What is a food allergy?
Food allergy occurs when the body's IgE antibodies react to food proteins. The IgE antibody identifies this food protein as an invader and then causes mast cells (cells that are located throughout our body - skin, digestive system, esophagus, lungs, nose) to release histamines.
Histamines cause a range of symptoms like itching, hives, coughing, lips/throat/face swelling, sneezing, wheezing, diarrhea, and vomiting. This response and escalate to become anaphylaxis - a severe reaction that may cause airway constriction, extreme blood pressure drop and death.
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What is anaphylaxis?
Anaphylaxis is a severe allergic reaction that involves two of the body's systems. For example, airway constriction (tightness in the throat) and itching would be an example of anaphylaxis as both the respiratory system and the skin are involved.
Based on statistics from Singapore, US, UK and Australia, food allergy is the leading cause of anaphylaxis.
Anaphylaxis can cause death. When in doubt, give the Epipen and go immediately to the Emergency Room/Accident & Emergency.
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What are the most common food allergens?
Top food allergens based on US, UK and Australia research: milk, egg, wheat, soy, peanut, tree nuts, seafood, crustaceans, and sesame (with mustard and celery added on the UK list). According to research from those same countries, 6-8% of children under 3 years old have food allergies. Those with milk, soy and egg allergies will most likely outgrow their allergies by the time they are 10 years old. Those with peanut, tree nut, seafood and crustacean allergies may expect lifelong allergic reactions.
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What is the cure for food allergies?
There is no cure for food allergies at this time.
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What about celiac disease and lactose intolerance?
Lactose intolerance is NOT a food allergy. It is a condition caused by a deficient enzyme that breaks down lactose found in dairy products. Celiac disease is NOT a food allergy. It is a lifelong autoimmune reaction wherein the body attacks its own tissues in the digestive system. Wheat, barley, rye, and oats are all glutens that are to be avoided by celiac individuals.
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How are food allergies diagnosed?
At this time there are ONLY 2 tests that diagnose food allergies in individuals.
1) Skin prick test (SPT)
2) RAST (ImmunoCap Rast) - a blood test
Both of these tests are available in Singapore and should only be done by a GP or a certified allergist.
Results of either of these tests will not predict the severity of an allergic reaction. The results only predict if a reaction will occur. The best diagnostic tool for an allergist is the patient's history. When meeting with an allergist, bring along a food diary and the corresponding reactions if possible. An Epipen (R) is only available with a doctor's prescription.
The IGG test is NOT accepted for food allergy testing.
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What is the treatment for food allergies?
At this point in time, the only treatment for food allergies is to prevent any reaction by strict avoidance of food allergens. To treat a reaction that is severe, an injection of epinephrine using an auto-injector called an Epipen (R) may be required. The epinephrine can help prevent death by stopping the anaphylaxis and reducing the symptoms. However, once you have used an Epipen it is CRUCIAL that you immediately go to the Emergency Room (Accident & Emergency) of a hospital. The Epipen gives you time, it is not the final solution.
People with both food allergy and asthma have an increase in the severity of a food allergy reaction. Timely treatment is a reaction is crucial.
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What happens after diagnosis?
Once a child is diagnosed with a food allergy, the family will undergo major lifestyle changes. According to a study families with a food allergic child deal with more stress than those with epileptic or asthmatic children. However, a normal lifestyle can be achieved by following simple guides:
- AVOID food allergens: NO amount, not even a trace amount, is acceptable.
- READ labels: take time in the grocery to read the ingredient list. Learn the alternative names for the allergen. For example, peanut oil is also known as arachis oil and can be found in causes, salad dressings and even dog food. AVOID bakery items as cross-contamination is high. If in doubt, DON'T consume anything without reading the ingredient label. NEVER assume.
- RE-READ labels: Don't assume that the ingredients remain the same over time. Just because you bought something before, don't assume that the ingredients will not change. They often do.
- CREATE an emergency plan and PRACTICE it: with your allergist, create a plan to know when to administer antihistamine or an Epipen (R). Make sure all family members (including helpers) know what their role is during an emergency. Know which hospital is closest to home and to school. Update this information regularly.
- TEAMWORK: schools, teachers, nurses, caregivers and the child. Everyone has their own responsibility. Make sure a school policy is in place and the emergency plan can be followed at school. Empower your child with knowledge and make sure they understand the rules of not sharing food and not eating anything offered. Class or school training on food allergy awareness is essential. EVERYONE, all school staff, should know what to do in case of accidental ingestion or contact.
- JOIN our support group! Learn to cope, share and understand more about food allergies through other families' experiences dealing with the same everyday issues.
- Internet support groups, like www.kidswithfoodallergies.org, offer 24/7 access
- Schools in Singapore with food allergy support groups include: United World College of Southeast Asia, Australian International School, Singapore American School.
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What does the future hold for food allergies?
Currently major research is underway to find a cure. Perhaps as soon as two to five years from now, a cure will be available where anti-IgE therapy will be able to shut down the whole allergy system for food allergies. Until then, we need to keep on our toes!
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Resources:
Scott H. Sicherer, MD, Anne Muñoz-Furlong, BA*, Ramon Murphy, MD, Robert A. Wood, MD|| and Hugh A. Sampson, MD. Symposium: Pediatric Food Allergy. PEDIATRICS Vol. 111 No. 6 June 2003, pp. 1591-1594.
FAAN (2005) Public Comment on 2005 Food Safety Survey: Docket No. 2004N-0516 (2005 FSS). Fairfax, VA, USA: Food Allergy & Anaphylaxis Network
FAAN. Impact of Food Allergy on Quality of Life. Food Allergy News, Vol. 9, No. 4
Chiang WC, Kidon MI, Liew WK, Goh A, Tang JP, Chay OM. The changing face of food hypersensitivity in an Asian community. Clin Exp Allergy. 2007 Jul;37(7):1055-61.
Thong BY, Cheng YK, Leong KP, Tang CY, Chng HH. Anaphylaxis in adults referred to a clinical immunology/allergy centre in Singapore. Singapore Med J. 2005 Oct;46(10):529-34.
Khoo J, Shek L, Khor ES, Wang DY, Lee BW. Pattern of sensitization to common environmental allergens amongst atopic Singapore children in the first 3 years of life. Asian Pac J Allergy Immunol. 2001 Dec;19(4):225-9.
Shek LP, Lee BW. Food allergy in children-the Singapore story. Asian Pac J Allergy Immunol. 1999 Sep;17(3):203-6. Review.
Hadley, Caroline. 2006 Food allergies on the rise? EUROPEAN MOLECULAR BIOLOGY ORGANIZATION. VOL 7. NO 11. 1080–1083 (2006)
Raymond J Mullins. Paediatric food allergy trends in a community-based specialist allergy practice, 1995–2006. The Medical Journal of Australia . Volume 186 Number 12. 18 June 2007.
