Food Allergies & Anaphylaxis

West Georgia Food Allergy Support Group is a non profit, volunteer support group for individuals and families living with food allergies in nearby communities. The site is NOT intended to be a substitute for professional medical advice, diagnosis, or treatment.

Watch a three-minute video about food allergies and how to manage a food allergy reaction – developed by the National Institutes of Health (NIAID, 2013)

Food allergy is an immune system reaction that occurs soon after eating a certain food. Even a tiny amount of the allergy-causing food can trigger signs and symptoms such as digestive problems, hives or swollen airways. In some people, a food allergy can cause severe symptoms or even a life-threatening reaction known as anaphylaxis.

Anaphylaxis is a type of allergic reaction, in which the immune system responds to otherwise harmless substances from the environment. Unlike other allergic reactions, however, anaphylaxis can kill. Reaction may begin within minutes or even seconds of exposure, and rapidly progress to cause airway constriction, skin and intestinal irritation, and altered heart rhythms. In severe cases, it can result in complete airway obstruction, shock, and death.

Anaphylaxis Symptom/s could include one:
1. A person has skin symptoms or swollen lips and either :

• Difficulty breathing, or
• Reduced blood pressure (e.g., pale, weak pulse, confusion, loss of consciousness)

2. A person was exposed to a suspected allergen, and two or more of the following occur:

• Skin symptoms or swollen lips
• Difficulty breathing
• Reduced blood pressure
• Gastrointestinal symptoms (i.e., vomiting, diarrhea, or cramping)

3. A person was exposed to a known allergen, and experiences:

• reduced blood pressure

~If you know you have anaphylaxis always carry your medicine with you at all times.
~Always make sure your medications are up to date.
~Wear medical I.Ds at all times.
~Don’t delay emergency medication, use immediately.
~If you have to use your emergency medication seek Doctor (ER)
~Epinephrine is not a FOOLPROOF, do not take chances and eat your allergen foods.

Top 8 Food Allergens
~only eight foods account for 90 percent of all food-allergic reactions in the United States

• Peanut
• Tree nuts
• Milk
• Egg
• Wheat
• Soy
• Fish
• Shellfish

Diagnosed
First step an allergist will take to diagnose a food allergy is a thorough medical history. The allergist will ask questions to determine if food allergy may be causing your symptoms and to identify the culprit food(s), and will then perform a physical exam. Then the allergist may conduct tests to help identify a food allergy. These tests alone sometimes does not always provide precise answers, the allergist will combine your test results with the information given in your medical history to provide a diagnosis. These tests may include:

Skin Tests

• Skin Prick Test or puncture/scratch test
  ~placing a drop of a solution containing a possible allergen on the skin, and a series of scratches or needle pricks allows the solution to enter the skin. If the skin develops a red, raised itchy area (called a wheal), it usually means that the person is allergic to that allergen. This is called a positive reaction.
• Intradermal test
  ~injection of a small amount of the suspected allergen under the surface of the skin. A typical reaction looks like a small hive with swelling and redness. The intradermal test is more sensitive than the skin prick test and can usually provide more consistent results.
• Skin patch test
  ~the allergen solution is placed on a pad that is taped to the skin for 24 to 72 hours. This test is used to detect a skin allergy called contact dermatitis.

Blood Test
Allergy blood tests detect and measure the amount of allergen-specific antibodies in your blood. When you come into contact with an allergy trigger, known as an allergen, your body makes antibodies against it. However, they can throw a false positive.

Oral Food Challenge
The allergist feeds you the suspect food in measured doses, starting with very small amounts that are unlikely to trigger symptoms. Following each dose, you are observed for a period of time for any signs of a reaction. If there are no symptoms, you will gradually receive increasingly larger doses. If you show any signs of a reaction, the food challenge will be stopped.
Most reactions are mild, like flushing or hives on the skin, severe reactions are uncommon, but if necessary, they will give medication such as antihistamines.

Food Elimination Test
The allergist may ask for you to temporary eliminate specific foods from your diet for about 2-4 weeks. You will be asked to monitor your symptoms. If one of the foods you eliminated was your problem food, your symptoms should go away by the end of the test. Your allergist could ask that you replace the problem food, in a gradual manner to see if your symptoms return.

Symptoms
An allergic reaction to a particular food may be uncomfortable but not severe. For others, an allergic food reaction can be frightening and even life-threatening. Food allergy symptoms usually develop within a few minutes to two hours after eating the offending food. Food allergies can occur even the first time you eat a food.

Mild symptoms may include one or more of the following:

• Hives (reddish, swollen, itchy areas on the skin)
• Eczema (a persistent dry, itchy rash)
• Redness of the skin or around the eyes
• Itchy mouth or ear canal
• Nausea or vomiting
• Diarrhea
• Stomach pain
• Nasal congestion or a runny nose
• Sneezing
• Slight, dry cough
• Odd taste in mouth
• Uterine contractions

Severe symptoms may include one or more of the following:

• Obstructive swelling of the lips, tongue, and/or throat
• Trouble swallowing
• Shortness of breath or wheezing
• Turning blue
• Drop in blood pressure (feeling faint, confused, weak, passing out)
• Loss of consciousness
• Chest pain
• A weak or “thread” pulse
• Sense of “impending doom”

How a child might describe a reaction:

• “This food is too spicy.”
• “My tongue is hot [or burning].”
• “It feels like something’s poking my tongue.”
• “My tongue [or mouth] is tingling [or burning].”
• “My tongue [or mouth] itches.”
• “It [my tongue] feels like there is hair on it.”
• “My mouth feels funny.”
• “There’s a frog in my throat.”
• “There’s something stuck in my throat.”
• “My tongue feels full [or heavy].”
• “My lips feel tight.”
• “It feels like there are bugs in there.” (to describe itchy ears)
• “It [my throat] feels thick.”
• “It feels like a bump is on the back of my tongue [throat].”

Exercise can induce a food allergy
Some people have an allergic reaction to a food triggered by exercise. Eating certain foods may cause you to feel itchy and lightheaded soon after you start exercising. In serious cases, an exercise-induced food allergy can cause reactions such as hives or anaphylaxis. Not eating for a couple of hours before exercising and avoiding certain foods may help prevent this problem.

Treatment
Strict avoidance, reading labels for all foods you come in contact with. If the product does not have a label, then if you know you have a food allergy that product needs to be avoided. If you are questioning a product be sure to email the manufacturer and ask them directly.

Epinephrine, also called adrenaline, is the medication of choice for controlling a severe reaction. It is available by prescription as a self-injectable device (EpiPen® or Twinject®) or Auvi-Q™.

Is there a Cure?
There is no cure for food allergies. Strict avoidance of food allergens and early recognition and management of allergic reactions to food are important measures to prevent serious health consequences.

If you think you may have a food allergy please seek an allergy specialist.

References:
http://www.phadia.com/en/Products/Allergy-testing-products/ImmunoCAP-Allergen-Information/Food-of-Plant-Origin/Grains/Gluten-/
http://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Practice%20and%20Parameters/Anaphylaxis-2010.pdf
http://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Practice%20and%20Parameters/food-allergy-2006.pdf
http://www.niaid.nih.gov/topics/foodallergy/clinical/documents/faguidelinesexecsummary.pdf
http://www.niaid.nih.gov/topics/foodallergy/clinical/documents/faguidelinespatient.pdf