Managing food allergies and dietary restrictions during the holidays

A plate of freshly baked cookies, a glass of perfectly garnished eggnog. For many, these images may conjure up warm memories and the anticipation of the forthcoming holiday season.

But for those with dietary restrictions, these goodies — and other holiday treats — can contribute to other emotions as well. During a season filled with parties and food, navigating the holidays while avoiding certain foods can be harrowing.

Well-intentioned hosts may prepare a selection of treats in a kitchen that includes flavours of the season. But without clear communication, detailed food labels and assurance of good practices to prevent cross-contact of foods, navigating a holiday tray or buffet line involves risk.

As an allergy researcher, my focus is on understanding the impacts of a food allergy diagnosis on people, families and communities, and what types of food allergy supports are most meaningful.

Many Canadians are increasingly aware of the foods they are eating, for reasons including but not limited to food costs, health and medical dietary restrictions. This latter reason can include efforts to reduce sodium or refined sugars, or avoid certain carbohydrates such as lactose or gluten for those with lactose intolerance or celiac disease, respectively.

But for the seven to nine per cent of Canadians with food allergies, the need to avoid is critical because of the risk of an acute allergic reaction. The most severe presentation of allergic reaction is anaphylaxis, which is potentially life-threatening.

Allergies and diet restrictions during holidays

Canadian research shows that, unlike holidays like Halloween and Easter during which children “hunt” for candy, rates of emergency department visits due to anaphylaxis during the winter holiday season are similar to the rates seen throughout the year. But that doesn’t mean food allergy restrictions don’t have an impact during these holidays.

Dietary restrictions can involve the need to avoid a range of foods. Health Canada has identified 11 priority allergens that are commonly associated with food allergies and allergic reactions: milk, eggs, peanuts, tree nuts, crustaceans and molluscs, fish, mustard, sesame seeds, soy, sulphites, and wheat and triticale. Notably, many of these foods commonly appear as ingredients in a holiday recipe, or as a single food item.

In a series of interviews with 21 families, colleagues and I identified that families dealing with food allergy learn quickly how to “decline something politely” stressing that they cannot eat the food, rather than being a picky eater. Nonetheless, they note feelings of grief, depression and anxiety as they strive to navigate events with their extended family and social circles. In some cases, families who manage multiple food allergies feel isolated, while some note that they are not invited to events because of their food allergy.

There are many ways that both those with dietary restrictions, and hosts, can lessen these impacts.

Practical actions

For anyone with a dietary restriction, there are certain actions that make holiday visiting more enjoyable and safer.

First, be certain to clearly communicate, in writing, any dietary restrictions to the host, at the time of accepting the invitation. Detailing which food options work within your dietary restrictions provides opportunity for the host to consider the menu, and to ask any questions at a calmer time than with a room full of guests.

You may also wish to bring a holiday treat that meets your restrictions. Eating a small snack ahead of any festivities can keep hunger at bay in case there are limited safe food options available. When in doubt about a food, do not consume it. Even if you have previously consumed the food, ingredient lists change occasionally.

Specific to those with food allergies, additional steps are warranted. Before leaving home, ensure that you have at least one epinephrine autoinjector that a trusted person can easily locate and use if anaphylaxis is suspected.

Food Allergy Canada offers some other practical tips for dining out. Awareness of the potential for co-factors to worsen the severity of a reaction is also needed. In addition to co-existing medical conditions, such as heart disease or asthma, research supports that alcohol, exercise, medication/drugs and possibly emotional stress may influence reaction severity.

Hosting this holiday season?

Welcoming guests can be joyful. But as the Canadian Psychological Association notes, there may be expectations of perfection, which — when not achieved — can contribute to stress. When inviting guests, ask about any dietary restrictions and bear these in mind while planning menus. Single food items or simple dishes may help your guests navigate food choices. Having a list of ingredients on hand, and adding labels and dedicated serving utensils to each dish, are similarly helpful.

The holiday season often involves sharing festive treats. By emphasizing joy and togetherness, memories can be made to cherish for a lifetime. With greater awareness of the needs of those with dietary restrictions, we can collectively work to ensure that everyone can safely indulge.