Health Tips

Introduction

Although many people have bad reactions to certain foods, a true food allergy — a reaction triggered by the immune system — isn't as common as you might think. But, the number of people who have a food allergy is growing. About 2 percent of adults and 6 percent of children have a true food allergy. Far more people have food intolerance, unpleasant symptoms triggered by food. Unlike a true food allergy though, a food intolerance doesn't involve the immune system.

This is little consolation if you've had a bad experience with a particular food and fear a recurrence. But it is an important distinction, because a true food allergy — also called a food hypersensitivity — can cause serious problems and even death.

If you have a reaction to a particular food, tell your doctor about it. Tests can help diagnose a food allergy so that you can take steps to avoid a repeat problem.

Signs and symptoms

For some people, an allergic reaction to a particular food may be uncomfortable but not serious. For other people, an allergic food reaction can be frightening and even life-threatening. Signs and symptoms of a food allergy usually develop within a few minutes to an hour after eating the offending food.

The most common signs and symptoms of a true food allergy include:

• Tingling in the mouth
• Hives, itching or eczema
• Swelling of the lips, face, tongue and throat, or other parts of the body
• Wheezing, nasal congestion or trouble breathing
• Abdominal pain, diarrhea, nausea or vomiting
• Dizziness, lightheadedness or fainting

The symptoms you have depend on what type of food allergy you have.

In a severe allergic reaction to food — called anaphylaxis — you may have more extreme symptoms including these life-threatening signs and symptoms:

• Constriction of airways, including a swollen throat or a lump in your throat, that makes it difficult to breathe
• Shock, with a severe drop in blood pressure
• Rapid pulse
• Dizziness, lightheadedness or loss of consciousness

Emergency treatment is critical in treating anaphylaxis. Food anaphylaxis is responsible for thousands of emergency room visits and as many as 200 deaths in the United States each year.

Exercise-induced food allergy
Some people have an allergic reaction to a food that is triggered by exercise. As the body is stimulated by exercise, a person with an exercise-induced food allergy may feel itchy and lightheaded. In severe cases, it can cause reactions such as hives or anaphylaxis. Not eating for a couple of hours before exercising can prevent this problem.

Oral allergy syndrome
Some fresh fruits and vegetables can trigger a mild allergic reaction that causes the mouth to tingle or itch. This is an example of cross-reactivity — proteins in fruits and vegetables cause the reaction because they're similar to those allergy-causing proteins found in certain pollens. For example, if you're allergic to ragweed, you may also react to melons; if you're allergic to birch pollen, you may also react to apples. Most cooked fruits and vegetables generally do not cause cross-reactive oral allergy symptoms.

Causes

In a true food allergy, your immune system mistakenly identifies a specific food or a component of food as a harmful substance. Your immune system triggers certain cells to produce immunoglobulin E (IgE) antibodies to fight the culprit food or food component (the allergen). The next time you eat even the smallest amount of that food, the IgE antibodies sense it and signal your immune system to release histamine and other chemicals into your bloodstream.

These chemicals cause a range of allergic signs and symptoms. Histamine is partly responsible for most allergic responses, including dripping nose, itchy eyes, dry throat, rashes and hives, nausea, diarrhea, labored breathing and even anaphylactic shock.

The great majority of food allergies are triggered by certain proteins in:

• Eggs
• Peanuts
• Fish
• Shellfish, such as shrimp, lobster and crab
• Tree nuts, such as walnuts and pecans

In children, food allergies are also commonly triggered by proteins in these foods:

• Cow's milk
• Wheat
• Soybeans

Chocolate, long thought by some parents to be a culprit among children, seldom is a cause of food allergy.

Food intolerance and other conditions: Not food allergies
Other reactions to food don't involve your immune system or the release of histamine. These reactions aren't true food allergies. Instead, they may be a food intolerance. Because a food intolerance may involve some of the same signs and symptoms as a food allergy does — such as nausea, vomiting, cramping and diarrhea — people often confuse the two.

If you have a food intolerance, you may be able to eat small amounts of problem foods without a reaction. By contrast, if you have a true food allergy, even a tiny amount of food may trigger an allergic reaction.

One of the tricky aspects of diagnosing food intolerance is that some people are sensitive not to the food itself but to a substance or ingredient used in the preparation of the food. For example, sulfite preservatives can trigger asthma signs and symptoms in sensitive people.

Common non-allergy related problems include:

• Absence of an enzyme needed to fully digest a food. You may not have adequate amounts of some enzymes needed to digest certain foods. Insufficient quantities of the enzyme lactase, for example, make it difficult to digest lactose, the main sugar in milk products. Lactose intolerance can cause bloating, cramping, diarrhea and excess gas.
• Irritable bowel syndrome. Certain foods may trigger the signs and symptoms of irritable bowel syndrome. You may find that certain foods will cause cramping, constipation or diarrhea. Steer clear of these foods to avoid the symptoms.
• Food poisoning. Sometimes food poisoning can mimic an allergic reaction. Some types of mushrooms and rhubarb, for example, can be toxic. Bacteria in spoiled tuna and other fish also can make a toxin that triggers adverse reactions.
• Recurring stress or psychological factors. Sometimes the mere thought of a food may make you sick. The reason is not fully

• Risk factors

  Certain factors may put you at greater risk of developing a food allergy:

• Family history. You're at increased risk of food allergies if other allergies, such as hay fever, asthma, hives or eczema, are common in your family. A child who has one parent with an allergy has about a 50 percent chance of developing an allergy. If both parents suffer from allergies, the child has about a 70 percent chance of developing an allergy.
• Age. Food allergies are most common in children, especially toddlers and infants. As you grow older, your digestive system matures and your body is less likely to absorb food or food components that trigger allergies. Fortunately, children typically outgrow allergies to milk, soy, wheat and eggs. Severe allergies and allergies to nuts and shellfish are more likely to be lifelong.

• When to seek medical advice

  See a doctor or allergist if you experience food allergy symptoms shortly after eating. If possible, see your doctor when the allergic reaction is occurring. This will aid in making a diagnosis.

  Seek emergency treatment if you develop any signs or symptoms of anaphylaxis, such as:

• Constriction of airways that makes it difficult to breathe
• Shock, with a severe drop in blood pressure
• Rapid pulse
• Dizziness or lightheadedness

  Screening and diagnosis

  The following may help determine if you have a true food allergy, rather than a food intolerance, food poisoning or some other gastrointestinal condition.

• Description of your symptoms. Be prepared to tell your doctor a history of your symptoms — which foods, and how much, seem to cause problems — and whether you have a family history of food or other allergies.
• Food diary. Your doctor may ask you to keep a food diary of your eating habits, symptoms and medications to pinpoint the problem.
• Elimination diet. You may be asked to eliminate suspect foods for a week or two, and then add the food items back into your diet one at a time. This process can help link symptoms to specific foods. However, this isn't a foolproof method. Psychological factors as well as physical factors can come into play. For example, if you think you're sensitive to a food, a response could be triggered that may not be a true allergic one. If you've had a severe reaction to foods, this method cannot safely be used.
• Physical examination. A careful exam can identify or exclude other medical problems.
• Skin test. A skin prick test can determine your reaction to particular foods. In this test, small amounts of suspected foods are placed on the skin of your forearm or back. Your skin is then pricked with a needle, to allow a tiny amount of the substance beneath your skin surface. If you're allergic to a particular substance being tested, you develop a raised bump or reaction.
• Blood test. A blood test can measure your immune system's response to particular foods by assessing the amount of allergy-type antibodies in your bloodstream, known as immunoglobulin E (IgE) antibodies. For this test, you give a blood sample in your doctor's office. Your sample is then sent to a medical laboratory, where different foods can be tested. However, these blood tests aren't 100 percent accurate.

Treatment

The only way to avoid an allergic reaction is to avoid the foods that cause signs and symptoms.

However, despite your best efforts, you may come into contact with a food that causes a reaction. In this case, you may need an emergency injection of adrenaline (epinephrine) and a trip to the emergency room. In fact, if you have a severe allergy, your doctor may prescribe you injectable epinephrine, such as EpiPen or Twinject. You need to carry this medication with you at all times so that you or someone you're with can give you an emergency injection if needed. Prompt treatment with an epinephrine injection is critical in treating an anaphylactic reaction.

For less severe allergies, your doctor may prescribe antihistamines, which can be taken after exposure to an allergen to control your reaction and help relieve discomfort. Creams may relieve skin reactions.

Children often outgrow food allergies, especially to milk and soy. They are less likely to outgrow an allergy to peanuts, fish or shrimp.

Prevention

The best way to prevent an allergic reaction is to know and avoid foods that cause signs and symptoms. For some people, this is a mere inconvenience, but others find it a greater hardship. For instance, if nuts are a staple part of your diet, it can be a challenge to come up with a substitute that has equal nutritional value. Also some foods — when used as ingredients in certain dishes — may be well hidden. This is especially true in restaurants and in other social settings.

If you know you have a food allergy, follow these steps:

• Know what you're eating and drinking. Be sure to read food labels carefully.
• If you have already had a severe reaction, wear a medical alert bracelet or necklace that lets others know that you have a food allergy in case you have a reaction and you're unable to communicate.
• Talk with your doctor about carrying emergency epinephrine (adrenaline).
• If you have asthma, be sure to ask if sulfites have been added to foods when dining in restaurants. When shopping for foods, check labels for the terms "sodium bisulfite," "potassium bisulfite," "sodium sulfite," "sulfur dioxide" and "potassium metabisulfite."

If your child has a food allergy, take these precautions to ensure his or her safety:

• Notify key people that your child has a food allergy. Talk with child care providers, school personnel, parents of your child's friends, and other adults who regularly interact with your child. Emphasize that an allergic reaction can be life-threatening and requires immediate action. Make sure that your child also knows to ask for help right away if he or she reacts to food.
• Explain food allergy symptoms. Teach the adults who spend time with your child how to recognize signs and symptoms of an allergic reaction.
• Write an action plan. Your plan should describe how to care for your child when he or she has an allergic reaction to food. Provide a copy of the plan to your child's school nurse and others who care for and supervise your child.
• Have your child wear a medical alert bracelet or necklace. This alert lists your child's allergy symptoms and explains how others can provide first aid in an emergency.

If you have a drug allergy, your immune system mistakes a medication for a disease-causing agent. A reaction to aspirin results in allergy-like symptoms but doesn't involve the immune system.

A drug allergy is a faulty immune system reaction to a drug. It's typically the same process that occurs when people have allergic reactions to pollen, insect venom, animal dander or peanuts. Like many other allergies, a drug allergy can cause a range of responses from a mild rash to life-threatening effects on many body systems.

Drug allergy: Not a side effect

All drugs have the potential to cause an adverse effect — a drug-induced symptom that may be tolerable, may itself require treatment or may require you to discontinue use of the problem drug. Many of these adverse effects occur because of some predictable, known effect of the drug on the body. Possible drug side effects are listed on the label of any medication you take.

Drug allergies are much less common, accounting for about 5 percent to 10 percent of adverse reactions to medications. These reactions are unpredictable responses of the immune system.

If you have a drug allergy, your immune system developed an extreme sensitivity to the drug during the course of treatment the first time you took it. Your body may also have produced allergy-type antibodies to the drug. Normally, your body produces antibodies to fight disease-causing agents such as a virus.

Although this first exposure to the drug can lead to sensitization, it doesn't always cause an allergic reaction. The next time you take the medication, however, the response of your immune system may have harmful effects on a wide range of body systems.

Penicillin and other antibiotics are among the drugs more likely to cause an allergic reaction. In addition, drugs administered by injection or applied as an ointment on the skin are more likely to cause an allergic reaction than are those taken orally.

Signs and symptoms of drug allergies

Many allergic reactions to drugs occur within a few days or as much as three weeks after drug treatment is started. If you're allergic to a drug, you may experience:

• Raised, red, itchy patches on the skin (hives, or urticaria)
• Itching sensation (pruritus)
• Swollen, red, itchy rash (dermatitis)
• Swelling or welts deep in the skin (angioedema), especially near your eyes and lips
• Mild or moderate wheezing

Anaphylaxis: Dangerous drug allergy symptoms
An uncommon effect of drug allergy is a life-threatening reaction called anaphylaxis. This reaction usually occurs minutes after exposure to the drug but may occur within a few hours. Signs and symptoms include:

• Difficulty breathing
• Wheezing
• Hives, usually affecting several parts of the body
• Swelling in the face
• Dizziness, lightheadedness or fainting
• Rapid or weak pulse
• Rapid drop in blood pressure
• Sensation of rapid, fluttering or pounding heartbeats (palpitations)
• Nausea
• Abdominal pain or cramps
• Vomiting
• Diarrhea

Evaluating allergic reactions

If you have any signs or symptoms that may be related to a recent drug treatment, consult your doctor. An allergic reaction to a drug can be difficult to diagnose because the reaction doesn't always occur immediately after beginning a treatment and because any number of medical conditions could cause allergy-like symptoms.

To assess your condition, your doctor will ask you when you first noticed problems, how the signs or symptoms changed, what medications you're currently taking, what medications you've taken in the past and whether you have other allergies. These questions along with a thorough medical examination can help determine whether you have a drug allergy.

Your doctor may also refer you to an allergist, who may be able to confirm whether you have a drug allergy. Allergy skin tests aren't available for all drugs, but specialized treatment centers may be able to perform allergy testing for a small number of drugs.

For a limited number of drugs, a laboratory test may be able to detect immune system antibodies in your blood that are specific to a drug. Tests may also reveal the presence of blood-borne markers, or "biological red flags," indicating that the immune system — rather than some other agent — played a role in causing symptoms.

Information from such tests can be important in guiding future treatment decisions by your doctor.

Treating a drug allergy

Anaphylaxis requires immediate emergency care. An injection of adrenaline (epinephrine) opens airways and helps increase blood pressure. Additional treatments of intravenous antihistamines and cortisone may be required to reduce inflammation of air passages and improve breathing.

Treatment of an allergic reaction that isn't life-threatening begins with discontinuation of the drug. Other treatments may include:

• Antihistamines to counter immune system agents that cause hives and itching
• Corticosteroid creams to alleviate itching
• Corticosteroid pills, such as prednisone, to reduce inflammation, rash and swelling

Aspirin sensitivity

Some people experience allergy-like reactions to aspirin (aspirin sensitivity) or to related medications called nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others), naproxen (Aleve) and indomethacin (Indocin). The immune system isn't usually the culprit, but these adverse reactions to aspirin and NSAIDs are related to the body's ability to regulate inflammation.

Most people with aspirin sensitivity also have asthma and soft, noncancerous growths on the lining of the nose or sinuses (nasal polyps). These two conditions contribute to chronic inflammation in the respiratory system. If someone also has aspirin sensitivity, taking the drug worsens inflammatory mechanisms in the body. The signs and symptoms of aspirin sensitivity may include:

• Nasal congestion
• Rash
• Hives
• Worsening asthma or an asthma attack
• Cough or wheezing
• Anaphylaxis

If you have a reaction to aspirin, your doctor will recommend discontinuation of aspirin and NSAID use and may prescribe medications to alleviate symptoms.

Preventing drug allergy reactions

If you have drug allergies or aspirin sensitivity, the best prevention is to avoid the problem drug and drugs that have similar chemical properties. Most people with a drug allergy can be treated with a safe alternative. People with aspirin sensitivity can usually take acetaminophen (Tylenol, others) to treat pain. Consult your doctor about safe alternatives for you.

In some circumstances, the only appropriate drug available for a serious infection may be one that causes an allergic reaction. If this occurs, your doctor may refer you to an allergist, who can administer a desensitization treatment. Under close supervision in a clinic or hospital, you receive a very small dose of the drug that isn't strong enough to cause an allergic reaction. You then receive a series of doses increasing in size until you achieve a dose strong enough for treatment purposes.

Similarly, people with aspirin sensitivity can also be desensitized to aspirin. Aspirin desensitization followed by a daily dose of aspirin may, in fact, result in improved asthma management and fewer nasal polyps. Most people can also take NSAIDs after becoming desensitized to aspirin.

If you've experienced an anaphylactic reaction or other severe reactions because of drug allergy or aspirin sensitivity, you should wear a medical bracelet that can alert emergency personnel of medications you can't take