Longer Expiry Date on Milk Allergy?

It seems that this was the week of the question mark, as just about every post title this week ended with said punctuation. I posted regarding human rights in Ontario, the possible role of RGS13 protein in the suppression of anaphylaxis and the mystery of vaccine-related anaphylaxis.

In each case the news provided as many questions as it did answers. This is nothing new to those dealing with severe food allergy and anaphylaxis. There are many questions yet to be answered, and likely many questions that we have not even thought to ask.

That theme continues tonight.

I read an article about a recent study that seems to refute the old adage that 75% of children with milk allergy outgrow their allergy by the time they turn 3. In this study, only 20% of children outgrew their milk allergy by age 4 and it took until the age of 16 for 75% of children to outgrow the allergy.

Could it really be that it is now taking 13 years longer to outgrow milk allergy?

There were concerns about the integrity of the results in that the population studied was highly atopic, however the study's co-author Dr. Robert A. Wood noted that "it may also be that the character of milk allergy has changed over time".

It was already difficult to study food allergy given limited budgets and a demanding time frame. If the 'target' now begins to move that research only becomes more difficult.

A Protein That Suppresses Anaphylaxis?

In late November research was published suggesting that a protein called RGS13 may play a role in suppressing allergic reactions and anaphylaxis. The research showed that mice deficient in RGS13 had higher mast cell activity and a higher incidence of anaphylaxis.

This study has the potential to help scientists understand why some people develop severe food allergy and anaphylaxis, and could possibly lead to a treatment down the road.

"Because RGS13 is also a protein found in humans and is expressed in only a limited number of cells--including the immune system's mast cells that are central to allergic reactions--scientists believe the protein may be an attractive target for developing new drugs to treat and prevent certain allergic reactions, including anaphylaxis."

"We still do not know what triggers the allergic or anaphylactic reaction in some people," says NIAID Director Anthony S. Fauci, M.D. "These findings open up important research avenues, such as examining the role of RGS13 protein in humans to determine if its deficiency or abnormal function triggers the mast cells to release chemicals that cause allergic diseases."

Though it will be several years before this research is complete and any resulting treatment is commercialized, this is certainly encouraging news.

Measles, Mumps, Rubella ... And Anaphylaxis?

Health officials across Canada have stopped using a vaccine for measles, mumps and rubella after several patients experienced anaphylaxis. Merck Frosst Canada shipped almost 300,000 units of the vaccine, with over 200,000 of those landing in Alberta. In all, six people experienced anaphylaxis. All six were treated and have fully recovered.

Though the response was swift, the disconcerting part is that the exact allergen has not yet been identified. I am sure that the first step will be to consult the six patients who had a reaction in an effort to identify common allergens and then to identify where in the process a new allergen was introduced.

"At this point, we haven't seen any problem," Merck spokeswoman Sheila Murphy said. "We've come up empty-handed so far."

Another interesting factor is that "at least five of the six patients who fell ill in Alberta had a history of allergic reactions." Though it is unconfirmed, that implies that one of the people might have had their first incident of anaphylaxis as a result of this vaccine.

Let Them Eat Candy Canes!

Our friend Gina at AllergyMoms posted a list of allergy safe candy canes today. Our daughter will be thrilled!

Is This A Human Rights Violation? - Part 2

Yesterday I blogged about the human rights action that has been taken on behalf of six children at St. Stephen School in Ontario. Today I interviewed the key spokespeople on both sides of the issue. Maurice Brenner is the human rights expert who is supporting the children and Chris Cable is the Communications Manager for the York District Catholic School Board. (I want to first acknowledge my appreciation for their time today.)

Student safety is the priority
Both sides agree that the ultimate goal is to provide children who have anaphylaxis with a safe environment at school. Mr. Brenner noted that there is a "need to minimize risk with a safeguard" though he did acknowledge that "no safeguard will be 100% effective and since accidents will happen an emergency plan must also be in place".

Ms. Cable concurs and noted that "human rights call for accommodations for disability and though anaphylaxis is not actually listed as a disability, the onus is on schools to minimize risk" for those students with food allergy and anaphylaxis.

So why have things escalated to the human rights tribunal you ask? Good question.

Brenner's goal: Reinstate the prior process of parents checking ingredients
Mr. Brenner noted that the sole objective of the human rights action is to reinstate the prior two- step process where parents noted that lunches were safe and teachers confirmed that each lunch had a parent's note attached.

Brenner said that the former process involved "a simple note, not a detailed ingredients listing. It was just a simple note that said the lunch was checked and it was allergy free." He continued to say, "teachers are fine with the existing practice and are just following the direction of the school board. The (ingredients list) practice had been in place for five years without incident and the recent change in administration resulted in a change in attitude."

Why was the ingredient list process canceled?
According to Cable, the school board canceled the ingredients list process for two reasons. The first is to mitigate risk and the second is that she questions whether the process adds value from a safety standpoint. "(School) staff is not qualified to determine if a lunch is allergen free and neither are parents," said Cable. "You would have to be a dietitian to do this and parents would have to send in packaging so (staff) could read the ingredient list. (The process) gives a false sense security".

Where do we go from here?
Both sides are determined to see this through to the human rights tribunal. While Brenner noted that he is open to mediation, it was clear from speaking with Ms. Cable that the school board is going to stand firm in its position to go without the ingredients list process. This does appear to be headed for a formal tribunal hearing and you can bet that every school board across Canada will be paying attention.

Ms. Cable is fine with whatever ruling the tribunal makes and feels that "if York is a test case for the betterment of all schools (the school board) is okay with that. If there are specific things that the tribunal wants they should be put in place and resources will be required. This is a bigger issue than York. It impacts school boards across Ontario and beyond."

Shrove Tuesday 2007
I was struck by the Brenner's comment that the change in administration resulted in a change in attitude. This perceived change appears to be one of the biggest reasons that there is a human rights action today.

The turning point in school board / parent relations just might have been the cancellation of a 'Shrove Tuesday' celebration earlier this year. Brenner noted that in preparing for the celebration the school departed from prior practice, where a community allergy committee was consulted, and instead went ahead and ordered a new pancake batter that contained an allergen. Cable countered that the school purchased the same batter it always purchased, and a parent raised a concern that the batter "might have been made in a facility that might also have made products containing nuts".

Not only do the two sides have their own version of what exactly happened, they also differ on what transpired thereafter. Brenner noted that the school board sent a letter to parents noting that the celebration was canceled and "made it sound like the allergic kids had it canceled". Cable does not agree that the letter blamed the children with allergies.

Though it is not surprising that the two sides have different versions of events, it does appear that the biggest issue with Shrove Tuesday might have been miscommunication.

NoPeanuts' take ...
I have to admit that I am surprised at the extent to which the children, and more importantly their parents, have held steadfast on this issue. Though Mr. Brenner noted that the prior practice was easy to implement and consistent with recommended guidelines for special events, I tend to agree with Ms. Cable's contention that the process provides limited additional security for allergic children while possibly exposing the school board to significant risk.

Think about it. How diligent do you think most parents would be when they are making lunches at 10:30pm? They would do a quick surface check for peanut butter or eggs, but do you really expect them to know that hydrolyzed vegetable protein might contain peanut or that
casein might trigger an allergic response in those who have anaphylaxis to dairy?

School staff would face similar challenges when doing a quick surface check of lunches. As I noted yesterday, it is not likely that a teacher would would catch the sandwich that accidentally contained egg mayo instead of the eggless variety.

It does not make sense to have added risk without a reasonable expectation of an incremental 'reward'. While Brenner noted an increase in the number of serious allergic incidents at St. Stephen since the ingredients list process was canceled, Cable is only able to recall a single incident requiring Benadryl but not an epinephrine auto injector.

I concur with Ms. Cable's contention that the ingredients list process might actually create a "false sense of security" for parents. As I noted yesterday, I would certainly not rely on it to keep my daughter safe. I would instead take comfort from St. Stephen's comprehensive allergy policy which extends beyond the requirements of Sabrina's Law. It seems to me that the allergic children at St. Stephen are indeed being afforded accommodation for their disability.

While I fully appreciate the right of the children to refer this matter to the human rights tribunal, my original conclusion remains intact. The specific issue to be decided is whether the ingredients list process is an accommodation covered by human rights for the disability of anaphylaxis.

As this process seems to provide limited additional benefit beyond the extensive policies and safeguards already in place, I would be surprised if their action was successful.

Is This A Human Rights Violation?

A very interesting story is emerging in Toronto. Human rights expert Maurice Brenner is supporting six children, aged 6-11, in bringing a human rights complaint against their school and its school board as a result of food allergy policy.

For the past six years St. Stephen Catholic Elementary School, in Woodbridge ON, has had a program aimed at making schools safer for children with severe food allergies. To augment the provisions of Sabrina's Law, which enacted formal policy to protect school children with anaphylaxis, St. Stephen required parents to list the ingredients of school lunches and required teachers perform a quick daily inspection of lunches.

The policy was appreciated by parents of children with severe food allergy, but has been canceled due to a need to conform with other provincial schools who do not have similar policies.

Chris Cable, spokesperson for the York Catholic District School Board, said that while the "Ontario Human Rights Code requires schools to accommodate children with disabilities, 'it makes no mention of daily inspections of children's lunches by school staff, nor does Human Rights require parents to send in notes with each lunch and snack to describe the ingredients.'" Cable added that schools in the district already comply with Sabrina's law and school board staff are trained twice a year to recognize anaphylactic shock and use an EpiPen.

Sabrina's Law sets reasonable minimum standards for anaphylaxis preparedness and the York schools appear to be in compliance. Though the heightened ingredient monitoring was well-intended, it did not align with other schools in the district and would certainly not have provided 100% safety for allergic children.

As I have written many times before, even the most well intended attempts to prevent food allergen exposure will not succeed 100% of the time. A quick surface inspection of lunches by a teacher would catch an obvious offender such as a peanut butter sandwich, but it would not likely catch something that contains a more obscure allergen, for example a sandwich that mistakenly contains real mayo (Daddy used the wrong jar) but the student honestly thinks thinks it is egg-free mayo.

The bottom line is that awareness and emergency preparedness are just as important as pure prevention.

While I share the fear that St. Stephen's parents have in sending their food allergic children to school, I am not convinced that there is a human rights violation in Woodbridge.

(Note: there is a follow-up to this post.)

From Soup To Nuts

Amanda (aka Mrs NoPeanuts) was in Toronto this past week. She had lunch in a church basement and the cooks had made a lovely Moroccan soup. She was surprised to find out that the soup had peanut butter in it! She was even more surprised that the staff demonstrated strong food allergy awareness by noting the inclusion of peanut butter directly on the soup placard. Very cool.
I was intrigued by the inclusion of peanuts in soup. I had no idea that it was so common.

I did a search at Epicurious.com and found 19 soup recipes that contained peanut. Most of them had peanut in the name so you'd clearly notice but several others, Szechwan Carrot Soup (1.5 tbsp peanut butter) and Long Leaf Noodle Soup with Hoisin Marinated Shrimp Soup (1/2 cup peanuts), are more obscure from a peanut perspective. Many other soups, including Chinese Hot And Sour Soup, contain peanut oil.

Obviously if we were making these soups we'd modify the recipe to leave out the peanut. That being said, if we were at a restaurant and saw carrot soup we would not have immediately thought 'watch out for peanuts'.

Of course we always ask about peanuts when ordering but I did not realize that so many soup recipes used peanut and I might have trusted the judgment of a seemingly astute waiter who told me their carrot soup was safe. I will ask a couple of follow-up questions in the future.

I am sure that people out there are saying, "I knew that soups often include peanut!" I guess this just highlights that allergy management is a perpetual learning process.

Thanks to the church staff in Toronto. Your simple sign noting that there was peanut butter in your soup has been more helpful than you know!

Over The Hills And Jar Away

This week I was at a software event in Los Angeles. In typical fashion there were cookies and other sweets laid out to fuel the event's patrons, many of who would spend hours on their feet presenting their products to customers.

Though people with peanut allergy would always be wary of cookies of unknown origin , I was somewhat surprised to note that the chocolate chunk cookies were set out in large glass jars filled with peanuts. Peanuts filled about half of the ~10L jars and the cookies were then stacked on top.

Though it is unlikely that a peanut allergic person would eat those cookies anyway, there is a chance that somebody could ask about the cookie, be told that no peanut was in them and then eat a cookie cross-contaminated by the peanuts that they were stacked on.

I know that seems like a bit of a stretch, but I am never comfortable around 5L jars of peanuts!

NoPeanuts In The Globe

Today we were quoted in the Globe & Mail, Canada's national newspaper. Globe reporter Tralee Pearce was intrigued by the rapid growth in the incidence of food allergy and we were interviewed as part of her research.

In reading the article I was interested to learn that "the median age of first peanut-allergy reactions has dropped to 14 months from 21 months over the past decade." Over the same period of time "the median age at which the allergic child was first exposed to peanuts has dropped to 12 months from 19 months."

As we all know, there is no definitive explanation as to why the incidence of peanut allergy is increasing. Pearce also pointed out that the drop in the age of the first reaction might be due to the fact that parents are now more acutely aware of the signs of a possible allergy.

In the course of our discussion I intimated that the most frightening aspect is the suddenness with which a reaction can appear. "It's all or nothing," Mr. Smith says. "She's either totally fine or it's an emergency."

Thank you Tralee for taking an interest in food allergy.

Fear, Frustration and Hope

Today I came across a great article on CNN. The article is written by the mother of a young boy named Teddy who has anaphylaxis, to peanut, egg, dairy and wheat. Unless you have a experience managing severe food allergy, you would not appreciate how difficult it would be to manage the allergy and keep Teddy safe. Teddy's exclusion list would dwarf Madeleine's, which is just egg and peanut.

I was struck at how well Teddy's mother articulated the fears, concerns and frustrations that parents face when they have a child with severe food allergy.

In the midst of managing a tough dietary regimen, Teddy's mother also faces the ignorance and fears of others. It is important to understand that most people just do not understand food allergy. They cannot comprehend that the perfectly healthy child in front of them goes into a life threatening reaction within seconds upon contacting the allergen.

An example of this is when people say to Teddy's mother "Oh, a little bite of cake won't hurt him" and "Why do you need to read the label -- I'm sure this is OK." If you have a child with food allergy you have almost certainly encountered this. It is frustrating, but your role as a parent protecting a food allergic child is to treat that as an opportunity to educate vs a reason to become frustrated.

Another classic example from Teddy's mother involved air travel. "When we fly, we have to fill out paperwork for a peanut-free flight, since even airborne peanut particles can pose a risk. Once a flight attendant slipped up on a connecting flight and began passing out peanuts. I asked her to please keep them away from our rows. "Oh? Is the peanut allergy still on board?" she asked." Though it is frustrating to have your child reduced to a label or stigma, this is another opportunity to spread awareness. It might he helpful to talk calmly to the flight attendant after the flight about her choice of language. Getting angry during the flight would just make you look like a 'peanut parent' who is totally overreacting.

School of course is a fear for all of us and Teddy's mother shares our concern that Teddy will "most likely have a segregated seat at lunch, and while that potential exclusion saddens (his mother), the growing number of children with allergies would seem to indicate he'll have some company in the lunchroom."

I chose to highlight this article as it covers many of the major concerns and fears encountered by parents if children with severe food allergy. We face these psychological challenges in addition to managing complex 'dietary logistics'.

Another element of the psychology of childhood food allergy is hope.

Teddy's mother says, "we still have hopes that Teddy will outgrow some of his allergies. After all, he's only 3½. If he can outgrow only one allergy, I hope it is cow's milk. He'd be able to eat the lengthy list of foods whose only allergen is caramel coloring. And I'd like to be able to drink a glass of milk and kiss him on the cheek without him getting a hive."

I've had this sample mental conversation myself many times.

Though we all have become adept at managing severe food allergy, the truth is that everyday we hope that it will somehow vanish in the same mysterious way that it appeared.

That Cookie Tastes Like Peanut

I read a story tonight about a child who showed great allergy awareness despite not being allergic himself. (Though it is a Halloween-related story it just came out.)

Adam Waldusky is a 7 year old from Chippewa Falls, WI. At a Halloween party with (supposedly) safe treats the kids were eating cookies. Soon after the kids ate cookies, Adam's friend raised an alarm by telling Adam's Mom that he tasted peanut.

Thought it is not clear why Adam did not notice this himself, within minutes he began to swell. Adam's Mom was prepared and after administering an EpiPen she brought Adam to the hospital for the 4-6 hour observation period.

Thought it is great that story had a happy ending. I was also impressed that Adam's friend was the first one to recognize the danger and report it. It is impressive that at a young age he was thoughtful enough to think of Adam's allergy after tasting peanut.

One of the contributing factors to his awareness was the fact that Adam's Mom talks to the kids in Adam’s grade once per year, to promote allergy awareness.

It takes a village ...

Hitch

Has anybody seen the movie Hitch? I had never seen it and was struck by the seen where Will Smith's character, Alex Hitchens, has an allergic reaction to shellfish. Though the movie found humour in the swelling reaction and showed him drinking enough Benadryl to appear intoxicated, it was very bizarre to see an allergic reaction played out in a movie.

Part of the comedy came through the distortions that the swelling reaction caused in his ears and face. The scary part though was that our daughter's anaphylactic reaction also had grotesque swelling in her neck, face and hands ... she was not even recognizable.

I wasn't sure whether to laugh or cry while watching the movie ... it was both funny and terrifying. It was truly bizarre how the scene made me feel. While Will Smith's antics were truly comical, recalling the image of my daughter lying on the bathroom floor was the antidote to humour.

Ann Munoz Furlong of FAAN summed this up well with the following quote:

"We hope not only does Hitch "get the girl," but he also needs to go see an allergist. He shows many of signs a major food allergic reaction. The next one could be even worse." said Anne Munoz-Furlong, Founder & CEO of FAAN. "It can be funny to watch in a movie, but if you are ever with someone experiencing a food allergic reaction it can be quite frightening. For those with food allergies, it is important to seek medical treatment immediately and to carry their epinephrine at all times."

Sunbutter Returns

I know many of you are sitting at the edge of your seats just waiting for the latest update on my quest for Sunbutter. I was disappointed when Stongs no longer carried Sunbutter and I took to the Internet to find a new source. With a peanut allergy in our house Sunbutter is the closest thing I will get to my beloved organic peanut butter.

The issue locally is that only specialty stores carry Sunbutter and they charge way too much. Online I could get it for about $5/jar, landed cost.

But this weekend I was pleasantly surprised to find Sunbutter on the shelves at Stongs again! I was way more excited than I should have been. Stongs carries it for $3.99 so not only is it easier, it's cheaper.

For now I am back in action. Stay tuned ...

Anaphylaxis (sp?)

It always strikes me as funny that the word 'anaphylaxis' comes up as a spelling error in Blogger. It fits the current level of awareness for the disorder.

Villagers of Distinction: Sara & Mike Shannon

The Villager of the Month accolade has gone to a person or group that has done something interesting or special for those with allergies. It has honoured several people but as I award this accolade this evening I am struggling with the title.

Let me explain ...

Today I posted about how I thought I almost received a peanut cookie at a café. Though I do not have any food allergies, I seem to be vicariously allergic to peanut through my daughter. I react to peanut with an urgency that would suggest I am allergic myself. It is downright scary to think that I could accidentally consume something that would cause a possibly fatal physiological response. It is scarier still to imagine my daughter have that same reaction.

Tonight Gina Clowes of Allergy Moms emailed me. She reminded me that my Villager of the Month accolade was again due and her nominees are an obvious recipient for any and all allergy-related accolades. My concern was that a 'Villager of the Month' accolade just didn't seem appropriate given all that they have been through, and all they have done for the allergy community.

Many of you will know the story of their daughter Sabrina. The best summary of the Shannons' dedication to their daughter is summed up by Allergic Living, "On that terrible last day of September 30, 2003, Sara had made this promise to her daughter: she would do everything possible to prevent another child from dying of anaphylaxis. That promise has become her mission."

Sara has followed through on that promise.

For those who have children with anaphylaxis, Sara and Mike should serve as your inspiration. Collectively, our worst fear is that we might someday lose our child to a fatal allergic reaction. The Shannon's have turned their tragic loss into triumph and proved that all you can do in life is make the most of any situation, no matter how dire.

Gina Clowes was one of the first people to ever comment on NoPeanutsPlease. She counseled me to think of those with allergy to things other than peanut, and highlighted the story of Sabrina and her parents. After Gina's post I lay awake at night for about a month and wondered if I would have the courage to follow in the Shannons' footsteps. In those initial days after our daughter's diagnosis the possibility of a fatal reaction were of course exaggerated in my mind.

Madeleine would cough at night and my immediate response was to rush in and make sure she was not having an allergic reaction. It sounds crazy ... and it was.

Over the ensuing year my thoughts have returned many times to the Shannons.

My pittance of an accolade cannot begin to demonstrate my respect and gratitude for what they have done. We live in Vancouver and when Madeleine goes to school in three years she will be safer than she would be if she entered school today. Because of the Shannons' support for bill M210 here in British Columbia there are new anaphylaxis policies in our schools. Though we did not secure a west coast version of Sabrina's law, the support of the Shannons gave credibility to the efforts of PACT.

Though I hope to never follow in their footsteps, I am deeply moved by their response to the tragic loss of their daughter. Though I cannot even fathom the loss of Madeleine, I would hope that I could have a fraction of the Shannons' courage.

In honour of Sara and Mike Shannon I have renamed my 'Village of the Month' award. Henceforth the accolade will be called 'Villagers of Distinction'. The word 'month' connotes a point in time. The Shannons have given so much to the allergy community that any accolade, no matter how small, requires an element of permanence. It is not melodramatic to say their through their efforts they have undoubtedly saved the lives of multiple children.

Their efforts in BC may even someday save Madeleine's life and that possibility alone makes me forever grateful for their courage and their contribution to the allergy community.

Thank you Sara and Mike. You are truly an inspiration.

No! No! Not The Peanut Cookie!

On several occasions I have blogged about the fact that it is impossible to completely avoid an allergen. If you have a peanut allergy it is likely that at some point you will inadvertently encounter surprise peanut protein, perhaps just when you least expect it. It is critical to be prepared for an emergency response should that be required.

Today we experienced this first hand

We were at a Vancouver café and my wife ordered an oatmeal cookie to go with her latté. (... how Vancouver is that?). I was watching as the café owner reached for the cookie and I said, "No! No! Not that cookie. We can't have peanuts!" I was slightly amused at the 'peanut conditioning' I have undergone. though I am not even allergic to peanut, (our daughter has the peanut allergy), I often react with an urgency that should be reserved for those who are actually allergic! It is very interesting.

The scare today was that I thought that the café owner had reached for the peanut cookies, and not the oatmeal cookies. When I looked closer I realized that he did indeed pick up an oatmeal cookie but their cookie label signs were in front of the wrong cookies. The peanut cookies were labeled as oatmeal and vice versa.

Let this be a lesson that even when you carefully read ingredients, signs, etc. you could still pick up a mislabeled food item and unknowingly consume an allergen.

This is just a fact of life for those living with food allergy. Though it is important practice safety and avoidance, it is critical that you carry an epinephrine auto-injector, such as an EpiPen or TwinJect at all times.

You cannot be too prepared and you just never know when anaphylaxis might be triggered.

It's The Leash You Can Do

This week we went to the allergist and our daughter's dog allergy was confirmed. Though it is not likely anaphylactic it is a serious allergy and does appear to have been the culprit in our daughter's scary swelling and skin reaction that resulted in my wife administering an EpiPen. The reaction appears to be in response to dog saliva. Hypo-allergenic dogs do trigger the allergy.

Given the severity of the reaction you can appreciate our concern when we are walking down our block and somebody is coming the other way with a dog that is off-leash. It also scares our daughter into our arms.

I urge dog owners to consider this the next time they are out for a walk. It is common for dogs to be up to 50 feet or more away from their owners when off-leash. We avoid designated off-leash areas as they are a concern. Outside of designated areas it is inconsiderate to have your dog off-leash.

Sunbutter Eclipse

Back in June I was so excited to find Sunbutter at my local grocer. Unfortunately they just took it off the shelves! The same distributor that sells Sunbutter also sells PeaButter. Apparently they are only going to carry one and Sunbutter is the odd butter out. Based on my PeaButter review I think you know how I feel!

Alas I am now searching for sub-$8 Sunbutter again. I think I'll check the Internet as suggested by a reader.

Peanut Free Baseball

In June I posted about how sports teams were beginning to take peanut allergy more seriously. I came across this article tonight which gives a first hand perspective of a father and son who attended a Washington Nationals game on a night where a peanut-free skybox was offered for allergic kids. Note that the young boy in question developed hives despite all of the cleaning and precautions. I suspect that peanuts are just 'in the walls' of a ballpark, just like eggs seem to be 'in the grill' at diners.

Trick Or Treat ... Give Me Something Safe to Eat

Today my mother-in-law told us that she has a friend who is going to buy peanut safe treats to give out at Halloween. After hearing many times about our daughter's allergy, this friend decided that she did not want to be responsible for a possible allergic reaction in a child who came to her door.

Though other allergies such as dairy or wheat are also a concern at Halloween, I thought that this was a great gesture. It shows the power of allergy awareness!

We are going to hand out Nestle treats at our door. Nestle actually offers a package of assorted peanut free treats including mini Kit Kat, Aero, Coffee Crisp and Smarties products. Our daughter loves Smarties so this works just fine for her.

As with all products marketed as peanut free, one caution is to not blindly assume that things are safe. In 2006 Nestle actually had an issue with the Coffee Crisp bars in its assorted peanut free pack. An unfortunate reality for parents of allergic kids is that even with peanut free products it is important to be ready for a possible reaction.

We are going to bring Smarties and Dare's Wagon Wheels to all of our neighbours' homes prior to trick or treating. That way we know that our daughter will receive safe treats at each home and we can just relax and enjoy our evening. My wife and the girls are going to be the three little pigs and I the Big Bad Wolf.

Happy Halloween!

Villager of the Month - Jen

The Villager of the Month accolade goes to a person or group that has done something interesting or special for those with allergies.

This month's winner is our neighbour, Jen. Our daughter was invited to her son's first birthday. A few weeks before the party Jen proactively reached out to ask for our Wacky Cake recipe. She then went a step further and told all of the other parents that there would be an allergic child at the birthday party and to avoid bringing peanut snacks.

How incredibly thoughtful!

Jen made four chocolate Wacky Cakes and as always, they were moist and flavourful. These cakes are hardly a sacrifice for anybody and are very helpful for those with severe food allergies. The cake was a hit with our daughter. I think she ate five pieces, though much of the cake seemed to be smeared on her face and her dress!

Just as the party was winding down, an incredible thing happened.

I was speaking with one of Jen's friends and I mentioned that the cake was nut and egg free. It turns out that she has anaphylaxis to peanut! She was very happy to learn that she could actually enjoy the cake with the rest of us.

This was a rare treat for Jen's friend and it was also a pleasant surprise for Jen as she was not aware of her friend's allergy. Consider it allergy karma! You just never know who is going to have an allergy in your circle of friends.

Other parents could really learn from Jen. She simply asked for a cake recipe, advised other parents to bring peanut-free snacks and ensured that whatever else she served was peanut free. She did not fear the allergy. She did not make us feel like she had to go out of her way. As a result we never felt like we were an inconvenience.

Though I did have to be careful of a few egg items on the buffet style party spread, our daughter was really just there to play with the other kids and to eat chocolate cake!

It Takes a Village to manage an allergy! Jen set a great example for parents looking to accommodate children with food allergies.

Do Eggs Make YOU Sick?

I thought I would share an interesting conversation that our 2 1/2 year old daughter had with her 2 year old friend. They were playing with our daughters' kitchen set. We have about 100 plastic food items and as they played our daughter picked up a plastic fried egg. The first time she saw the egg she asked us what it was. I was struck by that because we used to eat eggs every day but once we learned of her allergy we began to phase eggs out. She had never seen an egg!

As they played, our daughter turned to her friend and said ... 'eggs make me sick. Do eggs make you sick'? Her little friend had no idea what she was talking about.

I found this interesting because the day before I had explained to our daughter that not everybody gets 'sick' when they eat peanuts or eggs. I told her that though she can drink milk, other kids get sick when they drink milk. The point was that not everybody was allergic to peanuts, but there were things that were safe for her that others could not enjoy.

The concept of food allergy is very confusing for a two year old. Our daughter is starting to understand and it is fascinating to observe her as she scrambles up the food allergy learning curve.

Book Review: Mommy, Is This Safe To Eat?

I was recently contacted by Christina Black, author of two books for peanut allergic children and their parents. Entitled 'Mommy, Is This Safe To Eat' and 'Starting School With A Food Allergy', the books are intended to help young children understand how to stay safe while still having fun.

I decided that the best way to review these books was to read them to my 2 1/2 year old peanut allergic daughter. She has made great progress in understanding her allergy. Every time she sees peanuts, peanut butter or potentially unsafe cookies she says: 'No peanuts for me. Peanuts make me sick'.

That being said, it is very difficult for her to be aware of peanuts hidden in other foods. The photos in these books, such as those depicting potentially unsafe muffins or crackers, were very effective. She was confused at times, and the point was clearly made that Mommy and Daddy to help her determine if a food is safe.

The M&M's were particularly confusing since Smarties are safe, at least here in Canada. She pointed and shouted, "Smarties!" only to have Daddy tell her that they were not Smarties and that she should only eat things that look like Smarties if Daddy or Mommy say it's safe.

The books also capture food allergy safety from a child's perspective. The allergy learning process can be confusing and frustrating, and the books deal with some of the most challenging scenarios: grocery shopping , forgoing cookies or snacks in social situations and dealing with concerns that a peanut allergy is the antidote to fun.

In future titles I would suggest a more engaging narrative format to bring the child deeper into the book. Children love to follow a well formed story or theme. Another idea would be to have something, perhaps a peanut, that repeats on each page. Kids enjoy hunting for these items when they are hidden throughout the book.

Though there are many websites, such as Safe4Kids, with content related to food allergy in the classroom, sometimes it also helps to have a printed book with pictures. These books could serve as a useful teaching aid for all children, not just those with allergies, as they learn about food allergy safety.

Red Tag Lunches

I thought this was a cool idea. Though I abhor the term 'Peanut Police' I do like the idea of adding colourful tags to lunches that contain allergens. In this case lunches containing peanut are red tagged though no other allergens are identified. You could do the same for high risk foods such as dairy or wheat.

While many parents will immediately have a vision of adding so many tags to their child's lunch bag that it looks like a rainbow, within reason this could be a very effective way to give fair warning to those with allergies. It could certainly be something employed by the school lunch counter and parents could do their best to follow suit. Perhaps the home version would simply be a single tag that identifies that lunch as containing any of the major allergens.

The tag method is certainly a more pragmatic approach than a peanut ban.

Do Veggies And Omega-3 Reduce Risk Of Allergy?

(post by Mrs. NoPeanuts)

I recently came across a research study that claimed a diet rich in fish and fruity vegetables such as tomatoes or eggplant, can cut asthma and allergy incidence in children. As a biologist, I find the scientific side of my daughter’s allergy intriguing and the research (or lack thereof) always interesting to read.

Researchers from the Department of Social Medicine at the University of Crete, Greece, and writing in the journal Pediatric Allergy and Immunology, studied the diet of 460 Spanish children.

They discovered that children who consumed more than 40 grams of "fruity vegetables" a day - namely tomatoes, eggplant, cucumber, and green beans - were much less likely to suffer from childhood asthma. In addition they found that children who consumed more than 60 grams of fish with a high omega-3 content also suffered less childhood allergies.

The study adds to a body of evidence supporting the health benefits of omega-3 and a diet high in vegetables.

What is interesting to note is that my daughter and I ourselves participated in a research study for Omega-3 conducted at our Children’s Hospital. The purpose of our study of course was not to examine foods linked to allergies but to help determine whether a dietary supplement of docosahexaenoic acid (DHA) during pregnancy has any effect on pregnancy duration or early infant development.

At 17 weeks pregnant, I started to take a supplement (which could have been omega-3 or I may have been in the control group) and continued throughout my pregnancy. The supplement stopped when I delivered.

For the first 18 months of my daughter’s life, the researchers monitored weight, height, head circumference and we ‘played’ games that observed eyesight, speech perception, problem solving, behaviour, motor skills and cognitive understanding.

Interestingly enough, when I became pregnant with our second daughter, we enrolled once again in the study and by complete chance we were put in the same study group, meaning whatever supplement I received with my first daughter I also received with my second.

And low and behold…my first daughter suffered from extreme eczema during her infancy and now also lives with anaphylaxis to peanuts and eggs. My second daughter, who received similar Omega-3 exposure in the womb (as I didn’t change my diet – except for the removal of peanuts and eggs), has no eczema and to date, thank goodness, no allergies.

“This is not the first time a diet rich in "fruity vegetables" has been linked to having the potential to reduce the risk of respiratory conditions like asthma, chronic bronchitic symptoms, and wheeze. However, this study claims to be unique because it assessed maternal dietary habits during pregnancy as well as children's dietary habits.”

“Fruits and vegetables are rich sources of antioxidant vitamins such as vitamins C, E and carotenoids, and other antioxidants such as selenium and flavonoids, that are thought to reduce airway inflammation by protecting airway cells from endogenous and exogenous oxidative damage,” the researchers said.

However, they found that no other fruits or vegetables were significantly associated with wheeze or allergy prevalence. The lead researcher, Dr Chatzi commented: "The biological mechanisms that underlie the protective affect of these foods is not fully understood, but we believe that the fruity vegetables and fish reduce the inflammation associated with asthma and allergies."

Though I do not know for sure, there is reason to believe that I did indeed have the Omega-3 supplement during my pregnancy for our first daughter, vs the placebo. There were no actual numbers provided in the Spanish allergy study but it does sound like our daughter’s Omega-3 consumption would make her an exception to the rule.

Despite all of the current research efforts, we still do not clearly understand what causes food allergy. There is an apparent randomness as to allergy incidence and severity.

Villager of the Month - Summer 2007

This spring I started a new series called Villager of the Month. The intent is to recognize people and organizations who do special or interesting things to help those with food allergies. This month I have been featured in Allergic Living. I wrote an article about the theory behind this very concept and the reception has been great.

The latest recipient of the Villager accolade dovetails nicely with my post about the work that PACT had done with Bill M210 in B.C. The Food Allergy Initiative is a non-profit agency that raises funds toward the effective treatment and cure of food allergies. It also works to raise awareness of the seriousness of food allergy.

In August the FAI was a major force behind New York Governor Elloit Spitzer's decision to sign into the law the Allergy & Anaphylaxis Management Act of 2007 (AAMA) . The FAI's contribution was significant. "During the past year, FAI led a coalition of food allergy support groups and parents across New York State to achieve the passage of the AAMA. In March 2007, as a result of FAI’s leadership of a coalition in New Jersey, a similar bill, PL. 2007, c.57, was signed into law."

“This vital legislation will save lives,” said Robert Pacenza, Executive Director, FAI. “If a food-allergic child accidentally ingests even a minuscule trace of the wrong food, it can trigger a reaction that can kill within minutes. The AAMA will provide New York parents and schools with sensible guidelines to help keep these kids safe. FAI is proud to have been the organizing force behind this effort.”

Congratulations Robert and team. Great work on this legislation!

M210 Lives On ... In Spirit

This past spring bill M210 made its way through the legislative process here in British Columbia. As a result of a strong grassroots effort led by a group called PACT, the failed bill actually lives on, at least in spirit, via a new anaphylaxis directive handed down this week by Education Minister Shirley Bond.

“Children with life-threatening allergies need to be safe in B.C. schools, and our direction today is for all school districts to take immediate steps to ensure all students are protected,” said Bond. “Boards of education will now be required to have school-based anaphylaxis policies and practices that meet rigorous provincial standards.”

This is great news. PACT was my villager of the month for June and I am very pleased to see that in the absence of a true B.C. version of Sabrina's Law we do have protection for our allergic children in the province's skills.

Kudos to all of those involved in the lobby effort to make this happen.

Allergic Living Features NoPeanutsPlease!

The Fall 2007 issue of Allergic Living magazine features NoPeanutsPlease. I wrote a column on the concept of 'It Takes A Village' and it was included on the last page of the magazine: "Parting Shots: A father needs help to keep his anaphylactic daughter safe.". The article is not available online but was highlighted as a feature of the current issue.

You Ant Be Serious!?

I bought ant traps today after I found 20 little ants enjoying a slice of watermelon on our kitchen counter last night. I figured that the warning to keep them away from the kids was due to boric acid. Turns out that these traps 'may' contain peanuts so the boric acid is the least of our concerns. I learned today that many pest control traps use peanut butter as bait ... who knew that people with a peanut allergy needed to be wary of ant traps?

I am not super alarmed from the research I have done but I think it might be best to use boric acid in my beloved Sunbutter instead of the peanut butter ant traps.

My target is the ants ... not my daughter.

Don't Pass The Mustard

I read a piece this morning on mustard allergy. Even after the countless hours of research I have done, I was surprised to learn that a 2003 study found mustard allergy to be the fourth most prevalent allergy in children behind egg, peanut, and milk.

The article also presented an example of how overwhelming food allergy can be for parents. Here is a quote from the mother of a young girl who has anaphylaxis to peanuts and mustard:

[Emily would typically start preschool in the fall, but she will be held back a year. "I'm really considering looking into possibly home schooling unless there's something that I can really be assured she can be safe -- maybe a special place where the school is free of peanuts," Evans said. "Free of mustard is a stretch, a little bit.]

I remember having the same initial reaction. Over time you realize that despite your best efforts it is just not possible to completely avoid an allergen. It is important to practice avoidance but it is also important to be prepared in the event of an emergency.

Home schooling is a matter of personal preference. Though our peanut allergic daughter will go through the school system, I do have to admit that I am already very nervous for her first day of preschool this fall. I also hold out hope that BC passes anaphylaxis legislation prior to her first day of kindergarten in 2010.

Peanut Poetry

I received an email from Allergic Living magazine this week. They are having a poetry contest that is taking entries up until next Thursday. I find blogging to be a great outlet for me and I suspect that others might enjoy poetry. Feel free to post a verse or two as a comment on NoPeanutsPlease as well. Good luck!

Boston Baked Beans

This one is ironic. I was at a gathering of my extended family in Boston this past weekend. It was interesting to meet another branch of the family. We won a door prize as the people who traveled the greatest distance to be there. The prize was Salt Water Taffy and Boston Baked Beans. The irony is that unbeknownst to me Boston Baked Beans are chocolate covered peanuts. Sometimes you just have to chuckle. I'm glad that my wife noticed or I would have brought them home.

Peanut Parfait

This week we were out to dinner. While eating a delicious strawberry parfait I crunched into something that has become foreign to me … a peanut! Ironically, I had just finished saying how much our daughter would enjoy the parfait. I found it interesting to experience first-hand the shock that an allergic person would feel when finding a surprise peanut. My first reaction was one of fear. It was as if I was allergic myself. I felt very strange and I could no longer eat the parfait.

I have not had a peanut in about six months. The taste is now unsettling and for obvious reasons no longer welcome. While I can still enjoy an omelet while traveling on business (despite our daughter's egg allergy), I no longer have a desire to eat peanuts. I was surprised that I had such a strong reaction. It is funny how the mind works.

Villager of the Month - June 2007

This spring I started a new series called Villager of the Month. The intent is to recognize people who do special or interesting things to help those with food allergies.

For June 2007 I wanted to recognize the efforts of a group of concerned parents in British Columbia. Under the name Protecting Allergic Children Today (PACT), Caroline Posynick and other members of her organization spearheaded a letter writing campaign to MLAs and government officials in support of David Cubberly’s proposed anaphylaxis legislation.

Though Bill M210 failed to advance after its second reading, the government is certainly aware of the issue of allergic children in schools and that is largely due to the efforts of PACT and its supporters.

You can learn more about PACT or Bill M210 on the organization's website.

Six Months In

So here we are ... six months into our daughter's severe food allergy. I have been struck by how tight knit the anaphylaxis community is and just how much there is to learn. I think we've done a good job of managing the allergy without having to significantly alter the things we do, but it is certainly a challenge at times. It is difficult to be 100% compliant in reading labels, checking ingredients, quizzing servers, bringing the EpiPen, bringing safe snacks, etc. It is annoying to deal with people who think that you are overreacting. It makes me sad to hear my daughter It is also quite stressful to live with the intense fear that rises up whenever you see a red spot on your daughter's hand.

That being said, while it would be great for her to outgrow her allergy I would not change anything. She is an absolute treasure and the food allergy is part of who she is. I am certain that we appreciate every day with her even more after experiencing a near fatal allergic reaction to peanut six months ago.

Sunbutter On the Cheap

For those of you sitting at the edge of your seats wondering when I would find less expensive Sunbutter, the wait is over! I did a review of Sunbutter recently and noted that the only negative was its high price. Several readers commented that $8.49 for a jar of Sunbutter was ridiculous. Turns out they were right.

My wife talked to the grocery manager at Stong's our (excellent) local grocery store here in Vancouver. They now stock Sunbutter and price it at a reasonable $3.99. I guess that leaves me with a clean review of Sunbutter afterall!

Sunbutter is perfect for those with anaphylaxis due to peanut allergy in their homes. We do not let our daughter eat Sunbutter to avoid confusion but it has been an excellent peanut butter replacement for us.

Please Don't Pass The Mayo

Tonight we had an incident that reinforced our decision to remove all raw egg products from our home. We ate dinner on the deck tonight. My wife ran back into the kitchen but for an instant and in the time she was gone, our daughter grabbed her hamburger and took a big bite. In the past we always had mayo on our burgers. Given our daughter's egg allergy this would likely have been a bad situation.

But alas we are now using an eggless mayo so disaster was averted. There was no way I could have gotten to the burger before my daughter. Naturally my immediate thought was a mental image of the allergic reaction that might have ensued should the mayo have been of the egg variety.

Our decision to remove eggs from the home came after I ate an omelet. It was about a month ago. Up to that point we kept eggs but removed peanuts. The thinking was that we could be careful with eggs but despite all my precautions during the cooking process, I gave my daughter a kiss after eating the omelet and she had a large welt on her cheek. That was the final straw.

Ironically a week or so after we removed eggs from the house my parents were here. My Dad found four eggs in the back of the fridge and fried them up. My wife caught him just as he was bringing the eggs downstairs to my Mom, who incidentally was playing with our egg-allergic daughter. Understandably my Dad did not think about the allergy and it was only after my wife caught him at the top of the stairs with a plate of eggs that he remembered. I did not even realize we still had eggs in the back of the fridge.

Though (like me) you'll probably miss many of your favourite food items, I urge you to rid your home of any products that contain allergens harmful to your family members. Accidents happen and it is just not worth the risk.

Topic Of Conversation

I always find it interesting how many times our daughter's anapylaxis comes up in conversation. People are genuinely interested in it. Surely our forced preoccupation with her allergies is a major factor but when the topic comes up people do not shy away from the discussion. They are typically inquisitive and sympathetic at the same time and seem interested in discussing it at length.

I was reminded of people's interest tonight after reading an article which discussed the fact that food allergy seems to be growing exponentially. That point resonates with people whenever we discuss food allergy - they are not generally aware of this increase. The other thing they are struck by is how little research funding is out there. Though total research seems to be growing, at least anecdotally, the fact remains that food allergy research lacks funding versus other health issues. The Food Allergy Project sums it up well:

"Food allergy research is woefully underfunded. The National Institutes of Health (NIH) spends less than $10 million a year on food allergy research, compared to $107 million on attention deficit disorder and $1.2 billion on diabetes. These are all important diseases that deserve attention."

Whenever we discuss food allergy over dinner or in a group setting, people are troubled by the fact that while many healthcare professionals and scientists concur that there is likely a cure for food allergy, research into a solution is underfunded. Hopefully this will change as awareness builds.

Peanut Free Zone

The Padres have followed the lead of the 2006 Minnesota Twins, offering one home game with a peanut free section. Though this is a positive step, there is room for improvement. First of all, they are offering one game out of 80+. In addition, even with Padres attendance up 8% so far this year they draw only 33,000 per game versus the 42,500 seating capacity. There is an opportunity to have at least one peanut free section for every game.

The one difference here, as compared with the Twins, is that the allergic kids are at least sitting in a proper section of the ballpark instead of being quarantined in a skybox. To enhance safety, the Padres have assigned two additional ushers to the peanut free zone and have a paramedic in close proximity in the event of an allergic reaction.

Allergic fans should understand that there are no guarantees. There is always the risk of a remnant peanut from a prior game, but certainly this is much safer than sitting next to a guy who has a mound of shells at his feet and particles blowing all over those seated nearby.

Though the Padres are taking a step in the right direction, I am looking forward to the first stadium that steps up and ends the sale of unshelled peanuts. This would allow allergic kids to sit throughout the stadium. The Padres designated section 326 as the peanut free zone. From this seating chart you'll notice that section 326 is so deep in the recesses of the upper deck that you might as well be watching from home.

Note: Soon after I made this post I came across another article while visiting ABCPeanuts. It noted that the Edmonton Eskimos of the CFL played their entire 2006 home schedule peanut free. Kudos to this CFL team for being the first to step up!

Product Review: AllergyMama.com

Today marks the debut of NoPeanutsPlease Product Reviews. These reviews will focus on products that make life safer or more comfortable for those with severe allergies. The reviews will have four categories: Impact, Quality, Price, Style.

The first product I am reviewing came to my attention as a result of the interconnections created in May by Ria Sharon, our inaugural Villager of the Month. Ria highlighted other bloggers on her site during food allergy week. One of the featured sites was the Food Allergy Queen, who pointed me in the direction of AllergyMama.com. You could say it took a village ...

Product being reviewed
AllergyMama.com purses and totes

Impact
The first thing I look for is whether this product contributes to comfort or safety. We've often rifled through the recesses of a diaper bag trying to locate allergy medication that we know to be inside. The stylish and colourful AllergyMama.com totes and purses easily carry parental accessories. More importantly, the bags neatly hide allergy medication in a lined, zippered section on the bottom of the bag, thereby improving both safety and comfort.

Quality
The bags are made of a lighter cloth and to a high level of quality. Though I do have concerns about the durability of the cloth over time, and whether it will hold up in Vancouver's winter rain, there have been no issues to date.

Price
Priced at $65 for the purse and $82 for the tote, the bags are reasonably priced. In addition you have the option of ordering a custom bag at no extra charge.

Style
In addition to improving comfort and safety, these bags score points for style. Each bag is unique and the peppy colours, funky beads and catchy names (such as 'Harriet Takes New York') are just downright fun. A diaper bag has never looked this good!

Overall
The smart design of these purses and totes have been a hit with my wife. The zippered compartment is very convenient and the bags are quite stylish. Though the bags will likely not prove as durable as the traditional diaper bag, they truly are a great accessory for the hip urban Mommy.

NoPeanuts TV

YouTube (aka Google Video) has a cool blog widget that allows users to view videos. I have a video strip below that allows you to view videos that are pulled based on the following search terms: peanut allergy, food allergy, anaphylaxis. The risk is that some suspect videos show up but I think this will be an entertaining addition to the blog. Note that when you click on a video thumbnail the video plays at the top of the page.

Dare To Dream!

I cannot even imagine how relieved I would feel if our daughter grew out of her allergies. I just read an article about a four year old, peanut allergic girl who successfully completed a peanut challenge. She ate 39 peanuts! After living with a severe food allergy for three years I suspect that it would take an adjustment for her family to get back to 'normal'.

I am resigning myself to the reality that this is an unlikely scenario for us, (ie: <20% chance) , but it sure would be nice ... dare to dream.

Peanut Gala

Tonight I was at an awards dinner for the technology industry in BC. The first course was seafood spring rolls with peanuts sprinkled on the side. I passed my plate to a colleague. I was shocked that a shellfish and peanut dish was served to such a large group. Perhaps I have become so allergy aware that I am naive once more.

Don't Wait For The Big One

This week a 9 year old peanut allergic boy died in the UK after putting a piece of candy into his mouth. The boy had prior peanut reactions but none this severe. Sadly it often takes a severe reaction for parents to realize how dangerous the allergy is. This was the case for us and this particular story reminds me of how lucky we were.

Although our daughter had two minor reactions before her major reaction on Boxing Day, we were not educated enough to truly understand the risk. If your child has a history of even the smallest reactions to peanut you are advised to have an epinephrine auto-injector, such as an EpiPen, with your child at all times. At the first signs of an allergic reaction you should immediately call 9-1-1 and summon up the strength to use the EpiPen should that be necessary. If the reaction becomes more severe it is advised to use the EpiPen versus bringing it to the hospital with you.

Our (first) ambulance driver said it best, "don't mess with a peanut allergy".

Restaurant Review: Avenue Grill

NoPeanutsPlease Restaurant Reviews will assess a restaurant's level of allergy awareness based on three categories: Menu, Server Reaction, Attention To Detail. I will then provide an overall rating of Peanut (allergy risk) or NoPeanuts (allergy friendly). Where possible I will foward the URL of the post to the reviewee to give them the chance to reply.

For those with food allergies every restaurant poses a risk. The point of this series is to outline where restaurants can improve and highlight restaurateurs who are astute when it comes to serving food allergic patrons. Even if you do not live in Vancouver these reviews should be helpful in terms of showing you what we look for.

Reviewee
The Avenue Grill on 41st Avenue in Vancouver, BC.

Menu
The Avenue Grill has a fairly broad lunch menu but it stays true to its bistro-meets-diner ambiance by offering up a page of egg dishes and a variety of burgers and sandwiches that all seem to include mayo. For those with egg allergies this menu is an issue. Though you could order your sandwich without mayo, the large volume of eggs going through the kitchen heightens the risk of cross-contamination. We ended up choosing a fruit salad and cottage cheese for our daughter.

Server
In my opinion, when it comes to managing an allergy the most important person in the restaurant is the server. The cook plays a central role but the server is the one who walks a food allergic patron through the menu and makes the cook aware of the allergy. I prefer to see a server who is receptive, attentive and sincere while helping us select safe food items. In this case, when we told our server that our daughter had a severe peanut and egg allergy we were met with a blank stare. I suspect she was either indifferent or slightly overwhelmed. It is critical to watch for this first reaction as a parent.

Attention To Detail
We made it fairly easy for our server by ordering a fruit salad for our daughter. We did forget to ask for no mayo on my wife's sandwich and my burger. Though we should have caught this ourselves, it would have been impressive if she noticed that mayo would pose a risk to our egg allergic dining mate.

Peanut vs NoPeanuts?
Unfortunately my inaugural review presents a great example of why I decided to add this feature to the blog. The Avenue Grill would be a suitable place to eat for many but for the food allergic, (and especially those with egg allergy), it should probably be avoided. The lunch menu offers up only soup and salad as items that are egg free and though you could ask them to hold the mayo on sandwiches, with so many eggs going across the grill the risk of cross-contamination is high. In addition, our observations did nothing to convince us that the restaurant takes care to clean surfaces fully and avoid cross-contamination in the kitchen. Though our daughter did not come into direct contact with eggs, by the time we left she had well over two dozen hives on her arms and face. This was not a good experience.

Overall Rating: Peanut

General Comments:
Though this feature is focused on the allergy awareness of a restaurant, I figure that readers would also like to know what our overall impressions were. An institution for decades, the Avenue Grill was high on the list of neighbourhood restaurants that I wanted to try. Unfortunately the inattentive service and fairly bland meal did nothing to make me want to return. There are better options for lunch in Kerrisdale, egg allergy aside.

Peanuts! Getcher Peanuts Here!

If you have been to a baseball game or other major sporting event you are well aware of how prevalent unshelled peanuts are. Interestingly there have been several press releases recently advertising 'peanut restrictions' at sporting events. The most recent was for a peanut free home date for a Michigan soccer team. Another prominent example from baseball is the Minnesota Twins, who offer a peanut free skybox for four of their home games.

While a peanut free game is encouraging, I find the Twins offering to be patronizing, more than helpful. Though the Twins' press coverage generates allergy awareness, offering up one section for 5% of your games when you are averaging 28,000 fans in a 48,000 seat field is a pittance. I challenge the Twins and other major league teams to do more. It is great that they recognize this to be an issue. Though it would require some planning and oversight, it would be ideal if every stadium had a reasonable percentage of its seats designated as peanut free, or at least as peanut-shell free.

The last five times I have gone to an NHL game, in three different arena, a person within 5 seats of me has been eating a bag of unshelled peanuts. The fun of eating nuts this way is that it is publicly acceptable to make a huge mess. The downside is that I have to brush the peanut debris from my clothing before I head home to give my daughter a goodnight kiss. I am not looking to ban peanuts, but I would certainly prefer that only shelled peanuts were sold.

I understand that sporting events and peanuts go hand in hand. I used to eat a bag of unshelled peanuts myself at every NHL or NFL game I attended, complete with the aforementioned pile of shells at my feet. Now that I am aware of the danger that this might pose for those with allergies I could not imagine doing this again. Though there is a debate as to how dangerous this really is, a quick Internet turns up multiple cases of severe allergic reactions.

The Twins are helping on the awareness front but I challenge them to take a leadership role in making the game even safer for their younger peanut-allergic allergic fans. As we develop additional insight into severe food allergy, I hope that one day unshelled peanuts will become an artifact of sporting legend.

Peanuts, Peanuts Everywhere

Those managing peanut allergies received concerning news in late May. It seems that 'Peanuts Are Hot'. The number of top 200 restaurants serving menu items containing peanuts increased 84% since 2000, and the number of menu items with peanuts increased 142%. In grocery stores peanut butter is growing at a rate of 7.6% and peanut snacks at a rate of 56%. Consumer favour for peanuts is very high with 80% of consumers saying that peanut butter tastes great and 75% citing it as a good source of protein.

With several cities now banning trans fat from restaurants, peanut products will likely become even more prevalent. One item of particular concern is the positioning of refined peanut oil as allergen free. As noted in a prior post on NoPeanutsPlease, "there have been contradictory reports on the allergenicity of highly refined peanut oil" and those with peanut allergy should perhaps err on the side of caution and avoid peanut oil until the research is clear.

Headline News

Here are the peanut news headlines on NoPeanutsPlease.com today. It seems that everywhere I turn, whether online or in the Saturday Vancouver Sun I am reading about the Australian study on peanut allergy testing.

I understand that this is really big news and will lead to significant relief for many parents. But in addition to the concerns I noted earlier this week, I am worried that the non-allergic public will use these findings as the basis for claims that parents are overreacting and their child is probably not even allergic.

My research shows that this is not a particularly new finding and that instead we have a case of the media taking a story and running with it. I understand that this happens in reverse as well when a child dies from anaphylaxis but I continue to have concerns about how this story has been broadcast.

Sunbutter

After several readers suggested Sunbutter as a peanut butter replacement, I was finally successful in locating a jar. Incidentally we found it at a health food store just a few blocks away. Well, it was worth the wait. My last product review was for Peabutter and as you may recall, I was not a big fan. I was happy to finally get a chance to review Sunbutter.

In reviewing food products I review taste, texture, price, ingredients. It is a little unfair to review peanut butter replacements as I am not reviewing them in isolation. They are being put up against by beloved peanut butter, with which I had to part ways several months ago.

Taste: Sunbutter serves up a strong aroma of roasted nuts as soon as you open the jar. It tastes like a sweeter version of peanut butter. The biggest difference between this and Peabutter is that the taste also finishes nicely. I found Peabutter to have left a bit of a strong pea aftertaste (yes, I know that it is made from peas!) Sunbutter has a rich, nutty taste that lingers on the palate beautifully. I do think it is a touch sweet for my taste, but it is something I could eat daily.

Texture: The texture was more similar to a richer peanut butter and it is creamy enough for those who prefer highly processed peanut butters.

Price: Sunbutter is expensive. In fact price is the only real drawback I could find. We paid CDN $8.49 for a jar which is quite high. In fairness, grocery items can be very pricey at our local health foods store. We'll price it elsewhere as well. (Update: We have found a cheaper supply!)

Ingredients: The ingredients are acceptable. Like most peanut butters there is added sweetness, via cane juice in this case. That being said, the sugar only total 3 grams per 32 gram serving . In addition, Sunbutter is higher in protein, appears to be lower in sugar and higher in dietary fibre as compared to Peabutter. Iron deficiency can be an issue for many kids due to picky eating and Sunbutter helps there as well, providing 8% of the daily value for iron.

Overall: Overall Sunbutter passes the test for those who have to remove peanut butter from their home due to a peanut allergy. I would recommend this as a peanut butter replacement for any taste and I will certainly buy it in the future myself. Now I just need to find a less expensive place to buy it!