The Magical (Expensive and Elusive) Epinephrine

If you know about food allergies, you know how important epinephrine is. It is the only thing that can treat a severe allergic reaction. We’ve had to use it twice at home and both times I was amazed at how quickly it worked. To go from continuous vomiting, difficulty breathing, runny nose, baby in clear distress to breathing fine (although a little upset about needle jab) in minutes is nothing short of a miracle. But the fact that it is the only solution to a severe allergic reaction and a severe allergic reaction can happen at any time, means you have to have it with you at all times.

Not just one injector, though. No, you need two. With my kid. At all times. For us this mean getting four epinephrine autoinjectors- two to leave at school and two to keep at home/out to the park/with us wherever we go. For a baby this is a little easier because we have to have our diaper bag with us wherever we go. We just stick it in the diaper bag. 

What do people do once their kid is old enough to not need a diaper bag? A quick search online reveals lots of different epipen cases- pink girl ones and manly leather ones and carabiner clip on ones and fanny pack ones and ones that look like a stuffed lion. Presumably something for everyone. I just find it hard to imagine my kid grown up to a teenager and convincing her to carry not one, but two, around with her at all times. It seems like a hard sell. Maybe they’ll be some sort of phone autoinjector accessory and we can combine life saving device to social media and it will never be left at home.

Another problem? The epinephrine expires every year. I just had to refill the prescription and I thought it would be easier the second time around. But it’s not. Last year when we first filled, the pharmacy would only give us one pack of two because that’s the special they were running. You only have to pay $25 but you only get one pack. Then, if we needed more, we had to have another prescription from the doctor, then go through prior authorization from our insurance company, then depending on the copay they would use some sort of manufactures coupon to get the cost down?  You know what sounds really good together? Coupons and PRESCRIPTION MEDICATION. This year when the prescription went through, I had to talk to the pharmacy sales reps no less than four times. And we’ve still only received the first pack. The second pack was supposed to be delivered a few weeks ago. Where is it? The people I’ve called definitely don’t know, that’s for sure.

One reason it’s so complicated to get the epinephrine? Because it’s so expensive. There are a lot of resources online offering advice on how to get the cost of epinephrine down:

• Food Allergy Research & Education
• Kids with Food Allergies
• Allergy and Asthma Network

But wading through them is like being thrown into some sort of advanced placement extreme couponing class with never having asked for a rebate before. You can use this company if you have this commercial insurance for a coupon card that can decrease your out of pocket expenses OR you can use this other company and use their discount program OR if you don’t have insurance and make less than a certain amount per year you can get a pack for free OR you can use this company and get up to $35 off…. It’s really confusing and I say that as somebody who works in healthcare.

It's the kind of frustration nobody would go through unless it’s the only thing the entire world that could save your kid. Luckily for these pharmaceutical companies, that’s exactly what they are dealing with.

A Rant About Garlic

 

Most of this blog has focused on the top 9 allergens; after all, they are the most likely to cause life threatening reactions. Plus, my kid is allergic to three of them. I even did a whole ranking on which of the top ones are the worst to be allergic to. (It’s milk. It’s definitely milk.) However, garlic may be her most inconvenient allergy to have. Just ask a vampire. I mean, sure, they have to avoid lots of things... Holy water. Sunlight. Crucifixes. But garlic? That stuff is everywhere.

Why is a garlic allergy so bad? For one thing, trying to scan the ingredient list is so much harder for anything that is not a top 9 allergen. Remember how the top 9 have to be clearly labeled? Yeah, garlic isn’t included in that list. In the US, whole or ground garlic must be declared on the food label BUT garlic powder can be hidden under “natural flavors” or “flavoring”. So, every time I read an ingredient label and see “natural flavors” (and does anything not have “natural flavors” in it?), I have to wonder, is there secret, hidden, deadly garlic powder in here?

We love ketchup in this household and trying to find out if any ketchup was safe to eat led me to the great Heinz Ketchup garlic flavoring debate. Apparently, Heinz refuses to disclose if garlic is one of their “spices”, even when asked directly by people with physician verified garlic allergies. This has gone on so long that there is a change.org petition. I 100% love the enthusiasm. What I don’t actually love is Heinz ketchup. Despite having the largest market share in the world, I can tell you, blind taste tested, it is not the best ketchup. The best ketchup? Hunts. And, while Hunts has the black box of “natural flavors” in the ingredient list, it also clearly lists “onion powder.” I feel pretty good that if they listed onion powder, they would list garlic powder, too. We've gambled and hoped for the best. So far, it's worked out and we are a Hunts only family now.

Not only is being allergic to garlic hard because it’s difficult to decipher if it’s actually in an ingredient list or not, but it’s also hard because garlic is in almost every savory thing in the entire grocery store. Off the top of my head, here are a list of things that almost always have garlic in them:

• Salsa (of any kind)
• Pasta sauce (of any kind)
• Almost all premade sauces in the international section
• Potato chips with any flavoring other than plain
• Condiments of any kind (mustards, mayo, BBQ sauce, ranch, ketchup….)
• Spice mixes (chili powder, curry powder, everything bagel…)

It’s also in the breading on a lot of chicken nuggets. I’ve seen it in plant-based meat alternatives. Any premade frozen meal. It can be in anything. Really. Anything.

I recently found this website- gogarlicfree.com that has some products that are garlic free. (I don’t know how much I trust it though, because under their survival kit for garlic allergies they listed Benadryl, charcoal pills, tea… AND NO EPINEPHRINE which is ACTUALLY the only thing you need to SURVIVE a REAL FOOD ALLERGY. I’ve said it once, I’ll say it again: FOOD INTOLERANCES ARE NOT ALLERGIES. STOP SAYING YOU ARE ALLERGIC TO THINGS WHEN YOU HAVE AN UPSET STOMACH. YES, IT CAN BE UNCOMFORTABLE, BUT FOOD ALLERGIES CAN BE LIFE THREATENING.) Anyways, it has some suggestions for store bought salsas and tomato sauces without garlic which I have never seen in my grocery store. Instead? I spend my time making everything from scratch. Garlic free chili powder? Yep, mixed up a bottle and keep in the pantry. Curry paste? Yep, made a batch and it’s in the freezer. Pasta sauce? Yep, made some with roasted tomatoes. Made some in my instant pot. Made some from canned tomatoes. Living garlic free has meant making almost everything entirely from scratch.

The real kicker for my kid’s garlic allergy, though? We aren’t even sure if she’s actually allergic. With the positive skin test, she really only has a 50% chance of being actually allergic. All of her other allergies she has a positive skin test and a positive reaction when she's eaten it. What if she can actually have garlic and I’ve been making my own sauce/salsa/paste/powder for a year? I really want her to have her garlic food challenge… but only if she’s not allergic. Until then, goodbye Heinz ketchup. Hello homemade sauces. Salsas. Dips. Hummus. Curry paste. Spice mixes….. And, goodbye free time.

Ore-ooooohhh no

For the last few weeks, news stories have been popping up about possible shortages on Nabisco products at grocery stores. How some stores are stocking up to withstand the decreased production from the Nabisco bakeries around the US as workers have gone on strike after changes were made to their healthcare and overtime. While reading these stories, I had a horrible realization of just how many Nabisco snacks my kids and I eat. Reading the list of items started off bad:

• Ritz? (Those are my favorite crackers!)
• Wheat thins? Triscuits? Premium Saltines? (Are there any other crackers left on the cracker aisle?)
• Belvita crackers (nooooo those are the only sandwich crackers without peanuts/tree nuts!)

And just got worse and worse.

• Teddy grahams? (but those graham bunnies may contain milk!)
• OREOS?! (Nooooooooooooooo, not Oreos! ANYTHING BUT OREOS!)

Okay, okay, okay. Surely there are some other safe alternatives, right? Plain crackers are usually safe from eggs and milk so we can probably find another brand. But Teddy Grahams and Oreos are the only reliable desserts I’ve found in the store that don’t have milk or eggs in them.

Finding a readily available, not prohibitively expensive, dessert snack safe for my kid to eat was a huge win for us. I have played around with vegan baking and have made desserts with varying levels of success. But, they take time and effort to bake, not to mention tracking down the special grape seed oil or ground flax organic whatnot to make the recipe. In the end, it's never going to be the same as the real thing. Oreos are already the real thing! I don't need to adjust anything!

At get togethers or birthday parties or “year of life celebrations” at my kid’s school, I want to have a safe dessert alternative ready to go in the pantry so my kid doesn’t feel left out of the deadly birthday cake sprinkle ice cream extravaganza that she can’t have. Oreos are great for this. Do I eat them everyday? No, of course, I don't. Do I wish I did? Yes, of course I do.

The rest of the cookie aisle is packed with cookies made with dairy milk. Or eggs. Or both. There’s just something magical about the Oreo. What could possibly be in the cream filling? Is it just sugar? How do they make the chocolate cookies without butter or eggs? They’ve made it so shelf stable, so super processed, that they accidentally made it vegan. I assume it was on accident. “Milk’s Favorite Cookie” is stamped on the package and there’s pictures of milk splashing everywhere so it seems unlikely that they set out to make a vegan cookie. Whatever the reason, finding out that Oreos don’t have milk in them was such a happy revelation.

Which is why the prospect of an Oreo shortage was so sad. And, it’s not just that there may be a shortage due to the workers on strike. Danny Devito is asking for a boycott of all Nabisco treats to support the workers on strike: No Contracts, No Snacks! This boycott is not to be confused with the 2016 boycott of Oreos when Nabisco closed a US factory and opened one in Mexico. Or earlier this year when Nabisco’s parent company was accused of being complicit with child slave labor to get their chocolate. That's right, I said CHILD SLAVE LABOR. (To be fair, all of the big chocolate companies in the US were involved so this may be more of a chocolate in general problem than a Mondelez problem, but YOWZER.) That Oreo isn't looking so sweet now.

I haven’t checked out the packages of the other chocolate and cream sandwich cookies, but a lot of times store bands have extra allergen warnings on the ingredient lists. Even if they don’t have some of the Top 9 allergens, it’s more likely they have been processed in the same factory as other allergens. So, wish me luck this weekend at the grocery store as I look for an allergy friendly, worker friendly, (oat) milk’s favorite cookie alternative.

Cookbook Review: Milk Street Fast and Slow

 

I ended up finally getting an Instant Pot after our slow cooker died. My kid loves slow cooked meat. Pork. Chicken. Steak. If it’s falling off the bone, she’s going to love it. Pre allergies, we didn’t eat that much meat… but with dairy, peanuts, and some tree nuts out the window, our options were limited and I found myself hanging out in the butcher section a whole lot more. Turns out the weekly slow cooker meal finally did our Crockpot in. I thought about just replacing the slow cooker, but I had heard good things about the Instant Pot. From yogurt making to making meals quicker, it sounded pretty amazing.

The problem was, it’s a little bit intimidating. How do you know when your meal is done when is sealed up inside? How do you know you house won’t explode when you open something that is under high pressure? So I set out to find a good introductory cookbook specifically for the Instant Pot. I choose Milk Street Fast and Slow by Christopher Kimball because not only did it have a lot of reviews, but it had a wide variety of recipes.

Okay, so are the recipes actually good?

Yes. Yes. Yes. They are amazing. Everything I’ve made I’ve wanted to make again. The book is set up into seven sections- vegetables, grains, beans, one-pot pastas, chicken, pork, and beef. Some of the vegetable recipes are side dishes, but generally it’s just recipe after recipe of delicious one pot meals. Every recipe has how long the recipe takes with you actually prepping/cooking/standing by the Instant Pot, and how long it takes using the pressure cooker setting OR how long it takes if you use the slow cooking setting. Since everything takes different amounts of time for the pressure cooker to automatically reach pressure and release pressure, having the total time is super helpful. After getting over my fear of the pressure cooker setting, I haven’t done much slow cooking. It’s just too fun to set up the pressure cook and let the Instant Pot do its thing and then open it up and my food is magically, quickly cooked.

"Coconut Rice with Red Beans and Scallions"- no allergens!

Years ago, when Instant Pots were the hot, new thing, I almost bought one for one very specific reason: Indian food. I LOVE Indian food. And the thought of being able to make it at home, easily, was very tempting. Milk Street Fast and Slow has some Indian inspired dishes, sure, but it also has Italian, Mexican, Jamaican, Lebanese… there are dishes that I probably wouldn’t have chosen to make just scrolling through recipes- like "Vermouth-Braised Chicken and Potatoes with Fennel" (it’s not that I don’t like fennel… it’s just that licorice isn’t actually that yummy, you know?) that have a completely different (but still delicious) flavor profile than my normal rut of recipes. Okay, so the guy's white, and the recipes are inspired by his "travels" (white people be travelin'), so I'm not sure how authentic all of these flavors are. But, (as white person myself) I think they are pretty good for the average home cook.

It's also clear that Christopher Kimball (and Milk Street… which is apparently a cooking class/TV show/magazine that I hadn’t heard of but now want to know more about) put a lot of thought into creating each recipe. There are tricks in the introduction paragraph for each recipe- don’t worry there’s too little liquid, make sure you buy thighs not breasts, or remove the pot from the housing as soon as it’s done. There is also specific cooking you do on the sauté function before/after the pressure/slow cooking to make sure the dish is the right texture and as flavorful as possible.

So, is it good for people with allergies?

This wasn’t a cookbook I bought specifically for recipes for my kid with allergies, but rather a side effect of getting a new kitchen appliance. However, I’ve got to say it has been pretty easy to make a wide variety of food that is safe for the whole family to eat. Because you are making almost everything from scratch, it’s easy to avoid everything from milk to garlic for most of the recipes. There are some recipes that I don’t think I’ll be able to make-"Mashed Potatoes with Fontina, Asiago, and Black Pepper" sound great, but with butter, half and half, and 2 types of cheese, that just isn’t going to work. Other recipes I’ve been able to make with simple substitutions or just leaving things out. I was able to make "Chicken Rogan Josh" with vegan butter and vegan yogurt and I couldn’t tell the difference. "Spicy Collard Greens with Tomatoes and Peanuts" were delicious using Sunbutter. It’s not a cookbook made specifically for people with allergens, but the food is so good I don’t mind trying different substitutions.

 

"Two-Corn Chowder with Green Chili and Scallions" with vegan butter and coconut creamer- no dairy, still yummy!

Milk Street Fast and Slow was a great buy and I would definitely recommend if you have an Instant Pot!