Food For Thought: All About Food Allergies
Thirty-two million Americans have food allergies—that’s one in 10 adults, one in 13 children, or two children per classroom—says Lacey E. Neufeld, DNP, FNP-BC at Marshall Family Medicine.
The awareness of food allergies and proper diagnosis has come to the forefront only in the last 20 years, according to Travis A. Miller, MD, founder of The Allergy Station in Roseville. “There are many resources available to ensure patients live a good quality of life. Partnering with a board-certified allergist for proper diagnosis and management is key,” he says.
Chiraag S. Patel, MD, allergist and immunologist at Granite Bay Allergy, Asthma & Immunology, says food allergy is complex, and knowing where one falls on the spectrum is very important because treatment vastly differs based on the diagnosis. “Early introduction of allergenic foods starting at four months of age while breast-feeding has been shown to dramatically decrease the development of food allergy,” he says. Adding that a landmark publication in The New England Journal of Medicine in 2015 for peanut allergy prevention (“Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy”) should be a must-read for all physicians.
Taking a deep dive into the world of food allergies, seven local allergy experts answered some important questions about allergic reactions, treatments, and recent scientific breakthroughs.
Q: What are the most common food allergies?
A: “The eight most common allergies are cow’s milk; hen’s egg (usually outgrown during childhood or adolescence), peanut and tree nuts (more likely to persist or develop later in childhood or adulthood), soy, wheat, fish, and shellfish. Some other common allergies include linseed, sesame seed, peach, banana, avocado, kiwi fruit, passion fruit, celery, garlic, mustard seeds, aniseed, and chamomile,” says Neufeld.
Rubina Inamdar, MD, division head of Allergy and Immunology at Mercy Medical Group, says food allergies vary by age. “For infants, the most common are eggs, then milk, and peanuts. In older children it's peanuts, tree nuts, shellfish, sesame, and fish. For adults, shellfish, fish, and tree nuts. We’re also seeing a rise in atypical foods such as chickpeas and lentils.”
Q: What should we know about how to properly read labels to avoid allergens?
A: Casein is one of the sneakiest ingredients that causes reactions in people who are sensitive to dairy, according to Michele Raithel, ND, naturopathic medical doctor at Revolutions Naturopathic in Folsom and Roseville.
Victoria Dimitriades, MD, clinical professor of pediatrics and allergy and immunology at UC Davis Health, says once you’ve identified your food allergy, it’s important to know the different names that can be associated with that allergen. “For instance, did you know that some brands of hot dogs might have milk ingredients in them?”
Neufeld also suggests to look beyond the ingredient list as they oftentimes won’t contain any foods you’re allergic to. “If you look below the ingredient list for the words ‘may contain,’ you’ll read what could potentially have been exposed to this product during the manufacturing process.”
She also says to be aware of foods not labeled properly—including supplements and vitamins, which aren't always regulated by the FDA. “Unless a third-party consumer group is testing their products, you might not know exactly what’s in them. If you have any questions, it’s safer to avoid using the product,” she recommends.
Q: In what ways can food sensitivities present themselves?
A: Food sensitivities can present as headaches, psoriasis, eczema, joint pain, and many other indicators of inflammation, and they can take up to 72 hours after exposure to present, according to Raithel.
There are many different ways to react to foods—and not all of them are dangerous. “It’s important to review your symptoms with a physician in order to determine what—if any—further workup might need to be done,” says Dimitriades.
Q: How can you safely test yourself for an allergic reaction?
A: “Typically, we would discover this by ingesting the food and noticing that we no longer develop an allergic reaction. However, this is not a safe option,” says Neufeld. It is far safer to use the assistance of your medical provider and/or an allergen specialist, who will perform a skin-prick test and/or a blood draw to look for antibodies. Then, if the specialist or your provider determines that it’s safe to proceed, you will do a “food challenge” and have a very small portion of the food you were previously allergic to. “It is critical that you educate the people around you and have anaphylaxis medication (if you have them) nearby when you attempt the food challenge,” Neufeld says.
Q: Can you get over or outgrow allergies?
A: Patel says some food allergies can be outgrown. “For example, 85 percent of kids outgrow egg, milk, wheat, and soy by age five versus only nine percent of people outgrowing tree nut allergies.”
Inamdar notes there is a high false positive rate for skin testing and allergy blood tests, and they should be ordered by an allergist who can interpret the results based on your history.
Q: Can allergies worsen over time?
A: It is possible some allergies will get worse over time, according to Neufeld. “If you have an allergy to food that has ever caused neck or facial swelling, your medical provider should be notified so that they can refer you to a specialist,” she says. “Sometimes we have symptoms like runny nose, sneezing, and rashes, and don’t know what we’re allergic to. This would be another great reason to seek an expert’s opinion.”
Children with food allergies are two to four times more likely to have asthma. And almost half of children with an allergy to one food will be allergic to other foods, too.
Q: Can you develop new food allergies later in life?
A: Yes, says Mark Grijnsztein, MD, chief of allergy at Sutter Medical Group. Adults can develop food allergies but it’s less common than in children. “Adults tend to develop more food intolerances, which are different from food allergies,” he says.
Some of the food allergies adults are more susceptible to developing later in life include peanuts, fish, shellfish, and tree nuts, as per Neufeld. “We can truly never predict what allergies might be triggered later in life, so it’s impossible to avoid them,” she says. “Recent research even shows that trying to intentionally avoid certain foods for fear of developing an allergy to them later in life may actually make us more susceptible to them.”
So, Neufeld offers this piece of advice: “We still don’t fully understand why something we weren’t allergic to yesterday, we can be allergic to today; so, enjoy your healthy meals and live every day in the best way!”
Q: What happens with an allergic reaction?
A: The biggest risk factor for a more severe reaction versus a mild reaction is poorly controlled allergies and asthma, shares Inamdar. “If you know you have a food allergy, making sure your EpiPens are close by is very important. Many people are afraid of using the EpiPens but they are not dangerous and will help stop the reaction.”
If you know you have a food allergy, make sure everyone around you knows how to use the devices and when. The American Academy of Allergy, Asthma, and Immunology (aaaai.org) has an “anaphylaxis action plan” that can be helpful to know when to use your epinephrine devices, says Inamdar. “Also, remember that anaphylaxis can come in two phases. One quarter of people who have a reaction can have a second bump in symptoms within a few hours of the first. That is why epinephrine devices come in two packs,” he says.
Q: Is there medicine one should carry to help treat the reaction?
A: According to Inamdar, epinephrine injection devices are the most important. “Asthma inhalers can help with some breathing issues in the short term, and antihistamines might help a little with itching but often they hide symptoms of the second phase reaction so we seldom administer them.”
People, including some doctors, often think Benadryl (or other antihistamines) or steroids can be used; however, those medications only help some of the symptoms or decrease the risk of a second phase, and should never be substituted for epinephrine, which has to be administered into a muscle, like the thigh. “Essentially all fatalities from anaphylaxis are from a delay of epinephrine administration. I always tell my patients that if in doubt, just administer and you will never be wrong,” says Patel.
Q: What should you do to alert others when you're having a reaction?
A: Food allergic reactions are most often anaphylactic—which is a life-threatening condition and should be treated as such. “Self-administration of an epinephrine auto-injector is the very first thing to do followed by calling 911 or immediately going to the ER if able,” advises Patel.
Dimitriades says wearing a medical bracelet can help others know you have sensitivities to foods, along with having a plan in place with your friends in case of a reaction so you can get appropriate care. You should also explain what the reaction may look like, adds Neufeld. Turning red, developing a rash or hives, sudden swelling of the face and next, grasping at the neck, or abnormal breathing are all possible reactions.
Q: What’s new in allergy studies and/or developments?
A: There are emerging therapies for some of the severe food allergies (like peanut) to help protect children from life-threatening reactions, according to Grijnsztein.
Inamdar, whose passion is the prevention of allergies, says “We have a lot of people with severe food allergies that can get treated so they can be safe around foods and even eat them. We’ve successfully treated hundreds of children and adults with severe food allergies including peanut, tree nuts, milk, egg, shellfish, fish, soy, and sesame in a very safe and effective way. Because our program has been around for almost a decade, we have significant long-term experience with handling some of the most severe patients. Imagine what it would be like if you didn’t have to worry about your food allergies?”
by Kourtney JasonPhotos © stock.adobe.com.