Hi Cristina,

A diet free of milk, egg, garlic, tomato, peanut,
tree nuts, and berries is very restricted
already. It is important not to further restrict
the diet if it is not necessary to do so. We
would suggest that this mother discuss these
recommendations with the child's allergist.
Unless the doctor says to, we would not advise
avoiding pitted fruits or other legumes (beans,
chick peas, etc.). I'm not sure where the idea of
avoiding baking soda, baking powder, and cocoa
comes from, but we know of no reason to restrict
them based on the named allergies.

The articles below have more information about food families.

Debbie

The following is excerpted form the Research
Update article in the August/September 2002 issue of Food Allergy News
Copyright 2002 The Food Allergy & Anaphylaxis Network

Clinical Implications Of Cross-Reactive Food Allergens

Individuals with food allergy often wonder if
they have to worry about foods that are "related"
to the ones to which they are allergic. In a
recent review article, Dr. Scott H. Sicherer (a
member of FAAN's Medical Advisory Board and
Assistant Professor of Pediatrics in the Division
of Pediatric Allergy and Immunology, Jaffe Food
Allergy Institute, Mount Sinai School of
Medicine, New York, NY) summarized the rates of
cross reactions among various foods as shown below.

The article highlighted several points, among
them: 1) some food families are very cross
reactive (tree nuts, fish, shellfish, mammal
milk) while others are not (beans, legumes,
grains), and 2) allergy tests are often positive
for related foods (e.g., a positive test for
string bean in someone allergic to peanut) but
true allergic reactions when eating the related
food (in this case string bean) are comparatively uncommon.

The issue of cross-reactivity in food families
can be very complicated and requires a careful evaluation by your
physician.

The chart below summarizes the study findings.

If Allergic to - Risk of Reaction to at Least One - Risk Percentage:
A legume (peanut) - Other legumes (peas, lentils, beans) - 5%
A tree nut (walnut) - Other tree nuts (brazil, cashew, hazelnut) - 37%
A fish (salmon) - Other fish (swordfish, sole) - 50%
A shellfish (shrimp) - Other shellfish (crab, lobster) - 75%
A grain (wheat) - Other grains (barley, rye) - 20%
Cow's milk - Beef (hamburger) - 10%
Cow's milk - Goat's milk (goat) - 92%
Cow's milk - Mare's milk - (horse) - 4%

-Journal of Allergy and Clinical Immunology, Vol. 108, No. 6, 881-890



This article appeared in the October/November 1993 issue of Food
Allergy News
Copyright 1993 The Food Allergy & Anaphylaxis Network

Food Families and Restricted Diets: Do They Go Together?
by Jan Bernhisel-Broadbent, M.D.

If your child has food allergies, you understand
all too well how challenging and, at times,
frustrating a food-restricted diet can
be. Therefore, the last thing you should do is
restrict foods unnecessarily. This article
explains how the common practice of restricting
entire biologically related food families
originated, and why this practice is not needed for most children.

Foods were first classified into biologically
related groups for diagnosing an allergy, in the
late 1920s. Previously, foods had been listed
alphabetically. Some time later, a poorly
controlled study "diagnosed" 17 of 22 patients as
allergic to two or more legumes (peanuts, peas,
beans, soy, and lentils). A later study using
only laboratory blood tests concluded that
multiple food allergies within the legume food family is likely to be
common.

Based on these studies, doctors began to advise
the restriction of an entire biologically related
food family if a patient was found allergic to
one food in that family. There are several
important reasons to question this practice:

There is a problem with compliance. If diets are
overly restrictive, your child is less likely to
avoid the food to which he or she is truly allergic.

There are numerous reports of serious nutritional
deficiencies and diseases in children on overly restrictive diets.

Overrestriction is potentially abusive to your
child and family because food plays such an
integral role in our socialization and daily enjoyment.

The conclusions of the earlier research were not
based on well-controlled studies.

The conclusions of the earlier research were
generalized from information on pollen
allergens. Research has shown that typical food
allergens (the part of the food, usually a
protein, that causes the allergic reaction) behave differently than
pollens.

The evidence for discontinuing this practice of
restricting entire biologically related food
families comes from several well-controlled,
blind food challenge studies. In blind oral food
challenges, patients eat the food in question in
a "hidden" fashion and are observed by a doctor
for a positive or negative response.

Two scientists reviewed the results from 16 years
of oral food challenges of 480 children. They
found that only 11 percent of the children
reacted to more than one food despite many
complaints that multiple foods caused asthma or
other symptoms. Additionally, they reported that
of the 480 children, only 2 were allergic to two
legumes, and only 1 was allergic to two cereal
grains (oat, wheat, barley, and rye).

A much more common pattern of multiple food
allergies is for a child to be allergic to both
milk and egg or peanut and egg--three obviously
biologically unrelated foods. The researchers
also reviewed their peanut-allergic
patients. Only 5 percent of them were allergic
to another legume. None of these patients were
allergic to tree nuts (walnuts, pecans, hazelnuts, and brazil nuts).

In another study, 69 children with one or more
positive skin tests to legumes were
evaluated. Forty-one of these children were
determined, by oral food challenge, to be
allergic to a legume. Only 5 percent, or 2 out
of 41 children, were allergic to more than one
legume. Both of these children had peanut
anaphylaxis and soy allergies. After a two-year
soy-restricted diet, both children outgrew their allergies to soy.

If doctors had relied on the earlier practice of
positive laboratory blood tests or skin test
results to diagnose food allergy, 49 of the
original 69 patients would have been diagnosed as
having an allergy to two or more legumes. The
dramatic difference in numbers results because
many positive skin or laboratory tests to foods
do not accurately predict that allergic symptoms
will occur when the food is eaten. Other studies
have further highlighted how often positive skin
tests fail to predict true food allergy.

Investigators identified 145 patients with
positive skin tests to one or more cereal
grains. Only 21 percent were "truly" allergic to
grain when challenged with oral tests. Only 6 of
these children were allergic to more than one
grain. Similarly, the overwhelming majority of
children allergic to eggs or milk are not
allergic to chicken or beef, respectively.

Patients with fish allergy appear to differ
greatly, however. Some patients react only to
one fish; others appear to be allergic to
multiple fish species (cod, salmon, flounder, tuna, snapper, and so
on).

I commonly see patients who tell me they are
"allergic" to a long list of foods, based on
positive skin or blood tests. But, as you can
see, it is generally unnecessary to restrict
entire food families. There are two exceptions to
these recommendations: tree nuts and shellfish
(crustaceans, such as shrimp, lobster, crab; and
mollusks, such as clams, oysters, and
scallops). Adequate studies, of these food
families have not been completed to date.

Generally, if a skin test and history or oral
challenge are positive to one member of the tree
nut family, such as walnut, I would restrict the
entire tree nut family. The exception is if a
nonallergy to another tree nut, such as pecan, is
confirmed with a negative skin test and negative
oral challenge. Although a food allergy to tree
nuts or shellfish is often life-long and severe,
total group elimination is generally not nutritionally hazardous.

In conclusion, the diagnosis and management of
the food-allergic child should not be approached
casually. The overall goal for successful
management of your food-allergic child is
accurate diagnosis and total restriction of the
specific food only. This step, in turn, will
lead to better compliance, nutrition, and health.

Jan Bernhisel-Broadbent is an allergist in Salt Lake City, Utah.


At 07:30 AM 8/20/2007, you wrote:
>One of my new members has a 3 yr old
>anaphylactic to milk, eggs, garlic, tomatoes,
>peanuts, tree nuts and berries. A Nutritionist
>told her to avoid black all fruits with pits,
>beans, chick peas, baking soda, baking powder and cocoa. Any
thoughts?
>
>Cristina S.
><http://www.protectallergickids.com>www.protectallergickids.com

_______________________________________

Debbie Scherrer, Member Communications

The Food Allergy & Anaphylaxis Network