For families who rid their homes of allergenic foods, food storage, preparation, cooking, serving, and eating is of very little concern. The risk of accidental exposure is virtually eliminated along with the problem foods. For those who choose to make the problem food part of their family, however, mealtime can be a real challenge.

Not only do you have to sift through the grocery store shelves to find suitable substitutes and flip through food allergy cookbooks to discover recipes for palatable dishes, but you also have to master some techniques for preventing cross-contamination — an allergenic food tainting a non-allergenic food — and other opportunities for accidental exposure.

Preventive measures for cross contamination and accidental exposure apply to five areas:

• Storage
• Preparation
• Cooking
• Serving
• Eating

In some families, everyone’s on a special diet. The doctor places dad on a low-cholesterol diet. Mom decides to try the Mediterranean diet to shed a few pounds. And teenage brother opts for the Atkins diet. The cupboards and fridge are packed with an assortment of special foods, and mealtimes take on the air of a food court, with everyone preparing their own special meal.

The same situation arises in many families living with food allergy. Many processed foods are eliminated from the diet, and certain ingredients that are staples for some family members become taboo for others. Obviously, the most efficient solution is to round up the troops and convince the entire family to get on the same menu page.

With all the available substitutes on the market and the allergen-free recipes provided at the back of this book and elsewhere, you may be surprised to find that the rest of the family actually prefers eating allergen-free. And, because allergen-free meals often rely less on processed foods, they’re generally healthier than the meals you may be used to serving.

The process of planning and preparing allergen-free meals is especially bothersome for those who don’t like to cook. For those who enjoy cooking, however, perfecting an allergen-free recipe can really be fun. Try to make meal preparation a family affair, getting everyone involved in picking recipes they’d like to try, and then team up to perfect the recipes.

One of the tricks to allergy free cooking is finding suitable substitutes for what you need to avoid. Over the past few years this market has grown tremendously, so that for the most common problem foods, you can usually find one or more excellent substitutes. Because food companies are constantly developing new substitutes. Scour the grocery store and specialty store shelves for additional options. You may be pleasantly surprised at the wide selection.

Reducing The Risks

Families that eliminate allergenic foods have little concern over cross-contamination. Unless a neighbor, friend, or family member smuggles in a tainted dish, snack, or dessert, cross-contamination is a non-issue.

If your family has decided to establish a peaceful coexistence with the allergenic food, however, cross contamination becomes a significant concern. By setting a few rules and implementing proper preventive measures, however, you can establish a safe eating environment for your allergic family member.

One of the best ways to prevent cross-contamination is to focus on the areas where it’s most likely to occur:

• Storage: Store all food in sealed containers. As long as the egg noodles and the egg-free noodles are in separate, sealed containers, they’re highly unlikely to contaminate one another. Be careful of leaky packages or spills. A leaky milk jug stored on the top shelf can splash milk all over the place, especially if you have leftovers wrapped in cellophane or aluminum foil or stored in unsealed containers.

• Preparation: Food preparation is a common source of cross-contamination. Kitchen counters, cutting boards, knives, meat or cheese slicers, spoons, measuring cups, mixing bowls, spatulas, and a host of other food prep equipment can carry remnants of a problem food.

To reduce the risk, thoroughly clean cutting boards between foods. Likewise, thoroughly clean all measuring spoons, mixing bowls, and other equipment and utensils between preparing the safe and unsafe foods.

A cutting board made of plastic or another hard surface may be easier to clean than a wooden cutting board. Some families use two cutting boards.

• Cooking: The biggest risk with cooking involves shared utensils, so clean utensils thoroughly between cooking safe and unsafe foods. As you’re cooking, be particularly careful not to use the same spoon or spatula on a safe food that you used on an unsafe food. Contamination from spills or spatters is a lesser risk, as long as you keep the safe foods you’re cooking a reasonable distance from the unsafe foods . . . and don’t get too flip-happy with your spatula.

• Serving: With severe food allergies, even a trace of allergen on a spatula can trigger a reaction. Clean serving utensils thoroughly, and never use a utensil used to serve an unsafe food to serve a safe food. Remain extra vigilant when you serve safe and unsafe foods at the same dinner table to make sure the serving utensils remain with their respective serving dishes.

Grounding Airborne Allergens

When allergens take flight, they can cause inhalation reactions. Peanut dust, for example, can trigger even a severe allergic reaction particularly if a person is eating shelled peanuts in close proximity to someone with severe peanut allergy. In the kitchen, airborne allergens pose a risk, because heat, spatters, splatters, and steam can launch allergens into the surrounding air.

When cooking unsafe foods, the following conditions pose the greatest risk:

• High heat on an open stove: The greatest risk of a food allergen becoming airborne occurs when you cook the food at high heat on an open stove. The vapors and spatter that occurs can contain large amounts of food protein that can cause reactions if you are in close proximity to the cooking. Common examples of this would be frying an egg or hamburger or stir-frying fish or shellfish.

• Steaming foods: The process of steaming foods may also release large amounts of allergen. Steaming shrimp or crabs or boiling or roasting peanuts can pose a huge risk.

• Prepping foods: Some foods become airborne during the preparation process. Large amounts or wheat, for example, can cloud the air when you’re baking a cake, kneading bread or pizza dough, or grinding up peanuts or tree nuts. Professional bakers sometimes fall victim to a condition called baker’s asthma, triggered by a heavy exposure to wheat dust.

Airborne exposures are much less common when foods are baked or cooked at lower temperatures. So while reactions related to frying eggs are common, I have never heard of an airborne reaction from baking a cake. To reduce the risks of airborne allergens, take the following precautions:

• The person with allergies should keep a safe distance from the preparation or cooking area when unsafe foods are being handled. Staying in the next room is almost always safe, and we rarely see reactions when the person with the food allergy is more than five or six feet away.

• Install and use a well functioning exhaust fan on or above the stove. This can make a huge difference.

• Allow at least 30 minutes for the air to clear after a problem food has been prepared or cooked before the person with the food allergy reenters the room.

Most household cleaners combined with a little elbow grease are sufficient for removing food allergens from countertops, tables, and chairs. Following are some tips for cleaning specific items, as well as a few potential problem areas:

• Counters and table tops: You can effectively clean these rigid surfaces with most household cleaners and elbow grease. Timing and diligence are most important — clean immediately after all food preparation and eating, and don’t skimp on the elbow grease.

• Sponges: Patients often ask whether the kitchen needs to be equipped with two sponges, so an allergen-free sponge is always available. As a general rule, I do not feel that this is necessary. Using a sponge to wash dishes, even if the sponge is slightly contaminated does not pose a huge risk, as long as you thoroughly rinse the dishes after washing them. With counters and table tops, where rinsing is less of an option, thoroughly rinse the sponge after cleaning up potential allergens.

• Dishes: Thoroughly washing dishes either in the sink or dishwasher is usually sufficient for removing all allergens. When washing dishes by hand, diligence, elbow grease, and a thorough rinsing are the key ingredients to success. When using a dishwasher, carefully inspect all dishes as you empty the dishwasher to be safe — stubborn allergens clinging to dishes or a less powerful dishwasher can leave allergen residue on the dishes.

• Cookware: Practice the same techniques for cleaning pots, pans, and other cookware as you do for dishes. Some families choose to keep a separate set of allergen-free pots and pans, but this isn’t really necessary. As for loading your cookware into the dishwasher, however, I’m less willing to trust the dishwasher unless you’ve done a pretty good job of pre-cleaning your cookware. Stoneware or other pieces that are more porous than the standard pot or pan may pose an additional risk, although this has never been proven.

• Utensils: In general, follow the same precautions as those for cleaning dishes and cookware, paying special attention to cooked-on foods and the nooks and crannies characteristic of most utensils. Be especially careful cleaning beaters and whisks, which are more likely to trap food remnants.

• Dish rags, towels, and other fabrics: Though easy to clean — one run through an average washing machine can loosen the grip of even the most clingy allergen — kitchen rags, towels, and other fabrics pose a significant potential risk. A dish towel used to dry a clean plate is certainly nothing to worry about, but if someone used the towel to wipe up a spill and then snuck it back on the hook, the towel could be very contaminated and transfer the allergen to that previously clean plate you’re drying.

• Tablecloths: Vinyl or plastic tablecloths are best, because the surface doesn’t absorb the gunk. If you use a cloth cover, it can pose a risk, especially in the case of liquid allergen spills, such as milk or egg. Again, the best way to clean a cloth tablecloth is to run it through the washing machine.

• Grills: For families who enjoy grilling out (or in), the grill is a potential hazard. Grilling a safe food along with an unsafe food — for example, a plain chicken breast alongside a breast marinated in soy sauce — could result in cross-contamination from spatter. As for any allergen residue remaining on the grill after cooking, I believe you can remove almost all food residue by heating the grill back up to burn off the remnants and then thoroughly scrubbing it with a wire brush.

Heating and wire-brushing the grill, however, is not 100 percent safe. I’ve seen a fair number of reactions traced back to a contaminated grill. Following are some safer alternatives:

• Safe: Place a double-thick layer of aluminum foil over the area on the grill where the allergic person’s food is being cooked.

• Safer: For the more compulsive chef, a second, allergen-free grill grate offers added protection.

• Safest: For the ultimate in compulsive grilling, a two-grill system is the safest option. For all you grill cooks out there who want a new grill, tell your significant other that the doctor said you really need a separate grill for optimum safety.

Every family living with food allergy should have a minimum of one food allergy emergency kit, complete with instructions, stored in a convenient central location that everyone knows about. In addition, you may want to create an allergy information center where you store additional information, recipes, your doctor’s phone number, insurance information.

In a family in which the parents are often not present, educating family members and sitters and even perhaps neighbors is essential. Whoever’s in charge needs to know the rules, emergency procedures, and where the medications are stored. In the following sections, I lead you through the process of gathering the essential resources and medications, and making sure everyone knows where to find them.

Once you and your doctor have decided which medicines you should have on hand in the event of a reaction, assemble an emergency kit with the following items:

• Medications, including an antihistamine and epinephrine autoinjectors if your doctor prescribed them.

• Your Food Allergy Emergency Action Plan from earlier article, providing clear, detailed instructions of what to do in the event of an allergic reaction. (Review the plan regularly to make sure all information is current, especially contact names and phone numbers.)

Store the emergency kit in a safe, convenient place, and make sure everyone in the house knows where it is. Most families decide to keep two emergency kits — one that sits at home and one that travels with them. The travel kit may need to be a bit more compact but should still contain all medications and instructions.

A similar kit may also make sense if your child spends lots of time elsewhere, such as at the grandparents’ house. Leaving your child with a baby sitter is always a bit nerve wracking but this is multiplied by a thousand when your child has severe food allergies.

Here are some guidelines for making parents’ night out as safe and stress-free as possible for all involved:

• Find a babysitter who may be more mature than the usual fare. Sitting for a child with a severe food allergy is not an ideal entry-level position for a 13-year-old. If you’re really lucky, you can find a college student or other young adult. If you’re lottery-lucky, you may find someone who has a food allergy, a sibling with a food allergy, or best yet, a nursing degree.

• Tell the sitter exactly what your child is allowed to eat. Take-out orders, special snacks, and treats are strictly off limits. Set the acceptable food out as clearly as possible.

• Describe the foods that your child is allergic to, and make sure the sitter understands the house rules on what she can and cannot eat around your child. If you have two or more children, explain what they’re to eat and not eat, point out the designated eating areas, and review clean-up policies.

• Train the sitter on the treatment plan for a reaction. Show her where the emergency kit is stored, and review the plan in detail, including how to spot symptoms. Show her the epinephrine injector and demonstrate its use with a trainer. Then ask her to repeat it all back to you and demonstrate the injector, until you’re sure she “gets it.”

• Provide explicit details on how and when to contact you, as well as phone numbers for other people who may be able to help in the event of a reaction. This often includes a trusted friend or neighbor as well as your doctor.

• Stress the importance of calling 911 in the event of an emergency. If your child has a severe food allergy, make sure the sitter knows to call 911. If the epinephrine autoinjector is used, a call to 911 is mandatory.