I just came across an article from an recent Sunday Telegraph headlined ‘Food fight over allergy ban’ which investigated, once again, the extremely knotty problem of whether or not you should allow allergens into a household with an allergic member. There are in fact, two questions:
1. Does excluding a food or group of foods from the diet, especially of babies and very small children, make it more or less likely that they will react to those foods when they do encounter them?
2. If a person, especially a child, has a food allergy or a serious food-related condition such as coeliac disease, should they (or their parents) try to exclude that food entirely from their environment, if necessary making all other members of the family go gluten or nut free, in order to achieve this?
As far as the first question goes, with reference to babies, the jury is still firmly out and looks unlikely to reach any verdict in the near future. So, should pregnant women from atopic families avoid peanuts? There is no clear answer and although a number of trials are ongoing to attempt to find one.
In adults the suggestion that avoiding a food can sensitise you to it and therefore you will develop an intolerance to it when you meet it (as suggested by one dietitian in the Sunday Telegraph article) seems weird – especially since it is very unlikely that by the time you have reached adulthood there are many foods with which you would not have come into contact and therefore have been sensitised to.
What is maybe more likely is that, if you are sensitive to a certain food or have problems in digesting it, when you remove it from you diet, you will become super-sensitive to it for a period of three months to a year (depending on the individual) until your general digestive and overall health, and therefore tolerance, improves – after which you will probably be able to cope with that foodstuff again.
The much trickier question is to what extent an allergen (or gluten in the case of a coeliac) should be excluded from the environment of the affected person. And although there have to be guidelines for public places (such as schools), within the home this really has to be a matter of individual family choice, entirely dependent on circumstances and the personalities of both the person with the allergy and other family members.
That said, especially these days when the range of really acceptable ‘freefrom’ foods is growing ever wider, there are very few foods the exclusion of which would have a seriously deleterious effect on a family’s health. Despite the propoganda from the Milk Marketing Board, there are plenty of excellent sources of calcium apart from dairy products (pulses, green leafy vegetables, fish with bones etc etc); gluten is a glue used by the food industry to create a vast range of processed foods without which our diets would be a great deal healthier; nuts are highly nutritious (and delicious) but there are many other sources of equally good nutrition. However, it does still remain true (although hopefully this will become less the case fairly soon) that many of the alternative ‘freefrom’ foods are significantly more expensive.
However, the point is less the cost than the principle. If you have a very allergic child or one who is very badly coeliac, the stress of ensuring that they remain safe from their allergen if it is around in the house may take a terrible psychological toll on both the family and the child. If the childs belongs to a relatively relaxed family, has an easy going personality and is secure in the knowledge that they can always use an Epipen or other effective medication to deal with a reaction, the existence of the allergen in the house may not cause anyone much stress. But if the child is anxious or a worrier they can easily become paranoid and if they are to cope with the dangers of life in an allergen filled world, it may be better for them to be able to rely at least on an island of allergen-free security in their home. (See this report from FAAN about a severely allergic child who suffered from major anxiety about his condition.)
In nutritional terms, feeding the whole family on nut, gluten or dairy-free diets need not be an issue, but siblings (and even occasionally one or other parent) may have issues with restricted diets that have nothing to do with nutrition. So you need to be sure that you have everyone very firmly ‘on board’ before you dramatically restrict their diets (and their ability to have friends home to socialise etc) for the sake of one family member. (See this post about ‘hugging your non-allergic child’.)
In practical terms also, it is impossible to ever 100% guarantee that any environment will be absolutely 100% allergen free and even if you can get close to that within the home, once you get outside, it is completely impossible. So some allergy specialists feel that it is better for an allergic person, adult or child, to learn to cope within that allergic world rather than trying to create an allergen-free one for themselves. This is the argument used against banning peanuts, for example, from schools. It is better for the child to learn to take appropriate avoidance and protection measures in school which they can then apply wherever they are rather than creating a false sense of security by making the school peanut free – an almost impossible task in practical terms anyhow.
This argument apart, why should 95% of pupils be prevented eating a perfectly healthy, and indeed nutritious, food such as peanuts for the sake of 5% who can’t eat them? Should we not be educating the 95% to understand about the allergy of the 5% and to treat their allergic friends with care and respect? Well, yes, of course we should but, in an imperfect world this does not always to happen and, sadly, food allergy bullying is still, and is likely to remain, regrettably common. See this recent report from the University of Leicester.
I remember, some years ago, reading a report of a meeting of Tourette’s sufferers. (For those who don’t know, Tourette’s Syndrome is the condition in which, while you are 100% mentally and psychologically normal, you constantly shout out and make sudden and violent physical movements that you cannot control.) The comment of one attendee was that it was so relaxing, for once in his life, not to have to worry about what he was shouting out and likely to hit, because everyone else was doing it too. For a serious allergy sufferer there may be a similarity. You lead your life in a world in which you have always and constantly to be on your guard; maybe you need one place, even just one room, where you know that there are absolutely no allergy dangers and where you can go, just now and then, to relax.
But as ever, it comes down to the individual – how serious their allergy, how competent they feel to deal with it, their own personality traits, the support they get from friends and family.
Meanwhile, I remain constantly in awe of how those with serious allergies do cope and manage to live relatively normal lives – like Ruth Holroyd who writes the excellent What Allergy? blog and who has written several articles for us including drawing up an invaluable Allergy Action Plan. Despite being anaphylactic to milk and nuts and intolerant of a load of other foods Ruth continues to get out and about, was a guest at last year’s FreeFrom Food Awards party and is carving herself a good career, within the limitations of where and how she can work, as a writer.