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If you do a search online for “food allergies” you can find yourself going down the rabbit hole in a hurry. There are all kinds of things you can find and it can be difficult knowing what is truth versus fiction.
The American College of Allergy, Asthma and Immunology states that about 6% of children and 4% of adults have food allergies. That means most of us, 95% of us do not have to worry about food allergies. But I still see lots of patients coming in worried that they may have a food allergy.
It seems though that food allergies are being blamed for all kinds of health related problems these days. But there are food sensitivities, which is different than a food allergy.
A food allergy occurs when your immune system treats a type of food almost like a bacterial or viral infection and attacks it. Our immune system is supercharged against the food and sends antibodies to fight it. With food sensitivities, our immune system isn’t involved. Instead the problem lies with our gut and an inability or reduced ability to digest the food. An example of food sensitivity is lactose intolerance. People with lactose intolerance experience abdominal cramping, bloating and gas when they ingest dairy because they lack the necessary enzyme to digest the lactose. There is nothing life threatening about food sensitivities. Food allergies can be life threatening.
What are the most common food allergies? Overall 90% of food allergies are caused by these seven groups: nuts (peanuts, tree nuts, walnuts, cashews, almonds, pecans), milk, eggs, fish, shellfish, wheat and soy. The other 10% on the list encompasses over 100 different foods.
The symptoms can range from mildly annoying to life threatening. Most people will experience a skin rash called hives, as well as some tingling in the throat or throat tightness, shortness of breath, coughing and abdominal cramps. These symptoms can become so severe that the throat feels like it is closing up making breathing difficult. Blood pressure can drop if the vascular system gets involved which can then cause a fast, weak pulse, dizziness and feeling faint. Next comes anaphylactic shock where you have collapse of your entire body. Shock means your body can’t maintain basic bodily functions so your airway closes, your lungs aren’t working, your brain begins to shut down from lack of blood and oxygen, your heart tries to keep up but it can’t and so your blood pressure bottoms out and without immediate care you can die.
People with life threatening allergies should always carry an epinephrine injector with them at all times. A quick injection of this into your thigh or butt will save your life while you get to a doctor. The medicine, epinephrine (also called adrenaline) will boost your vascular system back so your blood pressure comes back up and you start perfusing your vital organs again like your brain and lungs. This, however, does not treat the over reaction by your immune system. For that we usually use a combination of steroids, Benadryl and Pepcid. This combination blocks the histamine receptors from being activated as well as other effects to shut down the immune system response to the food you just ate. The effects are usually felt within minutes and within a day all the symptoms are usually gone.
A quick note about epinephrine injectors. You may recall a little controversy back in 2016 when the makers of the Epipen, Mylan, jacked the price up from $100 to over $600. The price for a bottle of epinephrine is about $2.50 just to give you a reference. People suffered greatly from this savage price hike. At the time Epipen had 90% of the market. About two years after this, Mylan had to pay a $465 million dollar settlement for price gouging the government. There are now generic options available to you for around $100 again.
What is the main treatment for food allergies? Stay away from that food. This sounds simple but it can be difficult. The government now requires food labeling so we know what products are safe to shop for but it doesn’t cover all products. The law does not require meat or poultry or alcohol products to be labeled. It also does not include cosmetics, shampoo and other beauty aids to be labeled. Most restaurants now try to be respectful of people’s food allergies so be sure to alert your server if you have an allergy.
Besides having an allergic reaction how do we diagnose food allergies? Allergists, doctors specializing in allergies, can test you in their office with several different tests. There is a blood test that looks for IgE antibodies but it is not as sensitive as the skin test. The skin test involves pricking your arm or back with different food allergens and then looking for a reaction. If the area tested becomes red and itchy then you have a positive test indicating an allergy to that food. The best test is an oral food challenge. Patients are fed tiny amounts of the suspected food and are watched for a couple of hours for a reaction. These tests must be performed in a doctor’s office in case the patient has a severe reaction requiring medical intervention.
You may be wondering why no discussion of gluten sensitivity or celiac sprue was included. Gluten sensitivity seems to be “in style” these days. It is different than having a true wheat allergy, though. It is also different than having Celiac sprue. A gluten sensitivity is not an allergy but rather a problem with digesting it. Celiac sprue is also not an allergy but rather a condition that actually causes damage to the gut when exposed to gluten. If you suspect you have a gluten problem try removing it from your diet. If your symptoms improve then you fixed it.
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Dr. John Turner is a family medicine and emergency medicine doctor with 25 years of experience. He is also the owner of My Primary Care Clinic and My Emergency Room 24/7 here in Hays County. Dr. Turner may be reached at 512-667-6087.
