I usually love to look at old holiday photos, but there's one set of Christmas morning images that makes me shudder.

My children and their many cousins were piled into my grandmother's living room — all of them wearing matching red footie pajamas. Most of the kids were rolling around laughing, but my oldest son, Caleb, then 7, was sitting alone.

His mouth was itchy and his stomach ached, which he knew could mean an allergic reaction, and he didn't want to interrupt the fun with his bad news. In the holiday chaos, Caleb had a bite of a sandwich offered by a well-meaning family friend. The bread contained hazelnuts, sending Caleb into life-threatening anaphylactic shock, which for him includes throat-swelling, diarrhea, vomiting, and hives. We didn't understand then, but we know now, that Caleb needed a quick shot of epinephrine. Instead, we called 911 and spent Christmas Day in the emergency room. We returned home that night, and watched Caleb's every breath.

Carolyn Cannuscio’s son Caleb Rader, at right, learned about cooking from scratch — an especially important skill for those with serious food allergies — during a trip to Italy with family and friends.
Family photo
Carolyn Cannuscio’s son Caleb Rader, at right, learned about cooking from scratch — an especially important skill for those with serious food allergies — during a trip to Italy with family and friends.

That was the Christmas we learned just how treacherous holidays can be for people with food allergies. Now our traditions include survival strategies that may be familiar to families who have a child with severe food allergies.

But what if you are hosting guests with food allergies?

Careful planning is key to preventing allergic reactions. This means spending more time on allergy-friendly menu planning, shopping, food preparation, and serving. But it also can mean asking your guests with food allergies to help.

I am always delighted to bring food that is safe for Caleb – and delicious to share with the whole party. Asking for this kind of assistance is a wonderful, direct, and safe option. And it will allow you to light the fire and warmly welcome your guests – without fear that paramedics may have to be summoned later.

If you would rather do the cooking yourself, ask your guests or their parents:  Tell me about your food allergies. What foods can you safely eat? What foods or ingredients should I avoid? Can I send you my menu so you can tell me where allergy problems may lurk? If you have an epinephrine auto injector, can you please be sure to bring it? No, you aren't micromanaging with that last question; studies show that most people who should carry their epinephrine consistently, don't.

Keep the menu simple and the number of items limited, but do start from scratch whenever possible. Catered and restaurant meals can be a quagmire, based on research from my team at the University of Pennsylvania. We surveyed takeout restaurants in Center City and learned that not a single restaurant employee could accurately describe how to prepare a safe meal for a person with food allergies. And we have seen what can go wrong. One friend ordered an egg-free birthday cake from a local supermarket. Her son ate it and went into anaphylaxis. The market explained, "Oh, we didn't realize that both the cake and the frosting had to be egg-free!"

Plan for extra time at the grocery store, especially if you are new to reading food labels. The safest path is to rely on such unprocessed "whole" ingredients as fresh vegetables, meats, fruits, and herbs — foods that don't even need a label.

For people with nut allergies, tricky items include chocolate, breads and pastries, ice creams, sauces and salad dressings. These items all can contain nuts, perhaps just because they are processed near nut-containing foods. My sister-in-law was horrified to find even her mayonnaise labeled "may contain tree nuts."

It helps to know some reliably safe brands, such as Vermont Nut-Free Chocolate or Tootsie Roll Industries candies, which are free from peanuts, tree nuts, and gluten. My favorite desserts, for decadence and wow factor, are the nut-free 7-layer confections from Caroline's Cakes, which also carries gluten-free options.

When we go to friends' houses, they often ask me whether it is safe to have nuts on the table as long as they are kept separate from other foods. As a cautious mom, a public-health professional, and a host, I prefer to keep any potentially dangerous items totally off the menu, allowing guests with severe food allergies to have a worry-free visit. This approach may be particularly important if guests with food allergies are very young or distracted — perhaps by an extra glass of holiday cheer.

It also means you should start your cooking with allergen-free surfaces, utensils and cookware to prepare an allergen-free meal without worry about cross-contact with unsafe ingredients.

My aunts, who are excellent cooks, taught me two lessons about hosting allergy-friendly holidays. The first lesson is practical. Aunt Angel and Aunt Linda carefully track every item they prepare for my son. They either take photos of food labels and text them to me before the holiday, or they hand me a bag of food labels before the meal. Then we "read it before we eat it," making sure there are no nuts. These redundant safety checks help me — and Caleb — relax and indulge in the delicious meal they worked so hard to prepare.

The second lesson is symbolic. With all their care and concern, my aunts show us that they understand the severity of Caleb's food allergies, and that they care deeply about Caleb and our family.

I cannot think of a better holiday gift than that.

Carolyn Cannuscio is associate professor of family medicine and community health at the Hospital of the University of Pennsylvania.

Tips for hosting an allergy-friendly holiday gathering 

Menu planning

  • Ask your guests: Tell me about your food allergies. What foods are safe? Unsafe? What are hidden pitfalls I should look for?
  • Confirm food allergies in an email to make sure you understand the details (are they allergic to peanuts but not tree nuts, or vice versa).
  • Limit the menu to just a few dishes. Simple items, prepared from scratch, are best.

Shopping

  • Allow time to read food labels carefully. Read all labels, even if you wouldn't suspect allergens.
  • Go for "whole foods" whenever possible, including fresh vegetables and fruits, fresh herbs; unprocessed meats.
  • Beware of items that often include "top eight" allergens (peanuts, tree nuts, milk/dairy, wheat, soy, egg, fish, shellfish). For nut allergy sufferers, tricky foods include chocolate, breads, ice cream, and pastries.

Cooking

  • Minimize distractions, and re-read all food labels before you start cooking.
  • Make sure all cookware, utensils, and surfaces have been cleaned thoroughly, including a run through the dishwasher, especially for hard-to-clean items such as blenders.
  • Keep all food ingredient labels (even for spices or condiments), or take photos. Share with your guests.

Serving

  • When your guests arrive, walk them through menu options, explaining which may be unsafe for them.
  • Label foods on a buffet: "This stuffing is nut-free." Keep any "off limits" foods separate and clearly labeled. If you have young guests with allergies, keep these foods well out of reach — or better yet, off the menu.
  • At buffets, serving utensils tend to move from dish to dish. A good strategy is to make a "safe plate" for a guest with food allergies rather than sending them to the buffet.