About me

Lindsay is a Paediatric Dietitian based in Johannesburg. She returned to South Africa in 2014, after spending 13 years in the National Health Service in the UK working in the field of paediatrics and allergy. Lindsay has a special interest in food allergies and is the current Chair of the Allergy Society of South Africa (ALLSA) Allergy Dietetic Interest Group. She currently works at the Wits University Donald Gordon Medical Centre in Johannesburg as well practising at Centapaeds Therapy Centre in Edenvale and is a regular contributor to Your Baby magazine. Lindsay has a young son with food allergies and knows how difficult it can be to ensure an exclusion diet is healthy and nutritious. She has a passion for encouraging children to be adventurous with new foods and for establishing healthy eating habits early on in childhood.

I’m dreaming of an allergen free Christmas

The festive season can be a challenging time for parents of children with food allergies. Typically we love to indulge and most celebrations involve dining away from home, plenty of seasonal foods and an abundance of parties – all of which increase the chances your child may accidentally eat – or be tempted by – foods they are allergic to.  Christmas can also be difficult with family members and friends suggesting that your child should be able to have a “treat” in the form of a high-risk allergy food.

Managing food allergies

Before you can manage allergies to food, you must know what foods your child is sensitive to.  That may be milk, eggs, peanuts, tree nuts (such as walnuts, cashews, almonds etc.), fish, shellfish, soy, or wheat — eight foods that account for 90% of all food allergy reactions.  If you’re not really sure what’s triggering allergies, it’s probably time to see an allergist, a physician specially trained to diagnose and treat allergies.  Not only can an allergist help you discover what’s causing your child’s symptoms, they’ll also help you manage and even prevent them.

The main treatment for food allergies is to avoid what you’re allergic to.  In order to make avoiding the food easier, it is essential to communicate your child’s allergies to friends and family.  At seasonal gatherings, tell them about your child’s food allergies, ask about ingredients in meals and desserts, and solicit their help in avoiding foods your child is allergic to.

 

The following tips should hopefully help to make this festive season allergy and stress free:

  • Contact the host in advance, and gently remind them of your child’s dietary needs or offer to prepare food for your child.
  • If people ask what they can bring or make for your child, try and be specific. Specify brand names and where these products can be purchased.
  • Ask friends or relatives to save the labels of food ingredients, then you can check the ingredient list and determine if food is safe for your child.
  • Make a list of the food that your child is not able to eat OR alternatively, make a list of your child’s top 10 favourite foods that they can happily eat.
  • If relatives are staying at your home, label and name food for your child. Also have a labelled gluten free toaster so that nobody puts normal (gluten containing) bread into this toaster and labelled margarine so that it doesn’t get contaminated with a knife with gluten bread crumbs or butter/peanut butter.
  • Label food that is being brought into your home by relatives/friends as ‘safe’ or ‘non safe’ for your child.
  • Get to know your favourite restaurant and che Speak to the waiter/waitress/chef on arrival to inform them of your child’s food allergy.
  • Ask friends and relatives to check with you (Mum or Dad) before giving your child anything to eat or drink – even if they THINK the food/drink is safe for the child, have them ask first.
  • Be aware of the increased risk of cross contamination at buffets.
  • Teach your child to simply say ‘no thank you’ and to only accept food/drink from Mum or Dad.
  • If possible confine food to the kitchen/patio/dining room and ask that food isn’t allowed into the lounge room or where the children will be playing. That way, you will be able to better monitor food intake.
  • Buy a colourful “party” plate or lunch box and teach your child to only eat out of that container. Put a selection of “safe” foods on the plate for your child. That way they will know their plate and not get mixed up with other’s plates when others have the same.
  • Always have spare food on hand (nothing fancy- but just in case). People may have the best of intentions to provide for your child, but sometimes they overlook the sauce (like mayonnaise) or don’t realise other names for common allergens (i.e. albumen means it contains egg).
  • ALWAYS remember your child’s allergy medication – antihistamines and/or adrenaline auto injector e.g. Epipen. Have a written action plan for your child.
  • Bring a big pack of baby wipes where ever you go. If there is allergenic food, ask people to wash (or wipe) their hands and mouths before contact with your child. It won’t get rid of all traces, but should reduce the risk.
  • Remind friends and relatives that it is important that they wash their hands before touching your child in case they have touched a food allergen, this is particularly important for children with peanut or seafood allergy as just having traces of this food on skin can cause a serious reaction.
  • Be cautious of relatives and friends giving your child kisses!Ask relatives to kiss your child on the top of his/her head or give them a hug instead, just in case they have eaten anything that could be a food allergen to your child.

Have a merry allergen free Christmas!

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10 things to consider when eating out with allergies

Eating out can be a stressful experience if you or your child has food allergies, especially for those with the severest form i.e. anaphylaxis.   Restaurant staff may be well-meaning but ill-informed or worse could regard you as “fussy” rather than allergic and not take your request seriously.  For those with food allergies, particularly severe food allergies, here are a few steps to consider whenever eating out:

  1. Always ring or email in advance to check with the manager and/or chef that there are allergen aware, and in some cases pre-order your meal. Calling up also serves to see if they sound as if they know what they’re doing. If you don’t get a good feeling, find somewhere else!  Discuss the need for food to be prepared free from cross-contamination, and find out what dishes are likely to be safe for your child to eat.  You may then follow up via email and summarise the allergies and what you’ve mutually agreed upon before booking.  Doing this not only gives the restaurant advance warning but also serves to raise awareness amongst restaurant staff.
  2. Investigate every ingredient– flour, oil, gravy stock and sauces – to ensure none is a ‘may contain’ product and you won’t unwittingly be fed trace amounts or hidden sources.
  3. Upon arrival always reiterate your child’s allergies and the need for preparing the meal without cross contamination. Make sure your waiter is fully briefed, and have another conversation with the manager and chef too.
  4. Safe places: If you find a safe chain, don’t automatically assume every branch is equally allergy aware. You’ll have to go through the same procedure in every branch, as standards can vary enormously.  Remember: there may be staff turnover, recipes change – therefore remind them of your needs every time you visit.
  5. Go during off-peak times– aim for the quieter periods where possible: the start of a lunch or evening service is a good slot.  The kitchen will be more able to attend to your requirements if they aren’t rushed off their feet.
  6. Anticipate a longer wait as allergy friendly food will often have to be prepared from scratch.
  7. Communicate what you / your child can have, not just what you can’t. Make it easier for chef to be able to provide something suitable from their kitchen by giving them ideas on suitable options, it’s not their job to guess what we need.
  8. Decide on your own parameters. For me, the existence of nuts on a restaurant menu does not necessarily signify an automatic no-no, however we do tend to avoid restaurants where the use of nuts as an ingredient is prolific or the risk of cross-contamination is too great, such as Asian cuisine or self-service buffets.
  9. Rescue medication: make sure you carry any rescue medication with you, such as adrenaline auto-injectors (e.g. Epipens) and antihistamines. Despite your best efforts an accidental exposure may still occur.
  10. If you’ve got any doubts or don’t have full clarity on the menu items don’t order it.

 

A LEAP of faith for food allergy prevention

With the incidence of food allergies and in particular, peanut allergy being on the increase; researchers, allergists and paediatricians have been searching for answers on ways to curb this epidemic.  In the past we have been cautious and have advised on the avoidance of peanuts, particularly amongst high risk groups (i.e those with severe eczema, egg allergy or a first degree relative with allergies).  A recent study published in The New England Journal of Medicine in February of this year has potentially flipped this thinking on its head!

 

The highly anticipated Learning Early about Peanut (LEAP) study suggests that early introduction of peanuts may offer protection against the development of peanut allergies. The study was led by Professor Gideon Lack and our very own home-grown Dr George du Toit, at King’s College, London.  Professor Lack and the LEAP study team enrolled 640 infants between the ages of 4 – 11 months of age.  These infants were considered to be at risk of developing peanut allergies because of the presence of severe eczema, egg allergy, or both.  These infants were divided into groups based on whether they showed sensitivity to peanut extract or not (as determined by either positive or negative skin prick tests respectively). The infants in each group were then randomly assigned to either consume 6g of peanut protein per week – in the form of peanut butter or a peanut based snack called Bamba – or to avoid peanuts until 60 months (5 years) of age.

Remarkably, the overall prevalence of peanut allergy in the peanut-avoidance group was 17.2% compared to only 3.2% in the consumption group.  The prevalence of peanut allergies in children with negative skin prick tests early in life was at 13.7% in the avoidance group and 1.9% in the consumption group. Similarly, children already sensitive to peanuts reflected a 35.3% prevalence of peanut allergy in the avoidance group, compared to only 10.6% in the consumption group.

 

In summary, the LEAP study has demonstrated that the early introduction of peanut protein dramatically decreases the risk of developing a peanut allergy by a staggering 70-80%.  This intervention was shown to be effective in not only in high-risk infants who show no sensitivity to peanuts early on, but also effective in infants who already demonstrate peanut sensitivity.

 

The results showed that the window of opportunity to prevent peanut allergy is narrow, suggesting that as soon as infants develop the first signs of eczema or egg allergy in the first months of life, they should receive skin testing to peanut and then eat peanut products either at home if the test is negative or first under clinical supervision if the test if positive.  The study also suggests that infants without signs of eczema should be fed peanut products from four months of life, bearing in mind that infants should not be fed whole peanuts because of the risk of choking.
Whilst the study is called LEAP, it is really only the first step for re-writing the food allergy guidelines.  Other questions remain, such as what is the minimum amount of peanut protein required to reduce allergy risk and will this protective effect wear off in time?  The study authors are continuing to follow up their participants in a study called LEAP-on and hopefully in the not too distant future we will have guidelines to help reverse the increasing prevalence of peanut allergy.

 

Please note!  If you are already dealing with children with food allergies, this study does not apply to your situation.  The LEAP study was aimed at prevention and has nothing to do with reversing an already established food allergy. 

Fussy little critters

We’ve all been there! You’ve spent hours perfecting Annabel Karmel’s finest recipe only to have it thrown on the floor in the most animated display of toddler disgust.  Many children go through stages of being fussy with foods.  Fussy eating however isn’t always about a like or dislike of certain foods, but more often about children wanting to be independent.  They learn from an early age that “food battles” are an easy way to gain some control over mommy or daddy.

It’s natural for parents to worry about whether their child is getting enough food, however it’s best not to worry about what your child eats in a day, it’s more important to think about what they eat over a week.  As long as your child is well, active and gaining weight, then they’re likely to be getting enough to eat, even if it may not seem like it to you.

Aim to give your child some food from the 5 food groups, starting with the regular favourites, and gradually introducing other foods from each group

  • Milk and dairy products
  • Starchy foods
  • Fruit and vegetables
  • Protein
  • Fats and oils

 

Some handy tips:

  • Children learn by copying you, their siblings, their grandparents and friends. Try to eat with them as often as possible so that you can set a good example.
  • Offer the same foods as the rest of the family – don’t prepare separate meals.
  • Try new foods to taste alongside familiar foods. Encourage them to take a bite or even a lick of the new food and offer praise.
  • Give small portions and praise your child for eating, even if they only manage a little. Large portions can be overwhelming.
  • If your child rejects a food, don’t force them to eat it. Take away the food without comment. Don’t keep offering alternatives. Try to stay calm even if it’s very frustrating.
  • Don’t leave meals until your child is too tired to eat.
  • Set time limits for meals (20-30 minutes) and explain that once mealtime is over there’ll be no other food available. When the mealtime is over, take the plate away then remind your child that there won’t be any more food until the next meal or snack time.
  • Don’t give too many snacks between meals. Limit them to a milk drink and some fruit slices or a small cracker with a slice of cheese, for example.
  • It’s best not to use food as a reward. Your child may start to think of sweets as nice and vegetables as nasty.
  • Make mealtimes enjoyable and not just about eating. Sit down and chat about other things. Remove distractions such as TV or toys.
  • Children’s tastes change. One day they’ll hate something, but a month later they may love it. Don’t assume they will dislike a food and regularly offer foods previously rejected.
  • Be positive about new foods! Tell them that they will like it, don’t say “you’ll never eat this” or “you won’t like……”
  • As anxious as you may feel about their fussiness, don’t let them become aware of these feelings. Don’t shout, nag or fuss a child to eat as this may encourage fussy eating habits (children love a response!!).
  • Encourage their need for independence by encouraging self-feeding, encouraging them to help shop for and prepare foods.
  • Allow them to have a choice (within reason) as giving in to a few preferences will help them feel more in control and may reduce the overall battle.
  • Try disguise healthier foods in sauces or desserts, e.g. pureed vegetables into pasta sauce or pureed fruit into yogurts or ice-cream
  • Consider giving a multivitamin & mineral supplement during fussier phases.

Vegan chocolate cake for egg & milk allergies.

Ingredients:

 

30g dairy free margarine

60g castor sugar

2 tbsp golden syrup

30g cocoa

180g self raising flour

180ml soya milk

½ tsp bicarbonate of soda

 

  • Preheat oven to 180 °C / Gas Mark 4
  • Cream margarine, sugar and syrup
  • Sift flour and cocoa
  • Dissolve bicarbonate of soda into milk
  • Stir in flour and milk mixtures alternatively, a little at a time, stirring lightly until mixture resembles thick batter
  • Pour into an eight inch greased and lined cake tin and bake for approximate 40 minutes
  • Ice with chocolate icing made with dairy free margarine.

Double the recipe and pour into 2 tins to sandwich together to make a larger cake.