A growing problem in society today

An estimated 15 million Americans have food allergies, of which approximately one-third are children under the age of 18.

Statistically, this equates to one in 13 children who have this condition. Given the average class size in United States, this means up to three kids per class will have this medical condition in which exposure to an offending food protein can result in a potentially harmful immune response.

Food allergies occur when the immune system of the body attacks the protein of a food that is usually harmless and intended for human consumption. The symptoms of an allergic reaction can vary from very mild (i.e., itching) to life-threatening (i.e., difficulty breathing, throat swelling and/or chest tightness). This extreme manifestation is called an anaphylactic reaction and can be manifested by one or more of the following symptoms: itchy rash, throat/tongue swelling, shortness of breath, vomiting, light-headedness or death. An estimated 0.3 percent of those who go to the hospital for anaphylaxis do not survive, so early identification and treatment is of absolute importance. These symptoms can present rapidly over minutes or take hours to manifest, and the patient or caregivers must be vigilant to be able to recognize the presenting signs and symptoms.

Given the potential complications of food allergies, it is important to differentiate food allergies from food intolerance. Although some of the signs and symptoms of these conditions overlap, it is only when an allergy exists that the immune system is triggered. Conditions like Celiac disease or gluten sensitivity, in which the patient can present with diarrhea, abdominal pain and/ or bloating, are frequently mistaken for an allergic reaction. Differentiating these conditions is most easily done with testing either by skin-prick testing or blood testing for the given foods to identify those which can evoke an allergic reaction. Additionally, blood testing is possible to identify patients with Celiac disease, although gluten sensitivity can exist even in patients who do not have Celiac disease.

While 85 percent of food allergies develop in childhood, adults can also develop food allergies at any age. There are more than 170 various food that have been associated with allergic reactions, although the most common food allergens include milk, egg, peanut, tree nuts (i.e., pecan, hazelnut, almonds, cashews), wheat, soy, fish and crustacean shellfish (i.e., shrimp, lobster, oyster, crab). Cottonseed, sesame seed and sunflower seed oils are also an emerging concern and are frequently used in the manufacturing of food products. As the cost of food production continues to escalate, manufacturers seek cheaper alternatives to use in the production of their foods. This makes additives like cottonseed oil a much more lucrative product to use in reducing those overall cost. Cottonseed oil can be found in foods like peanut butter, boxed cereals, crackers, cookies, salad dressings, mayonnaise, marinades, artificial butter products and margarine, although a consumer will have to read food labels, as not all manufacturers use this in their products. Unfortunately, unless you seek the information on the ingredients list, those with allergies to this can have exposure without even suspecting the foods they consume on a daily basis. The Centers for Disease Control and Prevention estimate the prevalence of food allergy in children increased by 50 percent between 1997 and 2011. It is changes in food manufacturing like these that can explain the increased incidence of food allergies. From 1997 to 2008, the prevalence of peanut or tree nut allergy appears to have more than tripled in U.S. children.

Having food allergies may also result in the presence of having allergies to similar proteins found in other items. For example, patients with ragweed allergies may also develop reactions to bananas or melons. This cross-reactive type of response results when the immune system identifies one protein as being closely related to another.

As research continues, guidelines are changing with regard to introduction of various food items that are allergenic. Specifically, the National Institute of Allergy and Infectious Diseases has changed the recommendation about introducing peanuts to children at high risk. In the past when it was thought best to completely avoid peanuts in children who had a family history of peanut allergies, the guidelines now recommend introducing peanuts early in life – i.e., within the first year of life. It is important to have this discussion with your pediatrician should your child or family have this kind of history.

Treatment for food allergies is highly dependent on the manifestations of the condition. For conditions that manifest with anaphylaxis, epinephrine is the medication of choice. This is a prescription medication and comes in forms of auto-injectors like the Epi-pen © , Adreniclick © or Auvi-Q © .

For other manifestations (i.e., itching), antihistamine medications may offer symptomatic relief. These medications include (but are not limited to) Benadryl, Zyrtec, Allegra or Claritin. For those patients with eczema as a manifestation of their condition, treatment with steroid creams applied to the skin as well as antihistamine medications may be beneficial. Identification of the offending food through skin testing offered by an allergist, and regardless of the manifestation of the condition, avoidance of the foods that cause problems should be the primary goal of treatment.

At Highland Clinic we conduct skin testing on a daily basis to identify both environmental and food allergies using skin-prick method or serum testing. We would enjoy assisting you in identification and management of the food allergies that are affecting you or your family members.

– Robert Baye

Robert Baye, MPAS, PA-C, FAAPA is full-time in the Allergy/Asthma Clinic working alongside Drs. Whited and Johnson. He evaluates new and established patients to the practice for their conditions related to allergies, asthma and immunology. He can be reached at 798- 4651, and his office is located at 1455 East Bert Kouns Industrial Loop, Suite 106, Shreveport, LA 71105.