What Are Sulfites?

Sulfites are used as preservatives to slow the browning and discoloration in foods and beverages during each step of processing—preparation, storage, and distribution. They also occur naturally as a byproduct of fermentation, such as in wine-making. In wine-making, sulfites have been added for centuries to help ensure freshness and prevent oxidation. But they are added to many foods as an inexpensive, convenient method of limiting spoilage. Sulfites are used in most processed foods, but law prevents them from being used on foods meant to be eaten raw, such as fresh vegetables and fruits.

Sulfite Sensitivity and Symptoms

Less than 1% of the U.S. population experiences sulfite sensitivity, according to the Food and Drug Administration. But the likelihood increases for people who suffer from asthma—about 5-10%–especially those on steroid medications. Reactions occur after eating or drinking foods with sulfites, or inhaling the fumes from them. Sulfites may trigger asthma symptoms, including wheezing, chest tightness, coughing, and shortness of breath. Symptoms may also include:

• severe respiratory reaction
• flushing
• feeling of temperature change
• vomiting
• difficulty swallowing
• dizziness
• contact dermatitis

What Foods Contain Sulfites?

Sulfites are present in most processed foods. Food labels must list them if they are in concentrations of more than 10 parts per million. If used as a preservative, or for specific functions in a food, labels must list them at any level. Check labels for these sulfite-containing ingredients on foods, beverages, cosmetics, and medications:

• Sulfur dioxide
• Potassium bisulfite
• Potassium metabisulfite
• Sodium bisulfite
• Sodium metabisulfite
• Sodium sulfite

Major types of foods and drinks that may contain sulfites include:

Drinks: Bottled soft drinks and fruit juice, cordials, cider, beer, wine (including sparkling wine)

Other liquids: Commercial preparations of lemon and lime juice, vinegar, grape juice

Fruits: Dried apricots, fruit bars

Commercial foods: Dried potatoes, gravies, sauces and fruit toppings, maraschino cherries, pickled onions, sauerkraut, pickles, maple syrup, jams, jellies, biscuits, bread, pie and pizza dough

Salads and fruit salads

Crustaceans

Meats: Deli meats, mincemeat, sausages

Other foods: Gelatin, coconut

Beyond foods and beverages, sulfites may also be present in cosmetics—hair color, moisturizers, face and body washes, perfumes, blush—and pharmaceuticals—anti-fungal and corticosteroid creams and ointments, antibiotics, eye drops, some inhaler solutions, and more.

How to Avoid Sulfites

Sulfite-safe foods are whole foods, such as fruits and vegetables and other unprocessed foods in their whole, natural form. All packaged foods could contain even low levels of sulfites, so scanning the ingredients label is a must. There are some products, including wine, which are purposely produced without sulfites and may be labeled “sulfite-free.”

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Sesame is a globally popular ingredient, used in baking, oils, salads, even sushi, is more common than one might think. Sesame is the ninth most common food allergy, affecting more than 1.5 million children and adults in the U.S. But, sesame can be difficult to identify, as it is often a hidden ingredient in foods as well as some non-food products, like cosmetics. Because it is not recognized as one of the top eight food allergens in this country, sesame has not been required to be clearly labeled as a food ingredient.

Fortunately, a new law will recognize sesame as a major allergen and require it to be labeled on all packaged foods in the U.S. beginning January 1, 2023. Here’s what affected people need to know right now.

Sesame Allergy Symptoms

Sesame allergy is an allergy to the sesame plant, including sesame seeds, and products made from the plant, like sesame oil and sesame flour. As with other food allergies, a reaction is triggered when the immune system treats the proteins in a particular food (sesame, in this case) as harmful and defends against them by making antibodies to attack them. These antibodies cause the symptoms of an allergic reaction, typically within seconds to a few hours after the sesame-containing food is eaten.

As with other food allergies, symptoms may vary from mild to severe, including life-threatening anaphylaxis. According to the Food and Drug Administration, symptoms can include:

• Hives
• Flushed skin or rash
• Tingling or itchy sensation in the mouth
• Face, tongue, or lip swelling
• Vomiting and/or diarrhea
• Abdominal cramps
• Coughing or wheezing
• Dizziness and/or lightheadedness
• Swelling of the throat and vocal cords
• Difficulty breathing
• Loss of consciousness

How to Avoid Sesame

Sesame can be a challenge to avoid because it isn’t always as obvious as sesame seeds on the top of a hamburger bun or pressed into the rice on a sushi roll. Sesame seeds are a very common addition to crackers, breads, and baked goods, both sweet and savory, but may also be mixed into a food and not visible. Other products made from sesame are less obvious, such as sesame flour, sesame salt, sesame paste, and sesame oil. Common foods like these may contain a form of sesame:

• Breads and baked goods
• Cereals, granola, muesli
• Chips, crackers, pretzels
• Hummus and baba ghanoush
• Asian cuisine
• Dressings, gravies, sauces
• Energy and protein bars
• Noodles
• Sausages, veggie burgers, processed meats
• Spices, seasonings, and flavorings

A list of foods that potentially contain sesame would be exhaustive, so be sure to scan all food labels, even items one might least suspect. Look closely for sesame ingredients listed by uncommon names as well:

• Benne, benne seed, benniseed
• Gingelly, gingelly oil
• Gomasio (sesame salt)
• Halvah
• Sesamol
• Sesamum indicum
• Sesemolina, semolina
• Sim sim
• Tahini, Tahina, Tehina
• Til

In addition to food, people affected by sesame allergy should be vigilant about checking labels for Sesamum indicum, the scientific name for sesame, on certain non-food items: cosmetics (lotions, creams, soaps, body oils, hair care products, perfumes), medications, supplements, and pet food.

While there is no cure for sesame allergy, identifying the ingredient in foods will be much easier for those affected once the new labeling law goes into effect in 2023.

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As lupin beans and products are growing commercially, consequently, so is the incidence of lupin allergy. Here’s what you need to know about this emerging food allergy.

What is Lupin?

Lupin is a legume related to peanuts and soybeans. Traditionally, they were consumed in their whole form, but they can be used the same way as any other beans. Lupins are available as whole beans, bran, flakes, grits, flour, and as an ingredient in many food products. The rising popularity of this legume may be due to how well it suits several dietary patterns, including vegan and vegetarian, keto, and gluten-free. Lupins are a rich source of complete plant protein, a good source of fiber, nutrient-rich, and can be sustainably grown.

See more: Foods that contain lupin

Lupin Allergy Risks and Symptoms

For most people, eating lupins is safe. For some, however, it may trigger an allergic reaction. Because lupin and peanuts are in the same family, people with a peanut allergy are more likely to have an allergic reaction to lupin. But the allergy can present itself even in people without a peanut allergy. Studies are scarce, but lupin allergy seems to affect a very low percentage, less than 1%, of the population, though the percentage in people with peanut allergies is higher, ranging from 15% to 44%.

Allergic reaction to lupin is not more severe than to other food allergies; likewise, reactions and symptoms will vary. They may include swelling of lips and face, hives, stomach pain, nausea, or vomiting, itchy mouth, labored breathing, coughing or wheezing, even cardiovascular symptoms, like low blood pressure. Cases of anaphylaxis have also been reported.

The only way to protect against an allergic reaction is to avoid lupin and products containing any form of lupin.

Lupin Food Culprits

Those affected or potentially at risk should be aware of products that may contain lupin. Like other beans, lupins can be eaten whole, as well as ground into various forms, like flour, flakes, and bran. High in protein and fiber, ground lupin is used for adding fiber, texture, and protein to packaged foods. Because it is gluten-free, lupin is sometimes used as a wheat substitute in gluten-free products.

Lupin is also a soy alternative, so it might be used in beverages in place of milk or soy. Lupin is not one of the allergens that must be listed on U.S. packaged foods, though it may be listed as an allergen in different countries, such as those within the European Union.

Lupin can be eaten whole, just as you would any other bean. They also are often used as a vegan protein and fiber source in baked goods and other foods.

Ingredient labels should still list lupin, so be sure to scan labels and be aware that it may appear under other names including:

• Lupin(e) bean/flour
• Lupin seed
• Lupini
• Termes
• Altramuz
• Tarwi
• Termos

Types of foods that may contain lupin:

• Baked goods, like breads, desserts, cookies, muffins)
• Pastas
• Cereals
• Breaded or battered fish and meats
• Vegetarian faux meats
• Sauces and dips
• Tofu, tempeh
• Milks and creams
• Gluten-free and soy-free products (where lupin may be used as a substitute)

Now that you’re in the lupin loop, keep your eyes open for this nutrient-rich legume, but if you have a peanut allergy, be aware of the risk, however small, between a peanut allergy and potential lupin allergy. If you are affected, note the types of packaged foods, including “free-from” foods, like gluten-free, soy-free, as well as faux meat products made with plant protein, that may contain lupin. Definitely scan the ingredients list for lupin or its many pseudonyms to keep yourself safe.

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What Makes Food Organic?

Organically grown foods are produced on farms that mostly avoid synthetic pesticides, herbicides, or fertilizer and are free from genetic modification. As for livestock, they are fed organic feed, live on organic land, and are raised without routine use of growth hormones or antibiotics. Processed organic foods contain no synthetic additives. Foods that meet these criteria may become certified organic by the U.S. Department of Agriculture and carry the USDA Organic seal. To carry the seal, 95% of a food must be organic. Smaller producers are not required to have official USDA certification (it is an expensive process) to call their products organic, but they may not use the USDA Organic seal.

Organic vs Non Organic Food: Three Degrees of “Better”

Determining whether organic is better for you depends on what’s important to you and your family. Some people choose organic foods because they believe they are nutritionally superior and better for health than conventionally grown foods. Others prefer organic foods because they believe they are produced with methods that are better for the environment and the health of farm workers. Still, others gravitate to organics for what they perceive as better flavor.

1. Nutrition and Health

Studies have reported higher antioxidant levels and lower levels of toxic metal and pesticide residue in organically grown plant foods as well as higher omega-3 fatty acid concentrations in dairy products, eggs, and meat, but not all studies support these findings. More research is needed regarding the many variables impacting in the nutrient levels of crops. Additionally, organically grown crops are not necessarily pesticide-free. Growers are permitted to use non-toxic and safe pesticides and certain USDA-approved synthetic pesticides. It is important to note, both organically raised and conventionally raised crops must stay within maximum levels of pesticides according to Environmental Protection Agency standards, based on levels determined safe for human consumption.

2. Environment and Farm Worker Welfare

Use of synthetic pesticides and fertilizers may harm the soil, depleting it of valuable nutrients and contaminating it, nearby water sources, the animals that eat them, and the air that farmworkers breathe. Studies have linked exposure to some of these pesticides with certain cancers. The EPA has banned the use of many of the most toxic pesticides. Organic agricultural practices utilize more sustainable farming methods for the soil, which promote ecological balance and biodiversity in the environment.

3. Taste

For something as subjective as taste, some studies have shown that people have reported a taste preference for organic foods. These studies are not only small, but human opinion is just that—opinion. The flavor of food is as diverse as one’s preference for food. A food’s flavor is somewhat dependent upon many variables including the soil, the location and the climate in which it is grown, the specific farming methods used, and how the product is transported to market. An organic label does not necessarily promise better flavor, it just confirms the process of how it was grown and raised.

What Foods to Buy Organic

Though the price gap is narrowing with the increased availability of organic foods, they are usually more expensive than their conventionally grown and raised counterparts. In many cases, this could be anywhere from 5% to 50% higher, though there are ways to purchase them at lower prices to help fit into your budget, such as comparing prices, buying produce in-season, or finding deals at your local farmers market.

Let’s be clear – you don’t have to purchase solely organic foods. Certain fruits and vegetables, for example, may not be worth buying organic. Those with thick or inedible skins will have very little pesticide residue. When you wash them at home before eating, you’ll remove even more. The Environmental Working Group, a third-party organization that tests produce each year for pesticide residue levels, publishes a Clean Fifteen list of the fruits and vegetables that are safest to eat without buying organic and the Dirty Dozen of the twelve you should definitely purchase organic because they contain the highest pesticide residue levels.

The Bottom Line on Organic vs Non Organic Food

Nutritionally, there is no significant benefit to eating organic foods. Organic and conventional foods contain very similar nutrient levels. The choice to purchase organics comes down to the preference regarding how the food is cultivated. That’s where the focus of your decision between organic versus conventional falls. Your thoughts about the impact of synthetic pesticides and fertilizers, growth hormones, and antibiotics on your health and the health of the planet may ultimately influence your choice.

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Food sensitivities, like egg intolerance, are more common than food allergies and many adults have an egg intolerance. If you have egg intolerance, you may be able to tolerate a small amount of egg, but you may experience symptoms if you eat too much of it. Unlike a severe allergic reaction, an intolerance reaction is not life-threatening and mainly just uncomfortable. _[2,3]

Egg Allergy vs Egg Intolerance Symptoms

According to the American Academy of Allergy, Asthma, and Immunology, within a short time of eating an egg or sometimes even touching an egg and then touching your mouth, you may have these egg allergy symptoms: _[1]

• Skin swelling, rash, or hives
• Wheezing
• Runny nose and sneezing
• Red and watery eyes
• Stomach ache, nausea, vomiting, or diarrhea

A severe reaction – anaphylaxis – can cause a sudden drop in blood pressure, swelling in the throat that blocks breathing, and if untreated, can lead to loss of consciousness and may even be fatal. _[1-3]

Symptoms of egg intolerance, or other food intolerances, can cause the same digestive symptoms as egg allergy, but none of the other egg allergy symptoms. It does not cause anaphylaxis. Egg intolerance symptoms may also cause heartburn or headache, symptoms that are not common with a food allergy. _[3]

What Causes Egg Allergy or Egg Intolerance?

An egg allergy, like other food allergies, is caused when a food protein is recognized as a foreign invader by your body’s defense system, your immune system. Food allergies may be caused by genes passed down through families. If you have an egg allergy, your immune system makes antibodies to egg protein. If any egg protein – which is mainly in egg yolk – is detected, antibodies launch an attack by releasing chemicals, like histamine, that cause inflammation. _[1,3]

Food intolerances are often caused by lack of an enzyme needed to break down a food protein. That can make it harder to digest the food and may cause irritation in your digestive tract. Intolerance does not cause inflammation that occurs with an allergy. _[2,3]  People with irritable bowel syndrome may be more likely to have food intolerance. _[2] The most common food intolerance is milk, which is caused by not having enough of the enzyme needed to break down the milk protein lactose. _[2,3]

Diagnosis and Treatment of Egg Allergy and Egg Intolerance

The best way to diagnose egg allergy is with skin tests or blood tests to look for antibodies to egg proteins. The only treatment is to completely avoid eggs. Although most of the proteins are in the yolk, there are enough proteins in egg white to cause a reaction. Egg protein is in lots of foods; therefore, egg is one of the nine food allergies that packaged foods must include on their ingredient labels. If you have an egg allergy reaction, antihistamines may help. A severe reaction may require an injection of epinephrine. People who are at risk of anaphylaxis from egg allergy may need to carry an epinephrine auto injector. _[1]

Because egg intolerance does not cause an immune system reaction, there are no skin or blood tests that can diagnose it. Food intolerance is diagnosed only by your history. Your health care provider may ask you to keep a food diary to help link your symptoms to the foods you eat. Treatment of egg intolerance is avoidance, but unlike egg allergy, you probably do not need to avoid tiny amounts of egg in other foods. If you have a reaction, over-the-counter medicines for headache, heartburn, or other symptoms is the best treatment. _[2,3]

Egg Allergy, Egg Intolerance, and Vaccines

If you have egg intolerance, you don’t need to worry about egg protein in any vaccine, because the amount is so small. If you have egg allergy, you don’t need to worry about egg protein in the flu shot because egg protein has been removed. The CDC says that anyone with egg allergy can safely take the flu vaccine. One vaccine that still contains egg protein is yellow fever. Both the CDC and the World Health Organization say people with an egg allergy should not get it. You don’t need this vaccine unless you live or travel in South America or Africa. _[1]

Sources:

1. ACAAI, Egg Allergy | Causes, Symptoms & Treatment | ACAAI Public Website
2. Mayo Clinic, Food allergy vs. food intolerance: What’s the difference? – Mayo Clinic
3. Cleveland Clinic, Food Allergy vs. Food Intolerance: Symptoms, Causes & Prevention (clevelandclinic.org)

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Lactose is the natural sugar found in dairy products. If you experience dairy intolerance symptoms, your body may have a shortage of lactase, which is an enzyme that breaks down lactose so that it can be absorbed into the bloodstream.

The Wide Reach of Dairy Intolerance Symptoms

Dairy intolerance may also be commonly known as lactose intolerance. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) estimates that 30 to 50 million Americans are lactose intolerant.

Dairy intolerance symptoms are typically stomach-related as your body fails to properly digest the dairy product you consumed. Dairy intolerance symptoms vary from person to person, as severity varies. Symptoms may include:

• Stomach pain and cramping
• Nausea
• Bloating
• Gas
• Diarrhea

Dairy intolerance symptoms typically occur 30 minutes to two hours after consuming dairy. Common foods with lactose include milk, cream, ice cream, sherbet, yogurt, certain cheeses, and butter.

Lactose also can be added to prepared foods such as bread, frozen dinners, salad dressings, and more. According to the U.S. Food & Drug Administration, if a food label contains the word, or words, milk, cream, butter, evaporated milk, or others, it may contain lactose. For a full list of terms, review this milk avoidance list.

Are Dairy Intolerance Symptoms Related to Milk Allergies?

If you happen to be lactose intolerant, that doesn’t necessarily mean you’re allergic to milk. A milk allergy may bring a much more serious reaction and can be life-threatening. For many people, lactose intolerance is a discomfort.

Lactose intolerance typically is inherited from your parents. Many people do not show symptoms until adolescence. The level of sensitivity to lactose may vary from person to person. Some may be able to have a spoonful of cream or milk in their coffee in the morning without any symptoms.

Many people who are sensitive to dairy can eat yogurt or cheese without any issues because these foods are made using a fermentation process, which breaks down most of the lactose, according to the U.S. National Library of Medicine. However, others may have a harsh reaction to even a small amount of milk.

Since some symptoms of lactose intolerance also may be symptoms of other health problems, it’s important to see your physician for diagnosis. Your doctor may perform tests to check for intolerance. According to Johns Hopkins Medicine, these tests may include the following:

• Lactose intolerance test. You’ll be asked to avoid eating or drinking anything for eight hours before taking this test. After that, you’ll drink a liquid that contains lactose, and then undergo a blood test to measure your blood sugar levels. If those levels don’t rise after you consumed the lactose, you may be lactose intolerant.
• Hydrogen breath test. After drinking lactose, you’ll take a breath test to determine the hydrogen levels in your breath. High levels of hydrogen may be a sign of lactose intolerance.
• Stool acidity test. Primarily used for infants and young children, this test measures the amount of acid in your stool after consuming lactose. If there’s a high amount of lactic acid in the stool, it’s most likely a sign that the body isn’t digesting lactose properly.

Is There a Cure for Lactose Intolerance?

Unfortunately, there is no cure or treatment for lactose intolerance, but it may be managed. By keeping a close eye on your diet, you might be able to avoid some of the symptoms related to dairy intolerance.

Since lactose intolerance symptoms are likely not life-threatening, a key factor can be to take note of products that give you problems and to avoid eating them in the future. Also, keep a watchful eye on food labels, especially with prepared foods, as they may contain dairy products without you knowing.

Many supermarkets now carry lactose-free products, including milk. These products are treated with the lactase enzyme to break down lactose. Some of these products may taste different than their traditional counterpart but can be a great way to enjoy some of your favorite foods without experiencing the painful discomfort after.

Lactase tablets and drops are also available at most pharmacies or stores where over-the-counter medications are sold. By taking these products, it gives your body the lactase enzyme to help properly digest lactose. Consult with your physician before taking these products.

Originally published in 2016, this post is regularly updated.

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We asked several leading dietitians who are experts on the gluten-free diet for what has gluten in it, including some of the most surprising places you may find gluten. This information is especially important if you’re interested in preparing gluten-free recipes. Job 1, after all, is to determine whether you’re unwittingly serving foods with gluten in a recipe that claims to be gluten-free.

Here’s our list of a dozen foods that may contain gluten.

1. Soy sauce

You’d think soy sauce would simply be made with soybeans but not so, says Rachel Begun, MS, RD, a gluten-related disorders expert in Boulder, Colo. Most soy sauce is fermented with wheat; some brands contain nearly equal amounts soybeans and wheat. And look beyond the bottle. Soy sauce is also found in many salad dressings, sauces, marinades (think teriyaki), and packaged and frozen foods. Many tamari-style soy sauces—but not all—are gluten-free.

Look for: Gluten-free tamari (check out Eden organic and San-J brands) and Kikkoman gluten-free soy sauce. Bragg Liquid Aminos is another gluten-free choice, as is Coconut Secret’s Raw Coconut Aminos.

2. Oats

Is oatmeal gluten free? Although oats don’t contain gluten naturally, most conventional oats are contaminated with wheat (or barley or rye) during farming, harvesting, processing, and packing. Seek out certified gluten-free oats, says Marlisa Brown, MS, RD, author of Gluten-Free, Hassle-Free. Gluten-free oats contain less than 20 parts per million (ppm) of gluten. In contrast, some conventional oats have been tested to contain up to 1,800 ppm of gluten.

Look for: Certified gluten-free oats from GF Harvest, Montana’s Gifts of Nature, Cream Hill Estates and Bob’s Red Mill. Gluten-free instant oatmeal is available from Glutenfreeda and Bakery On Main.

3. Chicken stock

Many people don’t realize that wheat can be added to chicken broth, says Suzanne Simpson, RD, clinical nutritionist at the Celiac Disease Center at Columbia University Medical Center. Bouillon cubes and soup base mixes also may contain added gluten as a binding agent.

Look for: Gluten-free chicken broth and soups from Imagine, Pacific Foods and Kitchen Basics.

4. Corn Flakes and Rice Krispies

These corn- and rice-based cereals may sound safe but they usually contain malt flavoring made from barley, Simpson says. Is barley gluten free? No, barley has gluten. But Barley is not one of the top eight allergens and does not need to be identified in food labels, so look for cereals labeled gluten-free.

Look for: Kellogg’s Gluten-free Rice Krispies, Erewhon Corn Flakes and Erewhon Crispy Brown Rice Cereal, as well as Chex gluten-free cereals.

5. Licorice

Red or black, licorice is off limits. While licorice root does not contain gluten, licorice sticks and licorice candy are almost always made with wheat flour—and quite a lot of it.

Look for: Orgran Molasses Licorice and Gimbal’s Licorice Scotties.

6. Imitation crab

When you order a dish with crab meat—such as sushi, California rolls or crab dip—ask whether it is made from imitation crab, Simpson says. Imitation crab is made from white fish, such as pollock, wheat, coloring and flavoring, all put together to resemble snow crab.

Look for: Sushi made with real crab meat or soft shell crab.

7. Deli meat

Although many deli meats are gluten-free, watch the slicer, Simpson says, since gluten-containing meats may be sliced on the same equipment. Buy pre-packaged deli meats clearly labeled gluten-free or ask the person at the deli counter to change their gloves and discard the first one or two slices of meat from your order.

Look for: Gluten-free meats from Applegate, Boar’s Head, Columbus and Dietz & Watson.

Chocolate-lovers on a gluten-free diet should avoid products containing wheat, barley malt or, simply, malt. Check labels carefully.

8. Chocolate

Don’t lose heart, chocolate-lovers. Many brands of milk and dark chocolate bars and chips are indeed safe, but to be sure, scan the ingredient list for wheat, barley malt or, simply, malt, Simpson says. Also, beware of any chocolate with “crisps” or “crunch.”

Look for: Labeled gluten-free chocolate from Enjoy Life, Endangered Species, Chocolate and Scharffen Berger.

9. Pickles and other pickled foods

Malt vinegar, which contains gluten, is sometimes used in the pickling process, Rachel Begun says. Although distilled vinegars are gluten-free (the distillation process removes the gluten protein), malt vinegar is fermented, not distilled, so it is not gluten-free.

Look for: Mt. Olive, Bubbies and Heinz pickles.

10. Tomato paste

This pantry staple is usually a safe, single ingredient food. But you should always read labels when it comes to gluten because there are exceptions to the rule, Begun says. Flavored tomato paste (think tomato paste with Italian herbs) can contain gluten.

Look for: Plain tomato paste, including products from Bionaturae, Cento and Muir Glen.

11. “Wheat-free goods”

Products labeled wheat-free aren’t always gluten- free. A case in point: “Wheat-free” pie shells may be prepared with rye flour or spelt and “wheat free” cookies can contain oat flour or barley malt. Under the FDA’s new labeling rule, gluten-containing grains (such as wheat starch) that have been processed to remove gluten may be allowed in gluten-free foods as long as the total gluten content measures below 20 parts per million. This is probably okay for celiacs, but it may be a problem for those with wheat allergies, Marlisa Brown says.

What has gluten in it? That peanut butter jar in your kitchen could well have been contaminated by traces of gluten.

12. The peanut butter jar

Your favorite peanut butter may come gluten-free, but if you have gluten eaters in your household, it probably isn’t anymore. Double-dipping a knife into peanut butter, mayonnaise, mustard, or cream cheese renders otherwise gluten-free foods no longer safe, Brown says.

In addition, don’t use the same toaster for gluten-free and gluten-containing bread. Ditto for hard-to-clean kitchen items like colanders.

Originally published in 2016, this post is regularly updated.

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But they have more in common than just an aversion to gluten and their gluten-free diet regimen.

“We absolutely crave bread,” says Mary from her prim domicile located in a Houston suburb. “That means we have to get creative.”

Gluten-Free Diet: Flour Choice Is Key When it Comes to Baking

In sticking to a gluten-free diet, Mike and Mary rely on the host of alternative flours and flour blends to achieve the tasty—and safe—baked goods they thought they would never enjoy again following Mike’s celiac disease diagnosis.

How do they do it? With these alternative flours, Mike and Mary learned how to make their favorite foods without compromising taste and texture. In fact, you can add essential vitamins, minerals, protein, and fiber to your baked goods, fortifying your gluten-free diet in flavorful ways. From beans and grains to tubers and seeds, there’s a rich and wonderful array of delicious and nutritious flours waiting for you.

• Bean flours: Varieties include chickpea (garbanzo), bean (navy, pinto, and red) and soy. Garfava flour is a blend of flours made from garbanzo, fava beans and Romano beans. High in protein, fiber and calcium, these flours work best with heavier foods, such as breads and spice cakes.
• Pea flour and green pea flour: Both have benefits similar to bean flours but without the strong aftertaste. High protein content adds structure to baked goods without any distinct flavor.
• Amaranth: An ancient food used by the Aztecs, the seeds of the broad-leafed amaranth plant are milled into flour or puffed into kernels for breakfast cereals. High in protein, calcium and iron, this mildly nutty-tasting flour adds structure to gluten-free baked goods and helps them brown more quickly.
• Corn flour: Milled from corn kernels, this is finely ground cornmeal that comes in yellow and white varieties. One form of corn flour is masa harina (milled from hominy) used in making corn tortillas. If corn flour isn’t available, you can make your own by grinding cornmeal into a fine powder in a food processor. High in fiber with a slightly nutty taste, corn flour is a good source of fiber, riboflavin, niacin, folate, iron, and thiamin.
• Cornstarch: A flavorless white powder that lightens baked goods to make them more airy. Cornstarch is highly refined and has little nutritive value. Store in a sealed container in a dry location.
• Cornmeal: With a larger particle size than corn flour, cornmeal lends excellent texture to foods and has a nutty and slightly sweet taste. Cornmeal comes in yellow and white varieties and in fine, medium and coarse grinds. Select finer grinds for baking and for polenta. Use coarse meal for breading. High in fiber, iron, thiamin, niacin, B-6, magnesium, phosphorus, and potassium.
• Millet: An ancient food, possibly the first cereal grain used for domestic purposes, millet imparts a light beige or yellow color to foods. Millet is easy to digest, and its flour creates light baked goods with a distinctive mildly sweet, nut-like flavor. High in protein and fiber and rich in nutrients, millet adds structure to gluten-free baked items.
• Oat flour and oats: High in fiber, protein, and nutrition, pure, uncontaminated gluten-free oats add taste, texture and structure to cookies, breads, and other baked goods. If oat flour is not available, you can make it by grinding oats in a clean coffee grinder or food processor. (Quinoa flakes can be substituted for whole oats in most recipes.) Store in a tightly sealed container in a cool, dry place or freeze to extend the shelf life. (See also our post “Is Oatmeal Gluten-Free?“)
• Rice flour: This is the gluten-free flour that’s used most often by those on a gluten-free diet. It’s available as brown rice (higher in fiber), sweet rice (short grain with a higher starch content), and white rice. Rice flour is easy to digest and blend. The texture varies depending on how it’s milled—fine, medium, or coarse. Fine grind is used for cookies, biscotti, and other delicate baked goods. Medium grind, the most readily available, is suitable for most other baking. Coarsely ground is best for cereal and coatings. White rice flour has a bland taste. Brown rice is slight nutty.
• Sorghum flour: Some believe this flour, also called milo or jowar flour, tastes similar to wheat. Available in red and white varieties, it has a slightly sweet taste and imparts a whole-wheat appearance to baked goods. Sorghum is high in protein, imparting all-important structure to gluten-free baked goods. It’s also high in fiber, phosphorous, potassium, B vitamins, and protein.
• Teff flour: Milled from one of the world’s smallest grains, teff is a key source of nutrition in Ethiopia. It’s available in dark and light varieties. High in protein, fiber, and calcium, teff imparts a mild, nutty taste to cookies, cakes, quick breads, pancakes, and waffles.

Originally published in 2016, this post is regularly updated.

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The most successful anaphylaxis treatment is an auto-injectable epinephrine (AIE) like EpiPen. Problem is, the company that owns EpiPen has increased its cost by 400 percent, making it more difficult for the average person (and school) to remain well-stocked. More on that later. First, let’s talk about how an AIE saves lives.

What is An AIE and How Does it Work?

AIEs are filled with the drug epinephrine (a.k.a. adrenaline), a natural hormone secreted when your body is under stress. Once injected, the epinephrine “increases your heart rate and blood pressure, but it also relaxes your breathing muscles and reverses the swelling and your immune system’s response to the allergic reaction,” says Don Bukstein, MD, an allergist and pulmonologist in Milwaukee, Wisc.

Epinephrine acts on multiple systems in the body at one time, making it the only medication to reverse a severe allergic reaction. AIEs such as EpiPens are sold in pairs because those who are experiencing anaphylaxis often require another dose. They expire yearly, so the highly allergic will require another pair annually.

While epinephrine can reverse an anaphylactic reaction, it’s not a cure for anaphylaxis. As stated by the Asthma and Allergy Foundation of America, “there is no cure or preventative treatment for most causes of anaphylaxis, so immediate use of a prescription epinephrine auto-injector at the first sign of a severe allergic reaction is the standard-of-care for adults and children.”

Do You Have to Go to a Hospital After Using an AIE?

Once injected, it’s important to seek emergency medical help at a hospital or urgent care facility immediately, says Dr. Bukstein.

Do You Need a Prescription to Get Auto-Injectable Epinephrine?

Although AEIs are available without a prescription in Canada, all US states require a doctor’s prescription to dispense this medication in America.

EpiPen: The Cost Debate

In 2007, drug company Mylan purchased EpiPen. Since that time, Mylan has increased the cost of EpiPens sixfold, claims an article in The New York Times. In 2009, a two-pack of EpiPens cost about $100. Jump forward a few years and the price has risen to anywhere between $340 and $600. If you have good insurance coverage, you may not notice the increase. For those who don’t, however, the price of this medication can prevent them from having access to a life-saving drug.

As Andrew Murphy, MD, Chief Medical Offer of the Asthma Allergy and Sinus Center in West Chester, PA says, “Coverage decisions are made by the insurance company, and I cannot tell you why one brand is covered and another is not. In general, I would say it is probably related to cost-generic epinephrine can be as little as $100 and one branded AEI is [more than] $5,000!”

Amidst great scrutiny, Mylan has been better about offering coupons to help offset the cost. A quick online search at www.goodrx.com, for instance, showed you could purchase EpiPens for just under $147 at Costco, or for just over that amount at CVS and Walgreen’s with the help of coupons. That said, Dr. Bukstein says, “where I practice in the inner city, it’s a huge problem because nobody can afford epinephrine, so we have to try to figure out ways of getting them the epinephrine.”

Does EpiPen Have Competition?

Price isn’t the only setback in the battle to put AIEs into the hands of those who need them. Recently, Mylan’s EpiPen and its main competitor, Adrenaclick, made by Impax Laboratories, suffered from severe shortages. Auvi-Q, another brand of auto-injector didn’t face the shortage but wasn’t covered by many insurance companies.

In August, 2018, the FDA approved the first generic version of EpiPen and EpiPen Jr—a big step in the war on cost and accessibility. This direct competitor, made by Teva Pharmaceuticals USA, has been approved for use in anyone who weighs over 33 pounds. Note: It’s difficult to treat those who weigh less than this as current needle lengths can result in the needle poking a bone upon injection in very small children.

According to the FDA Commissioner Scott Gottlieb, M.D., “approval of the first generic version of the most-widely prescribed epinephrine auto-injector in the U.S. is part of our longstanding commitment to advance access to lower cost, safe and effective generic alternatives once patents and other exclusivities no longer prevent approval.

EpiPen Side Effects

Like all medications, EpiPens come with side effects. The following are the most common of these ill effects, according to the U.S. Food & Drug Administration (FDA):

• Anxiety
• Apprehensiveness
• Dizziness
• Headache
• Nausea
• Pallor
• Palpitation
• Respiratory difficulties
• Restlessness
• Skin or soft tissue infection
• Sweating
• Tremor
• Weakness
• Vomiting

 Those with underlying heart issues (e.g., cardiovascular disease) also may experience chest pain or an abnormal heart rate.

How to Use an EpiPen

At the first signs of anaphylaxis, you must immediately do the following:

1. Remove the auto-injector from the carrier tube. (Flip open the cap and slide it out of the tube).
2. Hold the injector in a tight fist, with the tip pointing down towards your thigh.
3. With your other hand, remove the safety release.
4. Place the tip at a right angle against the middle of the outer thigh.
5. Push the autoinjector firmly until you hear a “click.” This lets you know the injection has begun.
6. Hold firmly for three seconds.
7. Remove the injector from the thigh.
8. Call 911 or get to an emergency room or urgent care center immediately.

Note: Keep your AIE in a dark, cool place. Avoid long exposure to sunlight or extreme temperatures such as above 100 degrees and below 10 degrees.

Warning: Never inject an EpiPen into a vein, buttock, fingers, hands, or feet, advises the FDA.

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What Is Anaphylaxis?

Before discussing what immunotherapy is and how it works, we need to understand anaphylaxis. This serious, potentially fatal condition affects the entire body within minutes after contact with a life-threatening allergen (e.g. an insect sting, food, medication, or latex). Anaphylaxis can cause shock, an extreme drop in blood pressure, and breathing difficulties, among other serious symptoms.

During anaphylaxis, the body views the allergen as an invader, causing the immune system to go on full alert, overreacting by releasing chemicals which cause allergy symptoms (e.g. nasal congestion, sneezing, itching, hives, and swelling). Instead of attacking one area of the body (i.e. the face, if you’re allergic to an ingredient in mascara), an anaphylactic reaction attacks multiple parts (e.g. the heart, lungs, and throat) simultaneously.

Can Anaphylaxis Be Cured?

Anaphylaxis is not curable, says Dr. Bukstein. “Curable means that you treat it and it goes away and stays away forever. This is just the opposite. If you have asthma, or if you don’t have asthma but you’ve had an anaphylactic episode in the past, then you’re at the highest risk of having one in the future,” he explains. “The epinephrine just reverses the symptoms, so you don’t die or have a very severe reaction. It reverses the symptoms, but you still are anaphylactic.”

Dr. Andrew Murphy, Chief Medical Officer of the Asthma Allergy and Sinus Center in West Chester, PA agrees. “Anaphylaxis as a pathophysiology phenomenon cannot be cured, meaning there is no pill or injection that I could give to a patient that would forever prevent them from ever having anaphylaxis,” he says.

Immunotherapy Could Reduce the Risk of Anaphylaxis

A person can train his or her body to become less allergic through immunotherapy, according to the American College of Allergy, Asthma, & Immunology (ACAAI). This treatment helps prevent an allergic reaction by gradually increasing a person’s contact with a specific allergen. It’s been successful on allergens such as grass, pollen, dust mites, and bee venom. Here’s how it works: an allergist gives an allergic person gradually increasing doses of the allergen he or she is allergic to.

“Let’s say you have a reaction to venom from an insect sting, You’re allergic to yellow jacket venom. Well, we can desensitize people, so it will lower their risk to very low, just like the general population’s risk by giving them sequential injections of that allergen,

Over time, the person becomes less sensitive to the allergen. This works, “probably by causing production of a “blocking” antibody, which reduces the symptoms of allergy when the substance is encountered in the future. Immunotherapy also reduces the inflammation that characterizes rhinitis and asthma,” claims the ACAAI.

Currently, immunotherapy is best used for the environmental allergens listed earlier. According to Dr. Bukstein, though, a better solution for food allergies is near. “We’re right on the verge—in the next year probably—where we’ll have ways of [using immunotherapy] with food allergy,” he says. At that point, Bukstein explains, those with allergies will be able to be treated with oral or skin desensitization, allowing them to tolerate small amounts of the food (e.g. peanut). They won’t likely be able to consume peanut butter on toast, but these people may be better protected from anaphylaxis if they accidentally ingest the allergen.

Note: Not everyone is a candidate for immunology, so it’s important to talk to your allergist before undergoing treatment.

Signs of Anaphylaxis

According to Dr. Bukstein, the following signs of anaphylaxis should be taken seriously:

• A skin reaction (e.g. itching, hives, welts, and flushed skin)
• Feeling hot
• Swelling on the face, eyes, lips, or throat
• Difficulty breathing due to constricted airways
• Nausea, vomiting and/or diarrhea
• A weak, rapid pulse
• Dizziness, fainting or unconsciousness

What Are the Most Common Triggers of Anaphylaxis?

“Anaphylaxis is a lot more common in people who have asthma, and people who are allergic to food or drugs,” says Dr. Bukstein. According to the American Academy of Allergy, Asthma & Immunology (AAAAI), these allergens are the most common causes of an anaphylactic reaction:

1. Foods (e.g. peanuts, tree nuts, fish, and shellfish)
2. Insect stings (e.g. from wasps, hornets, yellow jackets, bees, and fire ants)
3. Medications
4. Latex

How Long Does It Take to Go Into Anaphylactic Shock?

While an allergic reaction differs for everyone, “anaphylaxis typically occurs within minutes of exposure to an allergen,” says Dr. Murphy. “There are some very unique allergens, however, that the reaction may not occur until several hours after exposure.”

According to Dr. Bukstein, anaphylaxis usually occurs within the first 30 minutes, but in very rare cases, it could take 72 hours for the ill effects to take hold.

When to See an Allergist for Anaphylaxis

“Any anaphylactic reaction seen in a doctor’s office, an emergency room, a hospital, urgent care, needs to be seen by an allergist. One-hundred percent of them, not 99, not 98, these are life threatening reactions,” says Dr. Bukstein.

How to Treat Anaphylaxis

The best way to treat anaphylaxis is to prevent it from happening in the first place. Know your allergens and steer clear of them. If you’ve had an allergic reaction (anaphylactic or not) for the first time,  see an allergist or immunologist for thorough allergy testing. “There are going to be ways of desensitizing patients and hopefully preventing it, but the best prevention is just avoiding the allergen. Almost all of these allergens have to be ingested or injected. If you can define them and know what they are, then you can avoid them,” says Dr. Bukstein.

The best and only successful treatment for anaphylaxis is epinephrine. As stated by the AAAAI, “anaphylaxis requires immediate medical treatment, including a prompt injection of epinephrine and a trip to a hospital emergency room. If it isn’t treated properly, anaphylaxis can be fatal.” Dr. Bukstein agrees, adding that people must be vigilant about understanding the symptoms of anaphylaxis since they may differ for everyone. “Recognizing anaphylaxis can be a little tricky,” he says. “I’ve been doing it for many years, thousands of episodes I’ve seen, and I can tell you, no two are exactly alike. Some of the symptoms can come with other problems, so, you have to be astute and you really have to recognize it.”

According to the Food and Drug Administration (FDA), “people who have had an anaphylaxis episode always face the risk of another one. Because of this risk, they must carry an emergency dose of epinephrine at all times.” To learn more about life-saving auto-injectable epinephrine devices such as EpiPen, read our post: “Are EpiPens too Expensive?”

Looking for a specialist? Use the Find an Allergist/Immunologist tool on the American Academy of Allergy Asthma & Immunology’s Website.

For other helpful resources, visit:

• Asthma and Allergy Foundation of America
• American Academy of Allergy Asthma & Immunology

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