Passover, nuts, and allergies

Nuts to you – but be careful about tree and ground nut allergies when Pessah foods are widely served.

 Nuts (illustrative) (photo credit: INGIMAGE)
Nuts (illustrative)
(photo credit: INGIMAGE)

Passover is the “nutty holiday” for Jews who encounter tree nuts like walnuts, pecans, almonds, hazelnuts, pine nuts, macadamia nuts, pistachios, shea nuts and more. They appear in haroset (groundnuts, wine and cinnamon) to represent the mortar used by the Israelite slaves in Egypt), in cakes, cookies and other delights. Peanuts, which are eschewed by many observant Ashkenazim, are also found in baked goods and snacks.

These products are very beneficial to health, helping to protect the heart (thanks to omega-3 fatty acids) by lowering low-density lipoprotein (“bad cholesterol”) and regulating healthy heartbeats.

They also improve digestive functions by feeding the microbiome (beneficial bacteria in the gut) and contain fiber that satiates. But don’t overdo it: a 30-gram daily dose of nuts is plenty, as an excess causes weight gain.

Beyond overeating, nut allergies can cause allergies, and the first time a child or an adult shows mild symptoms, including raised red bumps of skin (hives) and other allergic symptoms such as runny nose, cramps, nausea or vomiting can be scary.

Even more frightening is anaphylactic shock, which results from the immune system suddenly releasing chemicals. Blood pressure drops suddenly, and the airways narrow, blocking breathing. Food allergies can begin in young children or suddenly in adults at any age. The best way to manage peanut, tree nut and seed allergies is to avoid all products containing these foods.

In very rare cases, if the allergic person is not equipped with an injectable Epipen containing adrenaline (epinephrine) for immediate protection against shock, death can result. There was such a case last year, when a young woman ordered chocolate mousse at a kosher meat restaurant. She questioned the waiter several times but was assured there was no dairy in it. But somehow milk chocolate was used, and as she didn’t have an EpiPen with her, she developed anaphylactic shock and died.

The incident was in the mind of one of Israel’s leading allergists, Prof. Alon Hershko, chairman of the Department of Internal Medicine C at Hadassah University Medical Center in Jerusalem’s Ein Kerem. The president of the Israel Association of Allergy and Clinical Immunology for the last two years, he is a specialty in clinical immunology and allergy at the hospital and also teaches these subjects at the Hebrew University-Hadassah Faculty of Medicine in the capital.

He became interested in allergies “because they are very common; it is genuine medicine. People who have them suffer a great deal, but most can be helped.”

There are only about 100 certified allergy specialists in Israel. “This isn’t because newly minted MDs don’t want to go into the specialties, but because there are not enough job slots allowed by the government and the hospitals,” said Hershko. “There is a big shortage, especially in the periphery in the North and South. The whole field of allergy is neglected in Israel. There are no laws forcing companies, restaurants, cafes and other institutions to state exactly what potential allergens their products contain and whether food that has a low allergy risk is manufactured with equipment also used in products that have a high risk.”

In addition, young children in kindergarten and up to second grade are entitled to get a supervisor who watches them closely to ensure that they don’t receive food from a classmate that endangers them. There are no longer nurses in every school who has an EpiPen on hand and knows how to use it. Hershko insisted that every educational institution must have designated staffers – even a librarian – who has the pen.

All members of a health fund are entitled to get an EpiPen for NIS 20, and they are usable for up to a year. Anyone known to have a food allergy must take it with him/her at all times – even to the corner store – just as they never go anywhere without their smartphone, declares Hershko.

Emergency responses for a severe allergic reaction are to lay the person flat – do not allow them to stand or walk – and inject adrenaline. When someone dies because of the lack of an EpiPen, it always makes the headlines in Israel, unlike traffic accident deaths that are a daily occurrence, Hershko said.

The Israeli medical establishment does not know how many people in the country have food allergies, but the Hadassah professor estimates that there are 50,000 children with it. “We recommend that all schools be peanut-free and not allow pupils, teachers or visitors to bring the legumes beyond the gate,” he said. “Many kindergartens, in fact, do this and post signs.”

Israel is known for having a minimum of children with peanut allergies, thanks to the common practice of parents feeding Bamba and other brands of peanut-butter-and-corn snacks to their infants as young as six or seven months old.

“There are 20 times more children with peanut allergies in England than in Israel,” said Hershko. “When exposed early to the allergen in peanuts, the body’s immune system get desensitized to it,” a finding that has been proven in Israeli studies.

Hershko recommends that public health nurses in Tipat Halav centers tell all new parents to start giving peanut snacks to their infants at the proper age.

Food allergies are problematic because one does not always know if the food, even traces of it, is contained in packaged products at supermarkets, grocery stores and open markets and served at restaurants and cafes.

People don’t know when they are eating nuts, which are part of some cheeses, added as crusts to fish, or otherwise hard to detect. When a package of chocolate is labeled as being “liable to contain nuts,” it drives those with allergies crazy, bemoaned Hershko. The companies write that to protect themselves, but “in Israel, there are no standards and no obligatory law on this matter. I don’t know what to tell patients, because is no reference.”

“The first time one is exposed, there is sensitization. From the second time onward, there can be symptoms. There are many parents who believe their child is allergic to cow’s milk products because he or she may have had an upset stomach or have some other problem, so they stop feeding it to the child. This is a mistake. Parents get very stressed when their child is diagnosed with a food allergy. It harms the quality of life. My research team and I wrote an article that those who went into anaphylactic shock can get post-traumatic stress disorder, like soldiers after a war.”

The allergist advises parents not to stop giving the food on their own.

“If there are allergy symptoms such as a rash or hives, see a specialist who will do an objective skin-prick test,” Hershko said. “These are simple and produce accurate results. Blood tests for allergens often produce false-positive results when conducted on children, and are expensive. These test for the presence of a specific allergen named immunoglobulin E, which is an antibody that attaches itself to allergens.”

Food allergies are almost always lifelong. Studies have shown that only about 9% of children outgrow their tree nut allergy. Many children have only mild symptoms, such as reactions on their skin. Taking an antihistamine pill is often the solution. There are people allergic to only one type of nut, but they are better off staying away from all kinds.

“There are families with a tendency to develop an allergy – but to different things,” said Hershko. “One could get hay fever from grasses, and other could have a reaction to certain metals or foods, but it isn’t hereditary.”

Hershko said that a child with an allergy is nevertheless healthy. “He can even be an Olympic champion,” he said. “The only limitation is that he must not eat the problematic food.”