How to Eat Around Allergies

Cooking for people with food allergies and special diets.

Earlier this year, my 5-year-old son, Alex, joined the growing ranks of Americans who have tested positive for food allergies. Alex had been sick to his stomach, off and on, for weeks. Tests revealed allergic responses to a large number of foods and an abnormally high white blood cell count. An allergist advised us to temporarily eliminate wheat, dairy, chicken, fish, pork, beef and eggs from Alex's diet. My husband and I were stunned.

I ran through his favorite foods in my head, mentally ticking off those that were suddenly forbidden. Milk? Gone. Regular pasta? Nope. Bread, brownies, crackers, pizza? History. Cheese sticks, squeezable yogurts, hamburgers? Sorry.

For a while, it was tough going. Try explaining to a kid why you're suddenly serving his sandwiches on crackly brown-rice tortillas with egg-free mayo, and you'll know what I mean.

But we adjusted. Turns out, oat flour makes terrific cookies and pancakes. Quinoa spaghetti holds up well to marinara. Fortified rice milk and soymilk work beautifully in many recipes. And whoever invented dairy-free chocolate chips earned a place of honor in our home.

Perhaps what surprised me most during the early weeks of Alex's ordeal was how many people told me they, too, had to avoid certain foods, or knew of someone else with a food restriction. According to the Food Allergy and Anaphylaxis Network, about 12 million Americans have food allergies. A true food allergy causes the body's immune system to attack the proteins in a particular food, releasing chemicals (histamines) that cause symptoms like hives, gastrointestinal or respiratory distress. Symptoms, whether mild or severe, occur quickly: within a few minutes to two hours of eating. In the most severe cases, they progress to anaphylaxis, a potentially fatal condition in which the allergic reaction overtakes the entire body.

Any food can cause an allergic reaction, but 90 percent of the time one of the "Big Eight" foods-milk, eggs, peanuts, tree nuts, wheat, soy, fish or shellfish-is the trigger. Allergists and immunologists don't understand why these foods cause a reaction, nor do they know exactly what leads someone to develop a food allergy. There does, however, appear to be a genetic component, as studies show those who suffer from hay fever, or asthma, or who have family members with allergies, are more likely to develop food allergies.

Still, anyone can develop a food allergy, at any time, says Scott Sicherer, M.D., associate professor of pediatrics at the Jaffe Food Allergy Institute at Mount Sinai in New York and author of Understanding and Managing Your Child's Food Allergies (Johns Hopkins Press, 2006). Some allergies-including milk, eggs, soy and wheat allergies-appear more often during childhood, and many kids outgrow them. Others, like shellfish allergies, tend to develop during adulthood. Such is the highly individual (and unpredictable) nature of the food-allergy beast.

Many people mistake localized discomfort, say a rumbling tummy after eating certain foods, as a food allergy, but it's generally not. In fact, according to Dr. Sicherer, "Roughly 20 percent of people think they have food allergies, but the majority of them don't." They may, for example, have suffered a single bout of food poisoning or have trouble digesting certain sugars, but these don't fall under the food-allergy umbrella. Knowing the difference is often tricky, which is why consulting a doctor is so important.

For instance, milk is one food to which people can either be allergic or intolerant (or both), so it's useful for highlighting the difference between the two terms. When the milk's protein triggers an immune reaction like hives or breathing problems, this is usually a milk allergy. But when a person can't digest the milk's sugars (often causing loose stools), this is usually lactose intolerance.

According to Annie Khuntia, M.D., clinical associate of allergy and immunology at the University of Chicago, two main tests can help determine the presence of a food allergy. One involves putting a small amount of the suspected allergen underneath the skin and looking for a raised bump, or wheal. "This method provides quick, easy results within 15 or 20 minutes," Dr. Khuntia says. Another, the RAST blood test, "gives you a quantitative number to follow over time." (Both tests have high rates of false positives, so follow-up testing is sometimes necessary.) Once allergies are identified and foods are eliminated, patients may need advice on maintaining proper nutrition. It's unwise to self-diagnose and avoid foods haphazardly, since you risk depriving your body of important nutrients.

Avoiding known triggers is the only surefire way to prevent reactions-which can be life-threatening, particularly with peanuts, tree nuts and shellfish. So people with allergies must be on high alert at all times, fastidiously reading labels and avoiding cross-contamination. Even trace amounts of peanut protein lingering on a utensil can cause trouble for someone with a peanut allergy.

Fortunately, in the last couple of years, living with food allergies has become a little easier. Thanks to the Food Allergen Labeling and Consumer Protection Act (FALCPA), which took effect in January 2006, reading food labels is no longer an exercise in deciphering secret code. For example, before the law passed, those allergic to eggs had to memorize a laundry list of terms (e.g., albumin) that implied "egg inside." Now that food manufacturers must disclose in plain language the top eight allergens, those same people can look for a single word: "egg."

Also, the number of allergy-friendly products has grown surprisingly large. In fact, a 2007 report from Chicago-based market research firm Mintel shows that the number of new dairy-free products more than tripled between 2005 and 2006 due to an increased awareness of dairy allergies.

Eating with food restrictions (or cooking for someone with them) is far from easy, as I learned firsthand. Still, as I also discovered in the early weeks of Alex's allergy ordeal, many people do it every day, or at least know someone who does. I have a new appreciation for their challenges. I've also come to view acquaintances who keep kosher or follow vegan diets with new respect. After all, it's hard enough to restrict your diet when forced to by medical necessity, but they choose to do so for religious and personal beliefs.

Following Alex's initial diagnosis, I learned to cook creatively with the staples of an allergy-friendly diet-less-familiar grains, like quinoa, plenty of fruits and vegetables, fewer processed foods. The exercise was both eye-opening and a good lesson in nutrition.

As it turns out, we were among the lucky ones. Alex's symptoms were never life-threatening and we eventually got the green light to reintroduce many foods under careful supervision. Today, his diet is close to normal-a surprisingly quick turnaround that's hardly typical among food-allergy sufferers. This whole ordeal even had a silver lining: together, Alex and I discovered a wide variety of new, healthful foods we might not have encountered otherwise. In fact, his favorite breakfast is still banana-oat pancakes, which are wheat-, egg- and dairy-free. And his dinners include more nutrient-rich grains and vegetables than ever before.

In the days when Alex's eating was most restrictive, I came up with what I call "One Dinner Everyone Will Love," a menu of three recipes that contain none of the Big Eight foods, so they're appropriate for many allergy sufferers (as well as vegans and people with celiac disease). Even better, those without food restrictions can enjoy the same meal without ever suspecting that anything's "missing."