A Growing Problem
Food allergies have become a growing public health and safety issue, with reactions to peanuts and tree nuts doubling in the past decade. True food allergies affect 15 million Americans, including 6 million children, with one in six at significant risk of anaphylaxis.
Even though 25 percent of Americans report what they perceive as a food allergy, the problem only affects 3 percent of adults and 8 percent of children. Many times, they are experiencing an intolerance, not a true allergy.
To distinguish intolerance from allergy, it helps to know that food intolerance is an adverse reaction that has no immune system involvement and is not life-threatening. Some examples include gastrointestinal upset (milk/lactose), nervous system hyperactivity (coffee/caffeine), vascular headache or congestion (wine/sulfites) and skin irritation (orange/citrus).
A true food allergy is an immune system overreaction to a specific protein found in food. It can have both immediate and delayed effects and can vary in severity from person to person. Manifestations of food allergy can include anaphylaxis (hives, flushing, vomiting, difficulty breathing, diarrhea, dizziness and death), atopic dermatitis (eczema rashes), gastrointestinal allergy (vomiting, diarrhea, cramping, oral itching/swelling, esophagitis) and asthma.
Food allergy usually begins in infancy or early childhood as the result of both nature (heredity) and nurture (environment). Our immune system is trained from day one to distinguish harmless proteins (self, foods and environment) from harmful proteins (bacteria, viruses, parasites and toxins). In the case of food, a healthy gut is supposed to label a food as harmless the first time it passes through. The food is then ignored in the future. If the gut cell malfunctions, or if a food sneaks by the labeling process (leaks through an unhealthy gut, skin lesion/rash or unhealthy respiratory tract), other parts of the immune system may misinterpret it as harmful, and then remember the food to be recognized and acted upon in the future.
Food mislabeling by the immune system also seems to have a predilection for certain foods—only eight types of food account for 90 percent of all food allergies (milk, eggs, wheat, soy, peanuts, tree nuts, fish and shellfish). Some researchers think these foods may resemble pathogens, and once they sneak by, are forever labeled as such. Others speculate that the immune system is confused by our artificially processed food supply. Still others blame our packaged food and fast-food choices, which are cross-contaminated with large amounts of potential allergens and routinely fed to infants and young children. More recently, some are looking at the body’s vitamin D level, which is compromised in modern culture, but necessary for proper immune function.
To help prevent allergic sensitization to food, there are some practical measures that parents of babies can take. Consider breastfeeding for the first three months or more with an emphasis on hind-milk to help promote gut balance and immunity (see La Leche League at llli.org). Learn about the eight most common food allergens and plan to introduce them (in consultation with a doctor) one at a time on a healthy day. Wash hands after handling or eating high-allergen foods and before interacting with a baby. Avoid fast food and choose foods with simple ingredients, without warnings of cross-contamination. Seek medical advice sooner than later for chronic gastrointestinal problems, skin problems and respiratory problems, as they can increase the likelihood of food allergy. Develop a good skincare regimen that includes regular bathing, followed by a hypoallergenic skin cream barrier and consider vitamin D supplementation under the supervision of a physician.
Once a food allergy manifests, strict avoidance of the food and prompt recognition and treatment of allergic symptoms are the only options. If started early enough (infancy to early childhood), a medically advised elimination diet can help the immune system “forget” it is allergic, allowing reintroduction of milk, egg, soy and wheat 95 percent of the time. Early detection and elimination diets have also shown success with peanuts 20 percent or more of the time. Newer studies report methods for medically monitored food desensitization by wearing an allergen patch or receiving a vaccine.
Although encouraging, these methods need to be proven safe and effective before recommending general use. If a food allergy is suspected, it is best to have it detected early and managed by a board-certified allergist.
Lisa Sullivan, M.D., specializes in pediatric and adult allergy, asthma and immunology, with offices in Buffalo Grove and Vernon Hills. For more information, visit LisaSullivanMD.com.
Be Alert to Anaphylaxis Symptoms
by Lisa Sullivan, M.D.
Anaphylaxis is a systemic, full body, allergic immune response that can be life-threatening. Most people associate the word “anaphylaxis” with hives or trouble swallowing. This is only partially correct. Anaphylaxis can affect all body systems in various combinations and thus may fail to produce a tell-tale hive or swallowing clue. It is better to think of anaphylaxis as a rapid, downhill spiral of symptoms that can involve any body part or organ, generally within minutes to an hour after its trigger (e.g. food). For example, if a food allergic friend ingests something and then suddenly becomes ill with vomiting, diarrhea and dizziness, one should suspect anaphylaxis and not food poisoning or the stomach flu. The same would be true if an individual started having problems with their asthma shortly after eating. Therefore, if a food allergic individual experiences any symptom other than mild discomfort within an hour of ingesting a suspect food, administer epinephrine and call 911.