The study, published in the European journal Allergy, found that in a group of 141 selected children with peanut or cashew allergy, the cashew group was more likely to experience shortness of breath, wheezing or cardiovascular symptoms during reaction than the peanut group. (This was despite the fact that a majority of the children with peanut allergy also had asthma.)

The Study and Findings

In 2007, researchers paired 47 children whose worst ever allergic reaction was to cashews with 94 children whose worst ever allergic reaction was to peanuts. Two children with peanut allergy were matched to every one child with cashew allergy and comparison criteria also included sex,

The study revealed that 22 per cent of children with cashew allergies experienced shortness of breath and/or collapse compared to 1 per cent of children with peanut allergies.

Also, while oral antihistamines were most frequently used as treatment by both groups, epinephrine was administered much more often in the children with cashew allergies. (Thirteen per cent of the cashew allergic compared to 1 per cent of the peanut allergic.)

What This Means

This study is important because: it shows the severity of tree nut allergies in general, the cashew specifically and raises the issue of the need for better public awareness.

The researchers advised fellow health-care professionals that “the diagnosis of cashew nut allergy increases the odds of a severe reaction and requiring intramuscular adrenaline and should also be considered in the risk assessment.”

As well in terms of managing the allergy, they noted that cashew can be a hidden food. “Cashew nuts present a considerable hazard, being hidden in a wide variety of commonly ingested foods, such as Asian meals, sweets, ice cream, cakes, chocolates and they are increasingly used in commercially prepared pesto sauce instead of pine nuts,” they wrote.

awareness in the public of the seriousness of tree nut allergy is not as high as awareness of peanut allergy.   it places importance on tree nut allergies despite the fact that peanut allergies tend to get more attention in scientific studies and the media. While it is now very common to see “Peanut-Free” logos on snack foods and candy bars, it is rare to see the same for tree nuts.

Further, we now suggest that the diagnosis of cashew nut allergy increases the odds of a severe reaction and requiring intramuscular adrenaline and should also be considered in the risk assessment.

It has been suggested that cashew avoidance is easier than peanut avoidance (10, 14); nonetheless it is not straightforward. A recent study showed that 10/37 (27%) of nut-allergic children were unable to correctly identify the type of nut to which they were allergic (15). Cashew nuts are commonly sold as the whole nut alone, or packaged with other nut types. Cashew nuts present a considerable hazard, being hidden in a wide variety of commonly ingested foods, such as Asian meals, sweets, ice cream, cakes, chocolates and they are increasingly used in commercially prepared pesto sauce instead of pine nuts. Specific information on how to achieve nut avoidance should always be provided.

The study found that cashew allergies, specifically, are on the rise and are no longer uncommon. Furthermore, it can be just as challenging to avoid cashews as it is to avoid peanuts since cashews can hide in desserts, ice creams, trail mixes and other unexpected places.

More on this study, click here.

1. Refined Oil: When a peanut or nut oil is refined, the chances of the proteins of that food being in the oil are low. While pure refined peanut oil does exist, it is always safer to avoid peanut oil completely since there is no definitive way to tell how much protein is in that oil.

However, as Dr. Antony Ham Pong states, “if a peanut allergic person accidentally eats a food with refined peanut oil, the chances of having an allergic reaction are low because even there is peanut protein in there, it will likely be in very small amounts.”

2. Unrefined Oil: Peanut and nut oils that are cold-pressed,” “unprocessed,” “expelled,” “extruded”) peanut and nut oils are unsafe for peanut and nut allergic individuals. These are much more likely to contain peanut and nut proteins.

3. Where Peanut Oil is Found: It is also important to remember that peanut and nut oils are found in some cosmetics and body-care products. Pay specific attention to lip balms, lipsticks and lip glosses (some are even peanut-butter-flavored!) since those are coming in direct contact with your mouth.

In restaurants, be sure to  ask waiters specifically about the oil used in deep-frying or in sauces; sometimes it is peanut oil.

Sources include: Dr. Antony Ham Pong, allergist

When someone with a tree nut allergy ingests their allergen, even a trace amount, that person is at risk of a severe allergic reaction, called anaphylaxis. An anaphylactic reaction includes more than one of the body’s systems, such as the respiratory tract, gastrointestinal tract, the skin and cardiovascular symptom.

Symptoms of an allergic reaction include tingling in the mouth, swelling of the tongue and throat, itchy skin or hives, difficulty breathing, abdominal cramping and vomiting. In a severe anaphylactic reaction, a person may experience a drop of blood pressure, loss of consciousness and even cardiac arrest and death.

One of the issues in managing tree nut allergies is that reaction symptoms can vary greatly. A person may have minor symptoms on one occasion, but anaphylaxis on a next exposure.

Because tree nut allergy reactions can be severe, it is important that a person with this allergy carry an epinephrine auto-injector (EpiPen or Twinject) with them at all times. Research has shown that a small number of people (about 9 per cent) may outgrow their tree nut allergies.

Prevalence

In Canada, 2009 statistics show that 1.14 per cent of the population is allergic to tree nuts, while in the United States 1.1 per cent of children have the allergy and 0.5 per cent of adults. Tree nut allergy is on the rise: the 2008 telephone survey in the U.S. that found 1.1 per cent of children are allergic to nuts, compare that to just 0.2 per cent of children reported as allergic to nuts in 1997.

More on Tree Nut Allergy Statistics

Next Page: What is a Tree Nut?

Peanut

• Tennis player Serena Williams
• NHL player Tom Poti, defenceman for the Washington Capitals
• Singer Alex Kapranos, Franz Ferdinand
• Freestyle aerials champion Steve Omischl

Tree Nut

• Singer Clay Aiken
• NHL player Tom Poti

In her experience, airlines had stopped serving nuts years ago – pretzels were the norm now – so she didn’t think to contact Air Canada in advance.

But 10 minutes after takeoff, Humphreys’ tropical vacation became an allergy nightmare: Thousands of feet in the air and locked in the thin metal tube with nothing but hours of ocean ahead, the flight attendants began handing out packages of cashews – by far Humphreys’ worst allergy.

The 43-year-old knew she had to speak up, so she tapped one of the flight attendants on the elbow and explained that she was extremely concerned about the possibility of a serious reaction.

“The flight attendant was nasty. She said, ‘Well, we just can’t take care of everybody,’” recounts Humphreys. The crew continued to dole out the nuts. “So I had to bide my time and hope that nothing happened.”

Luckily, nothing did. But Humphreys and her husband spent much of their vacation trying to figure out how to get Paige home safely. Air Canada told them, as they do all allergic travelers, that it would be “unfair to other passengers” to withhold nuts, and that it was the couple’s responsibility to “bring the proper medication and to have the proper protection.”

Problem was, the “proper protection” included not being surrounded by people eating cashews. Humphreys began looking into other options. “But the other airlines serve nuts, too,” she says. So I thought, ‘I’m no better there – and I would be alone, too.’”

When it comes to nerve-wracking and sometimes dangerous experiences of flying with food or environmental allergies, Humphreys is definitely not alone. In the past decade, allergies themselves have taken off: roughly one million Canadians and 11 million Americans now have food allergies, and approximately 23 million North Americans have asthma.

Still, airlines have not adapted to this new reality. Few have clearly defined policies and procedures in place for allergic passengers, and they continue to serve some of the most highly allergenic foods, including nuts, sesame, fish and shellfish. Some even still hand out peanuts, the most prevalent trigger of serious reactions.

But many allergy sufferers and parents of allergic kids think it’s high time airlines made the skies safer for the millions of travelers with allergies. Dozens have filed formal complaints with airline regulators such as the U.S. Department of Transportation and the Canadian Transportation Agency.

In 2002, we took our first summer vacation in Europe with two children. Kieryn was not yet 3 years old and Taya had just turned one. We flew into Toulouse in the south of France and rented a car for what should have been a simple two-hour drive on the motorway to our villa near Perpignan.

We were barely onto the motorway when Kieryn called out: “I have to go pee!” Fortunately the French have a lot of rest stops, and we pulled over briefly. Back on the motorway, we’d only driven 15 minutes more when Kieryn again had to go.

She was toilet training, and we were trying to encourage that, so I pulled over at the next rest stop. Back under way and, you guessed it, 15 minutes later, Kieryn “had to pee”. I was a bit frustrated, but once more pulled over.

While my wife Keely and Kieryn were in the bathroom, Taya, our younger daughter, woke up crying; she’d soiled her diaper and it had leaked right up her back. I got her out and began cleaning up the mess. Keely returned to help, first giving Kieryn some bread with cream cheese to keep her occupied. We had Taya cleaned up and dressed when I noticed Kieryn had just spread the cream cheese all over the front seat.

At this point I lost it, asking Keely, whose bright idea was it to go on vacation to Europe with two small children. She calmly pointed out that it was all mine, to which I replied, “That’s why I married you, so you’d talk me out of these crazy ideas.”

Traveling with children, even without food allergies can be challenging, but it is also highly rewarding. Despite that rough start, we had a great first trip with two kids, and we find that enjoying new experiences as a family can be uplifting.

It does, however, take careful planning to travel with children with life-threatening food allergies. The good news is that our food requirements are complicated – so if we can do it, you can, too. Taya has multiple allergies, including peanuts, nuts, sesame and kiwi. Keely and I are vegetarians, and Keely is allergic to eggs. As well, I have allergies to dust and cats.

Our fundamental approach explains the “Have Kitchen” title of this series: we always stay in places with a kitchen, and prepare as many of our own meals as humanly possible. Not only does this keep us safe, it also saves money, especially in Europe where eating out can be expensive.

City or Countryside?

Europe has a wonderful selection of self-catered villas and apartments for rent, usually for a minimum of one week. While many people think villa vacations are for the wealthy, in fact, there are villas in every price range. Sharing these acommodations with family or friends makes them even more affordable.

If you want to spend your time sightseeing at museums, churches and landmarks, then look for an apartment in a city. If you want to spend it relaxing in the country or at the seaside, then there are lots of villas to choose from as well. For the best of both worlds, consider one week in a city and one in the country. (Remember that if you are renting outside a city, you will need to rent a car to get around for sightseeing day trips and for groceries.)

The Internet is a great source for finding villas. If you can travel outside of high season, you’ll find the best selection and prices. It’s possible to rent directly from an owner, but I recommend that first-time renters book through an agent. Check that the agent has seen the properties recently, and have a list of questions ready to ensure you get a villa that suits your family.

Our European Trips

England/Ireland – England is the most accessible of the European countries for English speakers, and what better way to experience it than to stay in an historic building. The Landmark Trust is a charity that rescues heritage buildings and gives them new life as places to stay. There are 185 “Landmarks,” including forts, manor houses, mills, cottages, castles, follies, gatehouses and towers (www.landmarktrust.org.uk).

We stayed in a 17th century house called Shelwick Court near Hereford, with beautiful countryside. The Irish Landmark Trust is a similar organization with properties throughout Ireland (www.irishlandmark.com/home/self-catering-ireland.html). You can also rent apartments in London and other major cities in the U.K.

Next: France, Spain, Italy

Owl’s Head – For more than 20 years now a large group of 50 family and friends has gone skiing every spring at Owl’s Head (www.owlshead.com) in the Quebec Eastern Townships, about 1.5 hours east of Montreal. Owl’s Head is one of the last family-owned ski resorts in Canada and also one of the best values. The resort offers one- to three-bedroom condos with full kitchens with excellent ski-in, ski-out access. It is rarely crowded, has a good mix of runs for all levels, but après ski activities are limited. Views of Lac Memphremagog are stunning.

Mont Tremblant – We have been to Mont Tremblant (www.tremblant.ca) in both winter and summer. It’s located 132 kms north of Montreal and consistently rated the Number One ski resort in eastern North America. It is pretty much the opposite of Owl’s Head, and is a full fledged four-season resort with shopping, swimming and lots of restaurants. It also has golfing, swimming, boating and biking in the summer. Tremblant has studio to four-bedroom condos with good ski-in, ski-out access. There is a good mix of runs and lots of après ski activities. But it can be crowded, and sometimes very cold.

Smugglers Notch – Smugglers Notch, Vermont (www.smuggs.com) is about 165 kms south of Montreal and is consistently rated the Number One ski resort for family programs in North America. Accommodations range from studio to five-bedroom condos with full kitchens and good ski-in, ski-out access. There is an excellent learn to ski program for children as young as 2½ years old, as well as more non-skiing activities for children than any resort I have been to. These include: a fun zone with inflatable slides, bouncy house, pools, basketball and mini-golf. Resort has a good mix of ski runs for all levels, but can be crowded on weekends because there are no high-speed chairlifts.

Sugarbush – My favourite ski area in the east is Sugarbush, Vermont (www.sugarbush.com), 235 kms south of Montreal. It has studio to five-bedroom ski-in, ski out condos with an outdoor, heated swimming pool and hot tub. There is a great variety of skiing, with lots of easy and intermediate runs as well as among the best expert terrain in the east. The luxurious new Claybrook Residences have a valet to park your car, a ski valet to stow your skis and a boot valet to dry and warm your boots.

Silver Star – My daughters’ favourite ski trip was to Silver Star Resort (www.skisilverstar.com) in British Columbia’s Okanagan Valley, about an hour from Kelowna. There are reasonably priced studio to six-bedroom condos and chalets with excellent ski-in, ski-out access. The chalet we stayed in was so close to the run at Silver Star that the kids could ski right onto the back porch. It has a good mix of runs for all levels, lots of après ski activities and rarely gets crowded.

Big Sky – My wife Keely’s favorite ski area is Big Sky (www.bigskyresort.com) in Montana, 70 kms from Bozeman. The village has ski-in, ski-out studio condos to five-bedroom homes. It features lots of groomed, intermediate cruising runs as well as easy and hard runs and never has crowds. There are swimming pools, restaurants, a spa, shops and it’s also near Yellowstone National Park.

Whistler Blackcomb – The largest resort in North America is Whistler Blackcomb (www.whistlerblackcomb.com) in British Columbia. This is a huge resort, 125 kms from Vancouver, which will host the alpine skiing event of the 2010 Winter Olympics. It features over 200 trails for every level of skiing. There are three villages at the base of two mountains with studio to six-bedroom units. Some of the accommodations are ski-in, ski-out, but others require you to walk or shuttle to the lifts. There lots of activities to keep you busy, regardless of whether you ski or not, but it is not cheap.

Next Page: More ski resorts.

Before you fly:

• Call the airline and ask about their allergy policy before you book your ticket. You don’t want to find out by surprise that peanut satay is being served on your flight to Hong Kong.
• Look at the airline’s website or call customer service to find out what foods are served or sold on board.
• When you book, make sure to tell the reservations or travel agent about your allergies, and what specific accommodations you need.
• Book a flight that’s earlier in the day, because the planes get cleaned overnight, and there is less likelihood nut snacks will be consumed in the morning. This means less chance of encountering the allergen on seats and in seat pockets, etc.
• Book direct flights if possible, so you’re not dealing with multiple planes and flight crews.
• Bring your auto-injectors and/or asthma medications with you onto the plane (do not check them). Security may require that these medications show a prescription label in the name of the patient/traveler.
• It’s wise to carry an official doctor’s note stating that the medication is required for severe allergies or asthma. See sample notes here.

When you fly:

• Tell everyone you deal with – the check-in agent, the staff at the gate, the flight attendants – about your child’s or your allergies. Even if the booking agent said you will be accommodated, play it safe and make sure everyone knows.
• Arrive at the gate early and talk to the staff before they’re too busy. Be clear, calm and polite.
• If concerned about contact with allergen residue from previous passengers, ask to pre-board and wipe down the seats, tray tables and armrests. You can also cover the seat with a blanket or a seat cover. Bring wipes to wash your hands.
• Bring your own food. Don’t eat meals prepared by the airline’s caterers, even if a flight attendant tells you there are no nuts or other allergens. You don’t know if there has been cross-contamination in the preparation. Bring extra food in case of delays.
• Keep medication with you; do not store it in the overhead bin.
• If someone near you is eating a food that is dangerous to you, politely explain your situation and ask if they would be willing to stop. If they are, say thanks and offer to buy them some food that is safe.
• Keep your hands out of your eyes and mouth.
• Have a plan for what happens if you react.
• If you are reacting to something, tell the flight crew. It is important that they know about your condition.

After you fly:

• If you had a good experience, make sure to thank the flight crew for their efforts, and tell them you’ll definitely fly with the airline again. Write a letter to the airline (copying the company president), expressing your appreciation, and noting that you will certainly travel with the company again and will encourage others to do so.
• If you have an unpleasant experience, write to the airline and politely explain what happened. Tell them that you and your family will think twice before flying with the carrier again. Also include information about what could have made your flight better.
• You can also lodge a complaint with the U.S. Department of Transportation or the Canadian Transportation Agency.
  

First published in Allergic Living magazine.
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See Also:

• Flying Allergic by Jennifer Van Evra
• Scott McKenzie’s Rules for traveling with food allergies
• Travel Guide 1 -Have Kitchen, Will Travel
• Travel Guide 2 - Off to Europe
• Flying With Food Allergies – Allergic Living’s Essential Tips

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