Allergy Friendly Halloween

The holiday season is about to begin, and that means many events and gatherings revolving around food.  For folks with food allergies, it can be extremely stressful to navigate through this all.  Halloween kicks it all off with the excess of candy, much of which is not allergy friendly.  Peanuts, tree nuts, milk, wheat, egg, and soy are common components of many candies and 6 of the top 8 allergens.  Kids really enjoy dressing up and trick or treating with friends, but some kids with allergies are not even able to participate if their allergies are severe.  For those that do, they often can’t keep much of what they come home with.  School parties are another place that the non-allergy friendly treats come out.  While many of us parents have figured out how to handle these situations well, it seems like there could be a better way.

In an effort to promote a safe Halloween for all, FARE (Food Allergy Research and Education) developed the Teal Pumpkin Project.  It is a way to draw awareness to food allergies and include all trick or treaters. Those who choose to participate put a teal pumpkin or teal pumpkin sign outside their door for Halloween.  This indicates that this house has non-food, allergy friendly treats.  Participants can even add their address to the map so that trick or treaters can plan out their routes.  This movement is getting bigger and bigger, and it is so encouraging!  Check out for more information.

Here are some of my ideas for non-food Halloween treats:

Allergy Friendly Halloween



I know not every family has food allergies.  From those of us who do, I want to tell you how much we appreciate when you include our kids and learn about their allergies.  It gives these kids a feeling of community and belonging.  It gives us parents a feeling of safety and relief.  

So thank you, it means the world to us.



Family Feeding

Family-style Meals with Food Allergies: Part 2

To the many families living with food allergies, this post is for you.  I want to discuss different ways to address serving dinner in a family-style way when you have food allergies to deal with.  I understand that there are so many different situations out there and many ways that people deal with them.  What works for one family will not for another.  This is why I want to give several options.

First a talk on family-style meals.  What does it mean and why do I recommend it?  A family-style meal is when you serve food on the table.  Each person selects what they want and how much they want on their own.  Everyone serves themselves.  This is an important activity.  It teaches children table skills and manners.  It also presents food in a non-pressure environment.  Nobody has to take something they do not want to.  I know all you vegetable pushers are freaking out here, but listen.  Over time, this method is much more successful in developing healthy, diverse eaters, than forcing children to eat specific foods.  Do not be confused though.  I am not suggesting you cater to your children and serve them whatever they want- no, no, no!  You decide on the meal and serve it.  They decide how much they want to eat and what they want from what you offered.  This may mean they eat only pasta one night and hamburger the next.  It’s ok.  This is how they learn to try foods and listen to their hunger signals.  As long as you are providing healthy meals in a non-pressure setting, you have done your job.

As far as food allergy families go, family style eating can be more tricky.  I will first touch on the safest route. This means you avoid all allergens of anyone in your house.  If there are peanuts, fish and egg allergies, there are none of those items in your home.  Nobody consumes these.  Your home is a “safe” place for everyone.  This is especially ideal when young children are in the home and you are concerned about accidental exposure. In this instance, serving a family style meal should be straightforward.  Since all the foods are safe for everyone, any person can choose what they like from what is offered.

Another option is to allow foods that some family members are allergic to on your table.  This will likely result in having 5-7 food options at every meal to accommodate everyone.  This may not be appropriate if you have severe allergies and/or small children who can accidentally take an allergenic food.  I would recommend this for families who have a variety of food allergies that become overly restrictive when you remove all the foods that everyone is allergic to and also for those who are comfortable keeping food allergen foods in their home.  This is not for everyone.  This is also an opportunity for older children to interact with their allergic foods as they will have to do this outside of the home.  It is good for them to learn to identify their allergens and avoid them.

The third option is a bit of a hybrid between the two listed above.  This would mean permanently excluding certain foods (severe allergens) but allowing others.  I will give an example from my own house.  Our allergens include peanuts, tree-nuts, shrimp, pork, turkey, eggs, chicken as well as a dairy intolerance.  We never buy peanuts or shrimp.  While the kids have never had an anaphylactic reaction to either, they did react enough that we think they have no place in our home.  At dinner, we do eat chicken about 6 times a month.  The child who is allergic to chicken either eats multiple side dishes or a protein he can tolerate.   He knows he can’t eat it and has no desire to even touch it.  This works for us but it is a family by family decision.  I am very comfortable with my kids’ knowledge of their allergies and how to treat others with allergies different than their own (hand and face washing after eating, etc.)

I want to stress that all of these options are ok.  Every family has to decide what works for them.  Read this information from FARE regarding this here.  If having allergens in the house makes you a nervous wreck, do not do it!  If there have been severe reactions in the past, I also do not recommend keeping allergens in the home.  Unfortunately, past reactions do not necessarily predict future reactions.  Mild reactions in the past may still become anaphylactic in the future.  Again, if you do not feel comfortable, do not do it, it’s not worth it.  Always consult with your allergist and hopefully a registered dietitian nutritionist, who can help you navigate your specific food allergy situation.

Rachael Costello, RDN, LDN, is a registered dietitian. The materials and content contained on this site ( are for general educational purposes only and are not intended to be a substitute for professional medical advice, diagnosis or treatment. Persons with serious medical conditions should consult a physician before beginning or modifying any diet, exercise or lifestyle program. The use of any information provided on this site is solely at your own risk.
Family Feeding, Health, Meal Plans

Family Style Eating with Food Allergies, part 1

I wanted to write a little about being a parent of food allergic kids.  The challenges are real and daily.  Our view of food changes from being something life-giving to something that can take a life away.  We can become overwhelmed in worry- so many what-ifs.  Once you begin feeling more in control and understand the allergy and all the precautions necessary, you start to feel more capable.  You still worry but you know that you have this figured out.  But sometimes, by trying to be so safe, we restrict our children’s meals too much and the chance for nutrient deficiency arises. As a dietitian, I am always stressing family style eating and not catering to certain family members by making them special meals.  I truly, truly believe in this approach.  I have, however, struggled with it on a personal level with my own children.  It is quite difficult to make a meal that everyone can eat here because of the variety of food allergies.  No two kids have the same allergies in our house.  Don’t get me wrong, there are meals that are totally allergy free for us but we are definitely limited.  So how do I walk that fine line between catering and providing wholesome meals for everyone?

I think two practices really help us- meal planning and family style meals.  When I spend the time to plan out our meals in advance, I can be strategic.  I can look at the week as a whole and spread out various proteins and side dishes.  This prevents us from eating the same meals over and over as well.  After doing this for years, I really know which meals will have leftovers.  I used to plan out seven new meals a week.  I quickly learned that a lot of food waste happens that way.  I plan for at least two nights of leftovers a week.

By serving our meals family-style, I am able to have various food choices on the table.  If one of the children is allergic to a dish being offered, she can choose something else.  Now I understand this practice does not work for all families.  Depending on the age of the child and the severity of the allergy, you may not even allow the food allergen in your home at all.  We are able to keep some of the foods in the home, not all though.

So what is catering and why is it a bad thing?  Catering is making a specific food or foods for a family member because you know they will eat it.  It allows them to eat something different than the rest of the family.  This happens a lot in families, not just families with food allergies.  Kids put up a fight about the dinner being served and the parent gives in and serves them their own meal.  Over time, children learn to demand foods and resist trying new ones.  Food allergy families can fall into this trap more easily because of the limited diet.  While it can prove to be even more difficult for these families to provide wholesome meals that everyone can enjoy, it is important to do so.  People with food allergies are already at risk for consuming a diet is nutritionally inadequate.  By not offering a variety of safe foods, the risk becomes greater.

As a food allergy parent myself, I challenge you to try new meals with your family.  It may take time to see acceptance, but that is ok.  Keep offering new, healthful, and safe foods.  Not that there is anything wrong with serving family favorites as well.  Adding variety, even slowly, will increase the nutrient consumption and you will see new meals become favorites.

Stay tuned for my next post which will delve more into how to serve family-style dinners for food allergy families.




Teaching Kids About Food Allergies

It is officially Food Allergy Awareness Week!  This is a great time to remind friends and family about the seriousness of food allergies, practice administering epinephrine,  try new allergy friendly recipes and educate your community.  This week I am lucky enough to present to some of the classes in my children’s school.  I think it is so important for the kids (and adults!) who do not live with food allergies to understand what they are and how to help.  Here are the basic topics I review:

What is a food allergy?  I think this is obviously the starting point for any talk on food allergies.  I explain that eating even a small amount of the allergen can cause a harmful reaction.  I talk about the top eight food allergens and how some of them hide in many of our everyday foods. I explain cross-contamination and the importance of hand-washing. With smaller kids, that is about how much I delve into it.  With older  kids, I explain more about the immune system and get more specific about what happens in the body during an allergic reaction. I really want the kids to understand that allergies are serious and their friend is not being “picky” when they say they cannot have even a small bite of the food.  I tell them that their friend can get sick very quickly and may need their medicine and possibly to go to the hospital.  Again with the older kids, I will go more in depth about what happens during a reaction.

How can you help someone with food allergies?  This is where I explain what signs and symptoms to look for and to get an adult quickly.  I like to reinforce that they need help fast and to tell the adult that their friend has a food allergy.  I also discuss bringing non-food treats for birthdays and including everyone.  I explain how it feels to be the only kid who can’t have a special treat at parties, gatherings, etc.

I think these are the main things to review, especially with the younger kids.  You can absolutely go into more topics, especially with the older ones.  If you know there is a bullying issue or just to reinforce an anti-bullying theme, that is another good idea.  I touch on that in my “including everyone” part of the speech but it can be elaborated on for sure.

 FARE has some free downloads on their site for presentations and handouts.  I like to give them one of the coloring sheets to take home and I send a letter to the parents in case there are questions later.  Kids are such sponges and can learn so much from even a 20 minute presentation.  The earlier on they understand this stuff, the better!

I would love to hear what you are doing for Food Allergy Awareness Week!



Dining Out with Food Allergies

This is an area of a lot of stress for many people dealing with food allergies.  Some choose to avoid it altogether because they feel it is just too dangerous.  Perhaps it is.  There are so many variables.  Did the kitchen staff wash the surfaces and utensils thoroughly before preparing my meal?  Did anyone touch my allergen and then touch my food?  Does the kitchen staff know if the ingredients used in my meal were processed in a facility where my allergen is used?

It is a good idea to ask around and see if people you know with food allergies have recommendations for allergy friendly restaurants. Some are known to be extremely careful, and to educate their staff on the seriousness of food allergies.

I like to review menus in advance and figure out what menu options seem allergy free.  Sometimes I call beforehand to make sure there are no ingredients that will be an issue. Once we are there, we always tell our server about all the allergies we have to deal with.  We explain that these are potentially life threatening allergies, NOT FOOD PREFERENCES!  Even if we have been to a restaurant and found it safe in the past, we go through the routine every time. Restaurants may change ingredients or recipes whenever they choose. We always have epinephrine on hand.  Since we have a peanut allergy, we rarely order dessert.  So many desserts are processed where peanuts are and it’s just not worth it. (We are usually full by dessert anyway, so it is not difficult to pass it up.)

Some people advocate that you should visit a restaurant during a downtime. The thought is that the staff is less busy and can focus better on your requests.  There is less of a chance of a mix up.  I do agree with this, however it is not ideal to have to eat dinner at 3pm or 10pm.  I can see both sides of this argument.  You should consider this and if possible, visit during these less busy times.

A great option is using chef cards or allergy cards.  These are cards that you print up and give to your server, who in turn gives it to the chef.  This gives them a written reminder about the allergy and how to proceed.  Many websites have downloadable versions that you can customize and print yourself.

FARE has a great one : Chef Card

You can also design them on a business card and have them printed.  I am working on one, I will post once it is ready!

Once your food is brought to the table, check to make sure it is correct,  Ask the server again if this is _________free.  Reiterate that this is an allergy.

The more your dine out, the more comfortable you will be with asking questions and telling your story.  Our nine year old does this himself now.  It is important to teach the kids to do this for themselves.  They will be away from you at some point and need to be their own advocate.

As a summary, here are the things to remember when dining out:

  1. Ask for recommendations

  2. Review menus ahead of time if possible

  3. Call in advance to verify recipes

  4. Optional: Visit during a downtime

  5. Stress to your server that these are allergies not preferences

  6. Bring a chef card with your allergies listed

  7. Check your food once it is brought to the table

  8. Always carry epinephrine!!


I will be posting an allergy friendly granola bar recipe this week, stay tuned!  Food allergy awareness week is next week!!!




Food Allergy Basics

If you or a loved one does not live with food allergies, you may not be aware of how involved  or serious they truly are.  Before our oldest son was diagnosed, I had no idea how much this would change our life, and I am a registered dietitian!  There is no cure for food allergies, total avoidance of the offending food is the only treatment.

There are a wide variety of reactions possible.  Hives, itching, swelling of the lips, throat, or tongue, dizziness, vomiting, diarrhea, and difficulty breathing are symptoms of a food allergy reaction. This is not an exhaustive list. There is always a chance of anaphylaxis, whether previous reactions have been mild or severe. It is very unpredictable and the treatment for anaphylaxis is epinephrine.  Benadryl will not stop an anaphylactic reaction.

Living with food allergies requires constant vigilance- always reading labels, always asking questions, always carrying epinephrine and always educating others.

There are eight foods which cause the vast majority of allergies.  These are egg, milk, peanuts, tree nuts, soy, wheat, fish and shellfish. In 2006, the Food Allergen Labeling Consumer Protection Act (FALCPA) went into effect.  This law made food labels much clearer to read in regards to these top 8 allergens.  The common name of the allergen is required to be listed on the label now.  This has made it easier to determine what foods are safe.  However this is not fool-proof.  Foods may be processed in a facility that processes an allergen, and this is NOT required to be listed.  More companies are voluntarily listing these warnings but this is not a law.  Another concern is that people are allergic to foods that are not in the top 8 allergens.  What about them?  It becomes more difficult to deal with a food outside of the top 8.

Unfortunately we often cannot rely on food labels due to the above reasons.  This means actually calling the company and asking specific questions to determine if the food is safe.  Imagine having to do this on a regular basis, just to stay safe.  This is a reality for many families dealing with food allergies.  And just because you call a company once and hear that it is safe does not mean it will always be safe.  Companies change their operation from time to time, so there is constant re-checking involved.

We also have to consider cross-contamination.  When cooking and preparing food, it is so important to wash surfaces and utensils that came in contact with the allergen very well before using those again for the safe foods.  This includes hand-washing and possibly brushing teeth.  If I were to eat peanuts, I would wash my hands and brush my teeth before giving my son a hug and a kiss. This may seem over the top, but we would much rather prevent a reaction and spend a few minutes cleaning up than end up in the ER.

Since 1 in 13 kids have a food allergy, this is real life for someone you know.  When we ask how food was prepared, when we ask to see a food package to read the label, when we ask you to wash your hands, I hope you will understand that we are not be being helicopter parents.  We don’t want to have to ask these questions.  We don’t want to constantly be on guard. It’s exhausting. We are trying to prevent a serious reaction.  We want our kids to live normal lives and not feel excluded, so we do it.  We do it because we have to.

We have amazing family and friends.  They have been so willing to learn our allergies and prepare food that everyone can eat.  They ask me questions, text me pictures of food labels, and always include our children.  I hope that all families dealing with food allergies have such an amazing support network.  We love you guys!!!