Patient Education

FOOD ALLERGY

Copyright 2000, Regional Allergy & Asthma Consultants, PA

It is estimated that up to 25% of the population think they have a food allergy, and there are many articles and reports in the press that blame food allergies for problems ranging from headache and fatigue to attention deficit disorder.  In reality, the true prevalence of food allergy is around 6%.

Symptoms of an allergic reaction to food include hives, swelling, throat or mouth itching, tightness in the throat, difficulty breathing, sudden vomiting and/or diarrhea, abdominal cramps, and sometimes wheezing.  A person having an allergic reaction to a food will usually experience these symptoms within a few minutes to hours of eating that food.  Although virtually any food can cause an allergic reaction, the most common culprits are milk, egg, wheat, soy, peanuts, tree nuts (such as cashews, walnuts, and pecans), fish and shellfish. 

A food allergy is the body's immune system overreacting to specific food proteins, as opposed to sugars or fats.  Some people have adverse food reactions that are not allergic ? for example, as in lactose intolerance.  This produces cramping, bloating and diarrhea in people who have trouble digesting the carbohydrate sugars found in dairy products.  This is an important distinction, because an adverse, non-allergic food reaction is not life-threatening.  In contrast, an allergic reaction to a food can sometimes be severe enough to produce anaphylactic shock ? which can be fatal.  Most importantly, the severity of a food allergy can never be predicted; a seemingly mild allergic food reaction can be followed by a much more severe reaction the next time that food is eaten.

Because of the way the immune system works, allergic food reactions can develop at any time in life, although children experience food allergy reactions more often than adults because their digestive system is not completely mature.  Furthermore, a food allergy never develops the very first time a food is eaten ? the immune system has to have "seen" the food protein at some point in the past in order to develop an allergic response to it.

If you or your child has a food allergy, the most important thing you can do is avoid that food at all times.  You should read ingredient labels carefully, looking for the allergenic food in prepared products.  Many food proteins can be found in unexpected places.  For example, some milk proteins are used as stabilizers in some soups and canned tuna.  It is wise to avoid foods which have vague labeling such as "natural flavorings" ? this frequently indicates the presence of soy or milk protein. 

If in doubt about a certain food, avoid eating it!  You will not "build up immunity" by eating occasional small amounts of the allergenic food.  On the contrary, children who outgrow their food allergy will do so more quickly when the implicated food is strictly avoided.  If your food-allergic child is of school age, you should share this information with his/her teachers.  You may want to provide "safe" snacks for your child to have at school in place of treats brought in from other homes.

Despite careful avoidance, some people accidentally ingest the food to which they are allergic, and should always be prepared for an unexpected allergic reaction.  It is important for the food allergic individual to have an EpiPen available at all times.  This is a self-injecting device that delivers a dose of epinephrine (adrenaline).  It should be given for severe allergic reactions such as throat tightness or shortness of breath.  It can be life saving when used properly, and will work better if used early in the course of a reaction.  The EpiPen, however, is not a substitute for seeking medical care; although epinephrine works fast, its effects wear off after 15-20 minutes.  If you have to use it, you should then go immediately to the nearest emergency room for evaluation.  We will demonstrate the correct use of the EpiPen for you.

For most people, food allergy is lifelong, especially in the case of peanut or shellfish allergy.  Most children outgrow certain food allergies, such as milk or egg allergy. This can be reassessed yearly through the use of allergy skin or blood tests, and occasionally an oral food challenge in our office under observation.

At this time, allergy shots or medications are not available to treat food allergies, and such measures may actually be dangerous.  Strict avoidance of the allergenic food is the only effective treatment method. 

Many patients and families with food allergy feel that they lack the knowledge and resources to deal with this problem effectively.  We hope these materials are helpful for you.  In addition, the Food Allergy Network (800/929-4040 or www.foodallergy.org ) is a national organization which is an excellent resource for food-allergic individuals.  They have a wide variety of age-appropriate educational materials, including booklets and videos for patients, parents, teachers, and caregivers.

Food Allergy ? Label Reading

Milk Allergy

Ingredients that indicate the presence of milk protein include:

Butter    Custard, pudding

Ice cream   Cottage cheese

Cheese    Casein, caseinate

Yogurt    Whey protein

Cream cheese   Lactalbumin, lactoglobulin

Sour cream  

Milk protein may be present in: caramel flavoring, chocolate, and "natural flavoring."

A "D" on a label next to "K" or "U" indicates the presence of milk protein.

 

Egg Allergy

Ingredients that indicate the presence of egg protein include:

Egg (dried, solids, white, yolk) Meringue

Egg substitute    Globulin

Mayonnaise    Albumin

Eggnog     Livetin

Ovalbumin (any food with prefix "ovo")

A shiny glaze or yellow baked goods usually indicates the presence of egg protein.

 

Peanut Allergy

Ingredients that indicate the presence of peanut protein include:

Peanuts, peanut butter

Peanut flour

Mixed nuts

Many candies, nougats, and ethnic foods may contain peanut protein.

Commercially available peanut oil is safe ? it does not contain peanut protein.  However, oils from gourmet or specialty stores may contain trace amounts of peanut protein and should be avoided.

Many patients with peanut allergy can eat tree nuts like cashew and pecan safely, because peanuts are actually legumes.  However, some "artificial" cashews and other tree nuts are actually deflavored peanuts to which tree nut flavor has been added.

 

Soy Allergy

Ingredients that indicate the presence of soy protein include:

Soybean    Tamari

Soy sauce    Tempeh

Tofu     Textured vegetable protein

Miso

Soy protein may be present in anything labeled "natural flavoring," hydrolyzed vegetable protein, and vegetable broth, gum or starch.

Commercially available soybean oil and soy lecithin are safe ? they do not contain soy protein.  However, oils from gourmet or specialty stores may contain trace amounts of soy protein and should be avoided.

 

Wheat Allergy

Ingredients that indicate the presence of wheat proteins include:

Bran   Seminola

Bulgur   Couscous

Durum   Cracker meal

Farina   Graham

Gluten

Wheat protein may be present in: "natural flavoring," vegetable gum, vegetable starch, modified starch.

 

Shellfish Allergy

Foods that indicate the presence of shellfish include:

Clams     Prawns

Crab     Scallops

Crawfish    Shrimp

Lobster (langouste)   Escargot (snails)

Mollusks    Calamari (squid)

Mussels

Shellfish protein may be present in bouillabaisse, fish stock, and seafood flavoring.

 

Tree nut Allergy

Foods that indicate the presence of tree nuts include:

Almonds    Marzipan

Brazil nuts    "Nu-nuts" artificial nuts

Cashews    Nut butters and pastes

Chestnuts    Pine nuts

Hazelnuts    Pistachios

Macadamia nuts   Walnuts

Artificial nuts may contain peanuts flavored with other nut protein, like cashew.

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