Finding out that you or your child are food allergic can be disheartening even to those among us who were expecting as much. For some it means major modifications to their diet. Add in multiple food allergies and it can double or triple the amount of homework and detective work to do. One must read food labels diligently, communicate with relatives, teachers, playmates and remain vigilant so an accidental ingestion leading to a life threatening anaphylaxis does not occur. Other hurtles can include proper nutrition, school bullying and social isolation in school.
The bad news, food allergies have been on the rise for the last two decades not just in United States but worldwide. The good news, more people are educated to this condition and public awareness is growing. Nut free classrooms and lunch tables are becoming commonplace in schools and daycares. Restaurants are more accommodating and there is a proliferation of websites offering nut free foods.
Up until recently, the prevailing treatment plan was to simply avoid the food item. Ingredients like soy, milk, egg and wheat are difficult staples to eliminate from the diet as they are in many things. The good news is that 80% of children outgrow these allergies by the time they are 15 years old. New research confirms cooked egg and milk byproduct should be well tolerated in most egg and milk allergic patients. Appropriate cooking denatures the protein as an allergen and improves patients chances of out-growing up to 90%. Cooked egg and milk byproducts should be the third ingredient or lower as listed on food packaging and should be fully cooked throughout. Peanuts, tree nuts, and seafood are easier to eliminate from the diet but are usually lifelong problems for most people. Only 20% of patients outgrow these allergies. Cooking these allergens will not decrease their allergenicity.
Sublingual Immunotherapy (“SLIT”) for food allergies is the newest form of treatment here in United States. While practiced over in Europe, research is still ongoing as to the efficacy of this treatment and it has not yet been approved by the U.S. Food and Drug Administration. See blog on Oral Immunotherapy (“OIT”).
If one child has food allergies, other siblings have a higher chance of also being food allergic. If there is eczema and food allergies there is a higher chance of developing environmental allergies and asthma. Around 35% of moderate to severe eczema in children is driven by food allergies and is a frequent reason for referrals to our office. While most food allergies present in childhood, adults too can develop food allergies later in life.
Important first steps in diagnosing food allergies is seeing a board certified allergist. A single screening test such as a blood test should not by itself be used to diagnose a food allergy. An allergist uses a detailed medical history, skin prick tests, serum assays (blood tests), and possibly an oral challenge to arrive at a diagnosis. A skilled allergist knows how best to interpret your clinical history with your test results.
True food allergies must be distinguished from food intolerances such as gluten intolerance (celiac disease) or lactose intolerance. True food allergies require a person to carry Epinephrine at all times. 90% of the time the skin is involved and patients classically present with hives. Other symptoms include:
- itching in the mouth/throat
- swelling of the lips, tongue, throat or face
- difficulty swallowing or drooling
- abdominal cramps & vomiting
- coughing, wheezing, shortness of breath and/or chest tightness
- loss of consciousness
A patient may present with one or more of these signs. Symptoms may start off as mild but can progress to severe within minutes. One should be prepared to administer Epinephrine immediately if one or more of these symptoms are observed.
Food intolerances/sensitivities usually result in GI symptoms such as bloating, nauseousness or diarrhea but are not life threatening therefore epinephrine is not needed. In both cases one needs to avoid the food item. Food allergies should always be taken very seriously. With the correct treatment plan, these patients can live healthy lives.
The Food Allergen Labeling and Consumer Protection Act of 2004 requires all food manufacturers to clearly label food packaging with the 8 most common food allergens: Eggs, milk, shellfish, soy, tree nuts/peanuts, wheat and whitefish. These 8 allergens are responsible for over 90% of severe allergic reactions to food. While this is a major leap forward for consumers, one must also read labels of non-food items like soaps, shampoos, detergents, lotions, paint materials, pet food and even some play dough’s before use.
At present it is voluntary for food manufacturers to warn of cross contamination from shared equipment or processing lines. Advisory warnings that say “made on equipment that also processes (allergen) peanuts, tree nuts, eggs, milk or soy” means one needs to avoid that food source as well.
We recognize that a new food allergy diagnosis can at first seem overwhelming but our office is here to support you during this transition. You undoubtedly will have many questions and may feel exhausted by all the information there is to read. We encourage you to reach out to other resources in the field such as FARE – the Food Allergy Research and Education Network, formerly the Food Allergy and Anaphylaxis Network. This national organization’s membership is comprised of consumers wanting to learn more about food allergies. Their website (www.foodallergy.org) has allergen free recipes, food recall alerts and educational material specific to each food allergen. Their newsletters address current legislation and research by experts in the field.
You may be interested in going to one of their local chapter meetings, the Greater Buffalo Food Allergy Alliance, for which Dr. Rockoff is the medical advisor. While there you can network with other people who want to share tips, listen to guest speakers and talk with others who have the same concerns as yourself. Food allergies can affect many aspects of your life. Your understanding on this topic is key to a successful outcome.
Our staff has brochures with kid friendly medic alert bracelets if you so desire. One should always carry liquid Benadryl and two forms of Epinephrine at all times. After using an Epi pen/Auvi Q/Adrenaclick, immediately call 911. Epinephrine is quick in its onset of action to reverse a reaction but observation and further medical care are needed. 15-35% of patients who present with anaphylaxis may need a second dose of Epinephrine prior to emergency care. You should take Benadryl Syrup after calling 911 if able to swallow.
A visit to our office will help you to learn several key things:
- Is there a food allergy?
- How to read a food label
- How and when to use an Epi pen/Auvi-Q/Adrenalclick
- What is an emergency plan of action form?