FOOD ALLERGY.
Food Allergy has been a popular topic of discussion in the news recently. This is due to young people with food allergies dying after inadvertently eating what they were allergic to.
Food allergy is a potentially life-threatening condition and there is need to increase our awareness around this condition especially at this time where fast foods and eating out is very common.
Indeed most fatalities reported around food allergy has occurred after a young person purchased a food item containing an allergen and this allergen has not been explicitly written on the wrap or there has been contamination from the allergen inadvertently whilst the food is being prepared. It is therefore important this serious and life-threatening condition is further put in the awareness of the public to reduce and if possible eliminate deaths from food allergic reactions.
It’s important to differentiate food allergies from food intolerance because these two are commonly confused with each other. Our discussion focus will be on food allergies.
In Food allergy, there is an abnormal reaction of the body’s immune system to a particular food (eg nuts, cow’s milk). This can range from a mild reaction ( itching, watery eyes, tingling lips) to one that is severe and life-threatening (anaphylaxis: breathing difficulties, racing heart, collapse).
This is in contrast to Food intolerance which happens because the body has difficulty digesting certain substances in food (eg lactose) or because certain substances (eg food additives )have a direct effect on the body in some way.
Food intolerance can cause symptoms such as diarrhoea, bloating and stomach cramps. However, with food intolerance, there is no allergic reaction and the immune system is generally not involved, so food intolerance is not a food allergic reaction and is generally not life-threatening.
A food allergy is an abnormal reaction of the body’s immune system to a particular food. This tends to cause unpleasant and unwanted effects (symptoms).
Is Food allergy common?
It is very difficult to know how common true food allergy really is. Studies tend to come up with very different figures, depending on how they are set up. They suggest that anywhere between 1 and 17 people out of 100 have a food allergy. People tend to report food allergy more often than it is confirmed by formal testing. Many people mistakenly believe they have food allergies. Also, children can ‘grow out’ of allergies – for example, to cow’s milk. The number of people with food allergies seems to be rising. However, the severity of these allergies varies.
What are the symptoms of Food allergy?
The nature and timing of the symptoms depend on the mechanism of the allergic reaction. Some symptoms tend to occur immediately, or shortly after, eating the trigger food and can be of sudden onset drastic and severe :
- Tingling in the mouth.
- Swelling of the lips, tongue or throat, which in severe cases can make it difficult to swallow or breathe.
- A rash and/or itching of the skin – the rash may be raised, blotchy and red or the skin may be flushed.
- Wheezing or feeling breathless.
- Nausea and or vomiting
- Tummy pain.
- Diarrhoea.
- Sneezing or a runny nose.
- Itchy, reddened, watery eyes.
- Swelling around the eyes or face
- Feeling light-headed.
Some symptoms tend to occur later, can be subtle, delayed with slow onset , persistent but less severe :
- Atopic Eczema that is seen in allergy-prone (atopic) families – often those with hay fever and asthma too.
- Effortless vomiting (gastro-oesophageal reflux).
- Loose and/or frequent stools (faeces).
- Constipation.
- Blood or mucus in the stools.
- Redness around the back passage (anus).
- Tiredness.
- Being pale (pallor).
- Poor growth. This is often seen in children
Foods that cause most allergies :
Nuts (especially peanuts), sesame, milk, eggs, shellfish and other seafood, wheat, soya and some fruits such as citrus and kiwi.
Diagnosis
Tests
If you think you have, or your child has, a food allergy, you should seek medical advice by seeing your doctor . You will need further tests and may be referred on for more specialist assessment( eg blood test and or skin prick test)
Food diary
Keeping a diary of what is eaten is a simple activity that can be helpful in some cases. You need to write down everything that is eaten and any reaction that you have. This will help in deciding further tests to isolate the food culprit.
Elimination and challenge
This is appropriate when it seems clear which foodstuff is causing the problem. The food should be excluded from the diet completely for 2-6 weeks, to see if symptoms improve. After this time, the food should be reintroduced, to see if symptoms return. You may need the Instruction or supervision of a Dietitian or a doctor to do this in some cases.
Treatment
Avoid the food that causes allergy – but this can be difficult. A dietician can help make sure you still have a healthy balanced diet. Antihistamines medicines can be helpful. You should have an adrenaline (epinephrine) injection with you at all times if you have severe allergy.
Allergen Avoidance
The only real treatment for food allergy and intolerance is to avoid that food.
It can be very difficult to avoid certain foods completely, particularly when eating out and buying food. Often foods are contaminated with traces of another food. An example would be that a factory may produce several types of breakfast cereal, including ones containing nuts. A brand that doesn’t specifically contain nuts as an ingredient may contain tiny traces of nut. This is because it has picked them up from machines in the factory, perhaps used after a nutty cereal has been made. For this reason, it is crucial to check the labels on packaging. There are stringent rules for manufacturers regarding labelling.
Referral to a dietician
Dieticians are qualified health professionals. They can assess, diagnose and treat diet and nutrition problems. If you have a food allergy, after seeking medical advice, a dietician can be a useful person to see for further help and advice especially in children with food allergies, as it is vital they maintain a balanced diet for growth and development.
Medications
Antihistamine (eg piriton tablets or syrup )can be helpful to relieve symptoms of food allergies and it is advisable to have them handy for immediate use.
Adrenaline may be prescribed in an injectable form (such as Emerade®, EpiPen® or Jext®) if a person has a history of anaphylaxis. It is important that this should be carried on your person at all times, and that you are trained in its use or how to give it to your child.
Other treatments are available under specialist advice for very severe allergies.
Outlook
Many children and adults grow out of allergies to eggs, wheat, milk and soya especially if an elimination diet is followed carefully.
Allergic reactions to peanuts, seafood, fish and tree nuts rarely get better.
Attention! ⚠
Anaphylaxis is a life-threatening allergic reaction. It is a medical emergency. It is a good idea to have a medical emergency identification bracelet or equivalent if you have a history of anaphylaxis. If you suspect someone has anaphylaxis, you should call for an ambulance/ medical assistance immediately.
What to do if you suspect somebody is having an anaphylactic reaction.
-First call for emergency medical help or get them straight to the nearest hospital in areas where there are no emergency ambulance response .
-If the person knows what their allergy is, they may have medication with them, like an auto-injector (for example EpiPen®, JEXT® or Emerade®). This is a pre-filled injection device, containing adrenaline which when injected can help reduce the body’s allergic reaction. Check if they have one, and if they do, help them to use it or do it yourself following the instructions.
-Help them into a comfortable sitting position, leaning forward slightly, to help their breathing.
-Should they become unresponsive place them on their left side leaned forwards , check they are still breathing, if they are stay with them until medical help is accessed.
-If they stop breathing start CPR (cardiopulmonary resuscitation – a combination of chest pressure and rescue breaths) until medical help is accessed.
Best wishes,
Dr Adeola .
References : patient.co.uk, St John’s ambulance, NICE Clinical knowledge summaries . GP notebook.
