Food Allergies: Types, Symptoms, and Effective Ways of Managing Food Allergies

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I remember having seen some of my friends in school suffering from food allergies. My teenage daughter’s friend is allergic to cocoa, citrus fruits and coconut. Similarly, you must have come across acquaintances, friends, or relatives having food allergies. Identifying the culprit (allergen) causing the food allergy is the most daunting task.

Researchers estimate that 32 million Americans have food allergies, including 5.6 million children under the age of 18. This translates to 1 in 13 children. Statistics show that about 40% of children with food allergies are allergic to more than one food.  

This post will enlighten you about

1. What is Food Allergy?
2. What are the types of food allergies?
3. Common food allergens
4. What are the symptoms of food allergy?
5.  Diagnosis of food allergy?
6. Effective ways of dealing with food allergies (specific to wheat and shellfish allergies)

What is Food Allergy?

According to Food Allergy Research and Education (FARE), a food allergy is a medical condition in which exposure to a particular food triggers a harmful immune response. The immune response, called an allergic reaction, occurs because the immune system attacks proteins in the food that are normally harmless. These proteins that trigger the reaction are called allergens.

The body releases histamine and prostaglandins during an allergic reaction, the reason why anti-histamines are prescribed to control the reaction.

Food allergies may occur within a few seconds to several hours after intake of food.

How Does Food Allergy Vary From Food Intolerance?

Food allergy involves the immune system and triggers an immune response, which can also be life-threatening sometimes.

Food intolerance does not involve the immune system and may be due to an enzyme deficiency or other factors. In this case, you may be able to eat a small quantity of food that you are intolerant to without much problem. Food intolerance may cause discomfort, but it is not life-threatening.

Predisposing Factors for an Allergic Reaction

1. Heredity
2. Physical or emotional stress (these may act as triggers)
3. Frequency of consuming the food containing the allergens
4. The amount of allergen contained in the food consumed

Types of food allergies

• Immunoglobulin E (IgE) mediated: In this type of food allergy, your body’s immune system produces IgE antibodies (blood proteins that recognize and fight infections) that react with certain foods and trigger an allergic reaction. An IgE-mediated allergic reaction usually occurs within several hours of ingesting the food allergen and can include mild to severe symptoms, including anaphylaxis.

• Non-IgE mediated. In this type of allergy, your immune system does not produce IgE antibodies, but other parts of the immune system respond against the perceived threat. A non-IgE mediated allergic reaction often involves the skin or digestive symptoms or a combination of both these symptoms. This may occur up to 3 days after ingesting the food allergen.

Eight Major Allergens (Ingredients) That Trigger Food Allergy

Eight types of food have been identified to cause 90% of allergies. They are:

• Eggs
• Shellfish (crustaceans such as shrimp, lobsters, prawns and crabs)
• Fish
• Milk
• Peanuts
• Soy
• Wheat
• Tree Nuts (Almonds, pistachios, cashews, macadamia nuts, walnuts and pine nuts)

Some of the less common food allergens include citrus fruits, banana, avocado, kiwi fruit, celery, garlic, broccoli, cocoa, mustard seeds, aniseed and chamomile.

Symptoms of Food Allergy

Food allergy symptoms may range from a mild skin rash, itchy throat, hives, and swelling of the face to more severe symptoms like throat tightening, shortness of breath, or loss of consciousness; and in extreme cases, anaphylaxis, which is a serious and potentially life-threatening allergic reaction.

Gastrointestinal symptoms:  Cheilitis (inflammation and swelling of the lips), stomatitis (painful sores and swelling in the mouth), colic in infants, abdominal distension and pain, constipation, diarrhea, dyspepsia, nausea and vomiting.

Skin: Dermatitis, edema, rash, urticaria (a rash with round red wells and very intense itching), pruritis (itchy skin), blisters and flushing of skin.

Neurologic: Fatigue, headache, irritability, stomach pain, restlessness, sneezing, etc.

Diagnosis of Food Allergies

Several steps are involved in the diagnosis of a food allergy.

Assessment: In this step, details such as the diet history, allergy symptoms and their timing, suspected foods and the amounts eaten to produce a reaction and also the family history of allergies is recorded. The cause may be a common food or foods or a non-food.

Maintaining a Food Intake Journal: The patient is asked to maintain a record of food intake and symptoms in a journal for 2 weeks. It helps to identify the foods causing allergy and also gives an idea of the nutritional adequacy of the diet.

Restricted or Elimination Diets: In this type of diagnosis, a restricted diet in which the various foods suspected to cause allergy to the patient are eliminated from the diet and this diet is fed for three weeks. The allergic food is included one by one at an interval of three days simultaneously, observing for symptoms.

But, the disadvantage is that an elimination diet cannot exactly differentiate between an actual allergy and food sensitivity. Also, if you’ve had a severe reaction to a food in the past, an elimination diet may not be safe.

Skin prick testing. In this test, a small amount of food is “pricked” into the skin using a tiny needle. The skin is then monitored for a reaction.

Oral food challenges. In this test, the problem food is fed in a controlled environment under medical supervision in gradually increasing amounts.

Blood tests: Sometimes, as part of the diagnosis, a blood test is prescribed to measure the level of IgE antibodies.

How to Manage Food Allergies in General?

When you have food allergies, you may feel challenged as you need to always be watchful of what you eat. As there is no cure, the best thing you can do is be vigilant about what you eat and avoid foods that trigger an allergic reaction. So, how can you manage food allergies? The following tips may be useful to you.

• Always read labels: Nowadays, labels on food items include important allergy information such as, “this was manufactured in a facility where nuts are processed”, “the product contains milk protein”, “contains gluten”, etc. Make sure to thoroughly read the labels for such information so that you can avoid buying the products containing the allergens specific to you.

• Buy products that are devoid of allergens: For example, if you have a milk allergy, purchase food products that mention “lactose-free”. Nowadays, a wide variety of lactose-free products or substitute products such as soy milk, almond milk, etc. are available, of course, you may have to pay a little extra. But, at least it will save you the cost of suffering and subsequent expenses if an allergic reaction is triggered.

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• Take extra care while cooking and serving: In a household, if a particular person is allergic to a specific ingredient, it is always a wise idea to cook a separate dish that is devoid of the allergen for that person. It is also advisable to use different serving vessels and spoons. For e.g., the same knife used for cutting peanut butter should not be used to apply butter on the toast for a person with a peanut allergy. Either a different knife should be used or it should be washed thoroughly with hot soapy water between uses.

• Be mindful while dining out: When dining out, inform the chef about your food allergy and the ingredients you are allergic to before ordering and insist that they do not add those ingredients to your dish. Most of the fine dining and medium-budget restaurants and coffee shops should oblige your request.

• Prepare an action plan: Make a list of steps that should be taken should you accidentally eat the food that you are allergic to and carry a printout of the plan with you.

• Always carry your medication when you leave home: If your doctor has prescribed emergency medication such as epinephrine for situations where you accidentally consume the allergen, please make sure to carry it with you when you are leaving home. This will give you relief from your allergic reaction. Also, carry antihistamines.

• Wear a medical alert bracelet or locket: This should contain information on the allergen.

• Patient education: Nutritional adequacy should be met for the allergic patient as avoidance of the trigger food may cause nutritional deficiencies. For example, if one is allergic to citrus fruits, other sources of ascorbic acid (vitamin C) such as guava, broccoli, green leafy vegetables, potato, etc., must be included in the diet generously. Also, nutritional supplements can be taken under the guidance of your health care provider.

How To Deal With the Two Most Common Food Allergies?

Wheat Allergy

Symptoms of Wheat Allergy

Hives, nausea, abdominal cramps, indigestion, vomiting or diarrhea. Sneezing, runny nose, headaches, asthma, and rarely anaphylaxis.

Managing wheat allergy means strictly avoiding wheat ingredients in both food and non-food products. Wheat, both in its original and processed forms, such as refined flour (all-purpose flour) is found in a wide variety of food products such as cereals, pasta, sooji, crackers and in a wide range of bakery products and even in hot dogs, sauces, etc. It is also found in cosmetic and bath products. 

• If a person is suffering from a wheat allergy, first and foremost, he/she should read the label or check the manufacturer’s website to find out if wheat or its allied products are part of the ingredients.

• It can be particularly challenging when it comes to baking as most of the baked products contain wheat and its associated products. Baked goods such as bread, muffins and cakes may be made using a combination of non-gluten flours such as those made from rice, soy, tapioca, sorghum, soy flour, or finger millet flour, although the end result and taste may not match wheat entirely.

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• Buy foods and flours made from other grains such as jowar, rice, sorghum, quinoa, amaranth, bajra (pearl millet), ragi (finger millet), etc. One can also go for gluten-free products.

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Shellfish Allergy

Shellfish allergy is different from an allergy to fish. In this type of allergy, the crustacean group (shrimp, lobsters and crabs) causes most of the allergic reactions. Shellfish allergies can appear at any age though they are not commonly seen until adulthood.

Diagnosis of shellfish allergies is often complicated as symptoms can vary from person to person and also the individual may not always experience the same symptoms during every reaction. Hence, it’s important to consult an allergy specialist.

Symptoms of Shellfish Allergy

 Vomiting, stomach cramps, indigestion, diarrhea, wheezing, shortness of breath, repetitive cough, hives, tightness in the throat, hoarse voice, swelling of lips and tongue, dizziness, confusion, etc.

Once shellfish allergy is identified, the best management is to avoid it.

• Read the labels carefully since manufacturers of packaged goods in several countries are mandated to declare the presence of crustacean shellfish in their products. Even in India, FSSAI has recently mandated the declaration of eight major ingredients that trigger allergy, crustacean shellfish being one among them.

• You must be extra careful when you eat out. Even vapors from shellfish preparations may carry small particles of shellfish protein. So, being close to where a shellfish dish is being prepared or even if shellfish containing food is served at the neighbouring tables can potentially cause a dangerous reaction in sensitive individuals.

FAQs

1. Can we outgrow allergies?

Allergies to peanuts, tree nuts, shellfish and fish are generally lifelong.

Children do outgrow egg, milk, soy and wheat allergies but recent research shows that 80% of the children are likely to outgrow milk allergies only by the age of 16 and 65% of the children outgrow a wheat allergy by the age of 12.

2. Are gluten intolerance and wheat allergy the same?

They are not the same. Wheat allergy is an allergic reaction caused due to eating foods containing wheat and also the byproducts of wheat. A person with a wheat allergy must avoid eating any form of wheat. The symptoms may vary from mild to life-threatening. A person with a wheat allergy need not necessarily be gluten intolerant. He may be able to tolerate gluten from non-wheat sources such as barley.

Gluten intolerance is not well defined and it is not an allergy as in the case of wheat allergy or an autoimmune response to gluten as in Celiac disease. It is the inability of the body to digest gluten, a protein present in wheat, barley, rye, etc. The symptoms may include bloating, abdominal pain, diarrhea or constipation, nausea and vomiting and there are no life-threatening symptoms.

Hope this post threw light on the important aspects of food allergies. Would love to receive your feedback/questions in the "Comments" section.

DISCLAIMER

No content on this post should ever be used as a substitute for direct medical advice from your doctor or a qualified clinician or dietitian. This post is only to create awareness about food allergies.