Can I eat Chick-fil-a if I have a peanut allergy?

I hear many parents or kids say they cannot eat Chick-fil-a because they are allergic to peanuts and Chick-fil-a uses peanut oil. There is a lot of confusion surrounding peanut allergy and peanut oil. There are actually 2 different kinds of peanut oils – refined and unrefined.

Refined peanut oil (also called highly refined) undergoes a process in which it is purified, refined, bleached, and deodorized which removes the peanut protein from the oil. These processes extract the oil but eliminate the pigments, aromas, and flavors. Refined peanut oil is stable, has a long shelf life, and has a high smoke-point which makes it ideal for frying foods. Chick-fil-a and Five Guys use peanut oil. Unrefined peanut oil, also referred to as extruded, cold-pressed, aromatic, gourmet, expelled, or expeller-pressed, goes through mechanical processes to extract the oil but does not go through any chemical or high heat steps as with refined peanut oil. This leaves the peanut flavors in the oil. Unrefined peanut oil does contain the peanut protein. Peanut allergy is caused by an allergic antibody (IgE antibody) to the peanut protein and not to the oil.

In 1981, doctors took 10 known peanut allergic patients and gave them peanut oil in increasing doses. They had them return 2 weeks later to eat the peanut oil again. None of the 10 people had any reactions(1). In 1997, researchers fed both refined and unrefined peanut oil on separate occasions to 60 known peanut allergic patients. The study was called a “double blind study” which means the participants did not know which of the 2 oils the were going to receive at which time and neither did the staff who were administering the oils. None of the patients had a reaction to the refined peanut oil. Six out of the 60 had reactions to the unrefined peanut oil(2). Recent studies on peanut allergy show that the amounts of protein found in refined peanut oil do not trigger reactions in people who have experienced very severe reactions(3). In fact, the FDA has specifically stated that highly refined oils (which includes peanut oil) is exempt from the Food Allergy Labeling and Consumer Protection Act.

The take home message is that highly refined peanut oil does not contain the peanut protein and studies have shown it to be safe in peanut-allergic patients. This is the oil that Chick-Fil-A currently uses. Unrefined or gourmet peanut oil does contain the peanut protein and needs to be strictly avoided. Always communicate with the restaurant. Menus/ingredients are always subject to change, and the online version may not change as quickly. So make sure to speak with someone directly at the restaurant to be safe. You can always speak with your allergist to make sure trying peanut oil is right for you. Don’t be afraid to ask and unnecessarily miss out on a lot of mouth watering food out there!

References:

1.) SL Taylor, Busse WW, Sachs MI, Parker JL, Yunginger JW. Peanut oil is not allergenic to peanut-sensitive individuals. JACI 1981;68:372-375.

2.) Hourihane JO, Bedwani SJ, Dean TP, Warner JO. Randomised, double blind, crossover challenge study of allergenicity of peanut oils in subjects allergic to peanuts. BMJ 1997;314(7087):1084-8.

3.) W Marty Blom et al. Assessing food allergy risks from residual peanut protein in highly refined vegetable oil. Food Chem Toxicol. 2017;106:306-313.

Don’t Let Back to School Mean Back to Allergy and Asthma Symptoms

Prepare now so your child eases into a symptom-free year

For kids with allergies and asthma, summer break from school can also mean a break from their symptoms. When school starts up again in the fall, classrooms are often filled with allergic triggers kids don’t face at home, causing parents to see a return of allergy and asthma symptoms they haven’t seen since school let out for the summer.

In the fall, allergists see an increase in kids’ visits for allergies and asthma because of a combination of factors, and hospitals see what’s known as the “September Spike” because kids who have been off asthma controller medications for the summer start experiencing flare-ups in the fall. When kids return to school they’re exposed to different allergens – in the classroom, out on the playing fields and in the school cafeteria – many that they probably haven’t run into all summer. In addition, it’s ragweed season and for kids who are allergic, it’s a terrible time of year.

Below are five tips from the American College of Allergy, Asthma, and Immunology to help your child steer clear of fall allergies in order to focus on classwork and school activities rather than suffering from runny noses, headaches and asthma attacks.

1. Find an allergist, find relief – Well before your child heads into the classroom, make an appointment to see your board-certified allergist. Your allergist will create an allergy action plan for your child by identifying triggers your child may run into and helping them understand what causes their symptoms. Children with asthma under the care of an allergist have a 77% reduction in lost time from school, and an allergist can set your child on the right track, for the long term, to handle their allergies or asthma.

2. Identify potential problems at school – Sometimes parents must act as detectives to root out asthma and allergy triggers at school. Does the school have new carpeting? Sometimes volatile organic compounds (known as VOCs) can result from new carpeting and cause wheezing and sneezing. Are there open windows where pollen can drift into the classroom? Is there a class pet that might be causing allergies? How about mold in the bathrooms? Potential triggers should be discussed with the teacher and school administrators to help ease symptoms.

3. Everyone out on the field! – If your child has asthma or allergies, they should still be able to play any sport they choose as long as they follow their allergist’s advice. While playground games, physical education class, and after-school sports can all trigger exercise-induced bronchoconstriction (EIB), if your child’s asthma is under control, they should be able to participate. Asthma symptoms during exercise may indicate poorly controlled asthma. Make sure coaches and physical education teacher know what to do in case of an asthma-related event.

4. An allergist can confirm a food allergy diagnosis – Parents are sometimes given misinformation about food allergies thanks to home tests and unreliable sources. About 5-8% of children have diagnosed food allergies, and it’s important to work with an allergist to arrive at the diagnosis. If your child does have a food allergy, make sure the school is fully informed. Work with your allergist and school staff to have an action plan that lists the foods your child is allergic to, what treatment needs to be given, as well as emergency contact information.

5. Prep your child – Make sure you’ve discussed how to handle emergencies with your child. No matter what state you live in, your child has the right to carry and use asthma and anaphylaxis medications at school. Children who are at risk of anaphylaxis should have auto-injectable epinephrine available to prevent the severe, life threatening reaction caused by allergies to certain foods or insect stings. Consider getting them a medical alert bracelet. Be sure your child and school staff know how to use emergency medications.

A board-certified allergist is the specialist best trained to treat your child’s allergies or asthma. Work with them to make sure your child’s allergy medications are appropriate for their height and weight, their asthma action plan/food allergy action plan is up-to-date, and that symptoms are under control.

Credit: American College of Allergy, Asthma, and Immunology

I’ll Have the Veggie Burger, Please

Alpha-gal syndrome is a more recently discovered allergy to meat that is most often caused by a tick bite. In 2006, cetuximab was approved as a cancer treatment for head and neck cancer and colon cancer. There were multiple cases of allergic reactions to this medication. Around the same time, there had been cases of adults having allergic reactions several hours after eating but with no known obvious cause. Through diligent research, doctors found that the reaction was to a carbohydrate known as galactose-alpha-1,3-galactose, called alpha-gal for short. Further investigation led them to find that all the cases seemed to be in the same geographic area where Rocky Mountain Spotty Fever, a tick-borne illness, was seen. They discovered that this allergy was induced by tick bites from the lone start tick, Amblyomma americanum.

It is thought that these ticks carry the alpha-gal molecules from the blood of the animals they bite. Then when they bite a human, they inject the alpha-gal into the person’s body. It is not known exactly why, but being bitten by the lone star tick in some people will cause them to develop the allergic antibody (IgE) to alpha-gal.

Alpha-gal syndrome typically presents in adulthood but can occur in late childhood. People could previously tolerate meat without any problems. Then they start to develop symptoms ranging from hives, swelling, abdominal pain, diarrhea, difficulty breathing, lightheadedness, and passing out after eating. Symptoms can by mild to anaphylactic shock. Symptoms typically occur about 2-6 hours after ingesting non-primate mammalian meat such as beef, pork, lamb, and deer. Alpha-gal is usually diagnosed by an allergist using a thorough history and a blood test. The primary treatment is avoidance of mammalian meat and carrying an epinephrine autoinjector in case of accidental exposure. In some cases, people can also react to organs (such as kidneys or liver), gelatin that may be used in candies/marshmallows, and dairy products such as milk and cheese. There are also non-food products that may contain mammalian products such as colloid plasma substitute, some vaccines, pancreatic enzymes, and bovine and porcine heart valves. Not everyone will have to avoid all of these, and this should be discussed on a case-by-case basis with the patient’s allergist. In general, avoidance of mammalian meat is sufficient in 80% of patients. Another 5-20% will also need to avoid gelatin and dairy. Less than 1% usually have to avoid all products that may be derived from mammals. It is important to avoid further tick bites as this can maintain or lead to increases in the allergic antibody to alpha-gal. Avoidance of tick bites can lead to decreases in the level of this allergic antibody. In some cases, it can become negative, and some people are able to add mammalian meat back in their diet.

Alpha-gal is different than the typical food allergies you think of such as to peanuts or shellfish in a few ways. First, alpha-gal is an allergy to a carbohydrate, and most food allergies are to proteins. Second, most food allergy symptoms present immediately after ingestion; whereas, symptoms are usually a few hours after eating the offending food in alpha-gal. Lastly, alpha-gal usually presents in adults whereas most other food allergies usually present in childhood. The best way to prevent the development of alpha-gal syndrome is to avoid tick bites. The lone star tick is in Texas, and I have seen several cases of alpha-gal. If you are having allergic reactions and are not sure of the cause or think you might have alpha-gal, see a board-certified allergist.