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1 Food Allergy Introduction A food allergy is an abnormal response to a food. It is triggered by your body's immune system. An allergic reaction to a food can sometimes cause severe illness or death. Tree nuts and peanuts are the leading causes of deadly allergic reactions. A deadly reaction is called anaphylaxis. This reference summary will help you understand the causes of food allergies. It will also discuss symptoms and treatment. Information about the diagnosis and prevention of food allergies is also included. Allergies The body s immune system fights viruses and bacteria that can harm the body. Some substances that enter the body are harmless. The body will ignore them. Allergens are harmless substances. However, they can cause allergic reactions in some people. Allergens include: Certain foods. Dander from animals. Household dust mites. Mold. Pollen. The body of an allergic person thinks that the allergen is a substance that could cause harm. Cells from the immune system then release substances to fight the allergen. One of these substances is known as histamine. White blood cells release histamine during an allergic reaction. Histamine causes small blood vessels to widen and leak. This can cause tissues to swell. It can also cause muscles in the airways to contract, gastric acid to be made and the heart rate to increase. 1

2 The release of histamine and other chemicals cause the symptoms of an allergic reaction, including: Runny nose. Sneezing. Itching. Swelling. Asthma. A person who is exposed to an allergen over and over again can have a more severe reaction with each additional exposure. Anaphylaxis is a severe allergic reaction that affects your whole body. It can cause death. The reason that some people have allergies is not clear. The risk to have allergies is thought to be hereditary. This means that it is passed on from parents to their children. Allergies to Food A food allergy is an abnormal response to a food. It is triggered by your body's immune system. The immune system responds to a harmless food as if it were a threat. It treats a protein found in the food as something harmful to the body. There are many types of immune responses to food. This program will focus on one type of reaction: when the body makes an antibody known as immunoglobulin E, also known as IgE. An antibody is a blood protein. It is made in response to a toxin, which is a type of poison, or another substance in the body. The antibody is meant to fight the substance. A person with a food allergy will not have symptoms the first time they eat the food. However, the immune system will respond to the food as if it is harmful. It will create IgE antibodies. This is the body s attempt to drive the protein out of the body. IgE antibodies move through the blood. They attach to immune cells. These cells are found in all body tissues, especially the nose, throat, lungs, skin and GI tract. GI stands for gastrointestinal. The GI tract includes the stomach and intestines. If the person eats the same food again, the IgE antibodies will recognize it right away. They will send signals to the immune cells. The cells will release large amounts of histamine and other chemicals into the bloodstream. This causes an allergic reaction. 2

3 An allergic reaction to food often takes place in a few minutes or a few hours. The timing and location of the reaction depends on the: Way the food is eaten and digested. Location of the immune cells causing the reaction. You are often first exposed to a food when you eat it. Sometimes a first or later exposure can happen without your knowledge. This may be true in the case of a peanut allergy. A person who experiences anaphylaxis on the first known exposure to peanuts may already have had contact with peanuts without realizing it. This could happen from: Touching peanuts. Using a skin care product that contains peanuts. Breathing in peanut dust in the home or when close to other people eating peanuts. The most common foods that cause allergic reactions to babies and children are: Eggs. Milk. Peanuts. Tree nuts, such as walnuts. Soy, primarily in infants. Wheat. In adults, the most common foods that cause allergic reactions are the following: Fish, such as salmon. Peanuts. Shellfish, such as shrimp, crayfish, lobster and crab. Tree nuts. Food allergies often develop early in life. However, they can develop at any age. Children often outgrow their egg, milk and soy allergies. Children, however, often do not outgrow their allergy to peanuts. 3

4 People who develop allergies as adults often have them for life. Regularly eating the same foods increases the risk that a person will develop allergies to that food. For example, rice allergy is more common in Japan than it is in the United States. Codfish allergy is more common in Scandinavia than the United States. Symptoms Allergic reactions to food can cause symptoms that range from mild to deadly. A person cannot tell how severe the next allergic reaction will be. It is not based on what a previous reaction was like. Immune cells protect the body from substances that could cause harm. Many of these cells are found in the nose, throat, lungs, skin and GI tract. These areas are often affected by an allergic reaction. Common symptoms of an allergic reaction include: Itching or swelling in your mouth. GI symptoms, including vomiting, diarrhea, cramps, or pain. Hives or eczema. Tightening of the throat. Trouble breathing. A person may also feel that something bad is going to happen during a reaction. Because of low blood pressure, they may have pale skin. They may lose consciousness. Food allergy can cause death if it is severe enough to cause anaphylaxis. The reaction blocks the airways. It makes it hard for a person to breathe. Diagnosis Your health care provider will diagnose a food allergy by asking you about your medical history and examining you. He or she will find the cause of your symptoms. They could be caused by an allergy to specific foods, food intolerance, or other health problems. Sometimes a diagnosis cannot be made using just your history or your exam. You may be asked to keep a diet diary. You will fill it with details about the foods you eat and whether those foods cause a reaction. A pattern in your reactions may develop and help with diagnosis. 4

5 A limited elimination diet may be used to find the cause of your symptoms. The food that is suspected of causing an allergic reaction is taken out of your diet to see if the allergic reactions stop. Do not begin such a diet without first talking to your health care provider. Your history, diet diary, or elimination diet may suggest a certain food allergy. If so, your health care provider will use the skin prick test to confirm the diagnosis. Your health care provider will use a needle for the skin prick test. The needle places a small amount of food extract below the surface of the skin on your lower arm or back. It will cause swelling or redness if you are allergic. The skin prick test is simple and safe. Results are ready in minutes. Skin Prick Test Instead of the skin prick test, your health care provider can take a blood sample. He or she will measure the levels of food specific IgE antibodies. You may have a positive skin or blood test to a food even if you do not have an allergic reaction to that food. A health care provider often makes a diagnosis of food allergy based on a positive skin or blood test and a history of reactions. The oral food challenge is the final method used to diagnose a food allergy. The challenge is made up of several steps: You are given small doses of different foods. The amount of each food will increase during the test. You will swallow each dose. Your health care provider will watch you to see if a reaction happens. The diagnosis of a food allergy is confirmed if you have a reaction only to the suspected foods and not to the other foods tested. Oral food challenges should always be done by a health care provider. They could cause a severe allergic reaction. Treatment There is no known cure for food allergies. Current treatments can only ease the symptoms. A person with food allergies must be prepared to treat a surprise exposure. Talk to your health care provider to create a plan. 5

6 You should take the following steps: Wear a medical alert bracelet or necklace that states your allergies; these can be found in most pharmacies. Carry an auto-injector device that contains epinephrine. Seek medical help as soon as possible. Epinephrine is a hormone. It is also a type of emergency medicine. It is made by a gland in response to physical or mental stress. It causes an increase in heart rate and blood pressure. It also opens up the airways. You may have mild symptoms that are not part of an anaphylactic reaction. Talk to your health care provider to find out what drugs may stop them. However, it is very hard for you to know which reactions will be mild or severe. Prevention You can only prevent symptoms if you avoid foods that cause an allergic reaction. After you and your health care provider identify the foods to which you are sensitive, you must not eat them. Check food labels when you shop for food. Read the list of ingredients on the label of each prepared food that you may eat. Many allergens, such as peanuts, eggs and milk, may appear in foods that you may not associate with them. Food manufacturers in some countries are required by law to list the ingredients of prepared foods. They must also use plain language to say if their products contain any of the top eight allergenic foods. The top eight allergenic foods are: Eggs. Milk. Peanuts. Tree nuts. Soy. Wheat. Shellfish. Fish. If you go out to eat, ask which ingredients are used when considering your meal. Do not take any chances. If the person you ask is not sure, it is better to eat something else that you know your body can handle. 6

7 Simple steps can take most allergens out of the environment of a person with a food allergy. For example, washing your hands with soap and water will remove peanut allergens. Most household cleaners will remove allergens from surfaces. Summary A food allergy is an abnormal response to a food triggered by the body's immune system. This reference summary focuses on one type of allergic reaction: when the body makes an antibody known as immunoglobulin E, also known as IgE. Allergic reactions to food can cause symptoms that range from mild to deadly. A person cannot tell how severe the next allergic reaction will be. It is not based on what a previous reaction was like. Your health care provider will diagnose a food allergy by asking you about your medical history. He or she will also perform several tests to discover which foods you are allergic to. Diagnosis is confirmed if you have a reaction only to the suspected foods and not to the other foods tested. There is no known cure for food allergies. Current treatments can only ease the symptoms. A person with food allergies must be prepared to treat a surprise exposure. Talk to your health care provider to create a plan. You should take the following steps: Wear a medical alert bracelet or necklace that states your allergies; these can be found in most pharmacies. Carry an auto-injector device that contains epinephrine. Seek medical help as soon as possible. You can only prevent symptoms if you avoid foods that cause an allergic reaction. After you and your health care provider identify the foods to which you are sensitive, you must not eat them. 7

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