Allergy Awareness

Vigilance today could save a life later
Author: Sarah M. Aldridge, MS

Honey roasted peanuts. Chocolate-dipped strawberries. Lobster thermidor. Your tantalizing treat may be someone else’s toxin. That’s because food allergies can trigger everything from hives to swelling of the throat and labored breathing.

If it seems that food allergies are on the rise, they are. Peanut allergies tripled in school children from 1997-2008, according to Food Allergy Research & Education (FARE). That means about 1 out of every 13 kids in every classroom has a food allergy. Further, 30,000 people are treated for food allergies in emergency rooms yearly. Approximately 150-200 Americans die annually of food allergy-related complications.

It pays to know which foods bring on your or your child’s allergic reactions, how to treat them and when to call 911.

Allergens and antibodies

Allergens are the causes of allergies. They are anything that your immune system considers foreign and causes it to mount an attack. To defend itself against this so-called “enemy,” your immune system produces immunoglobulin E (IgE), an antibody that attaches to cells on your skin and in your nose, throat, lungs and gastrointestinal tract. On the second encounter with the allergen, these cells produce histamines, proteins that flood the bloodstream, causing symptoms.

The problem with some people’s immune systems is that they are overly sensitive to the proteins in some foods, which they consider foreign invaders. Food allergy symptoms can occur suddenly or up to several hours later. They can start out mild, with a skin rash, itchy eyes and runny nose, and then become severe. Within minutes a person can experience:

  • Flushed or pale skin
  • Swollen face, lips, mouth, tongue or throat
  • Coughing, wheezing and difficulty breathing or swallowing
  • Diarrhea and vomiting
  • Weak, rapid pulse and low blood pressure
  • Dizziness, fainting, loss of consciousness or shock

These symptoms can be life threatening if the person stops breathing or the heart stops pumping.

Typical triggers

Although more than 160 foods can cause sensitivities, the US Food and Drug Administration (FDA) lists these eight groups as causing 90% of food allergies:

  • Peanuts
  • Tree nuts, such as almonds, Brazil nuts, cashews, hazelnuts, pecans, pistachios, walnuts
  • Milk
  • Eggs
  • Wheat
  • Soy
  • Fish, particularly bass, cod, flounder, halibut, salmon and tuna
  • Shellfish, especially the crustaceans crab, lobster and shrimp. Also mollusks, such as clams, mussels, oysters and scallops

Of these, milk and eggs are the top two allergens in kids. The American Academy of Allergy, Asthma & Immunology (AAAAI) says that children tend to outgrow these allergies and those to wheat and soy. However, shellfish allergies linger through adulthood. They can cause anaphylaxis, a life-threatening reaction that can lead to death.

Note that there is a distinction between a wheat allergy and celiac disease, a type of gluten intolerance. The former occurs when the immune system overreacts to a food protein, often causing hives. The latter is an autoimmune disease affecting the small intestines, causing malabsorption and chronic diarrhea.

Also be aware of food allergens not on the FDA list. Severe reactions have occurred from poppy, sesame and sunflower seeds, and to porcine gelatin, used as a stabilizer in vaccines.

Epinephrine to the rescue

If you have mild allergies, a dose of an antihistamine may do the trick. However, if you have severe allergies, your antidote can be as close as your pocket or purse. You should carry a hand-held device that auto-injects epinephrine, a type of adrenaline that reverses allergy symptoms. 

Mylan’s EpiPen® looks like a felt-tipped marker. Sanofi’s Auvi-Q™ is about the size of a small cell phone and talks you through the procedure. Both should be used right away, by jabbing them in your outer thigh for a few seconds to release the dose. Even if your symptoms disappear, you should head to the emergency room to be examined by a doctor. Then make an appointment with your allergist or immunologist, specialists who treats allergies.

Detection and prevention

In sports, they say the best defense is a good offense, and this adage applies to allergies as well. Learn to be a super sleuth when it comes to reading labels and interpreting ingredients. The FDA regulates food labeling, requiring manufacturers to list offending agents from the eight groups mentioned previously. For instance, a label on a bag of almonds will note: “Made on shared equipment and may contain: milk, peanuts, other tree nuts, wheat, soy and egg.” 

When eating out, request the ingredients list not only for the foods you’re craving, but also for accompanying condiments, gravies, salad dressings, seasonings, sauces or toppings. Remember, that cooking foods doesn’t render them safe. Even vapors in the kitchen or a small amount of the allergen-producing food left on a cooking utensil or food processing machine can cause allergic reactions, says the AAAAI. 

Also, wear a MedicAlert® bracelet or other tag on your body identifying your food allergies. That will come in handy for medical personnel who may need to treat you.

Allergy testing

Your allergist may recommend a skin prick test to confirm the presence of IgE antibodies. During the procedure, a small plastic probe or needle scratches the skin on your arm or back, sending a tiny amount of the solution just under the surface of your skin. A raised white bump surrounded by red, itchy skin, called a wheal, indicates a positive reaction.

On the plus side, the test is inexpensive, provides results within 30 minutes, is not painful and doesn’t cause bleeding. However, it has a high rate of false positives—up to 60%—indicating you have a food allergy when you really don’t. 

If you have severe eczema, a blood test may be substituted for the skin test. It also shows the presence of IgE antibodies. However, because of its high false negative rate—50%-60%—the AAAAI doesn’t generally recommend it.

The oral food challenge is considered diagnostic, though. At your allergist’s office, you eat small portions of the suspected foods, and are observed for symptoms. Lastly, a food elimination diet for 2-4 weeks can show the absence of symptoms when suspected foods are avoided.

Staying alert regarding your or your child’s food allergies may feel like a full-time job. But the vigilance you use now could literally save a life later.