Note to the reader: The following eight articles by Anne Munoz-Furlong, whichappeared in variousprevious issues ofPédiatrie Asthma, Allergy & Immunology, arebeing reprinted as resource materialforpatients, parents, andphysicians.

Helping Patients Manage Food Allergies

ANNE MUNOZ-FURLONG

INTRODUCTION

The topic of food allergy has long been shrouded inmyths and misinformation. Frequently, patients leavetheir doctor's office too embarrassed to tell the doctor they don't know how to comply with the prescribedelimination diet. Many aren't sure what it means to "avoid all milk and milk products." As a result, it is notuncommon for parents to eliminate milk from their child's diet, but give the child yogurt because they do notrealize that yogurt is a milk product !When you make the diagnosis of food allergy and prescribe the elimination of any foods, do not assume that

patients or their parents are knowledgeable about food ingredients or substitution ideas. It has been myexperience that they are not, and most often they welcome basic information.

WHAT'S IN A FOOD?

Providing patients with lists of food products to avoid or to purchase is not recommended for a number ofreasons: manufacturers often change ingredients without warning; some products are available regionallythroughout the United States; and old lists may be in circulation and patients are unaware of changes to theselists and may rely on outdated material, which can result in an allergic reaction for the unsuspecting patient.Instead, teach patients the scientific and technical names of foods as they are likely to appear on ingredient

statements and encourage them to read labels every time they shop. As a general rule, patients should be toldthat if they cannot be absolutely sure of the ingredients in a product, or if the product does not contain aningredient list, it is best to avoid that food.

READING KOSHER SYMBOLS

According to Jewish custom, milk and meat products must not be mixed. Many products found in localgrocery stores contain kosher symbols indicating the presence or lack of milk and meat. These koshersymbols, found on many food products, can be useful for people with milk allergy.A rating of "pareve" or "parve" on the front of the label near the product name indicates that the product has

been certified "safe" by a kosher agency/" This information can be used as a shortcut in finding milk-freeproducts. However, this system is not fool-proof; consumers should be advised to read the ingredient panel toconfirm that the product is indeed milk-free.<2)

Founder, The Food Allergy Network, Fairfax, Virginia.

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MUNOZ-FURLONG

A "D" beside a "U" in a circle or next to a "K" indicates the presence of dairy in the product. Occasionally,the ingredient statement does not indicate the presence ofmilk, and the product label contains a "D." This mayoccur when the amount ofmilk is so small it is not listed on the ingredient statement, or when milk is presentin the flavoring.1"

NATURAL VERSUS ARTIFICIAL FLAVORINGS

Many people believe artificial flavorings are to be avoided and that natural flavorings are preferable. Inreality, the reverse is true for people with food allergies. Natural flavorings can contain a large number ofingredients includingmilk, soy, wheat, and eggs, the foods that are the most common causes of food allergies.It is recommended that people with food allergies avoid products that contain natural flavorings unless they arecertain what ingredients are included.If patients want to use products with natural flavorings, advise them to call food manufacturers and inquire

about the ingredients. They should be specific when calling food companies; encourage them to ask if thenatural flavoring contains the allergen, rather than asking, "What is in the natural flavorings?" Flavoringingredients are considered proprietary and many companies purchase them from flavor houses and do notknow all the ingredients within these flavorings. However, they can usually determine if a specific ingredientis present.

CONCLUSION

There is no cure for food allergy. The only way to avoid the symptoms of an allergic reaction is to strictlyavoid eating the allergenic food. Just one little bite can hurt! Patients have reacted to as little as a fraction ofa teaspoon of the food. Severely allergic patients sometimes begin to experience oral allergic symptomsimmediately after taking a bite of the allergenic food/31 Avoidance, however, requires a whole new way ofapproaching food shopping and cooking. Doctors can play an important part in ensuring that patients withfood allergies adjust well to the restricted diet and learn what it means when you say "Avoid all milk and milkproducts."The Food Allergy Network (FAN) is a nonprofit organization based in Fairfax, Virginia. FAN publishes a

number of resources for patients with food allergies including a bimonthly newsletter, FoodAllergy News, avideo, and cookbook. Its mission is to increase public awareness about food allergy and anaphylaxis and toprovide education and emotional support to patients with food allergies.Formore information about FAN, or to receive a sample copy ofFoodAllergy News and free brochures for

your patients, write to: The Food Allergy Network RS, 4744 Holly Avenue, Fairfax, VA 22030-5647, or call1-800-929-4040.

REFERENCES

1. Regenstein JM, Regenstein CE. A shopping guide for the Kosher consumer. New York: New York State ConsumerProtection Board.

2. Jones RT, Squillace DL, Yunginger JW. Anaphylaxis in a milk-allergic child after ingestion of milk-contaminatedkosher-pareve-labeled "dairy-free" dessert. Ann Allergy 1992;68:223-227.

3. Sampson HA. Food allergy in young children. Food Allergy News 1991;1:1, 5.

Address reprint requests to:Anne Muñoz-Furlong

The Food Allergy Network4744 Holly AvenueFairfax, VA 22030

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