A wholesome approach to allergies

Being a parent is a tough job. Add a child’s food restrictions and life becomes a lot more complex. Food allergies are common challenges facing parents and schools, with studies reporting that one in ten Australian children are allergic to one or more foods.1Unfortunately, the rate of allergy prevalence appears to be increasing, with figures suggesting a 100% increase in peanut allergy over the past 15 years and hospital admissions for anaphylaxis have doubled over the last decade.

Food allergy versus food intolerance: what’s the difference?

It’s important to understand the difference between a food allergy versus an intolerance as one can be life threatening (allergy) whereas the other can cause severe discomfort but is not potentially fatal (food intolerance).

A food allergy is an adverse reaction to a generally harmless substance within a food (usually a protein) that is triggered by the body’s immune system. Food intolerance is a general term describing any reaction to a food that does not involve the immune system. At present, food intolerance can only be properly diagnosed by excluding a suspected food for a few weeks to see if the problem resolves. The food is then reintroduced and intolerance is suggested if the problem returns. If you think your child might have a food allergy or intolerance, don’t self-diagnose and restrict your child’s diet. It’s important to get advice from a qualified health professional who can help you navigate the challenges in an appropriate way that ensures your child is still receiving all the nutrition they need for healthy growth and development.

The most common foods that cause allergic reactions in Australian children are cow's milk, egg, peanut, tree nuts including cashew, pistachio, walnut, seafood (crustaceans and fish), wheat and soy. Although many children will outgrow their allergies to egg, milk, soy and wheat, in general allergies to nuts and seafood tend to persist into adult life.

A wholesome allergy-friendly diet

Unfortunately, many children with food allergies eat repetitive or less nutritious meals due to lack of knowledge on how to create nutritious substitutes. All children need the right types and amounts of nutrients to thrive, whether they have allergies or not. And with the right know-how, your child can enjoy delicious and healthy allergy-friendly food at home, school and everywhere else.

1. Switch this for that

   Cooking for children with food allergies presents challenges. Alternative ingredients may be unfamiliar and may not work in the same way as the usual ones. The table below shows substitutes for common allergens to help you create your own allergy-friendly recipes. Often it's a matter of trial and error to work out which ingredients and in which quantities work best in recipes and meals. Here are some ideas to try.

If you can't use...	Try...
Cow's	Soy, rice or oat milk (make sure it is fortified with calcium to provide at least 120mg calcium per 100mL)
Butter	Dairy-free margarine for baking Healthier spreads on school sandwiches such as avocado, vegetable dips or hummus
Cheese	Soy cheese Tofu
Egg	Commercial egg replacer: For general cooking 1 egg = 1 teaspoon egg replacer plus 2 Tablespoons water For baking 1 egg = 1 teaspoon egg replacer plus 1 Tablespoon liquid (e.g. water, milk) For binding ingredients 1 egg = ¼ cup mashed potato or pumpkin
Wheat*	Commercial gluten free flour Rice, buckwheat, chickpea or quinoa flour Arrowroot
Nuts	Desiccated coconut Puffed rice Corn flakes Oats Dried fruit

*No one flour used to replace wheat tastes the same as, nor does it behave in the same way as, wheat flour. That’s why in commercial flour alternatives, several different grains are mixed together. You could try make your own mix and experiment with different proportions of ingredients. It can be handy to have a big batch of flour mix ready to use.

1. Become label savvy

   In Australia, food manufacturers are required by law to state on the label if the food contains the top ten allergens (cow’s milk, egg, peanuts, all types of tree nuts, soy, wheat, lupin, sesame, fish and crustaceans). Other ingredients that must be listed include gluten-containing cereals (e.g. wheat, barley, oats, rye, spelt)as these need to be avoided by children with coeliac disease, sulphites in concentrations of 10mg/kg or more which can trigger asthma in sensitive people and royal jelly – a bee product to which some people are highly allergic.

   There are many products with “may contain” statements , which means the food may have been exposed to the allergen anywhere from the field in which it grew to the machinery in the factory in which it was made. It is difficult to know whether or not there is actually any risk and if your child is very sensitive to an allergen it’s best to discuss with their doctor whether “may contain” foods with the relevant allergen should be avoided.

   Many school canteens display allergen information on menus, and they are legally required to have allergen information available upon request, including a breakdown of all ingredients used in menu items made on site, as well as packaged ingredients. If you or your child are unsure about any item available at the school canteen, just ask!
   

2. To school and beyond

   Schools will have policies about managing food allergies. It’s a good idea to regularly discuss your child’s food allergy in every day conversations and make sure your child is informed about the school allergy policy, and how they can manage any potential situation where they may be exposed to a food allergen. Discuss what they would do in these situations and perhaps role play the actions and outcomes. Talk about school camps and excursions too.

   Most school’s will state that they are “nut aware” rather than “nut free” as it is unrealistic to expect a school to completely ban an allergen, because this cannot be policed and may promote a false sense of security. If your child is aware that there is always a possibility of an allergen being present at school, this will help them to be vigilant and stay safe.

   Parties, play dates and family events can also be well managed if you plan ahead. Teaching your child from a young age to ask what is in the food can encourage them to be brave and honest about their allergy. If your child is attending a party, there are some simple strategies you can use to make it simpler for both the party host and your child:

   • Call the host and offer to bring something) that all the children can share. Or you could take it one step further and prepare allergy-friendly versions of the foods the host is serving so your child feels they are eating the same foods as the other kids.

   • Put a small flag or toothpick on the foods your child can eat and tell them to look for this as these foods are ok for them to eat.

   • Bring some cup cakes with decorative icing that your child sees as special and place next to the birthday cake.

   
   Allergy management for many Australian families is a necessity of life, but with the right strategies in place, a bit of planning and experimentation, as well as a positive attitude, you can change the focus from what your child can’t eat, to highlighting the vast array of delicious, nutritious and allergy-friendly food they can eat!

References:

1. NJ Osbourne et al. Journal of Allergy and Clinical Immunology, Vol. 127, 2011.

This article has been written by the team of Accredited Practising Dietitians at www.foodbytes.com.au