• Section 6. Managing Food Allergies

    Section Summary

    The following topics are included in this section:

    • Managing food allergies
    • Treating Anaphylaxis
    • Pregnancy guidelines
    • Outgrowing food allergies

      

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    Managing Food Allergies

    There is currently no cure for food allergy, but there are many promising treatments under investigation. Avoidance, education and preparedness are the keys to managing food allergy.

    While exposure to airborne food allergens (e.g., from cooking vapors) usually does not result in anaphylaxis, it can cause a runny nose and itchy eyes similar to a reaction from coming in contact with pollen. However, eating even a small amount of the food, such as that left on cooking utensils or from a food processing facility, can cause a life-threatening reaction. This is why reading the ingredients on food labels and asking questions about prepared foods are an essential part of avoidance plans.

    The American Academy of Allergy, Asthma & Immunology recommends that people with food allergy should always carry auto-injectable epinephrine to be used in the event of an anaphylactic reaction. Symptoms of anaphylaxis may include difficulty breathing, dizziness or loss of consciousness. If any of these symptoms are present in the context of eating, use the epinephrine auto-injector and immediately call 911. Don’t wait to see if the symptoms go away or get better on their own.23

    Healthy tips include:

    • Always ask about ingredients when eating at restaurants or when eating foods prepared by family or friends.

    • Carefully read food labels. The United States and many other countries require that major food allergens are to be listed in common language (milk, egg, fish, shellfish, tree nuts, wheat, peanuts and soybeans).

    • Carry and know how to use auto-injectable epinephrine and antihistamines to treat emergency reactions. Teach family members and other people close how to use epinephrine and consider wearing an ID bracelet that describes the allergy. If a reaction occurs, have someone take the person to the emergency room, even if symptoms subside. Afterwards, get follow-up care from an allergist.

    Treating Anaphylaxis

    The symptoms of anaphylaxis vary and can be difficult to recognize.

    Anaphylaxis

    If a person is experiencing any one of the following three conditions, they may be experiencing an anaphylactic episode:

    • Symptoms appear within minutes to several hours and involve skin, mucosal tissue (moist lining of the body cavities, such as the nose, mouth, and GI tract), or both. Experience trouble breathing or a drop in blood pressure (pale, weak pulse, confusion, loss of consciousness).

    • Two or more of the following symptoms that occur within minutes to several hours after exposure to a suspected allergenic food: Hives, itchiness, or redness all over the body and swelling of the lips, tongue, or the back of the throat.

    • Trouble breathing

    • Drop in blood pressure.

    • GI symptoms such as abdominal cramps or vomiting.

    An anaphylactic reaction can occur as a:

    • Single reaction that occurs immediately after exposure to the allergenic food and gets better with or without treatment within the first minutes to hours. Symptoms do not recur later in relation to that episode.

    • Two reactions. The first reaction includes an initial set of symptoms that seem to improve and go away but then reappear. The second reaction can occur between 8 and 72 hours after the first reaction as a single long-lasting reaction that continues for hours or days following the initial reaction.

    Diseases such as asthma, chronic lung disease, and cardiovascular disease may increase the risk of death from anaphylaxis. Medications such as those that treat high blood pressure also may affect symptom severity and response to treatment.

    The National Institute of Allergy and Infectious Diseases, recommends treating anaphylaxis immediately after symptoms begin with an intramuscular (IM) injection of Epinephrine. After epinephrine has been given, the patient may be placed in a reclining position to help restore normal blood low.

    Epinephrine should be given immediately to treat anaphylaxis. Delays in giving epinephrine to patients can result in rapid decline and death within 30 to 60 minutes. Epinephrine acts immediately, but it may be necessary to give repeat doses.

    The Guidelines set by the National Institute of Allergy and Infectious Diseases (NIAID) recommends that a healthcare professional diagnosing a patient with anaphylaxis should understand the following:24

    1. Signs and symptoms of anaphylaxis
    2. Timing of symptoms in relation to exposure to the allergenic food
    3. Conditions such as asthma that may be associated with food allergy and how these conditions may affect treatment
    4. The limited value of laboratory tests during an anaphylactic episode

    Pregnancy Guidelines

    Breastfeeding

    The National Institute of Allergy and Infectious Diseases recommends that a mother not restrict her diet during pregnancy or when breastfeeding as a way to prevent food allergy from developing in her child. There is no evidence to suggest that restricting a mother’s diet while she is pregnant or breastfeeding prevents the development of food allergy in her child.25

    Additional recommendations during pregnancy are as follows:

    • A mother should exclusively breastfeed her infant until age 4 to 6 months, unless breastfeeding is not advised for medical reasons. There is no strong evidence that breastfeeding increases the likelihood that an infant will develop food allergy.

    • They do not recommend giving an infant at risk for food allergy soy milk formula instead of cow’s milk formula to prevent food allergy from developing. There is neither long-term harm nor significant benefit in giving an infant soy milk formula.

    •  Do not delay introducing solid foods, including potentially allergenic foods, to an infant beyond 4 to 6 months of age. There is no evidence that supports delaying the introduction of solid foods to an infant beyond 4 to 6 months of age to prevent allergic diseases from developing. This includes giving an infant a food containing milk, eggs, peanut, tree nuts, soy, or wheat.

    Outgrowing Food Allergies

    Most children eventually outgrow milk, egg, soy, and wheat allergy. Fewer children outgrow peanut and tree nuts allergy. Outgrowing a childhood allergy may occur as late as the teenage years.

    For many children, sIgE antibodies can be detected within the first 2 years of life. A child with a high initial level of sIgE, along with clinical symptoms of food allergy, is less likely to outgrow the allergy. A decrease in sIgE antibodies is often associated with outgrowing the allergy.

    Food allergy also can begin in adulthood. Late-developing food allergy tends to persist.

     
    Section 5. Common Food AllergiesSection 7. Case Studies