Wednesday, 5 August 2015

FAQ's: Is this an allergic reaction?

'Is this a reaction?'

It's one of the most frequently asked questions on online food allergy forums. 

Am I the only one who squirms slightly, when these pop up?

I completely understand why people ask these questions. As a mother myself of a child with a Non-Ige mediated food allergy I've been in that place where something-is-happening-and-you-don't-know-what any number of times!! The worry you go through, the need for answers, can become all consuming - even when the reaction is not in the least life-threatening. Something is happening to your child which is unpleasant and you immediately feel the need to understand/stop/control/prevent it from happening again! 

It doesn't help that these potential reactions often take place at inconvenient times - you know; in the evenings, in the middle of the night or at weekends, when getting hold of anyone can be quite tricky - especially someone with the expertise to help you! 

You need reassurance, understanding or maybe just a shoulder to cry on. You may have had a poor night's sleep or are having trouble keeping up with the washing or any one of a number of other things could also be pressing on your mind/attention. One other sudden, unexpected urgent thing on top of it all just seems too much to deal with. That's when people often turn to allergy forums/websites.

A lot of the contributors on these sites/forums are very experienced mums who have dealt with food allergy over some time. Some of them are also medical professionals (bonus!). You can learn a lot from them about suitable products, recipes etc. and forums can be a great place to safely rant/let off steam!! BUT one needs to be careful! Not all contributors are as experienced as others or medically qualified, so I get quite anxious when I see people ask the 'reaction question'. A photo might be offered  of a child's rash (some clearer than others), or a picture might follow of a poo-filled nappy. 

Pictures of rashes aren't always that clear! They're quite hard to photograph!

The problem I have with this is not that someone's shared the picture (although I often wish that some people would be a little more discreet about how they go about it - try to display children's private parts - you don't want to encourage the wrong kind of attention), but that it's really quite difficult to tell what could be the problem just from a picture of a rash or a nappy, or because a child has been sick or had a bout of diarrhea. This is because the symptoms to an allergic reactions can be so similar to a whole range of other illnesses - some as simple as a virus, which just needs to run its course, or a tummy bug, which still isn't great, but still just needs to run its course. 

I get concerned because despite the fact that most of these sites carry disclaimers, people seem far too ready to listen to advice from someone they've never met and I've often seen good advice disregarded over advice which I would consider not so helpful (please note, I'm not saying don't do this, just be careful). Yes, I know you don't always get the help you need even from your local Doctor - we got through two local GP's, who didn't spot the symptoms, before getting our diagnosis when we went private - but online forums are just not the ideal place to arrive at a diagnosis! Doctors will need to go through various assessments before they reach a verdict - they'll need a bit more info than a few pics! 

If you're new to all this and want to know where to start, you may find the 'Is it cow's milk allergy?' website helpful. It can give you some guidance as to what symptoms to look for and how you can go about getting a diagnosis. Their assessment sheet, is particularly helpful - it could be a very useful piece of evidence to take along with you, when you visit your GP.

If you're not new to all this and are just not sure if your child has reacted to something they ate today or even yesterday, the truth is this: if it's a delayed reaction the answer may not come immediately - it could take some time (days, weeks or maybe even months) to really work out where the problem really lies. 


So how can we tell, or get some idea as to what's going on?

Well first things first, if you suspect your child has had an allergic reaction that is potentially life threatening, you should use an epipen (if you have been prescribed one) and then call an ambulance. If you don't have an epipen, call the ambulance straight away! See here for more details about what to look for (and what to do) from NHS Choices.

If, like us (with 'Baby's' Non-Ige mediated milk allergy), your symptoms do not require immediate medical attention, then having cleaned up the initial mess and/or administered any necessary medication, then as much as we might like it to be sorted NOW, I'm afraid it's not that easy. I've found you usually have to kind of sit it out, wait for things to settle down, or for something else to happen. Often, else happening or even not happening can help you work out what's going on. 

So, for example, one time when we gave 'Baby' a scheduled food challenge at home, it took a while for symptoms to develop. She had a bit more wind than usual and her stools gradually changed colour and became looser, and she got the odd tummy ache, which then faded away. To begin with, I wasn't sure if it was the malted milk biscuit we had given her that had caused the problem or not, so let the challenge continue, to see if things would calm down. However, as the reactions became more intense and her botty began to get sore, I knew that I needed to stop. Although she was clearly tolerating milk better than she had previously, it became obvious to me that her body was not able to progress any further, it would just get worse. In all, this process took a couple of days.

I've found the best thing, if you suspect some specific item of food caused the problem (more obvious, I know, when undergoing a planned food challenge), is to remove it from your child's diet (unless it's gluten - see why here). Whether your kiddo is under the weather or experiencing a reaction, it's just not the right time to experiment with anything new. You need to stick to foods you KNOW are safe and wait for their body to settle down and recover. There's no point making them sicker, by giving them more of the same!

Then a few weeks later, keeping everything else 'safe' try again. If the same reaction occurs, then you may well have found the 'culprit'. At this stage, contact whichever healthcare professional (GP/Health Visitor/Allergy Nurse/Dietitian etc.) is overseeing your progress and discuss it with them (I have heard from some people who feel that they have been discharged from local services before their allergy has resolved or before they feel ready. If this has happened to you, and you still have concerns, you it would be best to go back to the GP, or find a new one.). If however, your little one appears to be fine with that food item, when it's presented to them (over three or four days) or, if it's not a scheduled 'milk challenge' and you've no idea why it's all happened, then maybe it's time to consider the following:


1) Are there any bugs going 'round?

Sometimes, when I have thought that 'Baby' has perhaps had a reaction to something, it has turned out to be a virus or tummy bug. The symptoms may be similar. Once when she had a sore throat and a tummy ache I was rather confused - her allergic reactions had never included a sore throat! I hadn't realised that there were glands in the abdomen.  

It's extremely easy for little ones to pick up tummy bugs. They crawl around on the floor and stick all kinds of things in their mouths. Unfortunately its par for the course with little ones. Its bound to happen sooner or later!! Then, unfortunately, it's a case of 'What can't be cured, must be endured!' 

Current advice in this instance is keep your child at home (this is important for up to 48 hours following the last issue of vomit/diarrhea to prevent spreading it around), keep them hydrated and feed them if they're hungry - keep it fairly bland though! See NHS Choices for more information.

Something else to consider, even if there are any bugs going around is the following...


2) Do the symptoms match the pattern of previous reactions?

The difference, with 'Baby,' is that if it's an allergic reaction her observable symptoms have usually taken place within the twenty four hours following an exposure to milk. Anything that continues beyond this (in our case, but not in all cases), is a bug, as far as we are concerned! So use your knowledge of how your little one tends to react.

For 'Baby' her reactions in the early days were intense tummy cramps, wind and diarrhea, within an hour or two of ingesting something which contained milk (and a very sore botty, from the diarrhea, when she was in nappies). But of course reactions can change, so this isn't a completely reliable measure! 

This caught me off guard recently, as I hadn't realised that 'Baby's' tummy was coping with milk more easily than it has done previously. So the intense tummy cramps were evident, but occurred much later - maybe five or even six hours later. Also the tummy cramps weren't followed by diarrhea. Her stools were still that distinct yellowy colour that always followed previous reactions, but instead, she appeared to tend towards constipation. 

Something to remember is that reactions can also become more intense - if the individual is unwell, or stressed or following exercise or has drunk alcohol (adults only, of course) or is affected by hormones (ladies, if it's you, consider your time of the month/pregnancy etc.). Also reactions can be different if it's an allergic response to another type of food.


3) Have you been out and about?

We manage things so well at home now, that most slip-ups occur when we've been out and about. It may follow a meal out at a restaurant or a cafe - in which case you can soon work out where things went wrong! However, whenever you're out and about you can come into contact with milk or its traces all too easily. 

Once (I am pretty sure - we'd not been anywhere else that day) 'Baby's' reaction stemmed from contact with traces of milk from a supermarket trolley (you see lots of kiddies eating all kinds of stuff whilst they're perched in the seats of these, I saw one spilling Actimel all over himself in one just today)! Hence I always take my wipes everywhere I go now - I religiously clean trolley handles apart from anything else, you'd be amazed at how dirty they can be! And, if we're eating out, I try to establish which restaurants/menu items are safe for 'Baby' before we go and communicate with staff about her milk allergy. But, even when you think you've covered your bases, life can throw you a curved ball. Looking back at days/times/events can help you here!

I've mentioned this before, but, when 'Baby' was younger she kept having tummy aches an hour or so after leaving a particular baby and toddler group ('Baby' was actually an articulate tot by this time, so she could actually give me some idea of what was happening inside her). After three or four weeks of this  I finally worked out that it was a particular day and time and that it must be because in this group children were allowed to wander around with food (sticky cakes were provided) and were leaving traces of their food (containing milk proteins) on the toys. It may have been minute, but it still caused my little one to react! Not everyone is as sensitive as this, so it might not be a problem for you, but it's as well to be aware!

The answer was to wipe 'Baby's' hands very thoroughly before eating, so she didn't transfer any traces to her food, and wash them thoroughly once we got home. If I stuck to this she was fine. Whilst at the group I also had to be vigilant - to make sure she didn't put anything in her mouth. Fortunately, for us, she's never been much of a one for doing that! 

Another time this helped was when I realised it was my trips to cafes like Starbucks and Costa that were causing the problem - about an hour or so after I left 'Baby' would have a severe tummy ache, even when she had been asleep in her pushchair the whole time and not touched/ate/drank anything there. My conclusion was that she must be reacting to the milk that had become areosolized when it had been frothed.

To test my idea, I eventually decided to just pop-in and grab a take-away coffee. If I did this the tummy aches stopped.  This was confirmed when one day The Hub decided to sit in with a coffee (did he think I was imagining things) and her tummy ache came back!  He did this a couple of times before he became more convinced. (This kind of reaction to milk is thought to be rare, but I have heard/read of other cases of the same, so it is entirely possible. But I wonder if it has been under reported.)

More recently, timing helped me work out that 'Baby' had been exposed to food containing milk whilst at school. I knew because each time it occurred she had an intense tummy ache at more or less exactly the same time of day. It was always around 5 pm. At this stage apart from the snack that I always gave her after school, I knew that the last thing she had eaten was food from school (every child at her school has to have school dinners). 

It's harder to track what is in your food, when you're eating out and about!

Frustratingly this took a lot longer to solve, as there was no obvious pattern to this one, apart from time of day (it didn't happen every day) but also because other children at school had been having tummy bugs, which clouded the issue. It was only once we started a new term, with no new tummy bugs doing the rounds, that I could be sure that she hadn't picked up something from someone else! 

It's definitely much harder to solve this kind of thing when your child is spending time in another environment, particularly when you can't be there to help manage it. A food diary (see below) can help, when you can't see an obvious pattern, but my attempts to keep a food diary in this situation were frustrated because (from what I could gather from 'Baby') the menus published by the school kept changing and didn't match-up with what she was offered! Once the school became aware of the problem and put a better tracking system in place to prevent it happening, funnily enough the intense tummy aches stopped! 


4)  Is there a pattern as to when reactions occur?

Keeping a food and symptom diary can help isolate problems. It helped us, once, when 'Baby' was much younger. Food and symptom diaries are time consuming (particularly if still breastfeeding - you need to include your intake too) but can be a valuable tool for identifying a problem. 

Basically you track everything your the allergic individual has eaten/drank (including medication) and keep note of any potential symptoms that occur. Recording visible symptoms with photographs can also be helpful. If kept carefully over a week, or maybe longer, you should hopefully start to see a pattern emerge.

It might look something like this (sample of one day):


Date:
Food/Drink Ingested
Symptoms
Breakfast                  
8 am



Cheerios with
Soya milk (75mls)
Water to drink



None
Snack
10.30 am

Two small rice cakes
Four slices banana
None
Lunch
12.30 pm


Half Tuna Sandwich
(Pure, Hovis Best of Both/Hellmann’s Mayo)
Handful of crisps*
3 slices apple
Small glass orange juice
Tummy pain between 2.30 and 4pm
Snack
3.00 pm

None (tummy still hurting)

Dinner
5.30pm


Homemade Shepherd’s Pie
Robinson’s Jelly & Swedish Glace (Vanilla)
Water to drink



Anything to add:
100mls soya milk 6.30pm
Diarrhea around 7pm
Wakeful: 11pm, 2am, 4.30am



NB. Don’t forget to include milk feeds (if still breastfeeding), *brands of food and any medication.

If you prefer a more techie approach, there are apps like this one (I've not tried it, by the way) that can help you record what's going on.


4) Is there something you've missed?

Sometimes we've found that we haven't checked our labels properly, or taken it for granted that something is safe, only to find that it isn't - this was much more common in the early days of 'Baby's' allergy. The first time this happened it was a packet of salt and vinegar crisps. I just hadn't expected to find milk in those (I still had a lot to learn)! It was only once the reaction had occurred that I began to ransack the cupboard to examine all the ingredient labels on everything I'd eaten that day and discovered where I'd gone wrong!!

Another time, we discovered that it was jam (butter had been used to clarify it) that was the problem! Check home made or artisan-style jams for this - I've not seen it on any jams in supermarkets (hence I had never imagined it could be a problem)!

Click on this link for the full story!


5) Could it be a 'may contain'?

If your child is reacting and you've ruled everything else out, look at products which carry 'may contain' warnings or which could potentially have been made alongside milk products (for example chocolate and ice lollies that you know have not been made on specifically dairy free premises). 

Remember that 'may contain' warnings are not legally required on food labels, so some products may look safe - no milk listed in the ingredients or even hinted at in a 'may contain' warning - but they may still actually have picked up a trace, during the manufacturing process, which could cause a sensitive allergic individual to react. 

Not all individuals with a milk allergy react to small traces, it depends on how sensitive one is, but they have definitely been a problem for us in the past. It is becoming less of a problem in baked goods, now that 'Baby' appears to be tolerating a certain amount of baked milk, but milk that has not been baked so well is still a problem, therefore I would not risk products such as chocolate, yogurt or ice cream which 'may contain' traces of milk.

Clink on this link for a previous post for more details about 'may contain' risks.


And finally...

If you think you've isolated a problem that you didn't have before, please make sure you discuss it with your health care professionals - doctor, dietitian, etc. I know from personal experience that this isn't always as easy as it should be - some are more helpful/better informed than others, but hopefully they'll be able to help you confirm your suspicions. 

It's important to do so, as otherwise you/your little one may end up living on a more restricted diet than is necessary and miss out on vital nutrients. It may also affect the medications that you could be prescribed. But also, when it comes to registering your child at school, if you declare an allergy, they'll often ask you for a letter from your Healthcare Professional regarding your child's condition. Take it from me, getting appointments etc. can take some time, so it's better to have it all in place in advance!



Related posts:











Wednesday, 15 July 2015

Living with Cow's Milk Allergy - how I try to keep the 'Dairy Free Baby' milk free!

Until fairly recently, I was pretty blase about 'Baby' starting school. I've taught in school for years. I've come across the odd one or two children with food allergies and nothing untoward happened on my watch. 

Last September, I was more worried about 'Baby' making friends than her milk allergy. 'Baby's' prospective school appeared to be so sewn up. They had a number of children with allergies and seemed to have all the right procedures in place. Unhappily, recent experience suggests otherwise! It seems to me that they understood the importance of an immediate reaction i.e. anaphylaxis, but not a delayed or Non-Ige mediated reaction. In fact, too few people are aware of the effects of cow's milk on Non-Ige sufferers, or of the importance of preventing exposure. I kind of blogged about it a short while ago. The link for that post is here.

I now feel that I should have taken nothing for granted, with school, but should have spelled out things right from the beginning. Better safe than sorry, and all that! You'd think, having been a teacher, that I would have known what to say/do, however, on our first encounters with the teacher, suddenly on 'the other side of the fence' as a parent, I was massively under prepared! So, I clammed up and couldn't think what it was that I needed to convey in detail. Doh!

Hindsight, based on sorry experience is a wonderful thing! It definitely sharpens your focus!! 

Here's some of the things that I would have said... if I only I'd had the benefit of hindsight:


Some Background:

A lot of people seem to assume that food allergy is all about anaphylaxis - an immediate matter of life and death.  That's the one, that if people are going to take food allergy seriously (and not get all dismissive) they take note. However, food allergy is not all about anaphylaxis. My daughter has a milk allergy, but is not anaphylactic. She has a Non-Ige mediated milk allergy - meaning that it won't cause a reaction that could kill her. Instead she will suffer a delayed reaction if she ingests milk, or any products made with milk.


Unfortunately, when most people grasp the fact that my daughter is not anaphylactic, they switch off and go, 'PHEW!' They might confuse it with lactose intolerance, or think to themselves, 'Oh well, that's alright then. I'm sure a little bit can't hurt!' They don't say it to my face of course, otherwise I'd put them right with a thing or two!! But it does come across in their attitude - the way they deal with it!


However, although my little girl's reactions won't kill her, they are not pleasant, and it's not nice seeing her suffer. Therefore we try to do our level best to avoid them!

Non-Ige reactions vary from person to person. In my daughter, a delayed reaction may include the following:
  • severe tummy cramps (they make her cry out in pain)
  • diarrhea
  • continued exposure to milk (including traces) will damage her gut, which will then struggle to absorb nutrients from her food. This could cause her to become malnourished. Nothing much can be done about the gut damage - you just have to let it run its course and wait for it to heal. It can take the gut quite a long time to heal following an exposure to milk - when she was little, we were told to leave three or four months between planned exposures to milk (otherwise known as 'milk challenges') which were meant to help assess her progress
  • once the gut has been damaged by milk it will take a while to heal, whilst sore, it may be irritated by foods with which it would normally be okay (this might depend on how much damage was caused), thereby causing similar symptoms to her milk allergy
Please be aware that allergic reactions can be worse if you're under the weather or following exercise (or, if you're an adult, alcohol and fluctuating hormones can also cause reactions to be more severe).

The threshold amount of milk that is required to cause a reaction will vary from person to person. My daughter has been sensitive to the minutest traces of milk, including milk that has been broken down by processing or baking. At one point, I couldn't even sit in a cafe to drink my coffee, without her reacting with a tummy ache later (that's even when I kept her strapped in her pushchair so she couldn't touch a thing, because I initially thought she must have been picking up traces of milk by touching unclean tables etc.)! It appeared that she could be reacting to milk aerosolised whilst it was being steamed for cappuccinos etc. If I went in and collected a take away coffee, she was fine, but if I stayed inside and lingered over my coffee, she wasn't. She also appeared to react to cheese being melted in a sandwich toaster at home. I believe that this kind of reaction is thought to be quite rare. 

It is hoped that at some stage my daughter will begin to outgrow her milk allergy. During the process of outgrowing her allergy, her threshold amount will change, until the point where (we hope) she can tolerate milk fully. We are unsure what her current threshold might be, as we have not had the opportunity to reassess this in over a year - due to our comings and going over our flat move and periods of illness, which disrupted our planned milk challenges.


Until such time as we can assess her progress once more, we must assume that my daughter continues to remain sensitive to the tiniest amount of milk. Because she has been so sensitive, you may think I'm overdoing it and maybe OCD, but these are the things we do to try and keep her safe at home:

(Please note: Not everyone with a milk allergy will need to go to these lengths in order to keep safe. These are the rules that I have developed for ourselves, over time, in the light of our personal experience of our daughter's milk allergy. As a result, it is rare for her to experience a problem at home. Out and about and catered for by others... well that is when it can and sometimes does go wrong - even when we think we've been careful to communicate with them regarding her needs!)


1. Golden Rule:

My daughter is never knowingly brought into contact with any products made with any mammals milk (cow, goat, sheep etc.). This includes products which state that they may contain milk, are made in the same factory as products made with milk or are not suitable for milk allergies. These products do not have to be food products they could (for example) be craft, cosmetic or cleaning fluids. 

We do not accept products with 'may contain' type statements because they're too woolly and we've no idea, in practice, what that might mean. The only exceptions to this rule are 'may contain' products that we have discovered are safe (by happy accident), or any planned milk challenges (by which she is carefully exposed to milk, to see if she's outgrown her milk allergy).


Common milk products include:

  • milk
  • cheese
  • butter
  • yogurt
  • cream
  • ice cream
  • buttermilk
  • sour cream
  • fromage frais
  • lactose
  • whey
  • casein
  • milk powder
  • quark
Products containing milk could include the following:
  • margarine
  • chocolate
  • cake
  • biscuits
  • sauces
  • pre-prepared sandwiches
In fact I could go on! It's in many processed foods - you'll even find it in some sausages, ready made Spaghetti Bolognese, chicken gravy, wine, and yes, even jam!!


2. Keeping clean:

Milk can get everywhere!  My daughter may not react to milk on her skin, (although she has had rashes on her face from kisses, in the past) but if she touches something containing milk and then forgets to wash her hands before eating, or absently puts her fingers in her mouth, she may ingest enough milk to cause a reaction. 

This actually happened at one stay and play venue, where children were given sticky cakes and were then allowed to go back to playing with the toys with sticky fingers. My daughter kept getting tummy aches an hour or so after each visit. It went on for a number of weeks, before I noticed the pattern. Once I cottoned onto this, and cleaned her fingers before she ate any food herself and after we got home from these visits, the tummy aches stopped.


Milk proteins cannot be killed with disinfectant (like bacteria), and are sticky so need to be washed off thoroughly. If not cleared up properly milk proteins remain on surfaces, even if they are too small to be seen. This is a particular problem if the surface is absorbent (e.g. carpet).


So to avoid any chance of accidentally ingesting small traces of milk, I now treat milk protein as a bio-hazard. I try to keep milk trace free by:
  • washing hands after handling milk - e.g. pouring milk from a milk carton, wiping up a spill, handling food made with milk, such as a cake/sandwich etc.
  • using hand wipes, to thoroughly clean hands, if we are out and about, and where water and soap is not available. Alcohol gels are useless, as alcohol cannot kill milk proteins. 
  • washing both our hands when we get home after being out and about.
  • washing my hands if I have had any contact with milk (e.g. in food or drink) prior to holding my daughter's hand or touching anything else she might pick up/touch.
  • cleaning up all milk spillages immediately and thoroughly. Mug rings from tea or coffee that has been made with milk on tables and other surfaces are a particular bug bear of mine, as people are inclined to forget that they contain milk. 
  • cleaning up spills by first blotting the spillage with a dry kitchen roll (the less milk being wiped around the better). I then clean the area of the spillage, using disposable materials, such as kitchen roll with hot soapy water. I think disposable is best, as milk proteins might remain 'caught' in the fibres of dishcloths.
  • cleaning tables (and chairs if necessary) in cafes/restaurants/trains/planes etc. with my own wipes, as soon as we sit down and before my daughter can touch the table. I clean the edges of tables too (little children often grab the edges of tables) and keep cleaning until my wipes come up clean (I once got through an entire pack of hand wipes when cleaning a table in Starbucks)!
  • taking my own crayons/comics/entertainment for my daughter in cafes/restaurants, as it can't be guaranteed that other children who have handled the ones in the cafe/restaurant had clean (completely milk free) hands when they did so!
  • using a dishwasher to clean crockery/utensils etc. as it is an excellent way of making sure items are cleaned thoroughly. I  just have to make sure that no residues of food remain at the end of the cycle. Anything not properly clean is returned to the dishwasher for another cycle, until it comes up clean. Anything that looks troublesome is soaked well first, and then wiped with a disposable cloth.
  • carefully washing up all utensils for food that are intended to be kept dairy free first, I then wash up anything else, or use a fresh bowl of water and use a separate brush/sponge just for dairy free utensils.
They say, 'Don't cry over spilled milk'... I may beg to differ!

3. Food Preparation:

When preparing food,  there is quite a lot of potential for accidental contamination of dairy free food, with traces of milk or milk products, therefore I:
  • wash hands thoroughly before preparing dairy free food.
  • wash hands after handling milk (e.g. pouring milk from a milk bottle, wiping up a spill) or after handling food made with milk, such as a cake/sandwich etc.
  • ensure the surface area is clean prior to food preparation - to ensure no traces of dairy remain.
  • use clean separate utensils when preparing dairy free food.
  • use clean separate wooden spoons/spatulas for dairy free food, when cooking.
  • use clean separate baking trays when baking or line them carefully with foil - to ensure no residues of dairy free fats could transfer onto dairy free food (unfortunately, I've found washing does not always remove all traces of dairy fats/grease - we've reacted to food cooked in other peoples' cake tins).
  • prepare dairy free food first, or be aware that saucepans cooking on the same hob may need covering with lids to prevent food containing dairy spluttering and transferring to any dairy free food in the vicinity (thanks to What Allergy for this tip).
  • don't prepare dairy free food using electrical appliances such as sandwich makers/waffle machines that have been previously used for food containing dairy, as they cannot be immersed in water and cleaned thoroughly (this has been learned through experience)


4. Food Storage/handling:

Some people will keep 'safe' food in separate cupboards or on separate shelves of the fridge. I don't, because I'm particular in the way I handle milk - washing my hands and surfaces frequently, and I'm usually the one who handles the food in our home. In kitchens used by others, this further precaution may be advisable. When handling or storing food, I:
  • wash my hands thoroughly before handling food.
  • keep milk products in sealed containers.
  • cover all dairy free food with cling film or store in clean sealed labelled containers.
  • use separate utensils for serving food eg. cake tongs, serving spoons etc.
  • only put clean knives/spoons into jam/pickle jars etc. better still, use a jam spoon - especially when others unused to dealing with milk allergy are around
  • don't put dairy free food (such as cakes/biscuits etc.) on the same plate/tray as food containing dairy.
  • avoid passing food containing dairy over dairy free food, to avoid contamination via accidental spillage.
  • avoid serving food made with dairy right next to dairy free food, especially if it is likely to splash around e.g. cheese sauce/chocolate sauce/custard/yogurt).
  • am careful to make sure that when I'm pouring milk from a bottle it doesn't splash over surrounding surfaces/food. If it does, I clean it up as soon as possible.
  • wear a clean apron to protect clothing, or remove clothing that has been splashed with milk or sauces containing milk - in case my daughter moves in for cuddles.
Sloppy stuff like yogurt served next to this fruit compote made the compote a 'no no' in case splashes of yogurt had accidentally made their way in to the compote. 

5. Other potential sources of milk:

Milk doesn't just appear in food! Where milk appears in other products, it does not have to be highlighted in the same way that it is in food. This means that you really have to keep your eyes open! So, I also check labels on the following:
  • some washing up/cleaning products which may be made with milk (yes, really).
  • some hand soaps.
  • chalks, playdough and other craft materials also need to be checked carefully in case they're made with milk.

This particular Ecover washing-up liquid is milk free - the Chamomile & Marigold (also by Ecover) isn't - it contains whey, one of the proteins found in milk!

Furthermore:

My daughter is quite articulate for her age but is still quite young. Although she knows that she is dairy free and that she requires dairy free food, it's not entirely clear how well she understands what this might mean in practice. 

Therefore, it cannot be assumed:
  • that she really knows what she can/can't eat - she may say food is okay that she is not supposed to have, either because she doesn't realise or because she likes the look of that food, or perhaps because it appears more appealing. If any adult dealing with her is not entirely sure whether she can have something, I would rather she were not given the benefit of the doubt. I would rather she was told that Mummy will be asked first, and then she can have whatever it in question, later (after it has been approved by Mummy), or on the next occasion it becomes available.
  • she knows/understands the need to keep her hands clean (although I keep trying to drum this one in at home). She may not realise that she has touched something that contains milk and that therefore some might remain on her hands and needs to be washed off. She may need to have this explained to her and be instructed to wash her hands.  Being a bit of a feisty minx, and not keen on washing her hands, she may be reluctant to do so!!

Platinum Rule, (to top my previous 'Golden Rule'): 


If in doubt, leave it out!


Addendum:
The above list has ruled our lives for a while now. Having written it down, it's suddenly hit me how many rules we've felt forced to follow. Living with it, I take it all for granted and it's become second nature. However, changes are afoot, which could bring an end to some of this, so maybe I won't show it to the teachers just yet. More to follow soon...

However, I will definitely point them in the direction of Allergy Adventures new online workshops, which have been created especially for school. They are completely free and are accompanied by short punchy videos. Check them out here!



The Allergy and Free From Show 2015 - A Retrospective

Time was when I would have been writing my review practically as soon as I left the show - on the way home. I'm a bit slower about the write-up this year - partly because time has been short (there's been a lot of end-of-term stuff for 'Baby') and partly because I sort of wanted to mull it over a bit and consider how it compared to previous experiences. I'm beginning to realise (maybe I'm growing wiser as well as older) that sometimes it's good to take your time and think things through. It helps too to chew over your experience with others online.

So, this year's Allergy Show in London. How was it?

Well...



There was a lot to look at and take in. It was a bit bewildering at first, even though I knew what to expect. However, I must admit I was a bit surprised to notice animal charities vying for space this year - including a dog shelter that split the two Udi's plots! 

I was there to shop for food - not talk about dogs! Or expensive saucepans either!! I wasn't surprised to see some appliances - after all at an allergy show there's bound to be people with eczema who want better hoovers, air filters and natural ways to wash/dry their clothes. The shopping trolley stall I could forgive - after all I've often thought there must be people who turn up and suddenly discover the need for one, once they discover the gems that are on offer! 

However, for the most part I can get over these extra stalls - I know they help to subsidise the show to some extent - just so long as they don't keep out genuine free from companies and prevent them from showcasing their wares! The only thing that genuinely sticks in the throat is the quacks - the companies taking blood and promising a diagnosis and this year a stand promoting some silicone gel that claimed it would fix a bad gut.

Personally, my gut is bad enough already without adding silicone to it methinks! SO when you go to this show, you do have to keep your wits about you - in order to sort the good from the just plain barmy!

So what was good this year? 

1)  Allergy Adventures

Without a doubt, Allergy Adventures is definitely one of the show's highlights - for 'Baby' (as it's the one thing aimed at her level), for The Hub (as it saves him wondering how to keep 'Baby' busy for a bit, without getting into trouble) and for me - as it frees me up to poke around the stalls for a bit without being too distracted!

In fact, I really wanted to fly solo this year and have more of a chance to see what I'd come for, but 'Baby' just wasn't having it. The Allergy Show, and Allergy Adventures in particular, is one of the highlights of her year. She was desperate to come, just for that!




'Baby' loved it, as ever, she knows it's something special for her. And when there's a space as inviting as this for children, it's not difficult to see why!

Hailley is such a great storyteller, she draws in the adults as well!

What I find completely shocking, is that beyond having a free spot, Hailley is not remunerated - either for her 'set', art supplies or expenses, or those of her amazing volunteers. This confuses me somewhat, as it seemed (from the publicity) that Hailley was sponsored. I really hope the organisers and sponsors rethink this for next year, as it seems only fair that her costs should be covered at the very least - especially when she keeps everyone's kids happy all weekend! Happy kids equals happy shoppers, equals money changing hands!!

Hailley also had a slot in Speaker's Corner - a new spot for this year. It was a shame this wasn't better attended. Hailley was sharing about her new workshops for schools, which are now available to view online for FREE! If you are a parent, a teacher or a school governor please, please go and take a look at her website and see how you can get this into your school. Just going from our own experiences with school this year, I think allergy education for pupils, parents and teachers is absolutely vital!


2)  Dr Adam Fox 

Last year, Dr Fox was a real highlight for me, and that was when I had to pay to see him! Mind you, it was only an extra £10, and as I'd got in free, it definitely seemed worth it - especially as he is such a big cheese in the pediatric allergy world! I mean where else would Joe Public get the chance to hear such an allergy expert as he (unless you're one of his patients of course!)

This year, it was possible to hear him for free in the Schar Learning Centre. He certainly drew a crowd - there wasn't enough seats - people sat all over the floor and stood around the open sides. It was a shame there wasn't more space and that he had to compete with the Eco Egg lady, on a nearby stand - who had miked herself up, to be heard over the speakers! (GRRR! How RUDE!!)

Dr Fox certainly drew a crowd!

It was great that we were able to listen to him for free, but I do wish that it had been a bigger space and somewhere where there were less distractions. I also wish (as I did last year) that he had there were published notes for us to follow - as Dr Fox comes out with such fascinating information, at such speed, that it can be difficult to keep up!

This year, he did a great job of covering several subjects, such as eczema, advances in research regarding nut allergies and FPIES. I also found it most helpful to hear him acknowledge that there really isn't much support out there for those with a Non-Ige allergy. I have to say, if Dr Fox is there next year (and I sincerely hope he is) he would definitely be well worth a listen!


3)  Free From Food

Well yes, that is what I went for and that is what I found. This year, though, rather than searching out the newest and latest products, I found myself hunting down old favourites from previous shows and stocking up on goodies that either aren't available locally, or used to be, but have been withdrawn from the shelves of the supermarkets (GRRR!!).  

I was particularly after:

i) Cocoa Libre - amazing free from chocolate and a product I've already reviewed here.  'Baby' loves it too! It's not something I can currently get locally. Suffice to say, I stocked up!

ii) Mrs Crimble's Pancake Mix - this might sound unexciting to you, but it has become a breakfast staple in our house! 'Baby' aint that much a fan of cereal and pancakes are a great alternative. No longer sold by our Sainsbury's or Tesco (Boo Hiss!!) I had to take advantage of their offer to buy five boxes for £5.00. Otherwise, I now have to buy this mix in larger amounts from Amazon.

iii) Eskal Ice Cream Cones - I always buy these at the Show, at show price, but this year I also found these, which look great for parties!


I was ecstatic to find these, 'cos although you can get plain-looking dairy free ice cream cones, finding them in interesting shapes is a mite harder. 'Baby' loved the look of these too and couldn't wait to try them out! I also went back for their chocolate after dinner wafers, which I discovered last year (you know, the ones that resemble cigars). I can't tell you how good they are. 'Baby' loves having these instead of a chocolate flake in her dairy free ice cream.


iv) Venice Bakery Pizza Bases - these are honestly the best gluten free pizza bases I've tasted! They're also egg free, soya free, nut free and corn free too! These weren't new to us, but a definite must for stocking up on - especially as 'Baby' now loves pizza and keeps on asking for it! 

Pizza perfection? 'Baby' thought so!

As it happened, you could buy a whole pizza for £8.00, so we did, and 'Baby' loved it so much, that she ate almost a whole one all by herself! Well that was her lunch sorted and one very, very happy kiddo! Only the day before she had been at a party and been begging and pleading me for pizza that she knew very well wasn't dairy free at all, because she wanted it so much. And here she was, a day later, living her dream!

The only thing I found perhaps misleading was that it was served with Vegusto cheese. Now I have nothing against Vegusto cheese (especially now it is made with almonds and not cashews, so I can eat it), but last year, Vencice Bakery served their pizza with Mozzarisella (soon to be available in a supermarket near you, with any luck), which, being made with rice was nut free, just like the pizza base. I do hope no-one was caught out by that this year!

v) Ms. Cupcake - the Vegan baker. She has a shop in Brixton and is a regular at the show. Fortunately for me, she is aware of the number of gluten free visitors to the show and everything on her stand was gluten free. A goodly number of her offerings were also soya free, including my favourite from last year, the Nanaimo bar! This year I bought the raspberry-flavoured one. It was a bit battered by the time I got it home, but it still tasted gooood!

Most yummy!

The recipe for these is actually in her cookbook, which I have, but I still haven't got 'round to making them for myself! This is partly because I lack decent gluten, dairy and soya free biscuits!


vi) Barkat - another great gluten free favourite of mine. I love their digestive biscuits. These are made with soya lecithin (which is okay for me) and without oats (which I sometimes have problems with, so I limit my intake), so Barkat's really are the only digestive biscuits for me! The woman on the stand couldn't believe I wanted so many packets, but then I can't get them anywhere locally!!


vii) Lovemore O'Choccos - gluten and dairy free 'oreos', to you and me! These were popular at the show, and had nearly all gone by the time I got there. They were priced at £1 a packet, so I'm not surprised they went down so well - they usually cost a lot more at Waitrose! I've noticed both Udi's and DS Gluten Free also make some, but Lovemore's are the only ones that are dairy free AND made with soya lecithin (rather than soya flour/protein). Lovemore also make Jammy Wheels (made with soya), which I buy for for 'Baby'. I reviewed them here. Their Double Chocolate Cookies also go down very well, in our house - wish I'd bought more!

New products, I loved:

i) Koko dairy free margarine - a new product from the makers of Koko Coconut Milk, this is a product I'd heard of, but had yet to try! I loved the sample, but was disappointed that they ran out of stock before I had a chance to buy!


New tub on the block!

It is meant to be stocked at Waitrose, but my local has yet to stock it. I have asked Waitrose to roll it out to more stores, so here's hoping!! I'm hoping to try it in cakes and icing, to see if it holds better than Pure Sunflower (our usual spread), which seems to split in buttercream.


ii) Violife - this is our regular go-to dairy free cheese - partly because we can get it so easily, from our nearest Tesco and partly because it is a pretty good sub for cheese - as dairy free subs go! 'Baby' has just got into it and we now get through quite a lot! 


The Violife stand was located in the Vegan section of the show.

This year they were showcasing their new Parmesan-type cheese. I must say I liked it a lot, but was disappointed that they hadn't brought any stock for customers to buy. Also they served a very nice soft cheese on a cracker that wasn't gluten free, which made it tricky for me to sample. Given that they are a gluten free product and many of the show's visitors are gluten free, this seemed counter-intuitive!


iii) Isabel's Free From Mixes - Isabel's mixes are all gluten free and a growing number are now dairy free as well. We love her gluten free Yorkshire batter mix, which you can usually find in Asda. What I loved this year, was her new packaging which highlights which mixes are also dairy free - really helpful for those of us who are avoiding both dairy and gluten. It would be great if more Free From manufacturers would highlight things in this way!



And then there were these new mixes of hers - I couldn't let a gluten free and dairy free doughnut mix pass me by - especially as 'Baby' is desperate to have a doughnut (thanks @gfreeb for pointing out these). I loved the look of these chocolate puds as well. The Hub and I don't usually 'do' pud, but having been introduced to dessert at school, 'Baby' is beginning to expect them, now!


iv) Nana dairy free ice cream - this little gem was tucked away beside the dog charity! It's an 'ice cream' made almost entirely from fruit which has yet to be launched! We bought a small tub of the chocolate flavour and ate it between us. 


Marketed as 'guilt free' we loved that it was 'dairy free'!

The ingredients for this one: Apple, Banana, Avocado, Sunflower Oil, Cacao, Dates. HOWEVER... I saw too late that it was made in a facility which handles nuts and dairy'! Bah! I wish products wouldn't market themselves as 'dairy free' unless they completely are (but that's a whole other story) as it is sooooo misleading! 

Fortunately, 'Baby' didn't eat that much of it and the tummy ache she had later seemed to fairly mild, considering (it might not even have been the Nana - difficult to tell from just one sample). For this reason, although it was delicious, I would be unlikely to buy it for 'Baby' again (as I wouldn't want to take the risk), which was a shame, as it apparently contained one of your 'Five-a-day'. 


v) Jollyum - a dairy free ice cream made with soya. I didn't actually sample this at the Show, as we found it in a local garden centre not so long ago! I stole a quick lick of a small pot which I bought for 'Baby' (it was all I thought I could get away with, without suffering as a result). Must say it seemed quite tasty!


vi) Sweet Mandarin OK Sauce - I've been desperate to find a Chinese sauce that is gluten free and soya free as well. Looks like I've found one! I already love their Sweet and Sour Sauce and Barbeque Sauce (great with chicken, I stocked up on these at the Show), so now I have one for stir fries too! Will have to let you know how I get on with it.


Sadly missing from The Allergy and Free From Show this year:

i) Glamour Puds - the stand was there, but empty! I was really sad to see this, as they were a highlight for me last year.

ii) Hotch Potch - mini gluten free Scotch eggs. I missed out on these last year and this year they weren't there!

iii) Focaccia Per Tutti - gluten free focaccia, and a Free From Award Winner. They sold out before I got there last year and were not there this year! Oops! I stand corrected! Alex Gazzola (@HealthJourno on Twitter) tells me they have re-branded as 'Anni's Country Kitchen' and were there, so I just missed them! :(

iv) Vegusto dairy free cheese - had it's own stand last year and was only represented by Venice Bakery this year.

v) Mozzarisella - dairy free mozzarella cheese. Last year served up on Venice Bakery Pizzas, sadly missing this year. Reviewed here.


A few final things:

Although all-in-all it was a great show, and there has undoubtedly been improvements over the years, there were a few sticking points for me:

i) On the whole it felt more spacious this year. There were still a few cramped corners, where, when things got busy, it became a bit tight. I was very glad we no longer needed our pushchair. I don't think there was quite the same sudden mad crush of punters that there were last year, which helped somewhat. Mind you there were several other notable events in the UK that weekend, so maybe that kept some of the tourists away!

ii) Some stands ran through their stock quite quickly - by midday Saturday, which was only halfway through the show!

iii) Some stands weren't really thinking about their customers. I was astonished to hear about an egg free mix whose samples were made up with egg! Then there was an American Muffin stand that had a box on display that clearly stated gluten free and dairy free, but whose individually packaged muffins (with exactly the same name) were made with milk!! Unfortunately, the stall holder could not see the problem with this!!

iv) I warned folks to dress light -  because Olympia was a bit like a large greenhouse, and I was right! it definitely got hot in there and more so as the afternoon progressed. No fans, no air-conditioning!

v) With it being so hot, I should have drank more. I didn't because for most of the day, as there were such long queues for the Ladies - so much so, that at a particularly busy point, people were queuing up the stairs! I saw only a few disabled toilets, but these were also the only baby change rooms as far as I could tell - not great for a family event. This isn't something the Allergy Show itself can perhaps solve, but something the visitor needs to know! 

vi) The Free From Cafe didn't feel quite so Free From friendly this year. The dairy free milk was kept behind the counter and cow's milk was kept in glass bottles near the sugar and stirrers. I was worried about spillages, as they didn't look that safe. Also although the allergen menu was available, it wasn't easy to spot with other people in the queue blocking it from sight. I would have preferred food packages individually labelled - as they were last year. 

I took this picture later in the day, when things were quieter!

Another thing I found was that the salad I had this year was definitely smaller, but was still quite pricey! And the staff were not that open to being asked questions about the food - despite signs inviting the customer to ask about allergens!

On the plus side, other cafes within Olympia stocked dairy free milk and gluten free sandwiches too! However, it's always much harder for people with several allergies to find food that is suitable.

Spot the dairy free milk!


So there we have it according to me - The Allergy Show and Free From Show 2015 - the good, the not quite so good, and the barmy. Definitely more good than barmy, so...

Will I be back, next year? I certainly hope so!



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