Understanding food allergies and sensitivities
Alex Francke Sohn starts to make dinner. She can’t eat gluten—products made with wheat, rye, barley or, for some people, oats—so that means no traditional noodles, rolls or tortillas go into her meal prep. She has an intolerance to dairy and soy, so she stays away from vegetable oil and cheese. If you haven’t experienced a food allergy, sensitivity or intolerance, you might wonder, “Why can’t she eat whatever she wants?”
Sohn, who grew up as a Blue Grass Energy consumer-member, struggled with nagging health problems as a freshman at the University of Kentucky in 2016. Her resident advisor had celiac disease and recognized Sohn’s symptoms. After testing, Sohn was diagnosed with celiac disease, and then later with intolerances to dairy and soy. While she is not at risk for a life-threatening allergic reaction, her doctor recommended strictly avoiding gluten, dairy and soy to stay well and prevent damage to her digestive system.
Sohn was relieved to know the source of her pain, but food restrictions were a different kind of worry. She couldn’t participate in food-centric social gatherings like midnight pancakes and pizza nights the way others could. “I wanted to be part of what the group was doing, but I couldn’t order much on a fast-food run,” she explains. “At that time, people were less aware of medically related food reactions. Sometimes I wouldn’t go eat with friends because I didn’t want to answer a million questions.”
to successfully manage her dietary needs, including while serving as Miss Kentucky in 2019–20. In her current role as director of marketing and public relations at Faithful Platform, a jewelry company in Lexington, she often travels for work. She has noticed an increase in options for gluten- and dairy-free eating.
“The number of allergen-free products in stores and restaurants is starkly different than it was even five years ago,” she says. “I’m grateful for that. Still, meals are something I have to be careful with every day.”
Alex Francke Sohn, left, and Brianna Butler enjoy a picnic at the park with allergy-friendly foods. Photo: Alex Francke Sohn
The risks are real
Samantha Griffitts thinks about what’s on her plate every day, too. She was 2 years old when she had her first life-threatening (anaphylactic) reaction to peanuts. Her mother acted quickly and got her to the emergency room, where the doctor treated her with an epinephrine injection.
During her school years, Griffitts remembers being fearful of contacting her trigger food, and feeling left out at times when she was made to sit at a table separate from other students at birthday parties. “I appreciated being kept safe, but no one should be made to feel isolated because of a food allergy,” she says.
Today, Griffitts is a psychotherapist based in Shelbyville specializing in treating obsessive compulsive disorder and anxiety, and she uses her experience to help others adjust to living with anaphylactic food allergies. “If you don’t have allergies in your circle of family and friends, it is hard to understand the fear some people have simply sitting down to eat. What should be a source of joy—a meal with family or friends—can sometimes cause anxiety. The right information and support help, but a food allergy is a medical condition that requires attentiveness,” she says.
Nearly 6% of adults and children in the United States live with a food allergy, according to the Centers for Disease Control and Prevention. Millions more struggle with ill effects from foods due to sensitivities or intolerances. The nine most common food allergens are milk, eggs, fish, crustacean shellfish, peanuts, tree nuts, wheat, soybeans and sesame, but people can be allergic, sensitive or intolerant to any food.
Samantha Griffitts draws on her own experience to help kids and families adjust to food allergies. Photo: Samantha Griffitts
What is a food allergy?
Food allergies occur when the body’s natural immune defenses, called antibodies, react abnormally to a substance in food. Antibodies in the bloodstream fight off bacteria, viruses and more. Occasionally, a person’s body misinterprets something that’s not harmful, such as a protein in a food, as a danger. When this happens, the body releases an allergen-specific antibody called immunoglobulin E or IgE, to attack the suspicious substance. This leads to a release of histamine. The person then experiences symptoms that can range from mild effects like an itchy throat or rash, to severe effects such as elevated heart rate and breathing difficulties that require medical intervention.
Experts do not fully understand why some people have the more life-threatening allergies to food, says Shaunah Ritter, a board-certified allergist, immunologist and internal medicine practitioner with Family Allergy and Asthma.
“We know there are several risk factors for development of a food allergy—like eczema, delayed introduction of allergenic foods or allergies in the family—but there is not one specific reason someone develops food allergies,” says Ritter, who serves patients in Georgetown, Richmond and Somerset.
Research is ongoing, but at this time there is no cure for food allergies. The primary treatment is strict avoidance. “One thing we have learned about preventing food allergy development is that, unless a child has a high risk of having an allergy, babies as young as 4 to 6 months should be introduced to a wide variety of foods, including possible allergens,” Ritter says.
Even with new research, food allergies remain mysterious—and dangerous. About 100 people in the U.S. die annually from food-related anaphylaxis. A food allergy diagnosis requires vigilant avoidance of the problem food and other safety measures such as carrying two portable epinephrine injection kits (EpiPens) in case of accidental exposure to the allergen.
These habits—avoidance and emergency treatment, along with other lifestyle changes—amount to a medical care burden, but not one people should be ashamed of. Ritter encourages families to face the diagnosis head on. “Be open to others about your allergies so you can enjoy day-to-day activities in a safe way,” she says.
Shaunah Ritter of Family Allergy and Asthma, right, talks with a patient about the possibility her symptoms are connected to a food allergy. Photo: Kristen White
What can I do to help?
Recently, I prepared dinner for a friend who eats gluten-free. I knew quinoa and rice were options for sides, but when I read ingredient lists, I found that most flavored kits contain wheat. Gluten sneaks into spice mixes. Soy is used in salad dressings and sauces. Bakery machines carry traces of peanuts. How can we provide uncontaminated options to friends and family who need them? Apply the 3 Cs:
• Careful cleaning: Residue from previous meals, such as crumbs or smears on tables, can trigger reactions for those with severe allergies. Thoughtful cleaning of surfaces increases safety.
• Cross-contamination caution: Many manufacturers list whether a there is a risk of cross-contact; avoid those foods and choose foods from dedicated allergen-free production facilities.
Similarly, while you prepare food for someone with allergies, don’t double-dip cooking or serving utensils into products with allergens. For example, don’t insert a knife used to spread peanut butter into a jelly jar available to the person with a peanut allergy or drain gluten-free noodles in the same colander as gluten-containing noodles.
• Check ingredient lists: U.S. Food and Drug Administration regulations and U.S. laws require manufacturers to list ingredients and top allergens in their products. Be sure to read all of the ingredients, not just the allergens labeled at the bottom of the list.
Even following these guidelines, some people with allergies may have reactions to seemingly safe foods. For example, some people with a peanut allergy cannot eat a popular brand of processed cheese, although peanuts are not listed as an ingredient. Still, the more information a family has, the safer the meal.
Samantha Griffitts, a psychotherapist based in Shelbyville who lives with a peanut allergy, sees progress in both product offerings and how schools, churches and other organizations handle allergies, but encourages people to build their understanding of food allergies. “Many new allergen-free packaged food options exist. Do what you can to keep snacks and parties open to everyone,” she recommends.
Lexington resident Alex Sohn also encourages anyone with family or friends who have allergies to go the extra mile: “Anytime you provide a safe food option, it makes such a difference to those of us with dietary restrictions. It communicates we are not too much trouble to include. Sometimes it’s as simple as asking which restaurant works best or picking up an allergen-free frozen option when having a pizza night. When someone thinks ahead and asks, it means so much.”
A deeper dive into cooking for those with severe food allergies
When my son was in high school, his friend Noah had a peanut allergy. On Fridays, the cafeteria served chicken sandwiches and waffle fries from a restaurant that cooks food in peanut oil. His friends were careful, but Noah ended up in the hospital one afternoon when some kids goofed off and he came into contact with a box of fries.
If you haven’t had experience with a friend having an anaphylactic food allergy, you may not think about factors like an allergic reaction to spice mixes, sauces or allergen-soaked packaging. Here are some precautions to take before preparing food for someone with a severe allergy:
• Before beginning, put away extra food items, snacks and oils that you normally keep on the counter.
• Wipe down counters, sinks, door and faucet handles, pots, pans, mixing bowls and utensils with a 1:10 bleach/warm water or 1:1 vinegar/hot water solution (use gloves). Making three passes with a terry cloth washcloth ensures a clean surface. Alternately, make two passes with alcohol-based sanitizing wipes.
• Wash kitchen washcloths, hand towels, aprons, and hot pads in hot water with allergen-free soap.
• Read ingredient lists! Watch for the possibility of cross-contamination or sneaky ingredients. For example, some crackers may be baked in a factory that makes cookies with peanuts. Some seasoning packets or packaged side dish mixes contain gluten. Some flavoring extracts include tree nut oils. Don’t add anything to your dish unless you are sure it is safe for your friend.
• Wash your hands and wrists well with soap, water, and friction before cooking.
• If you are making a gluten- or peanut-free dessert and then one that includes an allergen, make and seal up completely the allergen-free item and place in another room before baking the other. Wipe down counters again after baking the second item if you are hosting a meal for the person with the allergy.
• When serving foods in a buffet line, clearly label or communicate beforehand which items contain allergens. Place separate serving ware on each dish and keep an eye out to be sure they do not get switched.
What Is alpha-gal syndrome?
James Shelton, longtime Pennyrile Electric consumer-member and avid outdoorsman, suffered symptoms of alpha-gal syndrome (AGS)—an allergy to red meat and other mammal-derived products—for nine months before an allergist helped him uncover the problem.
“I’ve never felt that bad in my life. I endured months of severe, painful symptoms, upper and lower GI scopes, saw specialists in Nashville, and began to feel hopeless, until my allergist mentioned alpha-gal in passing. He said it can start from a tick bite. I told him I had picked several ticks off the previous summer, before I started to have symptoms. He ordered a blood test, and that confirmed it,” Shelton explains.
He went on a strict non-mammal diet for one and a half years, until his AGS antibodies tested so low he could start to reintroduce red meat. He enjoyed his regular diet for four years, but has since had two more short bouts with AGS after tick bites.
“When you’ve grown up eating all kinds of meats without issue, it’s a challenge to suddenly have only fish, chicken and turkey. However, using a variety of recipes, it has been tolerable for me to get through my restrictive diet stages,” Shelton says.
AGS is commonly known as the “red meat allergy.” Researchers are working to understand all causes of AGS, but it often starts with Lone Star tick bite. Some individuals’ immune systems, in an effort to heal the tick bite, interpret alpha-gal—a protein in the saliva of ticks and red meat—as the invader. The person begins to produce antibodies to work against this protein. Then, each time a person with AGS consumes a food or product with alpha-gal, the patient experiences a wide range of symptoms, including stomach pain, rash, vomiting, cough, and gastrointestinal upset.
Some patients can have severe anaphylactic reactions that require treatment. If it’s left undiagnosed, a patient can experience increasing anxiety associated with the medical condition. With strict avoidance of alpha-gal—including foods and medicines with animal-based gelatin—a person’s immune reaction can settle down and red meat can possibly be reintroduced.
“I’m seeing a steep increase in the occurrence of AGS in Kentucky,” says Vanessa McGregor, a family nurse practitioner in Paducah. “If you or a family member suspect AGS, consult with a practitioner who can test for it and coach you toward wellness.”
Psychological effects of food allergies
“Not all eating disorders are connected to body image. It is rare, but we sometimes see young people with food allergies develop rituals or compulsions around food,” explains Samantha Griffitts, a psychotherapist based in Shelbyville who coaches kids and adults in navigating anxiety related to food allergies. She explains that sometimes allergies trigger overwhelming fears.
“When a person begins to unnecessarily limit their eating, activities and relationships because of these fears, we need to make sure they are getting help,” Griffitts explains. She urges parents, educators and caregivers to watch for weight loss and excuses surrounding not eating.
“Cognitive behavior therapy can help with conditions like avoidant/restrictive food intake disorder. With guidance, families can create hope and positive meal experiences for their kids when big changes happen, like adjusting to a food allergy,” she says.
Celiac disease after mono?
When Layne Shelton Stieler was in high school, her mononucleosis seemed to linger, getting worse by the week. She had constant stomach pain, significant weight loss, headaches and even low blood pressure that required IV intervention. After months of bloodwork, scans and scopes that all came back normal, doctors kept pointing to the mono.
But Layne’s mom, Laura Shelton, a Pennyrile Electric consumer-member from Cadiz, was determined to find an answer.
“I have a nephew with celiac and, after yet another doctor appointment, I started to wonder if mono can trigger the disease,” Shelton says. Her daughter was willing to try anything, and after eliminating gluten from her diet, she felt like herself again.
Now, ten years later, she still experiences significant reactions to anything with gluten. She has her own toaster, butter and mayonnaise to avoid accidental exposure to gluten, avoiding cross contamination if a knife that swiped a piece of bread gets reinserted into a condiment. When eating out, she has found it is safest to choose restaurants that have a clear gluten-free menu and policies requiring workers to use separate utensils and change gloves before preparing gluten-free meals.
As a mom, Shelton works hard to provide gluten-free versions of foods everyone else is eating so Layne isn’t left out of the meal. “The hardest part about cooking for food allergies is cooking two versions of the same meal at the same time, keeping all ingredients and utensils separate. That takes a lot of concentration in the kitchen,” Shelton says, “but the blessing is being able to show someone how much you love them.”
