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Valentine’s still an open sesame to enjoy dinner despite allergies, expert says

By: Danny Barrett Jr.

Lovers and singles alike who might have allergies or hypersensitivities to certain foods can still enjoy a box of candied goodies or perhaps a candlelit dinner out this Valentine’s Day – but with just an added pinch of prevention for servers and chefs.

Portrait of Gailen Marshall

“Eating out is more of a challenge for people with a documented food allergy, but by no means should they not be able to eat out anywhere,” said Dr. Gailen Marshall, the R. Faser Triplett Sr. MD Chair in Allergy and Immunology at UMMC. “It’s just a matter of finding good establishments willing to prepare your meal completely free of exposure to specific major allergens.”

Allergies occur when the body makes a particular type of antibody called IgE, or immunoglobulin. They’re generally agreed to have evolved in humans to defend against worms and other parasites. In modern times, the curious component of the immune system is generated to ward off cancer cells but also bind to certain major allergens, such as peanuts or shellfish, triggering effects that range from skin conditions to life-threatening reactions

To avoid anyone’s top romantic culinary delight of the year be marred by ordering the wrong dish, Marshall advises diners with food sensitivities be cheery yet open and honest with wait staff.

“Look at the ingredients on the menu,” he said. “The better restaurants will show what the dish is and then how it’s prepared. If it’s not clear, it’s perfectly reasonable to inquire about it. Generally speaking, restaurant owners would much rather find out that way than find out the hard way – when you suddenly can’t breathe anymore and you’re sprawled out in the middle of their establishment.

“They should be able to tell you, for example, that their food prep equipment is or isn’t guaranteed not to have come in contact with things like shellfish, eggs or sesame. That’s in both yours and the restaurant’s interest to provide that information. You can always leave and try another venue, plus they don’t have to deal with the liability of your telling them about your allergy to certain foods and you get exposed anyway.”

Most research estimates say food-related allergens affect about 30 million people in the U.S., including about 5 million children. Major food allergens recognized by the U.S. Food and Drug Administration include milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, soybeans and, most recently as of Jan. 1, sesame.

Another 160 foods have been identified to cause food allergies in what the agency terms “sensitive individuals,” plus several other ingredients, typically color additives and preservatives in processed foods, found to cause nonallergenic sensitivity reactions for some people that require specific labeling. An example is gluten, a group of proteins found in certain grains such as wheat, barley and rye. In 2013, the FDA issued the first standards for labeling food “gluten-free” for those with celiac disease, which is an immune reaction to eating gluten.

Fans of sesame seed buns to hold together their favorite burgers or irresistible Asian-inspired dishes stirred or sautéed in sesame oil can still find ample supply despite the recent addition to the major allergen list. Labels on the backs of those products are expected to remain the same for 2023. After that, tahini, for example, a common condiment in Middle Eastern cuisine, must contain the word “sesame” in parenthesis in future labeling, while re-labeling the popular cooking oil may depend on the level of refinement in processing, FDA has said in a video released explaining the ins and outs of the federal FASTER Act, signed into law in 2022.

Marshall advises avoidance is still the best therapy for nearly all major food allergens. Studies are ongoing as it relates to FDA-approved immunotherapy geared to foster tolerance of low levels of proteins found in peanuts.

“It’s not the oil or the seeds that’s the problem for people with reactions to it or any of the other major food allergens,” he said. “It depends on the amount of proteins that survive the production methods and get into the oil or the final product. It doesn’t take much of these proteins to produce a reaction in highly sensitive people.”

The Allergy, Asthma and Clinical Immunology Clinic at UMMC offers an array of services to those dealing with allergies, asthma and other conditions related to the immune system.

“It’s best to talk to a board-certified allergist/immunologist,” he said. “Our group consists of eight adult and pediatric allergy specialists. We can determine whether a person has a food allergy versus another form of adverse reaction to food, give advice on what can be done about it and do so in a personalized fashion.”


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