Don't Poison the Guests: Advice on Food Allergies, Intolerances and Sensitivities

Illustrations by Lila Volkas

As her friend spooned a ladle of steaming, scalloped potatoes onto Tara’s plate, he murmured, “Oh, I always put a bit of flour in the sauce, I’m sure a little won’t hurt you.”

“Yeah, right,” replied Tara, who has celiac disease and had provided her host with a complete rundown of her extreme intolerance to gluten, “if you want me to end this evening in an ambulance!”

Modern menus have turned into minefields, as it seems that everyone and their little brother asserts their sensitivity to something: nuts, wheat, dairy, soy, eggs, fish--even cilantro. Suddenly, it’s puzzling or even perilous to invite people over for a simple meal. What’s the difference between a trendy, personal preference and a life-threatening condition and what can we serve that all our guests will enjoy without a trip to the ER?

When I cook for friends, I always inquire about their dietary restrictions, because I have a collection of my own: bell peppers make me burp, and dairy, wheat, and soy cause painful bloating. But luckily, my food intolerances are not the same as allergies and thus are easily managed. Lacking the right enzymes to digest these foods, I do best just avoiding them, but I’ve also found some workarounds.

Goat milk, for instance, is much easier to digest than cow’s milk because it contains less lactose and its fat molecules are one-fifth the size of those in the bovine beverage. So I only pig out on goat cheese. If someone offers me a tempting slice of their homemade pumpkin bread, I can pop a couple of enzyme pills, which usually do the trick. And even if I unknowingly consume a bite of wheat or dairy, while I might be uncomfortable for the rest of the evening, it won’t send me to the hospital.

Not so for my friend Rachel, who has severe allergies to a host of foods, especially fish and nuts. These extreme allergies run in her family and compel her to carry a self-injecting dose of epinephrine, which might just save her life.

Scientists cannot yet explain the recent rapid growth in the number of people (especially children) who suffer from potentially fatal food allergies. Nearly 15 million Americans have a moderate to severe food allergy. This now includes 1 in every 10 preschoolers, a rate that has more than doubled in the last decade.

These life-threatening allergies are a disorder of the immune system, in which the body sees the allergen as a foreign invader and mobilizes its forces to attack by releasing histamine and other powerful chemicals that trigger allergic symptoms, such as nausea, hives, itching, swelling, and shortness of breath.

It only takes a tiny bit of the offending food to unleash anaphylaxis which can lead to death in a matter of minutes. Even kissing a person who just snacked on sushi or polished off a PB & J is enough to spark an onset of dire symptoms.

With more children suffering from severe allergies, their parents try to cope by taking full control of everything their children put in their mouths--a daunting task. But recent news of a new therapy has shown promising results in desensitizing even those with multiple allergies.

When my friend Rachel was in her twenties and had a battery of allergy tests, her doctor noticed obvious positive results for allergies to many fish, but didn’t see a reaction to salmon and so recommended that she cautiously experiment with it. The next time Rachel and her husband went out to dinner, he ordered the grilled salmon and she dipped her fork into a drop of salmon juice run-off, but the minute it hit her tongue, Rachel immediately felt a tell-tale itching sensation on her lips. Her husband rushed her to the hospital and she made it just as her throat was dangerously starting to swell.

Now, Rachel picks her restaurants carefully (avoiding fish-forward cuisines like Japanese or even Thai, where fish sauce is a common ingredient although it’s not always listed on the menu). She informs waiters and friends that she cannot have any nuts or fish or even anything that came in contact with these foods.

“Sometimes people just don’t understand the severity of this condition,“ Rachel tells me. “Last summer, I was invited to a friend’s barbeque and although he assured me he would be preparing chicken and burgers, when I arrived I saw a plate of fish sitting by the grill. I was horrified. My friend had good intentions, but didn't understand that cooking my chicken next to his fish could cause an allergic reaction. In the end, to my immense relief, he decided not to cook any fish that night.”

Celiac disease is another autoimmune disorder, but one that targets the small intestines. Gluten destroys the villi, which are fingerlike projections lining the small intestines, where the vitamins and nutrients from the foods we eat are supposed to get absorbed. Continued exposure to gluten often wreaks havoc on the entire body.

My friend Tara only discovered she had celiac in her mid-30s, after a lifetime of assorted complaints (skin problems, arthritis and digestive issues). After a few months on a trip in India, (with its rice-based diet), her symptoms inexplicably improved. But when she returned to California, they worsened. A clever doctor made the connection and the diagnosis.

“Twenty-five years ago, there weren’t many resources for those who have to eat gluten-free,” says Tara, “but thankfully now there is so much more awareness, gluten-free products even restaurants with gluten-free menus. “And Mariposa Bakery in Oakland,” adds Tara smiling, thinking about their cupcakes.  Tara has become an expert gluten-free baker herself so that she does not have to feel deprived.

For both my friends Tara and Rachel, getting invited over to someone’s house for dinner necessitates preparation and backup plans. They let their hosts know their dietary restrictions and often offer to bring a dish to share. If they are going to a large event where it won’t be easy to know for sure what possible allergens are in the food, they may eat something at home first, or bring an emergency back-up snack, just in case.

Like my problem with peppers, some food sensitivities don’t fall neatly into the categories of intolerance or allergy. Take the great cilantro divide. Genetics seems to determine whether we love the fragrant green leaves or find their flavor reminiscent of soap.

And while the focus here is on medical conditions, strongly held personal preferences and practices -- from veganism to the Paleo diet -- can be just as fervently followed and thus present their own set of hosting hurdles.

ADVICE FOR THE HOST

What are the best ways to deal with this array of possible food proscriptions? It depends on the size of the group you are cooking for. If it’s an intimate dinner for a couple of friends, you can probably make the whole meal conform to their dietary needs and thus be assured of a relaxed evening for everyone. Here are some other strategies if you are coordinating a large potluck or serving a buffet for 100.

TIPS

• Ask guests re: dietary restrictions before you plan your menu. If you are unsure of the specifics of their sensitivities, ask clarifying questions.
• Keep the labels, boxes and bags of foods you used, so guests with allergies can check them out. Sometimes they will recognize a benign sounding ingredient as potentially harmful.
• On a buffet table: a card next to each dish, detailing ingredients will be much appreciated.
• Since even a small amount of an allergen can make people sick, avoid cross-contamination of utensils, dishes and cutting surfaces with offending foods.
• A “make-your-own” bar for salads, tacos or ice cream sundaes, etc. will allow guests the freedom to include or avoid ingredients.
• Provide questionable add-ins in separate bowls, each with its own spoon, to avoid cross-contamination
• For a potluck or buffet, set aside a corner of the table for g/f, nut-free, vegan, etc. so these dishes can be grouped together.
• Read labels. There may be hidden ingredients that you are not aware of, (e.g., regular soy-sauce contains gluten; while wheat-free tamari does not).
• Don’t take it personally, if a friend declines to try your prize-winning ceviche or sculpted marzipan fruits.