Food Allergies: a complete guide for eating when your life depends on it
Scott H. Sicherer, MD
Johns Hopkins Press
By Henry Ehrlich
One thing obvious to anyone who follows social media related to food allergies is that many questions arise in everyday living that allergists can’t or won’t answer, or Moms don’t ask them, preferring to post them to their peers. One recent example, “Kinda last minute, but any suggestions for a 5 yr old egg allergic child who wants to dye and decorate eggs just like everyone else?”
Or another: “My allergist is OK, but she is just so rushed at appointments. She chides me for being overprotective, and then after lecturing me about hurrying up to try new foods, I tell her OK, I will try pinto beans, she gasps, ‘NO! They are cross-reactive with peanuts!’ Ugh! Yes, I know a pinto bean is a legume, but my daughter eats green beans and soy without a problem.”
Wouldn’t it be nice to have a resource written by someone who has heard it all before, and can give the best medical information in clear language? Your prayers have been answered. Here in 279 well-organized pages are almost all the “q’s” you might want to ask, and the clear, concise, and wise “a’s” you need.
Consider this, on p. 154:
“Is it okay for a person with egg allergy to color Easter eggs?
Yes, but carefully…” The rest of the answer explains the biology, the risks, and precautions the child should take.
And this, on p. 33:
“If I am allergic to one bean, do I need to avoid all beans?
Usually not. It seams that among beans, peanut and soy are the main culprits. There is a bean called lupine (lupin) that may be higher on the problem list than others, especially if someone already has a peanut allergy. Next in line are lentils, chickpeas, and green beans. Allergy to string beans, kidney, navy, lima and others are far less common. A person with any allergy to one bean can usually eat other beans, but a person who has bad reactions to several beans might have trouble with most beans.”
An acid test for any such book would be the problem posed in a question like:
“Is there a skin prick testing number that drs. consider to be the magic number for an anaphylactic attack? My son’s milk and peanut allergy are at 18 (skin prick testing) for the last 2 years. Hasn’t gotten any worse. Tested at 7 for fish and shrimp and has eaten shrimp and no reaction. This testing drives me crazy!! Can eat popcorn, yogurt, Auntie Anne’s pretzels and stuff fried in peanut oil and no reaction. To me, if you’re allergic then you’re allergic. The testing is so not accurate in my opinion and once they start testing 20 different allergens then how do you know that they have the right allergen?”
This Mom scores very high for both powers of observation and for common sense. In more than thirty pages on testing, Dr. Scott H. Sicherer places the greatest emphasis on a history with the food, and analyzes the uses of the various tests, their strengths and weaknesses, what the various numbers mean, and why they are often so ambiguous, including the reasons for false negatives.
One exceptionally useful section is a quiz on when to administer epinephrine that lays out a series of scenarios and invites the reader to choose from several possible answers, followed by discussion.
Dr. Sicherer is renowned for being a distinguished academic with a great clinical touch. In 2012 he shared the title of top pediatric allergist in New York City with his boss Dr. Hugh Sampson (who also wrote the introduction for this book) and Dr. Paul Ehrlich. His book combines the best of both perspectives, and thus is a good argument for researchers to treat patients as well as their academic pursuits. The medical school setting provides exposure to cases that are by and large more complicated than those confronted in private practice, and access to specialists who can help. Thus, Food Allergies also addresses a range of gastric conditions that come up in food allergy discussions that we don’t address in our book, which concentrates on IgE-mediated ailments, including Irritable Bowel Disease (IBD), eosinophilic esophagitis (EoE), and food protein-induced enterocolitis (FPIES). It seems to me that all the conventional wisdom about such matters as maternal diet, and when to introduce foods, as well as the state of research into desensitization and “cures” is up to date, although these things do change. There is also very judicious advice on alternative medicine and quackery, dealing with school authorities, and much more.
This book is not going to settle every minutely personal problem or concern. Most data is couched in terms of probabilities, not certainties, although some of it will settle particular arguments for all practical purposes. For example, those with tree-nut allergies may wonder about exposure to acorns. Sicherer says, “Acorns are tree nuts, and they might be allergens if eaten, but they are too sour to eat, so there is no literature about reactions to eating them. Like other nuts, it is not likely that touching them would result in any significant allergic reactions.” (I guess the people who had the misfortune of finding out how sour they are had no allergies.) However, the big picture on contact and inhalation will not reassure every worried patient or parent in every instance. That should not stop them from reading the book because the benefits will hugely outweigh their arguments.
By and large, I would prefer not to think as highly of a book as I do of the one Paul, Larry and I wrote together (if I help Dr. Sicherer sell more than we have I’m going to be annoyed). But they are complementary books and there should be room for both on Mom’s night table.
{Note: Three of the five people Dr. Sicherer cites in his preface for having taught him in his career have written for this website—Hugh Sampson MD, Marion Groetch RD, and Sally Noone RN, all colleagues of his at the Jaffe Food Allergy Institute at Mount Sinai School of Medicine in New York City.}