are the body's abnormal responses to harmless foods; the reactions are caused by the immune system's reaction to some food proteins.
Food allergies are often confused with food intolerance. However, the two conditions have different causes and produce different symptoms. A food allergy is also known as food hypersensitivity. The allergy is caused when a person eats something that the immune system incorrectly identifies as harmful.
About 4% of adults have food allergies according to the National Institute of Allergy and Infectious Diseases (NIAID). The condition affects approximately 6 to 8% of children age 4 and younger.
The immune system works to protect the body and creates food-specific antibodies. The antibodies are proteins that battle antigens, substances that are foreign or initially outside the body. The introduction of an antigen produces the immune response. Antibodies are created to destroy the antigen or counteract its effectiveness.
The food that triggered that reaction is called an allergen. The antibodies are like an alarm system coded to detect the food regarded as harmful. The next time the person eats that food, the immune system discharges a large amount of histamine and chemicals. This process meant to protect the body against the allergen causes an allergic reaction that can affect the respiratory tract, digestive tract, skin, and cardiovascular system.
Allergic reactions can occur in minutes or in up to two hours after the person ate the food. Symptoms include swelling of the tongue, diarrhea
, and hives
. In severe cases, the allergic reaction can be fatal. The most severe reaction is anaphylaxis
, which could be life-threatening.
While food allergies involve the immune system, food intolerance is not related to the immune system. For example, a person who is lactose intolerant has a shortage of lactose, the digestive enzyme that breaks down the sugar in milk and dairy products. That person could experience stomach pain
or bloating several hours after drinking milk.
People who are food-intolerant can sometimes consume that food and not experience intolerance symptoms. Those diagnosed with food allergies must avoid the foods that produce the allergic reactions.
Although approximately 160 foods produce allergic reactions, approximately 90% of reactions are caused by some or all items within eight food families. These are milk, eggs, peanuts, tree nuts, fish, shellfish, wheat, and soy. These foods can cause severe reactions. The most adverse reactions are caused by peanuts and tree nuts. According to NIAID, about 0.6% of Americans are impacted by peanut allergies. Approximately 0.4% of Americans have allergic reactions to tree nuts.
Food allergy demographics
Most children have allergies to eggs, milk, peanuts or tree nuts, and soy, according to the American Dietetic Association (ADA). The young generally outgrow their allergies. They are more likely to outgrow milk and soy allergies, according to NIAID. However, children and adults usually allergic to peanuts and tree nuts for life. The most frequent causes of food allergies in adulthood are peanuts, tree nuts, fish, and shellfish.
Allergies are hereditary. There is a tendency for the immune system to create IgE antibodies in people with family histories of allergies and allergic conditions like hay fever
, according to NIAID. The likelihood of a child having food allergies increases when both parents are allergic.
Furthermore, people are allergic to the foods that are eaten frequently in their countries. A rice allergy is more common in Japan, and codfish allergies occur more in Scandinavian countries, according to NIAID.
Causes and symptoms
Food allergies are caused by the immune system's reaction to a food item that it believes is harmful. When the food is digested, the immune system responds by creating immunoglobulin E (IgE) antibodies as a defense. The antibodies are proteins found in the bloodstream. Formed to protect the body against harmful substances, the antibodies are created after the person's first exposure to the allergen.
The majority of food allergies are caused by foods in eight families. In some families, every food causes an allergic reaction. In other families like shellfish, a person may be allergic to one species, but able to eat others. The allergy-inducing foods include:
- Milk. The dairy family includes milk, ice cream, yogurt, butter, and some margarines. Nondairy foods that contain casein must be avoided. Prepared foods that contain milk range from breads and doughnuts to sausage and soup, according to the ADA.
- Eggs. Although a person may be allergic to either the egg white or yolk, the entire egg must be avoided because there is a risk of cross-contamination. Eggs are an ingredient in mayonnaise. Moreover, products such as baked goods, breads, pasta, yogurt, and batter on fried foods may contain eggs. In addition, some egg-substitute products contain egg whites.
- Peanuts grow in the ground and are legumes like lentils and chickpeas. A person with a peanut allergy may not be allergic to other legumes or tree nuts. Products to be avoided include peanuts, peanut butter, peanut oil, and some desserts and candy. In addition, some Asian dishes are prepared with a peanut sauce. Tree nuts include almonds, cashews, pecans, walnuts, Brazil nuts, chestnuts, hazelnuts, macadamia nuts, pine nuts, pistachios, and hickory nuts. Products containing tree nuts include nut oil, nut oil, desserts, candy, crackers, and barbecue sauce. A person may be allergic to one type of nut but able to eat other nuts. That should be determined after consulting with a doctor.
- Fish allergy is generally diagnosed as an allergy to all fish species because the allergen is similar among the different species.
- Shellfish species include lobster, crab, shrimp, clams, oysters, scallops, mollusks, and crawfish. An allergy to one type of shellfish may indicate an allergy to others.
- Wheat is a grain found in numerous foods including breads, cereals, pastas, lunch meats, desserts, and bulgar. It is also found in products such as enriched flour and farina.
- Soy. The soybean is a legume, and people who have this allergy are rarely allergic to peanuts or other legumes. Soy is an ingredient in many processed foods including crackers and baked goods, sauces, and soups. There is also soy in canned tuna, according to the ADA.
The chemical reaction
During the initial exposure, many IgE antibodies are created. These attach to mast cells. These cells are located in tissue throughout the body, especially in areas such as the nose, throat, lungs, skin, and gastrointestinal tract. These are also the areas where allergic reactions occur.
The antibodies are in place, and a reaction is triggered the next time the person eats the food regarded as harmful. As the allergen reacts with the IgE, the body releases histamine and other chemicals. Histamine is a chemical located in the body's cells. When released during an allergic reaction, histamine and other chemicals cause symptoms like inflammation.
The type of allergic reaction depends on where the antibodies are released, according to NIAID. Chemicals released in the ears, nose, and throat could cause the mouth to itch. The person may also have difficulty breathing or swallowing. If the allergen triggers a reaction in the gastrointestinal tract, the person could experience stomach pain or diarrhea. An allergic reaction that affects skin cells could produce hives. This condition also known as urticaria is an allergic reaction characterized by itching
, swelling, and the presence of patchy red areas called wheals.
Severe allergic reaction
Anaphylaxis is a severe allergic reaction that is potentially life-threatening. Also known as an anaphylactic reaction, this condition requires immediate medical attention. The reaction occurs within seconds or up to several hours after the person ate the allergy-inducing food.
Symptoms can include difficulty breathing, a tingling feeling in the mouth, and a swelling in the tongue and throat. The person may experience hives, vomiting, abdominal cramps, and diarrhea. There is also a sudden drop in blood pressure. Anaphylaxis could be fatal if not treated promptly.
Each year, some 150 Americans die from foodinduced anaphylaxism, according to NIAID. The casualties are generally adolescents and young adults. The risk increases for people who have allergies and asthma. Also at increased risk are people who experienced previous episodes of a naphylaxis.
The peanut is one of the primary foods that trigger an anaphylactic reaction. Tree nuts also cause the reaction. The nuts generally linked to anaphylaxis are almonds, Brazil nuts, cashews, chestnuts, hazelnuts, macadamia nuts, pecans, pine nuts, pistachios and walnuts. Fish, shellfish, and eggs can also set off the reaction, according to the ADA.
Cross-reactivity is the tendency of a person with one allergy to reaction to another allergen. A person allergic to crab might also be allergic to shrimp. In addition, someone with ragweed sensitivity could experience sensations when trying to eat melons during ragweed pollinating season, according to NIAID. The person's mouth would start itching, and the person wouldn't be able to eat the melon. The cross-reaction happens frequently with cantaloupes. The condition is known as oral allergy syndrome.
Food allergies are diagnosed by first determining whether a person has an allergy or if symptoms are related to a condition like food intolerance. The medical professional may be a board-certified allergist, a doctor with education and experience in treating allergies. However, some health plans may require that the patient first see a family practice doctor.
If food allergies are suspected, the doctor will take a detailed case history. The doctor asks the patient if there is a family history of allergies. Other questions are related to the patient's adverse reactions.
The doctor's questions include how the food was prepared, the amount eaten and what time the reaction happened. The patient describes the symptoms and actions taken to relieve them. The doctor also asks if the patient had other similar experiences when eating that food.
The patient receives a physical exam. In addition, the doctor may ask the patient to keep a food diary, a log of what the person eats for one to two weeks. The medical history and the food diary are used in conjunction with testing to diagnose the patient.
Doctors generally start the testing process with a skin test or a blood test. The prick skin test, which is also known as the scratch test, examines the patient's reaction to a solution containing a protein that triggers allergies.
The doctor places a drop of the substance on the patient's arm or back. The doctor then uses a needle to prick or scratch the skin. This allows the potential allergen to enter the patient's skin. If more than one food allergy is suspected, the test is repeated with other proteins applied to the skin. After about 15 minutes, the doctor can read the reactions on the patient's skin.
If there is no reaction, the patient is probably not allergic to that food. The possibility of an allergy is indicated by the presence of a wheal, a bump that resembles a mosquito bite. The wheal signifies a positive reaction to the test. However, the test may show a false positive, which is a reaction to a food that does not cause allergies.
The skin test is not appropriate for people who are severely allergic or have skin conditions like eczema. Those people are given the RAST (radioallergosorbent test). This test measures the presence of food-specific IgE in the blood. After a sample of the patient's blood is taken, it is sent to a laboratory. The sample is tested with different foods. Levels of antibodies are measured, and the reactions to different proteins are ranked. While measurement systems may vary, a high ranking indicates a high number of antibodies. Lab results are generally completed within a week.
Results to this test may not be conclusive. A negative test may not have identified antibodies in the patient's blood. Positive results make it probable but not definite that the patient has allergies.
Costs for blood and skin tests will vary, with fees ranging from $10 to more than $300. Insurance may cover some of the cost. While both tests are reliable, they aren't 100% accurate. If questions remain, the diagnosis takes into account the patient's medical history and the food diary. If necessary, the patient is put on a special diet.
If the skin or blood test shows strong positive results, the doctor may put the patient on an elimination diet. This is done when needed to narrow the list of suspected allergens. The person stops eating the foods suspected of causing the allergic reaction. That food is eliminated from the diet for from two to four weeks. If allergy symptoms improve, the food is probably an allergen.
If more confirmation is needed, the doctor may ask the patient to start eating the food again. The elimination diet procedure is generally not utilized if the patient initially had a severe reaction.
Other tests called food challenges may be performed. The challenges are done in a medical setting, with a doctor present. The patient is given capsules that each contain a different food. Some capsules contain allergy-producing foods. Other capsules may be placebos that won't produce a reaction.
The patient swallows the capsule, and the doctor watches for an allergic reaction. In an open food challenge, doctor and patient are aware of the capsule contents. In a single-blind food challenge, only the doctor knows. In a double-blind challenge, neither doctor nor patient knows the contents.
Challenges are rarely authorized by health care providers. Testing is time-consuming and many allergens are difficult to evaluate with the challenges, according to NIAID.
The treatment for food allergies is to avoid eating the food that causes the allergy. This preventive treatment includes reading food labels. Manufacturers are required by the U.S. Food and Drug Administration to list a product's ingredients on the label. However, if there is a question about an ingredient, the person should contact the manufacturer before eating the food. When dining out, people should ask if food contains the allergen or ingredients contain the allergy-inducing foods.
When reading food labels, people with food allergies should know that:
- Words indicating the presence of milk include lactose, ghee, and whey.
- Words signifying eggs in a product include albumin, globulin, and ovomucin.
- While it is apparent that peanuts are an ingredient in a product like peanut butter, there could be peanuts in hydrolyzed plant protein and hydrolyzed vegetable protein.
- People with tree nut allergies should carefully read the labels of products such as cereals and barbecue sauce.
- The American Dietetic Association cautions that surimi, an ingredient in imitation seafood, is made from fish muscle. Furthermore, fish in the form of anchovies is sometimes an ingredient in Worcestshire sauce.
- Words on labels that signal the presence of wheat include gluten, sietan, and vital gluten.
Allergies and children
Parents of children with food allergies need to monitor their children's food choices. They also must know how to care for the child if there is an allergic reaction. Parents need to notify the child's school about the condition. Caregivers should be informed, too. Both the school and caregivers should know how to handle an allergic reaction. Care must be taken because a highly allergic person could react to a piece of food as small as 1/44,000 of a peanut kernel, according to NIAID.
Living with severe allergies
Despite precautions, people may accidentally eat something that causes an allergic reaction. People with severe allergies must be prepared to treat the condition and prevent an anaphylactic reaction. A medical alert bracelet should be worn. This informs people that the person has a food allergy and could have severe reactions.
To reduce the risks from an anaphylactic reaction, the person carries a syringe filled with epinephrine, which is adrenaline. This is a prescription medication sold commercially as the EpiPen auto injector. While prices vary, one syringe costs about $50.
The person with allergies must know how to inject the epinephrine. It is helpful for other family members to know how to do this, and parents of an allergic child must be trained in the procedure.
The person is injected at the first sign of a severe reaction. Medical attention is required, and the person should be taken to an emergency room. The person will be treated and monitored because there could be a second severe reaction about four hours after the initial one.
Allergy treatment research
There was no cure for food allergies as of the spring of 2005. That could change, with some relief available for people diagnosed with peanut allergies. According to a study reported on in 2003 in the New England Journal of Medicine, 84 people who took the drug TNX-901 had a decrease in their IgE antibody levels.
Organizations including the Food Allergy & Anaphylaxis Network (FAAN) lauded the results of the study that was conducted from July of 1999 through March of 2002. Work on that study was stopped in 2004 when biotechnology companies Genentech, Novartis, and Tanox concentrated efforts instead on use of an asthma medication for treating peanut allergies. Research started in June of 2004 on omalizumab, a medication sold commercially as Xolair. The study of Xolair's effectiveness was expected to take from two to three years.
The only treatment for food allergies is for a person to stop eating the food that causes the allergies. Some alternative treatments may be helpful in easing the symptoms caused by allergies. However, people should check with their health care providers before embarking on an alternative treatment.
Food allergies cannot be cured, but they can be managed. The allergen-inducing foods should be avoided. These foods should be replaced with others that provide the vitamins
and nutrients needed for a healthy diet. Organizations including the American Dietetic Association recommend the following dietetic changes:
- Milk is a source of calcium and vitamins A and D. For people with milk allergies, alternate choices of calcium include calcium-fortified orange juice and cereal.
- Since eggs are an ingredient in products like bread, egg-free sources of grains are an alternate source of vitamin B.
- Peanuts are a source of vitamin E, niacin, and magnesium. Other sources of these nutrients include other legumes, meat, and grains.
- Fish is a source of protein and nutrients like B vitamins and niacin. Alternate sources of these nutrients should be sought.
- Wheat is a source of many nutrients including niacin and riboflavin. The person allergic to wheat should substitute products made from grains such as oat, corn, rice and barley.
- Although soybeans are rich in nutrients, very little soy is used in commercial products. As a result, a person with this food allergy would not need to find a safe substitute in order to get needed nutrients.
People prevent the return of food allergies by following treatment guidelines. These include avoiding the foods that cause allergic reactions, reading food labels, and taking measures to prevent an anaphylactic reaction.
Anaphylaxisisamajor concern after a diagnosis of severe food allergies. To reduce the risks associated this reaction, people with food allergies should wear medical alert bracelets and never go anywhere without epinephrine. If possible, family members or friends of adults with allergies should learn how to administer this medication.
The American Dietetic Association advises people to develop an emergency plan. ADA recommendations include preparing a list of the foods the person is allergic to, three emergency contacts, the doctor's name, and a description of how to treat the reaction. This list is kept with the epinephrine syringe.
Freund, Lee and Rejaunier, Jeanne. The Complete Idiot's Guide to Food Allergies. Penguin Group, USA, 2003.
The American Dietetic Association. Food Allergies: How to Eat Safely and Enjoyably. John Wiley & Sons., 1998.
American Dietetic Association. 120 South Riverside Plaza, Suite 2000. Chicago, IL 60606-6995. 800-877-1600. http://www.eatright.org.
American Academy of Allergy, Asthma & Immunology. 555 East Wells Street Suite 1100, Milwaukee, WI 53202-3823. 414-272-6071. http://www.aaaai.org.
The Food Allergy & Anaphylaxis Network. 11781 Lee Jackson Highway, Suite 160, Fairfax, VA 22033. 800-929-4040. http://www.foodallergy.org.
National Institute of Allergy and Infectious Diseases. 6610 Rockledge Drive, MSC 6612, Bethesda, MD 20892-6612. 301-496-5717. http://www.niaid.nih.gov.
Food Allergy An Overview. National Institute of Allergy and Infectious Diseases. July 2004. [cited March 30, 2005]. http://www.niaid.nih.gov/publications/pdf/foodallergy.pdf.
Peanut Anti-IgE Study Update. The Food Allergy & Anaphylaxis Network. September 2, 2004 [cited April 5]. http://www.foodallergy.org/Research/antiigetherapy.html.