Everything you need to know about food allergies

Q: How can a primary-care doctor make sure a certain food is the culprit?
A: Consult with a board-certified allergist. He or she can verify and evaluate via skin and/or blood tests, determining whether a food allergy exists. In addition, the patient should keep a food diary.

Q: Are there conditions that have mistakenly been attributed to food allergy?
A: Lactose intolerance is often mistaken for milk allergy. Lactose-intolerant patients have a reduced level of the intestinal enzyme lactose, which serves to digest milk sugars; such deficiency can lead to intestinal cramps and excess gas production. Sensitivity to food additives, such as monosodium glutamate, can cause symptoms of facial flushing, headache and sensations of warmth that mimic food allergies.

Sulfites, which are added to foods as a preservative, have been known to trigger asthma attacks in known asthmatics.

Survival strategies for patients with food allergies

• Strict avoidance is the key.
• Wear a medical identification bracelet.
• Review an emergency treatment plan.
• The same food can cause a different reaction from person to person.
• Treat all reactions quickly.
• Be a label detective.
• Have safe snacks handy, especially for travel and special occasions, so you’re not tempted to eat nuts or some other potential problem food.
• Keep a magnet on your refrigerator identifying all the family food allergies, including a description of any adverse reactions.

It’s important for the patient to note how much time elapses between eating the food and onset of the reaction.

Q: What is cross-reactivity?
A: Cross-reactive proteins found in the skin of many fruits can trigger an allergic reaction in individuals with seasonal allergies. These proteins occur, for example, in apples, cherries, pears, melons, bananas and even chamomile tea. Some individuals with oral allergy syndrome are able to consume fruits if they are cooked (e.g., apple pie) because the cross-reacting protein is disarmed by heat.

Q: What is exercise-induced food allergy?
A: Exercise can trigger or cause a full-blown allergic reaction, including wheezing, cough and trouble breathing, as well as hives and red and itchy skin. The patient does not usually have a reaction to the food alone or exercise alone.

Q: Are there any effective medications for food allergy?
A: No, not really. Avoidance is the only safe strategy. Epinephrine via an automatic injectable syringe is the treatment of choice for a severe, systemic allergic reaction (anaphylaxis).  According to a study by Korenblat et al, up to 35 percent of individuals in need of emergency epinephrine may require two or more dosages for recurrent and persistent symptoms (Allergy Asthma Proc. 1999;20:383-386).

Q: What are some popular misconceptions about food allergy?
A: Food allergens are distinct from airborne allergens. There is no current approved treatment for food hypersensitivity. However, as mentioned earlier, food allergies can disappear with age.

The author wishes to thank Songhui Ma, M.D., and Edward K. Chiu, M.D., for their assistance. For more information, visit the Food Allergy and Anaphylaxis Network, The American Academy of Allergy, Asthma and Immunology, and Allergy & Asthma Care of NY.

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