Living with food allergies

Parents in Pakistan often have a hard time getting allergies diagnosed and treated. Zainab Mahmood-Ahmad provides a handy guide

Living with food allergies
“Mama, can I eat this?” is a question many of us mothers train our children to ask (or at least wish they would) but for some of us, it has to be followed by a, “it doesn’t have egg, milk or wheat in it, so it’s safe for me right?”. We are mothers of children with food allergies and amongst all the challenges that parenting brings, this is ours.

What does an allergy look like?

Unfortunately due to a lack of awareness, specialists or allergy clinics, people in our parts of the world often don’t know what they are facing when it comes to constantly sick children – at the end of countless courses of antibiotics, a panel of generic blood tests which don’t reveal anything in particular, parents still aren’t given answers and accurate diagnoses. This requires a proactive response, which means learning to recognise the signs of a food allergy and knowing who to see about it and what kind of help to ask for. Food allergies are a reaction in our immune system (which is designed to protect us from toxins and infections) and can sometimes be seen immediately after ingesting the food, with an appearance of a rash, swelling of the mouth and airwaves leading to difficult breathing, loss of colour in the face, or much more subtle cues such as digestive problems, stomach pains, diarrhoea, constipation and vomiting. There can also be delayed reactions which can range from constant itchiness, appearance of hives and eczema (skin rashes on chest, back, legs and scalp), cough, runny nose, sneezing and muscle pains in arms and legs. With such a wide array of symptoms any parent could find themselves overwhelmed but knowing what you’re dealing with is half the battle won.

Getting a diagnosis

Once we feel that we are seeing signs of allergies then the next step is to know how to identify them. Unfortunately the general trend amongst the medical community here seems to be to prescribe medicines, nebulizers and inhalers while failing to empower the parent with knowledge about the bigger problem. Which is why we need to ask the right questions - if this is an allergy, is it environmental or food related? How do we test for that? What can we do about it? How long will it last? What harm is it causing my child in the process? Are these medicines safe to use for long periods of time?

There are a few blood tests available to begin the identification process. An IgE serum test can be conducted to find out if there are a high number of immunoglobin E in our body, the presence of which indicate that there is an allergy. There is also a basic food and environmental IgE test available in major cities across Pakistan to identify allergies to eggs, milk, peanuts, cockroaches, dust mites etc, as well as skin prick tests which are a painless method of depositing a diluted form of the allergen on the skin and waiting for a temporary skin reaction. The Allergy Centre at the National Institute of Health Islamabad also has a wider array of tests and therapies available to diagnose and medicate allergies.

Food diary and elimination

One of the simplest and least intrusive way to identify the problem is to begin at home, by keeping a food diary. You can begin with observing and noting down what your child eats for her meals and snacks for a few days and noticing what symptoms she experiences (even the ones that appear unconnected). The next step is removing the main allergens, one by one to see if there’s any change in symptoms, overall health and even behaviour. The 8 main allergenic foods are milk, eggs, fish, shellfish (prawns etc), tree nuts (almonds, cashews, coconuts etc), peanuts, wheat and soybean. By removing one item from their diet, completely, for a few days allows the body to return to its normal state, as being continually exposed to the allergen the body stays in a constant hyper-active combative stage which weakens the child and can result in fatigue, irritability, lack of appetite and overall failure to thrive. If during the time period when a specific food has been eliminated, the cough, sneezing, aches and pains and stomach complaints are reduced then we have a starting point to discuss with the right doctor (paediatricians or allergist) about what we need to do next.

Challenges of a new diet

Once the culprits have been identified they need to be taken out of your child’s regular diet for a prolonged period of time, to allow the system to heal and recover. Some scientific research has suggested keeping small amounts of the allergen in the child’s diet so that the body can continue to develop a tolerance to them, but this has to be done in consultation with the doctor and in very meagre amounts and as seldom as possible. There doesn’t seem to be convincing evidence to support the theory that bombarding the system with the allergen everyday, we will help our child “outgrow” or “beat” the allergy quicker, but what it can do is weaken them in the process.

Many people are apprehensive as they find the idea of removing regular milk, wheat products (atta, flour, toast, bread, cakes) eggs, or any other fruits/foods as overkill or ludicrous as we have come to believe that these foods are a vital part of a growing child’s nutrition. But the question we need to ask is, if removing the food allows our child to feel healthier and be rid of symptoms that they suffer from, is it worth the price of constant illness just to keep these foods in their diet?

It is incredibly hard to introduce alternate sources of fibre, carbohydrates, calcium or protein when we remove the usual items, but it is worth it. Learning about what to avoid and what to include is key and despite the limited range of allergy-free food items in Pakistan, there are several ways to improvise using locally sourced or imported items such as substituting dairy with buffalo or almond, soy or rice milk, using Egg-replacers (found in a few stores), flax seeds or apple sauce as substitutes for eggs in cooking, using rice or corn based cereals (that do not contain wheat or gluten), utilising makai or besan ka atta or rice flour, introducing more oats, quinoa, vegetables and safe meats and fruits to maintain a balanced healthy diet. Necessity is certainly the mother of invention which is why there are thousands of recipes available online for those inclined to cook and bake themselves, there are also a few local groups on Facebook to bring together people dealing with allergies, bakeries that offer speciality items can be approached and encouraged to experiment and develop breads/cakes/pita or naan breads to meet the needs of customers who need allergen-free items on a regular basis.

Having a plan of action

What most people do not realise is that food allergies can be life threatening. There is a great deal of data and research as well as legislation making up the global discourse on allergies allowing those battling with them to be aware of their rights. Educational institutes, offices, restaurants and communities at large have rules, meal plans, emergency plans and various accommodating features for children (and adults) with allergies. The lack of such an infrastructure in Pakistan puts the onus on us to adopt an active approach in involving teachers, principals, school nurses as well as restaurant staff and extended family members to understand that having a child with a food allergy is a serious concern and needs to be dealt with accordingly. We are a long way away from separate eating areas and the availability of allergy-free meals but where we can begin is making care providers (family or school staff) aware of what needs to be done.

We ourselves should develop an action plan where we know what anti-histamines, inhalers, nose sprays, ear drops or anti-itch creams we need to use when symptoms start appearing so we can contain the problem before it turns into a full-blown infection. We also need to be aware of the fact that a severe allergic reaction can lead to facial swelling and difficulty breathing which requires immediate medical attention in the form of a steroidal injection (Epinephrine), which is readily available abroad for people diagnosed with food allergies. Getting this injection on time can mean the difference between life and death when a child is experiencing a reaction therefore it is advisable to discuss the need for one with the doctor. Necessary medication can also be left with school staff and care should be taken when eating out by having a detailed discussion with restaurant managers about keeping your child’s food allergy free. We may not have full-fledge menus catering to our child’s needs but we can educate members of our food industry and ourselves to explore practical solutions.

Accepting the new reality and finding support

To maintain restrictive diets is never easy even for diabetics or those dealing with cholesterol or high blood pressure or other such conditions. But as awareness is increasing, more products become available and the plethora of information online can help us figure out pracical soloutions we can employ in our everyday life. Finding support and getting the family on board certainly helps. In our household for instance it is my daughter and I who are combating food allergies but yet the way the food is cooked for everyone has changed, to accommodate our needs. Speaking to nutrinitionists/dieticians can also help if one feels at a loss of knowing what foods contain the allergens we have to avoid and developing a meal plan that we can stick to.  But the bottom line remains, we as parents want to give our children the best shot at growing up healthy and well adjusted and sometimes doing that involves incredible challenges and sacrifices, but in the end it’s worth it. Particularly when they go to bed at night or wake up in the morning without a blocked nose, achy joints, stomach cramps, nightmares and recurring skin rashes. The long-term effects of ignoring food allergies can include the development of diseases such as asthma, irritable bowel syndrome, celiac disease (and other auto-immune disorders), which is certainly a road that all parents would want their children to avoid.

The writer manages a Facebook group for ‘Desi’ Parents and children, sharing personal experiences/queries, local and global resources and allergy-free recipes at:

An excellent online community with detailed allergy related information can be found at: