Uncommon Allergens: Mango

Since my daughter has oat and sesame allergies (aside from the more “mainstream” peanut and tree nut) and used to have corn and grape on her allergen list I keep meaning to organize some thoughts about the more uncommon allergens. Granted, oats benefit from the issue of gluten or wheat cross contamination but the rise of the “gluten free oat” has muddied the labeling waters for us.

A dear friend wrestles with a mango allergy and since mango is in the same family as the cashew (source), I have learned a lot from her struggles with this pesky ingredient not only in food but in beauty products.

Disclaimer: I am not a doctor, just a curious food allergy mom so please if you suspect you have an allergy to mango, do see an allergist about your concerns.  I thought people searching for information about mango allergies would find the links I’ve included courtesy of my friend useful.

In South America, for example, mango is readily available and consumed so it makes it onto lists of prevalent allergens (source).  When you search for information about mango allergies, oral allergy syndrome is one that comes up, with some people recommending to those with poison ivy issues that the fruit can still be consumed if it is peeled in a particular way (source).

In “Hypersensitivity manifestations to the fruit mango” from 2011, cross reactivity with other allergens may account for first reactions to mango where there is no prior reaction.  Latex allergic individuals have been reported to in some cases experience a mango allergy.   Also in the same article the geographic distribution of reactions seems to follow areas where consumption of mango is more prevalent, which makes the fact that it is appearing as an ingredient more often here in the United States of note.

Spotted at Trader Joe's - Mango in Cheese
Spotted at Trader Joe’s – Mango in Cheese

In beauty products, mango can carry the name “mangifera indica” or “garcina mangostana.”  Translations of mango are included on the “encyclopedia of life” website.  I have seen mango in everything from lip gloss to hair color and even in a balm that is marketed for relief in the early days of nursing a newborn.  Anything tropically themed may contain mango, such as Tazo’s Passion Tea or other drinks.  We have put together a panel about skin products for the 2014 Food Allergy Bloggers Conference (“Skin Deep – How Allergens Affect Your Skin’s Health“) and I’m very keen to learn more in September.  You can search for mango in the cosmetics database to see how it is popping up everywhere.

When a person’s allergen is not in the “top 8” here in the United States they face an uphill battle.  The connection between mango and tree nuts does make me wary but you also don’t want to go down the rabbit hole of finding out what is cross reactive with a given allergen and then avoid that item as well.  Supervised food challenges are the gold standard in allergy testing so stay safe.

I’ll end with a neat story from my friend, she is a teacher and one day at school they served mango in the cafeteria.  Her students later told her they’d taken turns washing their faces and hands before returning to the classroom.  It made me so happy to hear how considerate they had been!

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There are only a few more days to register your support of my friend Libby’s petition regarding ingredient disclosure in prescription medications.  Even if you feel the request is a broad one, a petition like this is meant to start the conversation, not end it, so I encourage you to check it out.

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Updated 7/8/14 to add this great link about cross reactivity on the Kids With Food Allergies page.

Vegan Slow Cooker Potato Leek Soup

Thank you to Sarah Norris of Gluten Free Dairy Free Walt Disney World for pointing me to this recipe – I had purchased Yukon gold potatoes and trimmed leeks at Trader Joe’s because the idea of soup when it is 100 degrees out is oddly appealing.  I adjusted it to be more calorie friendly and thought I’d share my version here.  First, let me direct you to the inspiration, Gluten-Free Goddess’ 2009 recipe.  Her post has wonderful pictures (with leeks for a garnish) and suggestions for a stove top method as well.  Also check out our Food Allergy Bloggers Conference post featuring Sarah, it was great to meet her last year!

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Ingredients

1 cup rice milk

4 cups vegetable broth

2 leeks, trimmed and sliced (I used a 6oz pre-trimmed pack from Trader Joe’s)

680g Yukon gold potatoes, washed and quartered (I leave the skins on)

1 tsp dried tarragon

1 tsp dried dill weed

1 tsp granulated garlic

Salt and Pepper to taste (depends on how much salt is in the broth you use)

1 tsp extra virgin olive oil

Supplies

Slow cooker or crock pot

Cutting board, knife

Teaspoon measurement

Immersion blender

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Directions

Start your crock pot on high, set it for 5 1/2 hours.  add the oil if desired and then the chopped leeks.  No need to worry about large rounds when you are chopping the leek, you will be blending this recipe up!  Add your quartered potatoes and then the 4 cups of vegetable broth.  You’ll see the ingredients are just about covered.  We don’t want the soup to be watery so trust me on this.  Cook on high and when when the 5 hours of cooking time has elapsed (I set it for a little longer so I have time to chop and prep while it heats up) you’re going to blend the soup in the crock pot with your hand immersion blender.  At this point add the 1 cup of rice milk, adjust your salt and pepper to taste, heat until warm throughout (shouldn’t take long) and you’re ready to serve.  Great with a salad.

Calorie and Nutritional Information

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The batch I made came to 1,763 grams and we like to do 100 gram servings in MyFitnessPal so it was 47 calories per 100 grams.  I didn’t list the spices and herbs in the recipe so that may have added a trivial amount of calories.  I’ve managed to put all my lost weight back on in the last year but I am still trying to fight my way back.  Here’s hoping!

Ingredient Disclosures for Prescription Medications (or: A Worthy Cause)

My heart sank when I read a message from my friend Libby that she had discovered that the drug information insert given to her by CVS pharmacy with her food allergic son’s medication was for the brand name drug and not the generic she was being given.  She had made a startling discovery after months and months of anguish and worry for her son’s declining health: the generic version of the drug contained a milk derivative.  The brand name did not.  She had been giving her son a medication that contained an ingredient directly contraindicated by his allergies.  Libby wrote more on her blog, The Allergic Kid.

Think about it this way, if pharmacies are supposed to look at the interplay between one medication you take and another, shouldn’t they also (1) provide accurate ingredient information, (2) consider the act of avoiding an allergen a prescription equal to something actually produced by a company and shipped to the pharmacy, and (3) have to engage in safe practices so that a person obtaining a medication won’t have their pills sorted on the same surface as a medication that would be unsafe for them to ingest?

Like any mama bear would, Libby has sprung into action and I want to help her reach as many people as possible.  If her petition to the White House (remember, President Obama is directly impacted by food allergies in his family) gains enough signatures by July 4, 2014, we can get an official response to her request that FALCPA be updated to include direction that prescription drugs, like the food on our store shelves, take food allergies into account.  This benefits the food allergy community, the celiac community, and the public at large that is owed transparency.

Will you join me in signing this petition?  Thank you!

Update: I am pasting this wonderful comment here so it isn’t missed.  Reader Tiffany writes:

I am a registered pharmacist. Actually I have a Doctorate of Pharmacy–PharmD. I am also the sister of a person within milk protein allergies and the mother of a son with severe food allergies–egg, soy, peanuts, and various tree nuts.

Pharmacists, in general, get no formal training when it comes to food allergies. I must train the technicians at each pharmacy to ask for food allergies in addition to medication allergies. A lot of food allergies can be placed into the pharmacy’s database. However I cannot guarantee that the inactive ingredients are tagged and appropriately flagged—that’s a whole other discussion LOL . Brand and generic medications do not, by law, have to contain the same inactive ingredients. Generic medications are only required by the FDA to show that they compare to the active chemical in terms of efficacy/safety.

I will say that there are numerous medications that contain potential food allergens such as soy, fish, milk, and wheat gluten. For example: Gel caps –soy oil, over the counter vitamins–especially children’s–soy, spectracef (antibiotic) contains milk protein, Androgel–soy, certain vaccines such as flu, MMR–egg, certain diabetes medication–fish/shellfish. I could go on…

Combivent just re formulated this year and no longer contains soy/peanut allergens–hurray!

My top three suggestions would be :

1. Please tell the pharmacist–and stress the importance and severity of the allergy. Make sure that the food allergy is placed into the profile either in the allergy section OR via a patient note. Heck, why not both! As I stated above, pharmacists are somewhat like the general population in terms of food allergy knowledge and most do not even realize that this could be as big an issue as it is. A pharmacist will/should know the difference between lactose intolerance and milk protein allergy. So by discussing the issues–the pharmacist should “get it.” But if the pharmacist/pharmacy staff was never informed then they can’t intervene.

By the way, the doctors are just as clueless. Should you make the doctor aware of food allergies? Yes. Does the doctor weigh this info when prescribing? Probably not.

In my opinion, standard allergy questioning for medical purposes should contain food allergy questions as well.

2. Ask for the package insert (PI) for the NDC THAT YOU ARE RECEIVING. The actual medication that is in your bottle. The NDC is the number that signifies the specific manufacturer, drug, and bottle size from which your prescription was filled. The inactive ingredients are listed there usually. Each bottle comes with a PI–some may have fallen off during shipping. Every pharmacist will know what an NDC is.

As a matter of fact, in most retail settings the pharmacist can order a specific NDC–one that does not contain a specific FA–provided that the product exists and is available. Be patient–it is going to take more than 15 min to track all this information down. It’s worth the wait.

3. Call the manufacturer if unsure. The pharmacist has access to and can provide you with the phone number for the manufacturer of the medication you are receiving.

I have discussed these issues on small scale and I totally agree that medical staff including doctors and pharmacists need better FA knowledge and training as it related to medications and treatment.

Sorry I wrote a book but I hope that will help answer some questions about FA and the pharmacy (FA and the pharmacy that sounds like a good title for a blog—hmmmm LOL)

I think she should certainly start that blog!  Thank you Tiffany for sharing your expertise!

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Update: 7/8/14

The petition didn’t gain enough signatures (when I checked last before it went offline I believe it was at about 200) but that doesn’t mean the issue should go quietly into the night.  In other news, Tiffany did get her blog started!