If you’ve never experienced an allergic reaction to food, then consider yourself lucky. According to the Asthma and Allergy Foundation of America, it is estimated that food allergies cause approximately 150 to 200 fatalities per year, based on data from a five-year study of anaphylaxis (an acute multi-system severe type I hypersensitivity allergic reaction) from the Mayo Clinic.
This is not to say that all food allergies are fatal. In fact, many people maintain healthy lives by avoiding the foods they know can make them ill. But what if you don’t know you’re allergic? Since each food is different, each allergic reaction can vary as well. Without proper care, testing and a follow-up visit to your physician, a simple rash could develop into something a lot more serious.
Food Intolerance v. Food Allergy
It is important to remember that a food allergy is a real—and often dangerous—condition. Affecting children and adults, a food allergy takes place when the immune system reacts negatively to a particular food protein. “True allergic reactions to food are less common; they are estimated to be present in 6–8 percent of children under the age of five, and in 3–4 percent of adults,” says Juliet K. Mavromatis, MD, FACP, medical director of Personalized Primary Care Atlanta. Food allergies can develop at any time in a person’s life.
A food allergy is an abnormal response to an otherwise harmless food triggered by the body’s immune system. When the food is first introduced, the body will build up specific, disease-fighting antibodies (known as immunoglobulin E or IgE). “IgE antibodies travel through the blood stream and settle on the mast cell. While the mast cell has many functions, it is responsible for allergic reactions. The next time that food comes into contact with the allergy antibody on the mast cell, it will activate the mast cell and cause an allergic reaction,” notes Karen A. DeMuth, MD, an assistant professor of pediatrics at the Emory University School of Medicine, and a physician on staff at Children's Healthcare of Atlanta.
Many people confuse food allergy with food intolerance, which is far more common and does not involve the immune system. Lactose intolerance, also referred to as lactase deficiency, is an example of food intolerance. “A person who is lactose intolerant lacks the enzyme needed to digest the milk sugar (lactose). When that person consumes milk products, he or she may experience symptoms such as gas, intestinal cramps, bloating and diarrhea,” says Julie Shipkoski, MS, RD, LD, at Open Hand Atlanta and Good Measure Meals. Lactase deficiency and other food intolerances are typically not dangerous; instead, they produce uncomfortable symptoms.
Common Food Allergies
The most common foods that people are allergic to are milk, soy, eggs, wheat, peanuts, tree nuts, fish and shellfish.
“The way foods cause an allergy, and the allergic reaction itself, is the same for both adults and children,” says DeMuth. “However, children are more likely to have an allergy to milk, egg, wheat and soy, while adults have a greater prevalence of peanut, tree nut, shellfish and finned fish allergies. Children are also more likely to ‘outgrow’ food allergies.”
The means by which children become tolerant to once-active food allergies has not been fully determined. “Some experts believe it involves a gradual decline in levels of IgE antibodies to food allergens over time,” says Mavromatis. Others note the body’s ‘acceptance’ of the allergen in spite of a consistent increase in antibody levels.
“According to the Food Allergy & Anaphylaxis Network, almost all children who are allergic to wheat or soy, and 85 percent of children who are allergic to milk or eggs, will outgrow their food allergy. However, allergies to peanuts, tree nuts (i.e. walnuts, almonds, cashews, pistachios and pecans), fish or shellfish tend to be life-long,” notes Shipkoski.
Symptoms of a Food Allergy
Typically, an allergic reaction to a food occurs within one hour of coming into contact with the allergen. “Food allergies can be very severe and cause life threatening reactions know as anaphylaxis,” says Eugene Hurwitz, MD at the Center for Allergy & Asthma of Georgia. “Other conditions that may be caused by food allergies include reflux problems and allergic inflammation of the gastrointestinal tract, hives, congestion problems with some foods, among others.” Many of the body’s systems can be affected during an allergic reaction, and symptoms may include the following:
Skin: Hives, swelling, itching, rashes, tingling or itching in the mouth
Stomach/Intestines: Diarrhea, nausea, vomiting, abdominal pain, ulcers
Lungs: Difficulty breathing, wheezing, cough, asthma
Heart: Low blood pressure, dizziness, weakness
If you’re experiencing the signs and symptoms of a food allergy, make an appointment with a registered dietitian or doctor prior to making adjustments in your diet. During the diagnosis process, he or she will assess your detailed history to ensure symptoms are consistent with those of a food allergy. If a diagnosis cannot be made, the doctor or dietician may ask you to maintain a food diary and/or implement an elimination diet to make a more accurate diagnosis.
If these tests point to a specific food, the doctor may wish to perform an allergy skin test to further identify the source of the problem. There are three kinds of skin tests: the scratch test (or puncture test), patch test and intradermal test. Skin tests typically involve exposing the skin to an extract of the allergen and examining its reaction. For those individuals who experience serious anaphylactic reactions, the doctor may perform blood tests, which evaluate the presence of food-specific IgE in the blood.
The double-blind, placebo-controlled food challenge (DBPCFC) is another effective method for objectively diagnosing a food allergy.
The patient is gradually exposed to increasing doses of the suspected allergen, which are hidden in capsules. After the patient ingests the capsule, he or she is closely monitored for an allergic reaction. The term double blind comes from the doctor being ‘blinded’ as well—the capsules are controlled by another medical professional.
Once an allergy emerges, you’re left with managing its symptoms. Although there is no clinically proven method of prevention, some experts believe there could be an advantage to early exposure. Food allergies are a complicated blend of genetics and environment, and everyone experiences them differently.
“Allergic reactions to food can be very unpredictable. Some individuals may react quickly and dramatically, whereas others gradually become sick. For some, a trace amount may trigger an allergic emergency, while others may need a comparatively large quantity before experiencing pain and discomfort. Some people have a single food allergy and others have allergies to multiple foods,” notes Shipkoski.
The best form of treatment for a food allergy is to simply avoid the food. When dining out, don’t be afraid to ask detailed questions about particular dishes and how they are prepared. “Eliminating foods altogether can leave you with an unbalanced diet, which may lead to other health problems,” Shipkoski adds. Therefore, it’s important to consult a doctor prior to making significant changes in your diet.
Despite best efforts, you may still come into contact with the offending food(s). In this case, over-the-counter antihistamines can help reduce the symptoms of a mild allergic reaction. For a more severe reaction, however, an emergency injection of epinephrine may be required to immediately reverse the effects. Oftentimes, people who experience life-threatening allergic reactions carry an epinephrine auto-injector, such as an EpiPen, with them at all times.
Wiggins offers advice for anaphylaxis-prone individuals: “It is critical for anyone with a life-threatening food allergy to have an emergency plan in place that includes epinephrine (adrenaline)—the primary treatment for anaphylaxis. The biggest risk factor for death in people with known anaphylaxis is a delay in the administration of epinephrine, so always have it within reach.”
Conclusion: Life Goes On
While there has been an overall increase in the number of people with food allergies, the exact reason is unknown. Some experts believe this growing number to be the result of improved diagnosis, while other studies suggest a switch from farm life to rigorous cleanliness. Early exposure to bacteria is actually good for the immune system, yet society has become overly sterilized. In essence, a cleaner environment could lead to an increase in allergies.
“The impact of living with food allergies is broad and can affect family, friends and even classmates or colleagues. The stress and anxiety that comes with managing a food allergy depends on the allergic individual, including his or her age, the amount of knowledge and education he or she has regarding food allergies, any history or experiences he or she may have in dealing with an allergic reaction or the use of epinephrine, and his or her support system,” says Karen Harris, president and founder of Food Allergy Kids of Atlanta—a nonprofit organization that supports and educates families that care for food-allergic children.
The good news? Thanks to continuous improvements being made in the understanding of, and treatment for, food allergies, individuals living with this condition do not have to suffer; instead, they can maintain a healthy, happy lifestyle.
Center For Allergy and Asthma of Georgia, (404) 844-5340, www.caawg.com
Children’s Healthcare of Atlanta, (404) 785-6000, www.choa.org
Food Allergy Kids of Atlanta, www.foodallergykidsatl.org
Open Hand Atlanta, (404) 872-6294, www.projectopenhand.org
Personalized Primary Care Atlanta, (404) 997-6790, www.ppcatl.com
Common Food Allergies
These foods account for 90 percent of food allergic reactions. Any ingredient that contains protein derived from one or more of them, are designated as “major food allergens” by the Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA).
4. Crustacean Shellfish
5. Tree Nuts
- U.S Food and Drug Administration
For people who want to take a more active role in helping to find a cure, there are a variety of local organizations that are looking for volunteers.