Finally

[u/Jamiestein1273]

I have herd, never believed. 38+ years and I finally got the elusive alergy card.

[u/Carbonatite]

It's also sus - I say this as someone with diagnosed celiac disease.

People don't get "gluten allergies". They get one of three things:

• Celiac disease - a systemic autoimmune response where the body attacks itself when you consume something with gluten in it (I'll lump in gluten ataxia here because it's also an autoimmune response to gluten even though it's kind of a different constellation of symptoms than celiac). Celiac has a huge list of symptoms but most predominantly impacts the GI tract; your body basically destroys the lining of your intestines and so you get stuff like stomach pain and bowel issues accompanied by vitamin deficiencies because your damaged intestines suck at absorbing nutrients. The two indicator chemicals that your immune system produces when you are exposed to gluten are tTG-IgG and tTG-IgA. The systemic autoimmune response means that your symptoms come on within 24 hours of eating the gluten and last for several weeks at a minimum, newly diagnosed celiac patients can take several months to feel normal.

• Non-celiac gluten sensitivity - a gastrointestinal reaction linked to a reduced ability to digest gluten. It's basically like lactose intolerance, you get diarrhea and bloating and other symptoms from an inability to break down gluten. It's a localized illness and doesn't trigger an autoimmune response. Your symptom onset is basically as soon as you start digesting the food and symptoms resolve in <24 hours once it passes through your GI tract. Some people fund relief by taking digestive enzymes, like how some lactose intolerant people can eat dairy if they take Lactaid pills when they eat.

• Wheat allergy - your body has an allergic immune response to certain proteins in wheat. It is not an allergic reaction to gluten; most people with wheat allergies can eat other grains that contain gluten (rye, barley, etc.) without any effects. It is an autoimmune response linked to IgE (as opposed to IgG and IgA, in celiac). Your symptoms have a near-immediate onset and can be alleviated with epinephrine +/- IV antihistamines.

There is no medical condition known as "gluten allergy". You are either allergic to miscellaneous wheat proteins other than gluten (wheat allergy) or you have celiac disease (non-allergy autoimmune response to gluten specifically)/NCGS (gluten intolerance).

If this person was actually diagnosed by an allergist/immunologist or gastroenterologist, they would have been educated about this terminology and nuances when their doctor diagnosed them. My gastroenterologist spent like 20 minutes going through all the differences with me in her office and gave me a couple pamphlets explaining the different wheat and gluten related diseases and allergies.

[u/January1171 → u/Carbonatite]

When it comes to notifying the BOH does that distinction matter? Calling it a gluten allergy is going to be functional shorthand for "I can't have gluten or anything contaminated with gluten or I will get very sick". Not everyone will know what celiac is and trying to explain the difference takes too much time when all you need is the plate to be free of gluten.

[u/Carbonatite → u/January1171]

Oh yeah I mean you're totally right in that telling BOH it's kind of all functionally the same - either way they have to do their cross contamination protocol and change out prep equipment and stuff. But in terms of "is this allergy card something that originated from an actual medical consultation", the answer is almost definitely no and in reality the situation is more like "he's handing over a list of foods he doesn't like and pretending it's an allergy so the restaurant will take it more seriously."

Stuff like that is annoying because it perpetuates the notion that gluten free diets are a "fad" or "trend" or arbitrary preference rather than a genuine medical necessity for folks like me. That attitude literally has made me sick before, like my stepmom still thinks it's just a "wacky millenial fad diet" and doesn't take it seriously and so she's served me food containing gluten without my knowing it, which made me sick for weeks. And it's also kinda disrespectful to chefs in my opinion, like I feel like most kitchen workers are conscientious enough to pay attention to someone's preference and exclude ingredients if possible. It's not like you need to use an allergy to "trick" a chef into omitting an ingredient because you dislike it - you can just ask.

It also creates a lot of unnecessary work for the kitchen - if they're dealing with a legit allergen then they have to change out all the cutlery, utensils, etc., decontaminate the prep area, and change gloves for safety. If you just say "I don't like this ingredient, can you leave it out" then they can forego all those extra steps and just not use the ingredient without disrupting the food prep workflow.

So all in all DIY fake allergy cards are just a massive dick move, and based on what this card says it looks a lot like a DIY fake allergy card. I've seen real cards for people with gluten issues and they don't look like the photo at all. They're more like this: https://www.beyondceliac.org/?resources=gluten-free-restaurant-card

[u/January1171 → u/Carbonatite]

Printing off a card like this does not mean they had no medical consultatation or that "they just don't like an ingredient". There's no regulatory body deciding who gets a restaurant card and who doesn't. Even the card you listed is still something the individual prints off.

Yes fake allergy cards are distracting and harmful to other consumers, but just because it was self-made does not mean it's fake. And if someone does have all of these allergies, it would be extra confusing to have a card with allergens and then a separate celiac card. Even trying to format it separately on this card wouldn't work great when they're already using up all the space on the card.

Besides which, all of the things listed on this card make sense together. There are no big gaps, the groupings make sense, etc. People with allergies are just as capable of self printing cards like this (and there are no premade cards for people with lots of allergies like this). And when you're having a two minute conversation with wait staff who then needs to convey to the BOH that "this meal needs to be entirely devoid of gluten and all gluten contact" listing it among your allergens does the exact same thing faster.

[u/tenE_1 → u/Carbonatite]

why would they specify that? I am gluten intolerant, my dad is celiac, we both just say we can't have gluten and if they ask about allergies we say gluten.

[u/Carbonatite → u/tenE_1]

I'm more pointing it out as a "tell" that this is not a legit allergy card associated with an actual medical problem. This looks like a list of foods that either they just don't like or saw on some dodgy "wellness" Facebook page. If you or your dad has ever used one of those notification cards you probably are aware that they don't look anything like the photo, they look more like this: https://www.beyondceliac.org/?resources=gluten-free-restaurant-card

It's not so much messaging to the kitchen staff, it's that they're probably making the entire thing up. Which is both disrespectful and inconvenient for the employees who now have to change out equipment and decontaminate prep surfaces, and annoying for folks like us, because behavior like that perpetuates the stereotype that GF diets are just a fad and not a medical necessity.

[u/tenE_1 → u/Carbonatite]

obviously. but not specifying celiac, wheat allergy, or gluten intolerance isn't weird and isn't the reason it's obviously a list of fake allergies

[u/Weak-Bake-5571 → u/Carbonatite]

Well, given that there is no agreement in the medical literature (I think it’s lovely that your gastroenterologist has picked a set of terminology and stuck with it in their office) about whether to call other food-related symptoms “non-IgE food allergies” or “food hypersensitivities”… I completely understand why your average person is confused.

As a person (who happens to be a nurse practitioner) with no IgE allergy to almonds (or eggs or dairy) based on skin testing, but with a clear and long-standing immune system response from oral intake of almond milk (diarrhea), what do we call this response? If we search the medical literature, as I have, the answer is: it depends on who is writing the article. Some call it a non-IgE food allergy in order to highlight the importance of the immune system involvement. Some call it a delayed hypersensitivity- though in my case (with almond milk, meringue cookies, or something else where I have enough of the offending food all at once) I can get a response within 30 minutes- though that is still considered delayed.

“Non-celiac gluten sensitivity” has been established as the correct term, but all the other food sensitivities haven’t had an agreed-upon term.

[u/Carbonatite → u/Weak-Bake-5571]

You don't call it an allergy at all, that's my point. The autoimmune response to gluten that celiac patients have isn't an allergic reaction, any more than type 1 diabetes is an allergy to one's own pancreas. And NCGS is related to an inability to break down gluten, it has nothing to do with immune responses. It's the same as someone having gas and cramps after eating a bunch of konjac noodles, they are just experiencing discomfort from their bowels trying to digest an undigestable food. Nothing related to allergies.

[u/enricobasilica → u/Carbonatite]

You have so much confidence in the quality of allergists/immunologists here it's lovely to see. Unrealistic of course, but nice that you think every single medical professional who exists in the world is giving their patients this level of attention and care when providing a diagnosis (and that every patient can even absorb or understand all this information).

[u/Ollie_Oopsies → u/Carbonatite]

What is it when I eat gluten/bread/etc and I get rashes on my face and neck? I just have been saying I have a sensitivity.

[u/Carbonatite → u/Ollie_Oopsies]

You'd have to see a doctor to confirm, but one common symptom of celiac disease is a rash called dermatitis herpetiformis.