a control freak, the sorting of safe food for Sidney is My Job. But the reason my Mum and husband knew they were on safe ground is because I’d been banging on about how much I’d like to try taking Sidney to Locanda Locatelli one day (subtle, me) because, as he revealed in a Guardian interview several years ago now,  Giorgio Locatelli’s own daughter Margherita, has multiple severe allergies: everything from eggs to nuts, fish, tomatoes, strawberries, peppers… As her mother Plaxy put it in a bathetic refrain no doubt familiar to most of us allergy parents: “Thank God she likes potatoes.”

Not only was this meal the best birthday present ever (of course, Sidney stuffed his little face so full of breadsticks, and rolls, and bits of pizza, that he could barely manage the rest of his meal), but it opened the floodgates. The following day, I made a New Year’s resolution: to find at least five Sidney-safe places where we could eat out as a family in 2014.

You know what? We found more than that. So, coming up in my next post is a run-down of our favourite allergy friendly eateries for the past year.

And for 2015 I am setting myself a task to find some more. And hoping Locanda Locatelli reopens in the new guise of an affordable, nationwide chain ;-)

See this Allergy UK link for a video interview with Giorgio Locatelli 

**UPDATE – FEB 2015** Woop! Locanda Locatelli has announced it will be reopening on March 14. Now to lobby for that high street offshoot…

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The new allergy regulations – FAQs & the chance to ask an expert

EVERY THURSDAY evening, from 8.30 to 9.30pm, we run an Allergy Hour (#allergyhour) on Twitter – a forum for allergy people and parents to ask questions, rant, rave, swap tips, share recipes. Last night the folks at the Anaphylaxis Campaign kindly offered up one of their experts to answer specific questions on the new EU allergen labelling laws. Today they’ve put together a handy FAQ guide to deal with some of the issues that came up. See here for more. It covers everything from how the laws will be enforced to where businesses can get advice. Continue reading

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Allergy Labelling – the new laws is a comin’

coffee-and-cake-pairing_emag_article_largeA YEAR or so back, I ambled along to our local park cafe – newly refurbed, ponced-up and handed to a big name London catering firm – and fancied buying myself a coffee and a cake.

Unable to eat nuts around Sidney, I asked the girl on the counter if she could tell me please what was in the carrot cake; might it contain any nuts, or nut flours? She trotted off to ask the chef. Minutes later, the reply came back: “The chef can’t tell you what’s in the cake. His recipes are secret.”

Needless to say that particular ‘chef’ was a twat, but it’s heartening to know that as of tomorrow this kind of response will be flat-out illegal. It probably always was a bit dodgy but the guidelines are now absolutely crystal clear.

The new regulations

Under the new EU Regulation 1169/2011 – aka the new EU Food Information for Consumers Regulation (FIR) – any catering business will have to have full and correct information on the 14 major allergens contained within its products.

The 14 major allergens are:

  • Cereals containing gluten (eg wheat, spelt, barley, rye and oats)
  • Crustaceans such as prawns, crabs, lobster and crayfish
  • Eggs
  • Fish
  • Peanuts
  • Soybeans
  • Milk
  • Nuts (almonds, hazelnuts, walnuts, pecan nuts, brazil nuts, pistachio, cashew, macadamia or queensland nuts)
  • Celery
  • Mustard
  • Sesame
  • Sulphur dioxide or sulphites (often found in dried fruit and wine)
  • Lupin
  • Molluscs like clams, scallops, squid, mussels, oysters and snails

The good bits

Now, I have my reservations about the new laws for various reasons but the good things, as far as I can see, are as follows:

* If you walk into any catering establishment and ask what allergens any of its foods or dishes contain, they have to be able to tell you. They can tell you verbally, or have the information written down, but there must be clear signposting to advise you how you can get this information from staff.

* Nobody can say ‘er, I dunno’ or ‘I’m so up my own ass about my bog standard scone recipe that I can’t tell you what’s in it’. They have to tell you if the food contains any of the 14 major allergens. They have to be accurate. If they are not, you can report them to the food environmental health team of your local authority or the Food Standards Agency.

* It means that every catering establishment will have to have at least this rudimentary understanding of the notion of allergens and what the biggies are. That’s a first step in the right direction.

* Every restaurant will have to list ALL of the most common allergens. I’ve lost count of the number of times I’ve tried to find out if a dish contains sesame (I’m thinking chains such as ASK, or Zizzi) and hit a blank.

Pre-packed food labels will change

The new laws also cover pre-packed foods, such as those sold in supermarkets. These foods will have to have the major 14 allergens clearly highlighted within the ingredients list (for example in bold). Be warned – it means the end of the old allergen ‘box’, stating ‘Contains: milk, eggs, whatnot’. We will no longer have this shorthand and will have to scrutinise the ingredients list to check for allergens. Bear in mind, too, that this information will be phased in, as some foods with a long shelf life will still not have switched over to the new-style labelling.

This is the old way, courtesy of M&S:

getty_rm_photo_of_nut_allergy_warning_label

This is the new (courtesy of M&S and beauty, allergy and eczema blogger Sugarpuffish):

food label

There are some very complicated and disputed bits to this law, which I won’t go into here but which ‘Health Journo’ and Coeliac expert Alex Gazzola covers brilliantly in his blog. It isn’t quite as straightforward as it sounds, and manufacturers – even the biggies – are still getting this wrong.

The less good bits

BUT.

Despite claims that this will revolutionise the way we eat out and shop as allergic consumers, I still have massive reservations. These include:

* It is still not compulsory for caterers to learn about allergen control and cross contamination. Without this becoming an obligatory part of basic hygiene certification (i.e. without chefs and caterers having to pass a module in how to guard against contamination) I don’t have huge confidence that the vast majority of outlets will be able to safely cater. They will be:

(a) scared, where they actually don’t need to be – catering for allergies is not a dark art, but many are petrified of the consequences because they don’t understand what simple steps they can take

(b) confused about what constitutes cross contamination (I once had a manager in a John Lewis cafe tell me their food was unsafe because there were nuts stored in an adjacent room. Possibly they were flying nuts but you’d think she would have mentioned it…)

(c) in some cases not shit-giving enough to do anything but the absolute minimum – i.e. list the allergens but not try to cater for the allergic.

* There is nothing to legislate for the bane of our lives – ‘may contain’ labelling. There are Food Standards Agency guidelines that note there should be “significant and demonstrable risk” for a product to bear the warning ‘may contain nuts’ or ‘sesame’ or x allergen. But there is no law to govern this, therefore it is still perfectly possible (if inadvisable) for a food manufacturer or supplier to state ‘may contain nuts’ etc where no genuine risk of cross contamination exists.

The divs

There are some amazingly wonderful people out there who go the extra mile to cater for allergy (and I’ll be posting about those that we have found, very soon), but there are also some divs out there huffing and puffing about the ‘extra admin’. I’m thinking of Stuart Atkinson, ‘VP’ of the National Federation of Fish Friers, whose empathy at the end of this Guardian report is heart-warming. As he puts it:

“This is yet another administrative burden placed on small businesses… Once all the interest in the new regulations dies down, we are still stuck with them.”

Yes, it’s sort of the point that the regulations last longer than a fortnight.

“Constant vigilance will be required on receipt of deliveries in case a supplier has altered a pie recipe, for example.There is no requirement for fish friers to be directly informed of any changes to the ingredients of the products we buy, other than the list of ingredients on the packaging. We must therefore check every delivery for any changes to this list.”

Welcome to our world.

Stuff worth remembering

Some other points to bear in mind:

* Unless they are a registered food business, charity cake sales and voluntary bake events are exempt. The Food Standards Agency’s Technical Guidance Notes here state that: “Individuals who are not food businesses and occasionally provide food at charity events or voluntary cake sales, for example, do not need to follow these requirements.”

* The new regulations are NOT a substitute for asking all the questions you should usually ask. Don’t assume that you can walk into any restaurant or cafe and eat safely if your allergen isn’t listed as an ingredient. Talk to the manager and, ideally, the chef. Explain your allergy/allergies and that you need your food to be prepared away from those allergens, and can’t eat food that ‘may contain’ any of the allergens. Explain the severity of your allergy. This checklist from the Anaphylaxis Campaign is helpful.

The responsibility is ours

At the end of the day, much of the responsibility still – rightly – lies with us as allergic consumers. It is down to us to explain what we need, clearly and fully, and down to us to help to educate others out there about how they can best cater for us safely.

So I’ll be viewing the new regulations with a healthy suspicion: as a good first step but far from perfect. I’ll be quick to praise and thank those who get on top of the new regulations and go the extra mile to cater for us, and I’ll be bracing myself to do the other with those that don’t.

As fellow allergy blogger @allergymumscouk put it on Twitter: “What’s the saying? ‘Walk quietly but carry a big stick'”.

Batons at the ready…

Mf_cavewoman

 

Extra resources: The Food Standards Agency’s advice to consumers leaflet is here, and its guidance for small and medium food businesses on the requirements for loose foods is here

 

 

 

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We cannot guarantee…

imagesSO today I had a call back from the head of the primary school we expect Sidney will be going to.

I had a mini tour of it a few weeks back and it seemed very warm and jolly. We were shown round by some older kids who were pretty clued up when I asked if any pupils had food allergies; I also spoke to the SENCO (the Special Needs Co-Ordinator) at the time, and she said all the right things. As soon as I walked into Reception I clocked the tots playing with egg boxes and lentils (!) but she assured me that equipment and lessons would all be made safe.

Then the head rang me today, because I requested a quick chat with him before we apply in January, and the first thing he said was: “It’s about allergies, isn’t it? Well, I have to say we can’t guarantee anything.” Continue reading

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Living on the egg-dge

IMG_2273SORRY, sorry. Just trying to find a way to express how daring my day was. Because today I took Baby Two for scrambled eggs.

It’s been almost exactly a year since the last time we managed to get some scramble down her – last December, on my birthday, during one night away from Sidney when Sadie was still too small to be left with her grandparents overnight.

Since then it’s been playing at the back of my mind. Every few months some article or other pops up on my Twitter feed proclaiming that avoidance of certain foods could actually lead to the development of allergies. Continue reading

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Shea panic

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ONE OF THE few mainstream chocolates that is safe for Sidney to eat is Cadbury’s Buttons. This is fantastic because:

* they are kiddie-friendly

* they come in teeny packs so it’s easy to limit the amount he shovels in

* they are available everywhere so it’s the perfect party bag sweet to suggest to friends

* they are available everywhere so it’s the perfect treat for family to buy

* they are available everywhere so if we find ourselves in a situation where we’re out with friends and every kid is having an ice cream, or a cake, or something Sidney can’t have, it’s easy to track down a packet of Buttons for him to enjoy

* they are brilliantly versatile for cake toppings, biscuit decorations, etc

So imagine the panic when a new ingredients listing turned up on selected packets of Buttons a little while ago: shea. Continue reading

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Hello…

im-backDear readers, I do confess, it’s been seven months since my last posting… What can I say, other than a demented 18-month-old, a four-going-on-14-year-old and the paid work I can squeeze into the moments when they are both asleep (ha!) mean I have reluctantly neglected my station?

There’s been so much I’ve wanted to blog about, too. This has been the Year of the Allergy Mama on a Mission. Our grassroots campaign to fight Alpro’s decision to merge nut and soya milk production and slap a ‘may contain nuts’ warning on all their soya products resulted in victory when they backtracked and agreed to keep the lot, bar chilled yoghurts, free from cross contamination. Continue reading

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Everything may contain nuts

images-7I’M BASHING this post out super-speedily. It demands much more time and effort, but until I can manage a proper write-up please may I direct you to the short but powerful blog post below, by ‘I Bake Without’?

There is a huge row ongoing on social media between families with allergies and Tesco. Very recently it has become apparent that the supermarket is slapping ‘may contain nuts’ warnings on everything from vegetables to fruit juice. It’s too convoluted to go into how utterly shit Tesco has been in responding accurately and coherently to consumers’ complaints about this. At first, the customer care staff confirmed that, yes, from now on ALL products would be slapped ‘with may contain nuts’ warnings. Then there was a huge and furious outcry. Then the bigwigs stepped in to issue a denial.

I’ll post more about this as soon as I can. But please have a look at this and see what you think:

http://ibakewithout.com/2014/04/04/why-must-we-fight-for-good-allergy-labelling/

 

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