Dr Du Toit has a research interest specifically in the field of Food Allergy and is able to offer the latest diagnostic tests for the investigation thereof.

EU Food Allergen Labelling

Every pre-packed food and drink sold in the UK or the rest of the European Union (EU) must show clearly on the label if it contains one of the following as an ingredient (or if one of its ingredients contains, or is made from, one of these):

• celery

• cereals containing gluten (including wheat, rye, barley and oats)

• crustaceans (including prawns, crabs and lobsters)

• eggs

• fish

• lupin

• milk

• mollusc's (including mussels and oysters)

• mustard

• nuts, such as almonds, hazelnuts, walnuts, Brazil nuts, cashews, pecans, pistachios and macadamia nuts, peanuts, sesame seeds, soybeans, sulphur dioxide and sulphites (preservatives used in some foods and drinks)

at levels above 10mg per kg or per litre.

'May contain' labelling

Some food labels say 'may contain nuts' or 'may contain seeds'. This means that even though nuts or seeds aren't deliberately included in the food, the manufacturer can't be sure that the product doesn't accidentally contain small amounts of them. If you have a nut or seed allergy you should avoid these food products. If you think a food product has been labelled incorrectly, report this to the trading standards service at your local authority.

Food allergy is a broad subject and has its own FAQ.

IgE-mediated food allergies, also known as immediate-onset food allergies, are most prevalent during childhood, affecting between 6 and 8% of children in the UK. The following food allergens account for the majority of food-induced allergic reactions in young children. As not all food allergies are outgrown, finned fish, shellfish, tree nut and peanut allergies are the most common allergies in adulthood.

Cross-reactive allergic reactions in pollen-allergic children and adults are common and known as the Oral Allergy Syndrome (OAS). An example of this syndrome is the teenager allergic to birch pollen and who experiences oropharyngeal tingling when eating an apple.

Milk Allergy is a childhood allergy and usually outgrown in early childhood (6-8 years); tolerance typically will first develop to baked/highly-processed milk protein (e.g. cake, biscuit), then very well processed milk (e.g. boiled milk - 120 degrees for 20 minutes, hard cheese, butter...) and ultimately, fresh milk. 

The proteins in cow's milk are very similar to those found in milk from goats, sheep and other ruminants (such as deer or buffalo), please avoid all. 

Soy milk and soy milk products are usually safe for cow’s milk allergic children (but avoid if testing is positive to same). 

In highly milk sensitive individuals, even aerosolised milk e.g. inside coffee shops or in aeroplanes, can induce reactions, usually including allergic conjunctivitis and/or wheezing. 

There are many terms used on labels to signify milk protein e.g. dairy, whey, casein, Beta-latcoglobulin, butter, dry milk powder, curds, and traditional foods such as ghee, kefir and kumiss. 

Remember that milk allergy and lactose intolerance are entirely different conditions; a milk allergy occurs to milk proteins and intolerance is to lactose (a sweet sugar found in mammalian milks e.g. humans and cow’s). LI occurs when a person can't digest lactose because the body doesn't produce enough of a specific enzyme Lactase (this typically arises after gastroenteritis and with increasing age in certain ethnic groups, but is rare in young children). Symptoms of lactose intolerance include abdominal pain, bloating and diarrhea. 

Rice Milk - use in young children

The Food Standards Agency have released the results of their study regarding the levels of inorganic arsenic in rice based drinks. The full report can be downloaded from their website: www.food.gov.uk.  The headlines have stemmed from two research papers by the same scientist who has published limited data on the analysis of rice milk and baby rice.
 
As a precaution the FSA recommend: Toddlers and young children between 1 and 4.5 years old should not have rice drinks as a replacement for cows’ milk, breast milk, or infant formula.  This is because they will then drink a relatively large amount of it, and their intake of arsenic will be greater than that of older children and adults relative to their bodyweight. The Agency is not advising anyone to change the way they cook rice as a result of this study. The research published today does not affect the Agency’s advice on any other weaning foods such as baby rice reported in an earlier survey. 

If your child is between 1-4.5 years and consumes rice milk as their main drink please read the recommendations below:

• Children over 1 year of age who are allergic to cow’s milk protein and not soy may be switched to calcium enriched soy milk

• Children over 1 year of age who are already on rice milk and are allergic to cows milk and soy protein may be switched to calcium enriched oat milk or a hypoallergenic formula.

• Children over 1 year of age who are already on a hypoallergenic formula (e.g. Nutramigen 1, 2, Pepti, Pepti Junior, Neocate LCP, Neocate Active or Advance, Nutramigen AA) and are allergic to both cow’s milk and soy protein may wish to continue on their formula and if required, be switched onto a hypoallergenic follow-on formula.

• Children avoiding milk and soy protein have a potentially low calcium intake. If this is the case we may need to consider the need for a calcium supplement and increasing their intake of calcium rich foods.

Avoid other (non-human) mammalian milks if allergic to cow's milk as cross reactivity is common and potentially dangerous. You can find additional information relating to milk allergy here and milk-free recipes here.

Introducing Protein

If unclear as to when and how to perform this, please d/w Dr Du Toit. You may find the Milk ladder helpful.

Dr Du Toit has a research interest specifically in the field of Food Allergy and is able to offer the latest diagnostic tests for the investigation thereof.

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Egg allergy is a childhood allergy that is usually outgrown in early childhood i.e. 6-8 years; tolerance will typically first develop to baked egg (e.g. cake), then very-well cooked egg (e.g. hard boiled egg, waffle, pancake...), and after some years tolerance develops to raw-egg protein (e.g. fresh mayonnaise, fresh ice cream, raw cake mix). 

Avoid the eggs of other fowl e.g. duck and quail as these commonly cross react with hen's egg. Egg white is the dominant egg allergen, but it is difficult to separate from the yolk (unless done as a hard boiled egg), please discuss this with me first if you wish to feed your e.g. allergic child egg yolk.

For 'egg free recipes' and 'egg substitutes', please contact our specialist dietitians. 

Vaccines containing traces of processed egg e.g. MMR and Flu (as injection and nasal spray), will be safely tolerated. We provide this service for Yellow Fever and Rabies, if ever required.

Whilst allergic reactions to egg can appear rather severe e.g. hives, facial swelling and red swollen eyes, egg-induced severe anaphylactic reactions are uncommon. 

Common processed foods containing egg include: malted drinks, custards, mousse, souffles, meringues, glazed rolls or pastries, cakes, and macaroons. 

Dr Du Toit typically performs testing to both processed and raw egg-prior to advising on dietary expansion; when heated-egg has been introduced and tolerated, then Dr Du Toit will recommend and organise for a supervised scrambled egg, or omelette, incremental oral challenge.

Click here for additional information relating to egg allergy

INTRODUCING EGG 

If unclear as to when and how to perform this, please discuss with Dr Du Toit, we have 'egg ladders' available which can guide this process.

EGG FREE COOKING

Powdered egg replacers can be used in most baking recipes that require egg e.g. cakes, cookies and pancakes. They are usually made from tapioca or potato starch and a raising agent such as baking powder. Vegan egg replacement powders will contain soya protein and can be useful for making meringues. Some egg replacers are available on prescription (ask your GP) or can be purchased from health food shops, supermarkets or your local pharmacy. e.g. No-egg replacer (Orgran), Ener-G egg replacer (General Dietary Ltd), Loprofin egg replacer (SHS international) and vegan whole egg replacer (Allergycare). Our dietetic team have many more helpful ideas.

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Nut Allergy is on the increase and one of the commonest forms of food allergy. Before trying to understand nut allergy, it helps to understand exactly what it is that defines a nut. These classifications become increasingly important when trying to safely manage avoidance or exposure to select nuts in nut-allergic individuals.

Whilst we know that the allergens in peanuts are similar in structure to allergens in tree nuts and sesame, these 'sensitivities' are not the same in every nut-allergic individual. Some 60% of people who are allergic to peanuts will also develop allergies to tree nuts; in addition, 25% will be allergic to sesame seed. The understanding of botanical and allergenic relationships between certain nuts is becoming increasingly clear. For example, common co-allergies exist between Cashew and Pistachio and Walnut and Pecan.

Definitions of a Nut: 

• Human Definition: A crazy person!

• Botanical Definition: A simple dry fruit with one or two seeds in which the ovary wall becomes very hard (stony or woody) at maturity. This excludes 'drupes' which are considered 'fruits' in which an outer fleshy part surrounds a shell (the pit or stone) of hardened endocarp with a seed inside (see examples below).

• Common 'cuisine definition': Any large, oily kernel found within a shell and used in food.

Examples of common 'nuts':

• Peanut is a seed/legume/pulse.

• Almonds, Walnuts and Pecans are the edible seeds of drupe fruits (the leathery "flesh" is removed at harvest).

• Brazil nut is the seed from a capsule, as is Horse-chestnut (an inedible capsule).

• Cashew and Pistachio nuts are seeds of thin-shelled drupes.

• Coconut is a dry, fibrous drupe.

• Macadamia nut is a creamy white kernel.

• Pine nut is the seed of several species of coniferous pine trees.

• Doughnut is made of deep fried dough!

Peanut is a legume, like peas, lentils and chickpeas. The proteins in peanut are very different to those in tree nuts (like almonds, brazil nuts, cashews, hazelnut, macadamia nuts, pecans, pistachios or walnuts). Nonetheless, 60% of children allergic to peanut will be allergic to one or more tree nuts and/or sesame.

Nut-induced allergic reactions usually arise due to nuts being eaten in unfamiliar foods (usually provided by an adult). Please teach your child to recognise different nuts and typical nut-containing foods e.g. peanut in snickers bars and crunchy nut cornflakes, pine (and increasingly cashew) in pesto sauce, hazel in nutella, and almond in marzipan. Indian, Chinese and South Asian cuisines frequently contain peanut and cashew nut. The naming of any one specific nut may vary e.g. peanut may be labelled as groundnut, monkey nut, or Arachis. Bird and animal feeds often contain peanut. Kiss-contact may induce allergic reactions; the family (and partners when older) should therefore only eat nuts that we have identified as 'safe'. 

The ‘may contain’ and ‘made in a plant’ labels are a great stress to nut allergic families as they are generally unhelpful and do not guarantee absolute product safety; however, within the EU most of these products seem to be well tolerated by nut-allergic children. If you decide as a family to include such products in the diet then please eat familiar brands and foods that intuitively do not seem to be at higher risk of containing nuts; unfamiliar ‘may contain’ products should also initially be smeared on the lips and ‘cautiously tasted’ before swallowing in larger amounts, this will increase the chance of nut detection (in the event of hidden nut protein). Children must be encouraged to trust their ‘detection instincts’ as this often proves correct i.e. early symptoms must be reported to a responsible adult, a process that is embarrassing with increasing age). Unlike for milk and fish, allergic reactions due to the inhalation of nut protein is rare; hence we perform nut testing with the raw nut proteins in a small clinic room. Whilst refined nut oil is usually safe crude nut oil is definitely not - it is therefore safest to try to avoid all nut-derived oils. Reassuringly, the vast majority of nut-induced allergic reactions are mild-moderate in severity but severe anaphylactic reactions are possible (risk factors include, previous skin contact reactions, increasing age > 5yrs of age, diagnosis of wheezing/asthma). Families must therefore be skilled in the identification, and step-wise management, of severe allergic reactions (anaphylaxis).

Nut allergies are infrequently outgrown (10-20% of cases). Certain nuts are botanically and allergenically closely related; examples include Cashew & Pistachio (and to a lesser extent Brazil nut) and Pecan & Walnut; these patterns will be used to guide our avoidance and consumption decisions. Many of the foods that we considered to be "nuts" are in fact part of a seed or its food source, often with the outer fruit or coating removed. So while we often use the terms "tree nuts" or "seeds" to describe some foods, these categories are rarely useful for predicting allergy to foods of similar appearance or taste. Coconut (including the husk and inner white flesh that we eat) is a seed, albeit a very large one, so if tests are negative you may introduce this. This is true of pine nut. It is not possible to reliably predict the likelihood of allergy to seed or nut-like food without detailed allergy testing, or an unequivocal history of exposure and tolerance. I am not yet offering desensitisation, this is in keeping with leading International Allergy Society recommendations, these interventions are best performed in research settings as they are not always tolerated or successful and are associated with significant risk.

Herewith a great link to more information on Peanut Allergy

Peanut allergy is on the increase and is now one of the commonest forms of food allergy in urbanised, predominantly English-speaking, countries. Nearly 1:50 children in the UK are currently peanut allergic. The exact cause of peanut allergy remains unknown. However, it may be that sensitisation initially occurs via the skin, particularly abraded skin, such as that found in eczematous children. It is therefore critical to control eczema 'aggressively' in young children. Although it is widely accepted that genetic predisposition plays a part, genes would not account for the significant rise in peanut allergies over such a short period. Human genes are unable to change that rapidly. There are no known studied communities that are protected from nut allergy. Peanuts are actually not a true nut, but rather a legume (pulse) ie in the same family as peas and lentils. Peanuts are often called monkey or ground nuts.

Peanut allergy is outgrown in only 25% of children. Peanut-induced allergic reactions are usually mild-moderate in severity but can be severe. Research has shown that peanuts are the top culprit of fatal food allergy reactions, followed by tree nuts i.e. these allergies should be taken seriously by all concerned.  Traditional testing to peanut includes Skin Prick Testing and Specific IgE's. These tests are able to predict for the likelihood of future reactions (upon accidental exposure) but are unable to predict for the severity of future reactions.  

Dr Du Toit is also able to offer advanced testing to peanut including testing to the peanut 'components'. The components are the proteins (rAra h 1,2,3,8,9) that make peanut so allergic; early research suggests that recognition of one or more of the dominant proteins (rAra h 1,2, 3) increases the chance of a more significant reaction upon accidental peanut exposure, particularly if the component is the rAra h 2 protein. The 3 dominant proteins are relatively heat and digestion-stable proteins. In contrast, r Ara h 8 and 9 are heat and digestion labile proteins; sensitivity to these proteins usually arises through cross-reactivity with tree pollens and seldom result in severe reactions i.e. reactions are usually as expected for the Oral Allergy Syndrome (the OAS is more common in children approaching, or in, their second decade of life).

Ingredients to try avoid if you are allergic to peanuts 

Beer nuts, ground nuts, mixed nuts, monkey nuts, nut pieces, and Arachis containing products. Peanut oils represents a low, but real, risk and are best avoided. African, Chinese, Indonesian, Mexican, Thai and Vietnamese dishes commonly contain peanut. Peanut is also called Arachis e.g. Arachis oil (refined peanut oils represent a low but real risk of triggering a reaction). Food products from within the EU are required to indicate the presence of peanut.

You may be able to tolerate one or more tree nuts if you are peanut allergic. This should only take place after Dr Du Toit has performed detailed testing. The nut could then be eaten from the shell to be certain it is not contaminated with nuts to which the patient is allergic.  

Prevention of peanut allergy: Please read up on out recent LEAP Study findings. Dr Du Toit will happily discuss and supervise this approach for all young infants with a Skin Test to peanut of less than 5mm. 

Tree Nut Allergy:
Dr Du Toit will test and advise on all nut allergies. As with peanuts, tree nut reactions can be very severe, even with small exposures.  Cashew Nut Allergy is now increasingly common. Cashew reactions can be rather severe in nature so a clear and detailed emergency plan is therefore prudent. Cashew frequently cross-reacts with Pistachio nut, both should be avoided, unless testing suggests otherwise. Beware of commercial Pesto sauces as these now frequently contain Cashew as a cheaper substitute for pine Nut. Cashew is also frequently found in Indian cuisine.

The botanical definition of a nut caries enormously, for example, pine nuts are a seed and coconut is not a nut. Nonetheless, allergies can develop to these proteins and testing is indicated in nut allergic patients to ensure that this will be safe.

Every pre-packed food and drink sold in the UK or the rest of the European Union (EU) must show clearly on the label if it contains one of the following as an ingredient nuts, such as almonds, hazelnuts, walnuts, Brazil nuts, cashews, pecans, pistachios and macadamia nuts AND peanuts. You find more information here and nut-free recipes here.

Medications that may contain peanut in the UK

Skin creams: 
Siopel (barrier cream) 
Zinc and castor oil ointment (nappy rash, 30% peanut oil) 
Zinc cream (nappy rash, eczema) 
Hewletts (For chapped hands) 
Calamine oily lotion (note no peanut oil in aqueous cream or the ordinary lotion) 

Skin conditions: 
Polytar liquid, AF, emollient (psoriasis, ezcema) 

Gastrointestinal conditions
Colpermin (peppermint oil, often given for irritable bowel) 
Arachis oil enema (for impacted faeces) 

Ear drops: 
Cerumol (ear wax removal) 

Supplements
AT 10
Abidec

Anaesthetics
Propofol - uses soybean oil as a base so theoretically there is a cross-reaction risk. The general feeling seems to be that the very small amount of protein involved makes the risk negligible, but worth being aware of. (Hypertension and general anaesthesia: guidance for general practitioners and results of a questionnaire. Anaesthesia. 63(4):439-441, April 2008. 
Pierson, R. J.; McSwiney, M. M. ) 

Hormone replacements
Deca-Durabolin
Sustanon 100/250
Utrogestan

Miscellaneous
Naseptin cream - to remove staphylococcal infection from nose
Ortho-Gynest - a particular type of topical HRT
Dimercaprol - emergency treatment of heavy metal poisoning.

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Seed Allergy (sesame, poppy seed, pine, linseed, flax-seed). Seed allergy can be severe. The true prevalence is not well known. In the USA, in a study published in 2010, however, researchers at New York’s Mount Sinai School of Medicine concluded that 0.1 percent of the general population may have a sesame allergy, based on a national survey that focused primarily on the prevalence of peanut and tree nut allergy.

Sesame should as best possible be avoided, esp. as sesame pastes e.g. hummus and tahini. Whilst individual seeds e.g. on the base of a seeded roll, or in refined sesame oil, seldom cause reactions, they should nonetheless be avoided. Seeds, unlike nuts, seldom cross react, but for poppy seed. Other seeds e.g. sunflower, linseed, flaxseed may be trialled - if not already eaten. Mustard seed allergy is more common in France.

Every pre-packed food and drink sold in the UK or the rest of the European Union (EU) must show clearly on the label if it contains one of the following as an ingredient (or if one of its ingredients contains, or is made from, one of these): sesame and mustard seeds.

Seeds are often used in bakery and bread products, and extracts of some seeds have been found in hair care products. Some seed oils are highly refined, a process that removes the proteins from the oil. However, as not all seed oils are highly refined, individuals with a seed allergy should be careful when eating foods prepared with seed oils.

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Cereal Grain Allergy (wheat, oat, rye, barley, buckwheat). Wheat Allergy is one of the more common food allergies.

It is most commonly the gluten protein in wheat that causes the allergy. 

Gluten is the major - but not the only - allergen in wheat. Gluten is found in significant amounts in Wheat, Rye and Barley. Oat, Buckwheat and Quinoa are gluten-free and usually well tolerated by patients who are gluten allergic (Buckwheat is found in Japanese noodles and N. Italian Pasta, our Dietitians will have additional recipes). Gluten allergy is not the same condition as Gluten sensitivity (also known as Coeliac Disease), but they are managed the same way i.e. gluten avoidance. 

Dr Du Toit will advise on which cereal grains to trial after testing.

Tolerance to wheat is expected over time, this usually presents as tolerance to small amounts of wheat ie corner of a slice of bread. Larger amounts of wheat e.g. Wheetabix are more allergenic. Wheat reactions can be slightly delayed after eating, typically 60 minutes or so, and can be more common if eaten after exercise/activity.

Gluten allergy is not the same condition as Gluten sensitivity ie Coeliac Disease, but they are managed in the same way i.e. avoidance.

Every pre-packed food and drink sold in the UK or the rest of the European Union (EU) must show clearly on the label if it contains one of the following as an ingredient (or if one of its ingredients contains, or is made from, one of these):cereals containing gluten (including wheat, rye, barley and oats).

Wheat allergy: allergic reactions to wheat and other cereals usually resolve within the first few years of life. Whilst some children develop hives (urticaria), other common symptoms are those of worsening eczema. This usually occurs within a few hours of eating wheat or other cereals that an individual is sensitive to. 

For gluten free diets please click here. 

Wheat allergy can also present as - Wheat dependent exercise induced anaphylaxis, or as an occupational allergy - bakers asthma.

Herewith a great link to more information on wheat allergy

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Seafood Allergy: The two invertebrate phyla, crustacean and mollusks, are generally referred to as 'shellfish' in the context of seafood consumption. Fin-fish can be subdivided into the bony fish, to which most edible species belong, and the cartilaginous fish (sharks and rays). Most studies of fish allergens have focused on cod and carp; however, fish consumption, thus exposure (and subsequently allergy), depends much on regional availability.

• Shellfish Allergy: People who are allergic to one type of shellfish may be at risk for allergies to other shellfish. Shellfish allergens are not entirely similar to fin-fish allergens. Cross reactivity between shellfish and fin-fish is therefore uncommon, but nonetheless requires exclusion until firmly diagnosed. Shellfish allergy can often cause severe reactions, and some people can react to the vapours from cooking shellfish. Severe reactions, usually in patients with both fish allergy and asthma, have been described. Long haul airline travel is a real concern to fish allergic families, as fish is often served hot, and the fumes can be smelt which creates understable concern, and are occasionally enough to induce symptoms such as itchy eyes, runny nose and airway irritation/asthma. Here is a link to a recent review by Prof Du Toit et al.

• Mollusk Allergy: Allergy to the Mollusk family in childhood is described, but rare (in the UK); Mollusks allergy i.e. allergy to one or more of the following : mussel, oyster, squid, limpet and abalone, is more common in exposed populations e.g. Asia. Pre-packed food sold in the UK, and the rest of the European Union, must show clearly on the label if it contains crustaceans (these include lobster, crab, prawns and langoustines) or mollusc's (including mussels, scallops, oysters, snails, whelks and squid).

• Fin-Fish Allergy: Allergy to fish is common. It may be possible, with detailed clinical analysis, to identify one species that will be tolerated, Dr Du Toit will facilitate such testing. To facilitate this process you may need to bring bring a selection of fish to your appointment. Fish-induced allergic reactions usually result from ingestion of seafood but can also be triggered from inhaling cooking vapors and handling seafood in the domestic or occupational setting. Allergic reactions to seafood are not always to the fish proteins; for example, contaminants such as the parasite Anisakis, if present, can cause severe allergic reactions.

Every pre-packed food and drink sold in the UK or the rest of the European Union (EU) must show clearly on the label if it contains one of the following as an ingredient (or if one of its ingredients contains, or is made from, one of these): fish,  mollusc's (including mussels and oysters).

Anisakis (also known as the cod worm): it is possible to be allergic to the worm-like parasite called Anisakis. This parasite, relatively common in coastal fish, can cause urticaria, gastrointestinal upset or even anaphylaxis when present in fresh cephalopods, hake, anchovy or cod. If you react to a particular fish on one occasion, but later eat it with no problem, you should consider the possibility that the cod worm was responsible. An alternate explanation is a scromboid reaction. This usually occurs after eating tuna fish (or other dark fleshed fish e.g. mackerel) which is slightly 'off' and hence full of histamine. The reaction can therefore appear like an allergic reaction but testing will be negative and tuna will beaten in the future.

Shellfish allergic individuals need not avoid iodine. This is an element present in certain seafood including shellfish, seaweed and cleaning products. It is possible to be allergic to iodine, but in fact iodine allergy is unrelated to shellfish allergy which arises due to an allergy to the muscle protein in the flesh of the shellfish.

Herewith a link to helpful information on Fish Allergy and Shellfish Allergy

Names of some of the common major edible seafoods that can cause an allergic reaction include.

• Mollusks: periwinkle (alikreukel), abalone (perlemoen), back mussel, blue mussel, clam, flying squid, limpet, octopus, oyster, ribbed mussel, scallop, snail, squid, white mussel and white squid or smal squid (chokka)

• Crustaceans: crab, crayfish, deep water Prawn, pink shrimp, lobster, langoustine, rock lobster, shrimp, tiger prawn and zebra prawn;

• Fish: anchovy, angelfish or pomfret, Canadian salmon (geelbek), chub mackerel, cob (kabeljou), cod fish, eel, hake, hake, halibut, herring, jack mackerel or scad, jacopeve, John dorey, kingklip (S. Hemisphere eel like fish), mackerel, Maasbanker, megrim or whiff, monkfish, plaice, rainbow trout, salmon, sardine or Japanese pilchard, snoek, sole, and tuna.

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This a well described, but less prevalent allergy. Soya Beans form part of the legume (pulse) family. Soya is used as an ingredient in many food products, including some bakery goods, sweets, drinks, breakfast cereals, ice cream, margarine, pasta and processed meats. Soya flour is used to increase the shelf life of many products and to improve the colour of pastry crusts. Textured soya protein is made from compressed soya flour. It's used as a meat substitute and to improve the consistency of meat products. Reactions have been reported due to Soy in generic medications. Testing to the 'soy IgE components' is a recent advance that increases the accuracy of this diagnosis; Dr Du Toit undertakes such testing.

Eating Soy will not result in peanut allergy, despite both being from the pulse/legume family.

More information on Soya Allergy:

Soya Milk and Allergy: Indications and Contraindications

FARE (Food Allergy Research & Education)

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Kiwi fruit was once considered a luxury food item but are now commonly found in the UK: over the last ten years Kiwi has become hugely popular as part of a healthy diet for children. 

The kiwi fruit initially comes from China, but is now produced in New Zealand, the United States, Italy, South Africa and Chile. 

There  are many health advantages to eating kiwi (if non allergic) as kiwi is rich in vitamins C and E, serotonin and potassium and is purported to have antioxidant activity. Indeed, Kiwi fruit is known to have the highest density of vitamin C for any fruit, and is low in fat with no cholesterol. 

If kiwi allergic, please avoid both golden and green kiwi as they frequently cross-react. Cross reactivity with other tropical fruits e.g. passion fruit, star fruit, dragon fruit, is not well studied. If you are kiwi allergic and wish to eat other exotic fruits, Dr Du Toit will need you to bring small specimens for skin testing prior to advising. 

Kiwi fruit allergy may result in severe allergic reactions and asthma, rash, "hives," and swelling have also been reported.

Whilst kiwi can cause classic and even severe allergic reactions, most kiwi-induced allergic reactions arise due to Birch pollen cross reactivity - this is part of the Oral Allergy Syndrome. 

Kiwi fruit allergy may also occur as part of a cross-reactive syndrome in patients allergic to latex and who may then also develop symptoms when eating bananas, kiwi, avocados, European chestnuts, and, less commonly, potatoes and tomatoes, and peaches, plums, cherry

Skin contact irritation to fruit:

Foods such as tomato, pineapple, kiwi, citrus and berries (which are sometimes low in ph - due to natural acids and high in histamine) may irritate facial eczema; these foods should continue to be eaten but will be best tolerated when eaten cooked, and after the application of a thick moisturiser e.g. Lucas’ PawPaw Ointment (buy online) or Vaseline to any dry skin or eczema around the mouth.

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Allergy to celery is uncommon in childhood but more common beyond the second decade of life. Celery often causes reactions as part of the Oral Allergy Syndrome ie cross reactivity with pollens. Celeriac (the celery root) allergy is more common than to celery (the stalks of the plant), but both can sometimes cause reactions. Cooking of celery does not always render it tolerable. Testing is best performed using fresh celeriac, please bring this to clinic for testing if this allergy is suspected.

Every pre-packed food and drink sold in the UK or the rest of the European Union (EU) must show clearly on the label if it contains celery as one of the ingredients.

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Children can develop allergies to any fruit. Fruit allergies in childhood are on the increase. Kiwi allergy is a particularly well described fruit allergy (both golden and green Kiwi). Dr Du Toit is frequently asked to test to exclude suspected allergies to less common fruit and veg e.g. banana, tomato, melon.

It may also be that foods such as tomato, citrus and berries (which are low in ph and high in histamine) may irritate facial eczema; these foods should continue to be eaten but will be best tolerated when eaten cooked and after the application of a moisturise to the skin and eczema patches around the mouth. In older children, food allergies more commonly arise due to the Oral Allergy Syndrome.

The Oral Allergy Syndrome is caused by 'cross-reactivity' between proteins found in particular fresh foods (fruit, vegetables and nuts) and pollen (usually birch and grass pollen in the UK). OAS symptoms are milder than 'classic' food allergy' symptoms and usually restricted to the mouth and pharynx e.g. tingling and a metallic taste. Birch pollen cross reactivity may occur to one or more of the following foods; hazelnut, apple, peach, pear, apricot, carrot, celery, cherry, kiwifruit, and nectarine. Grass pollen cross reactivity may occur to one or more of the following foods; melon, tomato, orange. The responsible proteins are heat labile, hence the foods will be best tolerated when eaten cooked. peeling of apple also reduces the allergen load. Symptoms are most prevalent during the associated pollen season.

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There are numerous foods that belong to the Legume (Fabaceae or Leguminosae) family and nearly all have been described as potential allergens. Legumes typically develop from a simple 'carpel' which 'dehisces' i.e. opens along a seam on both sides.

More troublesome legumes include:

• Peanut (also called monkey nut, ground nut, Arachis)

• Soya bean

• Beans - there are numerous bean varieties.

• Alfalfa, Clover, Carob

• Peas (green...)

• Lentils (Daal or Dal), there is enormous variation in appearance including; yellow, red-orange, brown and even black

• Lupins (also called lupine flour, lupine seed)

• Mesquite (legumes of mesquite plant)

Peanut Allergy would represent the commonest allergy to a legume in Westernised countries. Interestingly, Legume allergy appears more common among allergic children (i.e those with eczema or egg/milk allergy) of S. Asian descent. In this scenario detailed allergy testing will be required (unless these foods have previously been eaten and tolerated) prior to safe dietary expansion. Testing is best performed with fresh specimens of these foods which should ideally accompany parents to clinic if such allergies are suspected: this will facilitate 'prick to prick' testing.

The cross reactivity within an between beans, and lentils, is not well studied. Dr Du Toit will perform testing prior to advising on the safe introduction of an alternate member of the family.

The Legume Family (Leguminosae)

• Acacia gum (E414)

• Adzuki bean

• Bean sprouts

• Black gram

• Black eyed beans

• Broad bean, faba/fava bean or windsor bean

• Butter bean, lima or Madagascar bean

• Carob/Carob gum (E410)

• Chick pea (Bengal gram/gram flour/Besan)

• Cow peas

• Fenugreek

• Flageolet bean

• French bean

• Green bean

• Ground nut (peanut)

• Guar gum/Guaran/Guar beans/cluster beans (E412)

• Haricot bean (baked bean)

• Karaya gum (E416)

• Kidney bean

• Lentils (all types eg brown, green, red)

• Liquorice

• Locust bean gum (from carob tree) (E410)

• Lupin

• Mangetout

• Mung bean, green gram or golden gram

• Marrowfat peas

• Peanut, ground nut or monkey nut

• Peas

• Red gram or pigeon pea

• Rice bean

• Runner bean

• Snow peas

• Snap bean

• Soy beans / soya / soya bean hemicellulose / edamame beans (E416)

• Split peas

• String bean

• Sugar snap pea

• Tamarind

• Tara gum (E417)

• Tonka bean

• Tragacanth gum (E413) – is from the sap of Astragalus gummifer shrubs which is part of the Astragalus family of shrubs and weeds, - these are classified as Fabaceae or Leguminosae, so Tragacanth gum may be classified as a legume. There have been case reports of reactions to tragacanth gum but there are no allergens identified. As it is from the sap of the plant it may need to be taken with caution, or even avoided if people are highly sensitised and reactive to legumes

• Winged bean, ogoa bean or asparagus-pea

 The following are NOT legumes but some patients may react to them:

• Agar (E406) –a polysaccharide found in seaweed

• Carrageenan gum (E407) – a polysaccharide found in seaweed

• Gellan gum (E418) an extracellular polysaccharide, secreted by the bacteria Sphingomonas paucimobilis

• Gum Arabic (E414) – from the sap of the acacia tree. Gum Arabic is defined as the natural exudate from Acacia Senegal (L) Wild.

• Karaya gum (E416), from the sap/dried exudate from Sterculia wens Roxb of Sterculia trees

Xantham gum (E415) it is a complex exopolysaccharide produced by the plant-pathogenic bacterium Xanthomonas campestris pv. campestris

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Lupine (flour/seed) is an Australian seed, related to legumes such as peanuts, peas, lentils and beans. Lupinus albus (of the genus Lupinus, which has about 500 members, including ornamentals) is the species most widely cultivated for food. Dried lupini, prepared by boiling — a traditional snack in some Mediterranean countries — have been reported to cause anaphylaxis. Lupin flour and bran are widely used in Europe in bread, pasta, biscuits and other baked products, confectionery, and soya substitutes. Inclusion of lupin in wheat flour was officially authorised in France in 1997. Lupine was introduced in the United Kingdom in 1996 and has been recognised as a new or novel food. Lupin flour and bran are now entering into food manufacturing, where they contribute favourable protein content, fibre, and some textural properties. Lupine flour is occasionally used in foods such as pastries, pizza bases.... only in very few peanut allergic children will it cross react. Allergy to lupin has been recognised for some time in mainland Europe, particularly in France, where lupin flour is used widely in food products. 

Reactions are usually mild-moderate in severity, however, anaphylaxis, is described. There have been very few confirmed reports of lupin allergy in the UK so far (but many peanut allergic children will return low positive allergy tests to lupine; this arises due to cross-reactivity and does not always imply 'allergy').    

Every pre-packed food and drink sold in the UK or the rest of the European Union (EU) must show clearly on the label if it contains lupin as an ingredient.

Here is a link to the UK Anaphylaxis page on Lupine Allergy.

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