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FOOD ALLERGY: THE FACTS by DONALD B. PERLMAN, M.D. Allergy is defined as an unusual or unexpected reaction to a common material in the environment, such as pollens, dust, mold, animals, foods and medicines. Allergy is a common disorder of growing incidence and increasing recognition in America today. There is a great deal of misinformation about allergy in general and even more so with regard to “food allergy.” A true allergy occurs when a person is exposed to an allergen, usually a protein. Your immune system then produces an antibody of the Immunoglobulin E (IgE) class against that allergen. When you encounter that allergen in the future, a cascade of events is set in motion that results in an allergic reaction. The reaction in the case of food allergy can vary greatly from mild itching and a few hives, all the way to anaphylactic shock and death. Although an extreme reaction is rare, for some individuals it remains a real and very frightening possibility. Food allergy symptoms can include itching of the skin, hives, itchy and runny nose and eyes, tightness in the throat, coughing and wheezing. Paradoxically, gastro-intestinal symptoms, such as nausea, vomiting, cramps and diarrhea are rarely caused by true food allergy. Knowledge is key and misinformation is rampant with regard to food allergy. Not all reactions to food are truly allergic in nature and it is important to distinguish between a true immunologically-mediated allergic reaction to a food and an intolerance to that food. An example of a food intolerance would be a deficiency of the lactase enzyme leading to the inability to digest milk. Another example would be migraine headaches that stem from eating chocolate. An intolerance to a food can be annoying and inconvenient, however, a true allergy can have grave consequences and therefore strict avoidance of the allergen is essential. Anyone at any age can develop a true food allergy. Food allergy is quite common in childhood. A child will frequently outgrow an allergy to egg, milk or grains by the age of 3 or 4 years, however, one rarely outgrows an allergy to peanuts and shellfish. If a food allergy is suspected, a careful evaluation by an allergist is important to clarify the true nature of the problem. It would be unfortunate to deprive a child of a food, make all the necessary lifestyle alterations and suffer anxiety if the child is not really allergic to that food. If a child has hives, asthma, eczema or nasal allergies, he should not be told to avoid a list of “allergy food” until he is tested for each one, as true food allergy is relatively rare. When a true food allergy is apparent, avoidance is the only solution. The person should scrupulously avoid the food or any food that might contain the allergen (i.e. nuts in a brownie). The individual must be provided with an EpiPen, oral steroids and oral antihistamines for use in case of an inadvertent exposure. The patient and family should be thoroughly educated about the meaning of food reactions, the need to avoid the food and use of appropriate medications (in particular the appropriate use of an EpiPen). The patient should also be given an application for a MedicAlert bracelet and information about the Food Allergy Network. Lastly, with regard to misinformation about food allergy, it is important to mention the issue of food allergy with regard to behavior changes. It is very, very rare that a food or a nutritional group can cause changes in behavior. Although this concept is very pervasive in our society, there is no real scientific evidence to support the concept that sugar or food additives can influence behavior. However, untreated allergy to inhalants and the subsequent changes in the lifestyle due to chronic illness can have a profound effect on behavior. Allergy in general and allergy to foods specifically need to be addressed in a logical fashion to arrive at a medically accepted plan of action. I hope that this article serves to dispel some myths surrounding food allergy. For a referral to a Saint Barnabas Medical Center allergist, please call l-888-SMBC-DOC. To contact MedicAlert, call 1-800-IDALERT (1-800-432-5378). To contact the Food Allergy Network, call (1-800-929-4040). [ top ] |
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