Avoiding foods: Learning the procedures food allergies can be the difference between life and death

2013-10-16T10:15:00Z 2013-10-17T12:44:37Z Avoiding foods: Learning the procedures food allergies can be the difference between life and deathJane Ammeson nwitimes.com
October 16, 2013 10:15 am  • 

"One of the fundamental things in any discussion of food allergies is to separate food intolerance versus true food allergies,” says Cynthia Lerner, MD, who specializes in pediatric and adult allergies. “There’s mass misinformation and confusion to the terminology of food allergies.”

As an example, Lerner notes that celiac disease is not a food allergy, it’s a gastrointestinal intolerance to wheat.

“A person who is allergic to wheat, who gets hives, vomits, collapses is far different than the individual who has celiac disease,” says Lerner, an assistant professor of pediatrics, Northwestern University, Feinberg School of Medicine with private practices in Munster, Tinley Park, Illinois and at the Ann and Robert Lurie Children’s Hospital of Chicago New Lenox Outreach Clinic. “People might say, 'I’m allergic to milk,' but really what they have is a lactose intolerance.”

According to Lerner, peanuts and cow’s milk lead the list of most common food allergies followed by tree nuts, soy, wheat, finfish and shellfish.

“On the more unusual side celery is seen as benign,” she says, “but some people have an allergic reactions to it.”

A May report from the federal Centers for Disease Control and Prevention notes a 50 percent rise from 1997 to 2011 in the number of U.S. children who have food allergies. According to a 2010 study, peanut allergies among children appear to have tripled between 1997 and 2008.

“Food allergies do appear to be on the rise and people are becoming more aware of them,” says Carol Bliznik, a registered dietitian with Franciscan St. Anthony Health-Crown Point.

“Symptoms can be relatively mild such as a minor rash or itching, mild such as hives, intestinal problems and mild diarrhea or can be severe requiring immediate hospitalization or result in rapid death,” says Michael S. LaPointe Ph.D., Associate Professor of Biology at Indiana University Northwest. “Most individuals do not know they have a food allergy until they first encounter the food. Severe allergies may result in hives the first time an individual eats it. Eating the food a second time can cause a severe reaction and death.”

LaPointe notes the different levels of allergic reactions to food.

“Mild allergies leading to a rash, itching or hives can usually be treated by an antihistamine such as Benadryl, or topical creams to relieve the itching,” he says. “Eating of peanuts and shellfish can lead to a severe drop in blood pressure – hypotension -- and closure of the airways, so a person cannot breathe. Individuals that know they have these will typically carry an epi pen, containing the hormone epinephrine, also known as adrenaline. Epinephrine increases the heart rate and blood pressure and causes the airways to open.”

Responding to the rise in food allergies in school age children, the U.S. House of Representatives recently passed a bill, which President Obama signed, expanding access to epinephrine auto injectors in schools.

“The most important concern to the public at this point is not esoteric sensationalism of allergies but the treatment,” says Lerner. “The new Auvi-Q is an epinephrine auto‑injector that talks you through the injection process during a severe allergic reaction.”

Both Lerner and LaPointe recommend anyone with a moderate to severe food allergy always carry at least one epi pen with them.

“Both parents and kids need to be prepared and need to check so they’re not carrying around expired adrenaline,” Lerner. “And everyone should have at least two on them. They come in two for a reason. The mantra is epi everywhere – on the parents, on the child, in the glove box of your car. If someone is experiencing anaphylaxis, a severe life-threatening allergic reaction, those around them should use the epi, call 911 and later you can address the cause of the problem.”

Lerner also is an advocate of wearing a bracelet with information about a person’s medical conditions.

“Don’t put a card in your wallet,” she says. “People won’t find it in time.”

“The best way to avoid foods causing any allergic reactions is to read food labels and ask question when you’re in a restaurant or out some place,” says Bliznik noting that many restaurants now have dishes for those with food allergies.

But it is important to be aware of cross-contamination.

“There have been cases where someone had died from exposure to minuet traces of peanuts,” says LaPointe. “For example, food cooked in pots that previously contained peanut oil, or kissing someone that had eaten a peanut butter sandwich. “

What’s causing this increase in allergies is unknown at this point. The previous paradigm that pregnant women should not eat certain foods during pregnancy and particularly in the last trimester, is now considered ineffective.

“They really have gone away from avoidance during the pregnancy and the last trimester,” says Lerner. “In the past, we delayed introduction to what we considered allergenic food to infants. In the years I was having kids we didn’t introduce eggs before age one and peanuts until age two. Now that we are having this incredible rise in allergies across the world, the new paradigm is introducing the new foods much earlier one at a time.”

As scary as this may sound, LaPointe notes that some children grow out of their allergies. And Lerner says true food allergies are much less common than positive skin tests might indicate.

"We have a lot of people who test positive and maybe are sensitized but could eat peanuts or other foods,” she says. “And sometimes people are over diagnosed which causes a lot of anxiety. Though 1 percent of the population has peanut allergies, only about a tenth are severely anaphylactic while the other 90 percent may just have symptoms like a rash, wheezing or gastrointestinal upset.”

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