What You Need to Know About Food Allergies

As a recent research report from the Centers for Disease Control and Prevention (CDC) has shown, the incidence of food allergies is on the rise, especially in children. While there is neither a known cause for this increase nor a cure for food allergies, there have been actions taken recently to increase awareness and understanding of food allergies.  Julia Bradsher, CEO of the Food Allergy and Anaphylaxis Network (FAAN),  says, “There is no cure for food allergy – yet. In the meantime, we must do everything we can to raise awareness and educate the public.”

What is a Food Allergy?

Many people confuse a food intolerance with a food allergy; however, they are fundamentally different. A food allergy is an immunologic response to a food protein and may be life-threatening. A food intolerance, on the other hand, is thought to be a digestive issue that is not life- threatening and is usually related to carbohydrates in foods.  

To be certain that one is dealing with a food allergy, it is important to consult a qualified health professional (a primary care physician or an allergist) and be tested.  Diagnosis of a food allergy requires obtaining a history of food allergic symptoms, plus administering a skin prick or blood sample test in a healthcare setting.  Regardless of the outcome of these tests, an oral food challenge is thought to be the only definitive test for food allergy, according to Dr. Robert Wood, Professor of Pediatrics and International Health Director, Pediatric Allergy and Immunology at Johns Hopkins University School of Medicine.  An oral food challenge can confirm the outcome of a skin prick or blood test, positive or negative.

According to FAAN, the most common food allergies are often referred to as “The Big 8” and include milk, eggs, peanuts, soy, wheat, tree nuts, fin fish and shellfish.  Specific populations tend to be more prone to some allergies.  For example, the most common food allergies for children are milk, eggs, peanuts, soy, wheat and tree nuts; while adults’ most common food allergies are peanuts, tree nuts, fin fish and shellfish.  Interestingly, children seem to have a higher incidence of food allergy (about six to eight percent) than adolescents and adults (about three to four percent), indicating that children may grow out of most allergies (except peanuts, tree nuts, and fish/shellfish).  FAAN states that of children with food allergies, the most common one is milk (about two and a half percent), while the most common food allergy for adults is shellfish (about two percent).  

What does a reaction look like and how can it be managed?
The signs and symptoms of a food allergic reaction can range from low-grade to life-threatening, which indicates the importance of understanding these symptoms and how to respond.  Common signs and symptoms for most include hives, eczema, vomiting or diarrhea, swelling of face, lips or tongue, coughing or congestion, or wheezing.  Difficulty breathing, hypotension or shock, and anaphylaxis are the most severe reactions but occur less frequently.  No two reactions are alike, so one should not assume that a mild reaction for an individual on one occasion will mean that all future reactions will be mild.  It is possible that reactions to the identified food will progress to become more severe if the food is not eliminated from the diet.  

The best way to manage food allergies is to avoid the allergens.  Even a small exposure to an allergen can cause a reaction.  Unfortunately, accidents do happen, and an individual with food allergies can be exposed to the allergen and develop a reaction no matter how diligent he or she is about avoidance.  The one thing that can be controlled in such an instance is to have an established food allergy action plan.     

For those individuals with severe allergies, especially to tree nuts or peanuts, a systemic reaction known as anaphylaxis, generally occurs immediately after exposure to the allergen.  Anaphylaxis may involve multiple organ systems and can range in severity from mild to fatal.  The reaction can sometimes manifest with skin symptoms such as flushing, hives or swelling that may be easier to see; however, other symptoms that may not be as easy to see include throat or chest tightness, wheezing or coughing, shortness of breath, cramps, nausea or vomiting, diarrhea, hypotension/shock and chest pain.  Dr. Wood warns that 80 percent of fatal, food-induced anaphylaxis cases were not associated with skin-related symptoms, so it is important to be aware of other symptoms.   

Although there is no cure for food allergies, they can be managed, and reactions can be treated.  Receiving dietary guidance from a registered dietitian along with carrying a self-injectable epinephrine (e.g., EpiPen®) at all times is recommended. The symptoms of milder food allergic reactions can be managed with an antihistamine (e.g., Benadryl®). In the event of an anaphylactic reaction, epinephrine should be administered promptly (within 30-60 minutes) as it is more effective the sooner it is given.  It is also important to call 911 and go to the hospital emergency room following an anaphylactic reaction and administration of epinephrine, as some anaphylactic reactions may recur even after epinephrine is administered.  

Food Allergy Awareness

In an effort to increase public awareness and provide education about food allergies, FAAN created Food Allergy Awareness Week (FAAW) in 1997.  In 2010, FAAW took place during the week of May 9-15.  However, the importance of food allergy awareness persists year round and FAAN has many educational materials related to FAAW available on its Web site.  The materials are designed for a variety of audiences, including health professionals, teachers, students and family members.  

Although there is currently no cure for food allergies, research is ongoing.  Hopefully, there will be a cure in the future.  Until then, awareness and elimination of identified food allergens are the best defense.