Are Allergy Flares Like Little Flags Saying, "Stop or I'll Shoot?"
February 22, 2012 7:20 PM   Subscribe

Flares but no wheals. What does this mean? Also, casein-milk allergy, but no allergies to cheese, cheddar-type, and cheese, mold-type. I've been unable to locate even a single discussion or explanation of these phenomena online. Any ideas?

Last week I was allergy skin-tested at a major big-city hospital. And in two months I will be blood-tested to try to further confirm what's an undisputed allergy and what's not.

In the meantime, I'm suddenly having to remove a whole lot from my diet, as I appear to have tested positive for wheat, milk/casein, all nuts and seeds, carrots, and rice. Most of these do not come as a huge shock, as I'd noted some problems/possible allergies for milk, nuts/seeds, wheat, and grains in general when I performed a food challenge four or five years ago.

In fact, as a result of the food challenge and my doctor's advice at the time, I dropped wheat entirely, went light on the grain, and avoided milk and nuts up until the last several months when, in an effort to round out what I was eating nutritionally, I started drinking a lot more milk (avocado milkshakes, yah!), eating a lot more rice (both in gluten-free packaged food and directly), and trying to up my intake of nuts.

Past symptoms to this sort of eating included sinus problems (runny nose, stuffy ears, light stomach upset, etc.) that were moderately uncomfortable but not alarming (no itchy mouth or tightening throat), and I've been noting over the last month or so some of those symptoms returning—although I hadn't really thought through why.

Anyway, my take during the food challenge was that I was somewhat sensitive to these items, and that if I mostly avoided them much of the time all was well. I suspect/hope for the same result this time. But still I'm a bit flummoxed by my allergy results, and my allergist was hugely flummoxed: My only flare and wheal response was to dustmites. For food, I rendered flares, but no wheals. Have you ever heard of this before?

Also, I don't know what to make of the casein-milk allergy, but no allergies to cheese of the varying types listed above. Cheese has always been an important component of my diet! Can I still eat certain cheeses? All the information online seems to suggest I can't. But the testing information from the allergist's makes a clear unexplained distinction on the paperwork.

I've been utterly unable to find any information about this online. Nor did my allergist give me any guidelines at all. I should have called him on it at the time, but somehow I didn't. So now I've got a call into the clinic, but their hours are peculiar, and they will not be open again until Monday. In the meantime, I was wondering if any of you know of any casein information that could shed light on this distinction, so I have a better idea of what, if anything, dairy I can still eat?

Extra credit questions: I'm leery of soy; apparently the wheat-allergic should be wary of oats. Nix to all the nut milks. Nor can I do rice, and hemp uses rice as a filler. So... the only kind of milk I can drink is potato milk! (Pathetic, isn't it?) The homemade batch I made recently made came out quite well. But it was labor intensive. Anyone know how or if I can make potato milk with instant mashed potatoes? Also any frozen yogurt replacement ideas? Thanks!
posted by Violet Blue to Health & Fitness (13 answers total) 1 user marked this as a favorite
Coconut milk as a dairy-milk substitute is starting to show up in more grocer's dairy cases, I've noticed.
posted by Juliet Banana at 7:35 PM on February 22, 2012 [1 favorite]

Coconut milk is great.

Can you borrow an ice cream freezer and try running a container of coconut yogurt through it? I have done this with regular yogurt and it's great. If not, maybe Sharons sorbet, which is dairy and soy free, will hit the spot.
posted by padraigin at 7:43 PM on February 22, 2012

Response by poster: Oh, Sharon's Sorbet looks great, thanks! Can't do coconut, alas, because of the "nut" part, but I appreciat the suggestion.
posted by Violet Blue at 7:53 PM on February 22, 2012

Frozen yogurt replacement: Yonanas?
Without buying the little machine: banana ice cream

Aside from that I've seen dairy-free, soy-free frozen yogurt/ice cream recipes - here's a few I found in a quick look around:
vegan chocolate sorbet
strawberry ice cream made with coconut milk
Rick Bayless's dairy-free avocado ice cream (made with tequila!)
basic vanilla-coconut ice cream
rum raisin ice cream
ginger ice cream
fresh mint ice cream
spiced sweet potato ice cream

Just saw your update... darn. A lot of these do use coconut milk (but not all of them). However I thought coconut was usually okay for people with nut allergies? Here, I googled this: Is coconut safe for people with tree-nut allergies?

I've always heard lactose-intolerance often does not extend to aged cheeses, because lactose is in the whey of the cheese, so as they age they lose moisture and are much lower in lactose than, say, ricotta. Cheddar and mold cheeses are aged. Is having a casein-milk allergy perhaps analogous to lactose-intolerance? If you're already leery of soy, fake cheese is likely off the table; not only does it have soy, it often has casein.
posted by flex at 8:03 PM on February 22, 2012

Response by poster: Imagine the -e in there, and keep the suggestions coming!
posted by Violet Blue at 8:05 PM on February 22, 2012

A family member has developed an allergy (separate than her previous lactose intolerance) to cow's milk, which I believe is actually to casein. She can have sheep and goat's milk products, along with the more exotic things like true mozzarella di bufala; there are some fantastic goat's milk ice creams, and if you like the flavor, Trader Joe's and other stores (even most normal big shops now) carry goat's milk yogurts and milks. I might have missed something in your information but definitely consider looking closely at the labels of your favorite cheeses to see what kind of milks go into them. Many traditional European cheeses are not based on cow's milk, although their American counterparts (I'm looking at you, feta!) may use more cow dairy. Alternatively you might show a reaction but not actually have much of an intolerance. I've been skin-tested and had major reactions to such weird things as perch and salmon but I eat products with trace amounts of fish sauce on a regular basis without a problem. Talk to your allergist to see what these baselines actually mean, and to what extent you should monitor your diet and your reactions.
posted by jetlagaddict at 8:49 PM on February 22, 2012

The issue with oats and wheat is cross-contamination. I've never seen oat milk that wasn't from gluten-free oats; that means no cross-contamination with any of the wheat proteins, including whichever one you're allergic to.
posted by Sidhedevil at 8:50 PM on February 22, 2012

Oh and although it's not nutritionally that awesome, horchata is pretty much amazing and it looks like you could drink it! (I picked that recipe at random, so google around if it sounds enticing.)
posted by jetlagaddict at 8:51 PM on February 22, 2012

Coconuts aren't nuts. Were you tested for coconut allergy? It's not linked to tree nut allergy.
posted by Sidhedevil at 8:53 PM on February 22, 2012 [5 favorites]

You seem to be getting some, er, idiosyncratic info from this allergist. A second opinion might be in order.
posted by Sidhedevil at 8:55 PM on February 22, 2012 [1 favorite]

Response by poster: Flex's coconut controversy link is interesting. But this link notes that "there is also some evidence of cross-reactivity between coconut, walnut, and hazelnuts, which are not related." Regardless, the testing sheet did mark me as being allergic to coconut; just for fun I also tested positive for seeds....

Jetlagaddict's comments about different cheese milk sources give me hope, as does Sidhedevil's info about oat milk!

Drink some horchata for me, jetlagaddict, unfortunately, I can't do the rice in it, at least for the next two months.

Interestingly, the hospital/allergist is all very fancy ivy league. But the complete lack of take-home info was, upon reflection, really irresponsible. So I agree with you, Sidhedevil. Unfortunately, this clinic is all that's available to me insurance-wise at the moment.

Anyway, thanks for all your comments! I'll be happy to read more, if you have more to say!
posted by Violet Blue at 10:11 PM on February 22, 2012

Are you lactose-intolerant? I have no experience with these food allergies but, speaking as a biochemist, I'd speculate that some cheeses are OK for people with lactose intolerance because the microbes used to make those cheeses eat up the lactose during the fermentation process. "Fresh" cheese like cottage cheese isn't fermented; the casein is coagulated into curds by acid or rennet and then the cheese is eaten right away. Most of the lactose drains off with the whey but there's probably enough left to upset lactose-intolerant people. Aged cheeses (common hard cheeses like cheddar, Swiss, etc) go through a ripening process in which the curds are inoculated with various bacteria and/or fungi to give the characteristic flavor. Lactose is readily metabolized by most microbes, so aged cheeses are probably low enough in lactose for most people to handle.

Now to your question about casein. Casein is the major protein in milk (about 80% of the protein in cow milk), but there are other proteins present at lower concentrations. The non-casein proteins are known collectively as whey proteins. Casein is usually the protein that triggers allergic responses to milk, but some people might react to one or more of the proteins in the whey.

Again I'm speculating here, but one of the important biochemical processes in cheese ripening is proteolysis, the digestion of proteins, by bacteria or mold (see the ripening link again). After the casein is broken down by the microbes it may no longer trigger your allergies. I assume the "Cheddar-type" and "mold-type" cheese on your allergy test refer to cheeses primarily fermented by bacteria and mold/fungi (like blue cheese) respectively; both of these types are ripened and undergo the proteolytic process during aging. In fresh milk, however, the casein remains intact and triggers your allergic response.

I speculate that you should be able to eat aged cheeses. Since you say you don't get any scary anaphylactic-type symptoms, go ahead and try a little and see if you feel OK. Stay away from fresh cheeses (cottage cheese, paneer) and milk. Approach yogurt, cream cheese, and sour cream cautiously - they are fermented but the microbes may not digest the casein enough for you.

(Ricotta, by the way, does not contain much, if any, casein since it's made from the whey proteins left over after the casein is removed and used to make other cheeses. You may be able to eat ricotta - test cautiously.)
posted by Quietgal at 10:18 PM on February 22, 2012 [2 favorites]

There is rice-free hemp milk.
posted by barnone at 10:33 PM on February 22, 2012

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