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New Food Allergy Guidelines Released

By: , SparkPeople Blogger
12/20/2010 12:04 PM   :  12 comments   :  9,319 Views

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In some individuals, foods, medications, latex or insect stings cause an immune response. More than 170 food or food additives have been found to cause allergic reactions. However, over ninety percent of those responses come from eight common food types: milk, eggs, peanuts, tree nuts (such as almonds, cashews, walnuts, and pecans), fish, shellfish, soy, and wheat. After eating one of these foods, people may experience a variety of allergic responses from a mild reaction such as a tingling sensation to a more severe anaphylactic response.

There is currently no cure for food allergies, only avoiding the offending food or additive or managing resulting symptoms. Allergies to milk, egg, soy, and wheat are often outgrown, but allergies to peanuts and tree nuts tend to persist throughout life. It is also not uncommon for people with food allergies to also have other diseases like asthma, eczema, or eosinophilic esophagitis (EoE) as well.

According to the Center for Disease Control and Prevention, there were about three million children under the age of 18 with reported food allergies in 2007 which is an 18 percent increase from a decade before. That means one out of every 100 children had a food allergy of one type or another. Although food allergies are more common in children, one in 25 adults suffers with a food allergy as well. Since people do not live in a vacuum, an entire family is likely to be affected in one way or another when someone in the house has a food allergy. Because of this, allergy awareness has continued to rise over the last decade making it a subject of increased public concern.

Without a clear set of clinical guidelines, there can be wide inconsistency in allergy diagnosis and treatment. This is especially true when such a wide variety of medical professionals and specialists are managing allergies. Last week the National Institute for Allergy and Infectious Disease issued the first ever Guidelines for the Diagnosis and Management of Food Allergy in the United States. The new guidelines provide 43 specific clinical recommendations for diagnosis and food allergy management for healthcare professionals. Although the new guidelines are not protocols for diagnosis, more than likely they will serve as a guide to clinical practice and for public educational material development.

What Happens

A food allergy is caused by an abnormal immune response. There can be several different immune responses but the most common is the production of the immunoglobulin E (IgE) antibody to specific molecules in the food. A person doesn't experience an allergic response with the first exposure to a food. Unfortunately, knowing when a first exposure occurs is not always easy but the first exposure triggers the body to produce IgE antibodies. The next exposure to the food (allergen) causes a response that can range from mild to severe when antibodies are released to attack the allergen. If there is a family history of allergies, there is typically a greater allergy risk. A child with two parents with allergies of any type is more likely to develop a food allergy than a child that only has one parent with allergies.

Allergy or Intolerance

Sometimes a response to a food or additive is related to intolerance instead of an actual allergy. This is very common with cow's milk. Milk sugar known as lactose requires the enzyme lactase to break it down for digestion. Intolerance to milk comes when lactase is missing. While undesirable symptoms occur, it is not the same as an IgE allergic response, which tends to be related to the protein of the milk. Flavor enhancers like MSG, sulfite preservatives, and gluten also tend to cause intolerance responses more than IgE antibody responses. Oral Allergy Syndrome (OAS) is an allergic response to raw fruits and vegetables. It is common in people that also suffer with hay fever especially when they are sensitive to birch and ragweed pollen. Foods such as apples, cherries, kiwis, celery, tomatoes, and green peppers can cause tingling or swelling in the lips, tongue, or mouth as well as watery eyes, runny nose, and sneezing. Cooking or processing the offending fruits or vegetables can break down the proteins that are causing the response and may allow those foods to safely be consumed.

It is important to distinguish between foods that are not tolerated compared to those that actually cause an antibody response. When foods are not tolerated, they can cause very uncomfortable symptoms that can only be avoided by limiting or omit them from the diet. When foods are eaten that cause an increase in IgE antibody, those antibodies can lead to increasing allergic response that could build to anaphylaxis. The more the exposure to allergens the more risk of increased antibodies and physical responses that could lead to restrictive breathing and altered blood circulation that can become life threatening.

Allergy Diagnosis

When an allergy is suspected, it is important to consult your health care professional for complete medical advice. The new guidelines suggest that blood and skin tests once conducted first and thought to be the standard for identifying food allergies may not be sufficient diagnostic tools.The reason is that it may be identifying people that "could" react to a food instead of those that do. This causes people to avoid foods and follow a restrictive eating plan that may not be necessary. Here are the recommended steps for a reliable food allergy diagnosis.

  • Detailed History Your medical provider will need to conduct a detailed medical history related to how quickly a response was experienced after the suspected food was eaten, how much food was consumed, how frequently the food was consumed prior to reactions and if anyone else consuming the food had a reaction. Write down as much as you can remember after a reaction and take the information with you to your appointment.

  • Diet Diary - A food diary helps the medical team identify the offending food or additive. It is very important to be as accurate and thorough as possible when keeping a record. Be sure to include brand names and serving sizes as well as the time of day for everything consumed while keeping the diary. Since there could be cross contamination issues, be sure to include any supplements, vitamins, or medications that you are taking as well.

  • Elimination Diet - An elimination diet is used to evaluate suspected foods. Foods are removed from the diet for a short time and then re-introduced under the direction and monitoring of a health care professional for evaluation and diagnosis.

  • Skin Prick Test - When the history, diet diary, or elimination diet suggest there is a food allergy a skin prick test is recommended to confirm the diagnosis. A positive skin prick test and a history of reaction to the same specific food are suggestive of an allergy

  • Blood Test - A blood sample to measure IgE antibody levels to a specific food may be used instead of a skin prick test. As with the skin prick test, both antibodies and other reactions to the same food are necessary to suggest an allergic response.

  • Oral Food Challenge - Once a food allergy is suspected an oral challenge can be used to confirm a diagnosis. Several foods are presented with at least one being the suspected allergen. The initial doses are very small but gradually increase during the challenge. The food allergy is typically confirmed if there is a reaction to the suspected allergen but no other foods offered. Because of the risk of anaphylaxis, health professionals with experience performing food challenges should only conduct an oral challenge. Individuals should NEVER try a food challenge without medical supervision.
The Bottom Line

Food allergies have increased in prevalence for children and adults, which have caused them to become a concern of public health. A set of guidelines has been developed to help health care professionals and individuals diagnose food allergies. If you or someone you know experiences undesirable symptoms after eating a specific food, seek medical attention to help distinguish between non-allergic responses from food intolerances and life threatening IgE antibody producing allergies.

Do you think these new guidelines will be helpful in identifying and managing food allergies?


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Comments

  • 12
    I'd encourage anyone with questions to go to a Board Certified Allergist. I work for one. There are many that are not certified, and will test, and treat, with unrecognized methods. - 12/26/2010   8:43:19 PM
  • 11
    I never had allergies until after I had open heart surgery at age 54... now I'm sensitive to things I never even thought of before, especially soy. - 12/22/2010   2:33:44 PM
  • 10
    Well my older sister was the bottle-fed one and has no allergies. Meanwhile, I was exclusively breast-fed, no baby food even, for the first ten months and have multiple tree nut allergies. - 12/21/2010   12:16:45 PM
  • 9
    wow the timing of this is ironic. I just learned last week that I am allergic to lobster- I had no idea. I broke out in the most horrible itchy rash everywhere! and am taking meds non stop to help with the itching :( I spent years living on the gulf and eat shrimp & crab all the time with no issues...

    my son also has an odd milk allergy- he doesn't have an immediate reaction to it but if he has a lot in a short amount of time he ends up with ear problems- was the cause of his chronic ear infections from 6mos to 3.5yrs...had hearing loss, surgeries, etc- all related to his milk allergy. He is supposedly going to outgrow it...but any time he has more milk than usual he ends up with ear problems. His pediatrician that diagnosed him said it's a very unusual milk allergy b/c of the way it presents. - 12/21/2010   8:51:00 AM
  • 8
    It seems like a step in the right direction but only time will tell. - 12/21/2010   12:37:17 AM
  • 7
    Research shows that children who have been breastfed have a far lower chance of developing allergies, so for that reason I made sure to nurse my children for at least six months. I think allergies have risen along with the huge number of babies who were put on commerical baby formula beginning in the '50s. - 12/20/2010   9:06:26 PM
  • 6
    My son is going in for an oral food challenge this week at his allergist's office. He has a high peanut allergy, low allergy to cashews but tested negative for tree nuts (almonds, pecans, walnuts, brazilnuts). Just to make sure it's not a false negative, they suggested we do that. It's an interesting article and definitely hits close to home! - 12/20/2010   6:55:56 PM
  • 5
    I'm glad doctors are going to be "encouraged" to be more open-minded to food allergies and intolerances. - 12/20/2010   4:51:52 PM
  • 4
    Good article. My son is allergic to eggs and has had both the skin and blood test. He did not react to the skin test but his IgE levels were through the rough. It is difficult for him to eat sweets and many versions of pasta which contain egg products. But many websites have helped with providing alternative substitutes. Now it would be nice if the flu shot was produced in an alternative fashion so he could get that, as for now it is culture with egg product which cause the risk of an allergic reaction if given the shot. More should be done for those with allergies so their live can be as normal as anyone else. - 12/20/2010   4:26:57 PM
  • 3
    I am allergic to tree nuts. Most, if not all, of varying degree of allergic reaction. I've never been officially diagnosed, except for my first allergic reaction to almonds. I would like to get a "scratch" test done to confirm and identifiy other tree nut allergies. - 12/20/2010   4:07:21 PM
  • 2
    Thank you for sharing this very informative article. - 12/20/2010   4:00:03 PM
  • 1
    Thank you for this very concise article. I and My Dh have allergies. This was written so he can understand why he cannot eat raw apples and pears but when I cook them there is no reaction Thank you . - 12/20/2010   1:36:33 PM

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