Food Allergies – More Common Than You Think
Food allergy is a serious, and potentially life-threatening medical condition. There is no cure, only prevention. It affects 32 million people in the United States, including 5.6 million children. It’s so common that it affects 1 in 13 children and 1 in 10 adults.
Any food can be an allergen. In the US, the top eight most common food allergens are: peanut, tree nuts, cow milk, egg, wheat, soy, fish, and shellfish. These account for 90% of all allergic reactions.
Sesame is the ninth most common food allergen. Peanuts are legumes which grow underground; they are different from tree nutswhich grow on trees. Tree nuts include cashews, pecans, walnuts, pistachio, almond, hazel and brazil nuts. Allergy to peanuts and tree nuts are usually lifelong. Milk is the most common food allergy in infants and young children and often will be outgrown. The allergy is to the milk proteins, casein and whey, which should not be confused with an intolerance to the milk sugar, lactose. Lactose intolerance can cause gastrointestinal discomfort with gas, nausea, cramps and diarrhea but is not life-threatening. Wheat (gluten) allergy is different from Celiac disease. Celiac is a digestive disease of the small intestine with serious symptoms of malnutrition and intestinal damage but not acutely life-threatening. Soy is another type of legume and one that usually doesn’t cross react with peanut. Among finned fish allergy, salmon, tuna and halibut are most common and usually lifelong. Shellfish allergy has shrimp, crab and lobster as the most common.
Food allergy occurs when the body’s immune system identifies a food protein (an allergen) as a threat and attacks it. The immune system’s attack produces abnormally large amounts of antibody which triggers the release of histamine and other chemicals that result in the symptoms of an allergic reaction.
Symptoms of an allergic reaction can involve:
- The skin (swelling, itching, hives or redness)
- Gastrointestinal (nausea, difficulty swallowing, vomiting or diarrhea)
- Respiratory (cough, wheeze or difficulty breathing), neurological (feeling bad, anxiety or confusion)
- Cardiovascular (paleness, weak pulse, dizzy) systems.
Typically, symptoms appear within minutes to several hours after eating the food. Reactions can be different each time the offending allergen is ingested. Symptom severity can range from mild to severe and may be life-threatening which is called anaphylaxis. In the US, food allergy symptoms send someone to the emergency room every three minutes.
Anaphylaxis is a severe allergic reaction that comes on quickly and it often affects multiple systems of the body. It’s a medical emergency and, if left untreated or if treatment is delayed, could be deadly. Epinephrine is the first line treatment. It may need to be repeated in 5 to 10 minutes if symptoms haven’t resolved. Antihistamines like Benadryl (diphenhydramine) don’t treat the severe allergic reaction it just helps you not feel itchy during it. Asthma increases the risk for severe or fatal food allergy reactions.
Managing food allergy is multifactorial. First and foremost, the goal is to reduce the risk of exposure to known food allergens. This can be accomplished by eating food that comes from a trusted source and has a label that clearly identifies its ingredients and whether it was produced on designated equipment or in a designated facility. The
Food Allergy Labeling and Consumer Protection Act only requires food labels to declare the top 8 major food allergens or any ingredient that contains proteins from a top 8 major food allergen as an added ingredient. Labels are not required to declare if the product “may contain”, “processed on shared equipment” or “made in a facility” with any allergens. Thus, it’s also helpful to find brands that have been vetted. Websites such as SnackSafely.com and Allergence.snacksafely.com can help facilitate finding safe brands.
Other ways to reduce the risk of exposure includes good hygiene. This includes washing hands before and after handling food. Hand sanitizer does nothing to eliminate food allergens. Surfaces should be washed with soap and hot water or an all-purpose cleaning agent. It’s also extremely important to teach children not to share food, drinks or utensils. Classrooms should be kept free of food whenever possible. At minimum, known food allergens should be restricted from the classroom. Homemade goods should be avoided for celebrations as cross contact with allergens can be an issue. When possible, celebrations should include non-food incentives, activities, prizes and projects.
Any person with a food allergy should have a “Food Allergy and Anaphylaxis Emergency Care Plan” and two epinephrine autoinjectors available for use. The care plan should be completed by a clinical provider and shared with schools, family members and friends. People with asthma are more likely to have more severe allergic reactions, so it’s important that their asthma rescue medication is also available. Additionally, epinephrine auto injector training is essential for all caretakers, teachers, and friends of those with food allergies. Two epinephrine autoinjectors should always be carried with the allergic person to insure easy and rapid access should an allergic reaction occur.
Annapolis Pediatrics has a dedicated Asthma Educator who specializes in putting a plan together with you and your family to manage your child’s asthma and allergy triggers. If you suspect allergies or asthma symptoms, please discuss with your provider.
Food allergies can impact the whole family’s psychosocial well-being. One in three children have reported being the victim of bullying, teasing or harassment with their allergen. Children with food allergy are twice as likely to be bullied as are children without food allergy. It can cause social isolation as well. From fear and worry, more than 25% of parents of children with food allergies don’t allow their children to go to camp or sleepovers, more than 15% don’t go to restaurants and more than 10% avoid childcare or playdates at friend’s houses. Mothers of food allergic children under 5 years old have significantly higher blood pressure and significantly greater levels of psychosocial stress than mothers of children without food allergies. However, in recent years there has been some encouraging developments in the allergy community.
In March 2019, the American Academy of Pediatrics updated its guidance for preventing childhood food allergies and other allergic conditions, such as eczema. Their recommendations are based on a review of clinical studies, including the LEAP (Learning Early About Peanut Allergy) and EAT (Enquiring About Tolerance) studies on food allergy prevention. Accordingly, parents are being encouraged to introduce allergenic foods as early as 4 to 6 months of age to help reduce the risk of developing food allergies. In babies with severe eczema or egg allergy, parents should first consult their pediatrician before introducing peanuts or other allergens, to determine if allergy testing is required first. This past January, the US Food and Drug Administration (FDA) approved Palforzia, the first peanut powder product designed to help reduce the risk of severe peanut-induced allergic reactions through oral immunotherapy desensitization.
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