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Allergies are among the most common chronic medical conditions throughout the world. The symptoms of allergies range from very benign, such as nasal congestion, to life threatening problems, such as anaphylaxis. In addition, allergies can affect many parts of the body including the skin, sinuses, airway, and even the digestive system.
The body’s immune system normally helps to protect us from invading organisms and environmental pollutants. However, when the immune system mistakes a harmless invader for a potentially dangerous one, it is termed an allergy. The substance causing this reaction is then referred to as the allergen .
The immune system’s response to this allergen can cause life-threatening conditions for a person, which can be referred to as a severe allergy. The most common culprits of severe allergies are pet dander, insect stings, medications, such as penicillin, and food.
When certain components of food trigger this allergic process, it is referred to as a food allergy. The most common foods that cause this reaction are peanuts, tree nuts, fish, shellfish, eggs, milk, wheat, and soy.
When the allergen triggers the immune system, the body produces a substance called immunoglobulin E (IgE), which is a specific protein that signals an invader and starts a cascade of other immune system responses to attack the invading substance. One of the main results of IgE production is stimulation of basophils and mast cells in the body, which release histamine in the presence of IgE. This histamine is the main culprit behind many of the symptoms experienced by those with allergies.
People may be exposed to allergens via multiple methods, which include:
Both genetic and environmental risk factors play a role in the development of allergies (3). According to the Mayo Clinic, your risk of developing allergies increases if the following apply to you:
The diagnosis of severe allergies and food allergies typically begins with a thorough medical history. Your doctor will ask about your symptoms, perform a physical exam, and then may ask you to keep a diary of exposures and symptoms (5). If a food allergy is suspected, the physician may ask you to eliminate certain foods from your diet and then track your subsequent symptoms to attempt to identify the triggering food.
Other diagnostic tools include:
In addition to the above diagnostic tools, a simple history of a severe allergy may prove enough to justify a diagnosis of allergy and avoidance of the offending allergen.
Symptoms of allergies include :
Symptoms of severe allergy, also known as anaphylaxis:
Prognosis is excellent for anyone who avoids known triggering substances and who carries an emergency epinephrine shot (a device used to inject a known quantity of epinephrine), which is the critical component of treatment for severe allergy, or anaphylaxis.
Those who do not avoid triggering agents and do not carry an Epi-pen are at risk of very serious symptoms and even death in the case of anaphylaxis.
Living with severe allergies and food allergies may restrict certain activities, which allow exposure to known allergens and certain types of food. In addition, it is important to read about your food allergy to be able to discern which foods and ingredients are likely to contain either the food you are allergic to or even just the proteins that cause the allergic reaction. With these minor inconveniences, living with these conditions can be very normal and enjoyable.
Here are common tips and tricks for living with common food allergies:
Milk allergy. Someone with a milk allergy should avoid all food, which contains cow’s milk or milk products. Further, milk from sheep or goats may also trigger this response as the proteins are similar in structure so one should be careful with these food products as well. A common protein in milk that can cause allergic reactions is the casein protein. Thus, at times people will refer to a milk protein allergy or casein allergy. However, a true milk allergy is much different than lactose intolerance, which refers the body’s inability to digest the sugar found in milk known as lactose. As a result of lactose intolerance, you will experience pain, bloating, gas, and loose stools. Unlike an allergy, this should pass relatively quickly and will not have other systemic effects, like wheezing or rashes.
Common dairy products someone with a milk allergy should avoid include butter, cheeses, cream, custards, milk, yogurt, ice cream, and puddings. Other foods that may contain milk include au gratin dishes, baked goods, cereals, margarine, mashed potatoes, salad dressings, and sorbets. Finally, ingredients that may contain milk proteins include artificial butter or cheese flavors, casein, curd, ghee, hydrosylates, lactalbumin, rennet, and whey.
If you have a milk allergy, it is important to find alternative foods to provide you with nutrients commonly found in dairy products, such as calcium, protein, and vitamins D and B12. As an alternative, you can eat foods like broccoli, spinach, and possibly soy derivatives. Furthermore, you can try dairy substitutes such as soy, rice, and almond milk. Pay particular attention with kosher products as some may have milk proteins even if they are labeled as “pareve” which is milk-free under kosher guidelines. If you have a baby, discuss your options for safe formula with your pediatrician. He or she may recommend a specialized formula that is extensively-hydrolyzed and casein-based. Finally, be careful to avoid milk proteins found in other products besides food, such as cosmetics and medicines.
Egg allergy. As prolific as eggs are in the modern diet, it is a must to educate yourself on common foods, ingredients, and products that contain eggs. Although the majority of people are allergic to the proteins found in the egg white, not the yolk, it is safest to avoid all components of the egg including egg powder, dried eggs, and egg solids. Eggs are commonly found in baked goods, breaded foods, custards, puddings, egg substitutes (funny, right?), fizzes, candies, marshmallows, frostings, pastas, sauces, soups, and even wines. And, don’t be fooled by these ingredients, which all contain egg proteins – albumin, globulin, lecithin, lysozyme, ovalbumin, ovovitellin.
Interestingly, there are also egg proteins in the measles-mumps-rubella (MMR) vaccine and the flu vaccine. Studies have shown the MMR vaccine to be safe for people with egg allergies. As for the flu vaccine, it was historically not advised for those with egg allergies. However, the American College of Allergy, Asthma, and Immunology now states the amount of egg protein in the vaccine is so minimal, it is unlikely to initiate an allergic reaction. If you are still concerned, you should discuss this with your physician. In addition, there is an egg-free flu vaccine, Flublok, which can be administered to those between the ages of 18 and 49 years old. As with all food allergies, careful ingredient reviews and self-education are critical. Fortunately, many young children will outgrow their egg allergy and can eventually consume eggs without problem.
Wheat allergy. Common foods to avoid with a wheat allergy are bran, bread crumbs, bulgur, couscous, durum, einkorn, farina, farro (also known as emmer), kamut, semolina, sprouted wheat, triticale, germ, gluten, grass, malt, starch, wheat berries, acker meal, ales, beers, baked goods, breaded foods, cereals, processed meats, ice cream, salad dressings, pasta, sauces, soups, soy sauce, and imitation crab meat known as surimi. Ingredients to watch for with a wheat allergy are gelatinized starch, gluten, hydrolyzed vegetable protein, natural flavoring, starch, and vegetable gum. If you have a wheat allergy, it is possible for you to be allergic to other grains as well. Discuss this with your doctor. One of the wheat proteins, called gluten, is also in barley, rye, and oats. Some people can have an autoimmune reaction that can cause damage to the intestine when exposed to a certain type of gluten protein, which is termed celiac disease. (LINK TO CELIAC SPRUE?). Finally, take heed to the presence of wheat not just at the dining table. Decorations, such as wreaths or garlands, may contain wheat products.
Nut allergy. Although nuts themselves and foods like nut butters and breads quite obviously contain nuts, some foods, like sauces or gravies, may surprisingly contain trace amount of different nuts. Nuts are potentially very potent allergens and only require trace amounts to trigger an allergic reaction. If you are allergic to peanuts, you may also need to avoid tree nuts, and vice-versa. Tree nuts include almonds, brazil nuts, cashews, chestnuts, filberts, hazelnuts, hickory nuts, macadamia nuts, pecans, pine nuts, pistachios, and walnuts. Common foods that contain nuts are baked goods (cookies, candies, pastries), candy (chocolate, nougat, marzipan), ice cream, puddings, cereals, granola, soups, breads, protein or energy bars, honey, international foods (especially Thai and Indian), Mortadella, vegetarian burgers, salads, and salad dressings. As for ingredients, be on the lookout for nut butters, nut pastes, nut oils, hydrolyzed plant or vegetable protein, peanut flour, and nut extracts. Especially important for those with nut allergies, is an appreciation of “cross contact.” Cross contact occurs when food made at the same facility that processes other foods with nuts allows trace amounts of nuts into the “nut-free” food. Foods with this potential must be labelled as such in the United States. As with many other food allergies, ensure there are no nuts in other places besides the kitchen. Nuts may be present in pet food, shampoo, and many cosmetics.
In recent science news, there is emerging evidence to suggest that exposure to peanuts (and possibly many other common foods that are sources of allergies) at an early age lowers a child’s risk of developing a peanut allergy (8). As a result, you may want to discuss what types of food to expose your newborn to and how fast as this may help him or her avoid future food allergies.
Fish/Shellfish allergy. Some people may only be allergic to a single species of fish and may be able to consume others without problems. However, the majority of people are allergic to all types of fish. Although avoiding most fish will be easy, there are some surprising foods that contain fish, such as Worcestershire sauce, Caesar dressing, Caponata (Sicilian eggplant relish), and gelatin. Also be sure to avoid caviar, fish roe (fish eggs), and fish oils and sauce. You should also avoid dining at seafood restaurants as it is possible for your non-fish food to be cooked alongside or prepared with other dishes and cross contact your food. You should also avoid shopping for fish as you may develop a reaction from simply touching it. If you are allergic to shellfish, you may want to not consume imitation seafood either, as some manufacturers will add shellfish to these products for flavor. Finally, those with shellfish allergies should do their best to avoid areas where it is cooking as it is possible for the proteins be become released into the air during cooking.
Sulfite allergy. Sulfites are a group of sulfur based compounds that occur naturally in some foods and are added to others to enhance flavor or as a preservative. People may be sensitive to these compounds and have mild symptoms or have true allergic responses to them as well. As of 1986, the FDA banned these compounds from foods, which are eaten raw, such as many fruits and vegetables. As a result, they are now found in cooked and processed foods. They are also naturally occurring in beer and wine. Foods that may contain sulfites include baked goods, soup mixes, jams, canned vegetables, pickled foods, gravies, dried fruit, potato chips, bottled lemon juice and lime juice, tea, condiments, molasses, and shrimp. Ingredients to be wary of include sulfur dioxide, potassium bisulfite, potassium metabisulfite, sodium bisulfite, sodium metabisulfite, and sodium sulfite.
Soy allergy. Although soy is commonly known to be in soy sauce and tofu; soy beans are found in many processed foods. Thus, with a soy allergy, you should avoid edamame, miso, natto, shoyu sauce, soy fiber, soy flour, soy grits, soy nuts, soy sprouts, soy milk, soy yogurt, soy ice cream, soy cheese, soy protein, tamari, tempeh, textured vegetable protein (known as TPV), baked goods, canned broths or soups, canned tunas or meats, cereals, energy bars or protein bars, infant formula, low-fat peanut butter, processed meats, vegetable oil, and Worcestershire sauce. Also be aware of these ingredients: glycine max, hydrolyzed vegetable protein (HVP), mono-diglyceride, and monosodium glutamate (MSG). Take extra precaution dining at Asian restaurants as cross contact is a real possibility. Do consult your physician regarding soy oil and lecithin. Research demonstrates that many people with soy allergies can safely consume soy oil and soy lecithin, which can be used in chocolate candy, peanut butter, and margarine.
Screening for allergies may be accomplished via the skin testing and RAST tests as described above. These should be done in a medical setting with rescue mediations, such as epinephrine and albuterol, readily available.
Prevention of allergies is accomplished by avoiding known triggers, or allergens. This is accomplished with behavioral changes and protective clothing as necessary for triggers from insects, chemicals, etc.
Treatment for non-severe allergies has many options, many of which can be obtained over the counter and without a prescription. Medications include antihistamines, such as diphenhydramine, which come in various forms including pills and sprays, and mast cell stabilizers, which block the production of histamine. Other treatments are decongestants, which help to decrease secretions and reduce swelling. One of the most popular decongestants is pseudoephedrine, which is available without prescriptions. However, it should be noted that decongestants have the potential for numerous side effects, such as increased blood pressure, anxiety, and insomnia. Another class of medications available to help treat symptoms of non-severe allergies is corticosteroids. These medications are potent anti-inflammatory substances, which suppress the overactive immune system present in allergies. However, side effects such as increased urinary frequency, skin changes, and severe immune system depression can occur.
For severe allergies or anaphylaxis, definitive and potentially life saving treatment requires epinephrine. Epinephrine is available in the form of emergency epinephrine shots and can be carried on your person at all times. Common name brands are EpiPen, Emerade, Twinject, Adrenaclick, Anapen, Jext, Allerject, and Auvi-Q. If you begin to experience symptoms consistent with severe allergy or anaphylaxis, you should administer your epinephrine and contact emergency medical services as a second epinephrine dose may be required. In addition, you may need medications to prevent airway swelling or to keep you blood pressure up.
Although the treatment for severe allergies requires the use of epinephrine, there are a variety of alternative and complimentary treatments for non-severe allergies. These treatments include:
If you or your loved ones develop signs or symptoms consistent with a severe allergy or food allergy, you should seek medical attention immediately. A severe reaction, including anaphylaxis, is a medical emergency and needs to be treated immediately.
Although primary care physicians can often diagnose and treat many types of allergies, you should also seek the consultation of an allergist or immunologist, who is a specialist trained in treating allergies for optimal care.
When you go to see your doctor, it’s good to have a list of the questions you’d like to have answered. Take a moment to write down some of the things you want to know. Your questions for your doctor might include some of these:
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