Food Allergies, Intolerances and other Food-related Illnesses 

Are you one of the estimated 76 million people in the United States who get sick each year from food-borne illness? Or maybe you know one of the 30,000 people who suffer from a true food allergy. There are many reasons a person can get sick from the simple act of eating a meal. Here’s a little help in understanding why and what you can do about it. The most common food-related illnesses are: Food Allergies Food Intolerances Food Aversions Food-Borne Illnesses Food Poisoning

Stop food-related illnesses in your home Prevent food allergies in your children What to do when you experience a bad reaction Find out what’s causing the illness

Food Allergies
A true food allergy causes a reaction in a person’s immune system. During an allergic reaction, the immune system recognizes the food as a harmful substance and attacks it. This attack causes reactions in the skin, respiratory system, gastrointestinal tract, and even the cardiovascular system, depending on the severity of the immune response. These are also called anaphylactic reactions. Such symptoms as tingling sensations or swelling of the tongue in the mouth or throat, difficulty breathing, wheezing, hives, vomiting, abdominal cramping, diarrhea, a drop in blood pressure (causing pale skin color), a loss of consciousness (fainting), and sometimes, if the symptom is not treated immediately, even death, are all characteristic of a food allergy. There is no cure for a food allergy.

According to the Food Allergy and Anaphylaxis Network, only 2% of adults and 8% of children in the United States have real food allergies. Sometimes children outgrow their allergies, while adults with food allergies are likely to keep them for the rest of their lives.

The eight most common food allergies in the United States are to shellfish and fish, peanuts, tree nuts, eggs, milk, wheat, soy, and corn. According to the National Institute of Allergy and Infectious Diseases (NIAID), the foods that cause most food allergies in children are eggs, milk, peanuts, tree nuts, and sometimes soy; whereas adults suffer from more shellfish, peanut, tree nut, fish, and egg allergies.

There are also “cross-reactive” food allergies, as outlined by NIAID, that trigger foods similar to the food a person is allergic to and may cause a comparable, and possibly severe, allergic reaction. For example, a person who is allergic to crabmeat may also be sensitive to lobster, shrimp, or crayfish.

A person with a food allergy may not even have to consume the trigger food to have a reaction if he or she is highly sensitive to the allergen. For example, some people with peanut allergies may be so highly sensitive to the allergen that they may have a reaction when hugged or kissed by someone who recently consumed a product with peanuts in it or will be able to tell immediately if products containing peanuts are in a room because their skin or respiratory tract will react.

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Food Intolerances
While many people believe they have an allergy to a certain food, it may be that the person really has an intolerance to the food. Food intolerance is far more common than a true food allergy. It is understandable that people with a food intolerance will think that they have an allergy because some symptoms are similar. The difference is that food intolerances do not trigger an immune response or anaphylactic reaction. For example, lactose-intolerant people may experience diarrhea and abdominal cramping from consuming milk products. These people are not experiencing an allergic reaction. Their adverse reaction is caused by the lack of an enzyme, called lactase, required to digest the milk sugar lactose.

Some intolerances may be very similar to allergies and just as dangerous. For example, gluten intolerance (also known as Celiac Sprue syndrome) may seem the same as having a wheat allergy. Gluten-intolerant people suffer from an autoimmune disorder leading to damaged cilia on the intestinal walls from the gluten protein (which comes from wheat, rye, oats, and barley products). The disorder ultimately puts the person at risk for nutrient malabsorption, among other serious problems. There is a genetic link to this disease, and currently it is incurable. People who are gluten intolerant can eat wheat without an anaphylactic reaction, but they should not eat wheat because of the inflammation and damage that occurs to the intestinal walls and the long-term damage that can occur to the lower gastrointestinal tract. This may, in turn, lead to nutrient deficiencies or other more serious problems, like osteoporosis and cancer.

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Food Aversions
A person may also have a food aversion that has nothing to do with an actual food allergy, but psychologically the person is unable to consume the food without believing that something similar to an allergic reaction will happen afterward. A doctor can help identify whether this fear is, in fact, an allergy or an aversion.

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Food-Borne Illnesses
Food-borne illness can also cause severe gastrointestinal symptoms and discomfort, but it is different from an allergic reaction because the food itself is contaminated by mold, bacteria, viruses, or other agents from undercooking, cross-contamination, improper storage, or being outdated.

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Food Poisoning
Food poisoning is different from food-borne illness. Food poisoning is defined as an actual inedible particle found in a food that is not supposed to be there (for example, a piece of metal, cleaning solutions, chemicals, or other materials that would otherwise not be consumed or are not edible).

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Stop food-related illnesses in your home
Here are some tips for preventing food-related illnesses in your home:

• Know what foods you buy. Pay attention to news about food contamination and recalls
• Keep your kitchen clean. Use a hand sanitizer before, during and after handling foods. Use separate cutting boards for meats and vegetables.
• When hosting a party, ask your guests whether anyone has a sensitivity to any foods or whether special accommodations should be made because of a food allergy.
• Read labels for ingredients that may cause illness. If necessary, look at containers before buying foods, and write down the company’s phone number or website to check out the ingredients online. If you can’t confirm all the ingredients, it may be safer not to buy the food if you are highly sensitive to a particular ingredient.
• Avoid spreading allergens through such habits as dipping a knife in a jelly jar after it has touched peanut butter.
• Use a dishwasher to clean utensils and plates adequately.
• When eating out, ask the waiter whether a product contains a food that you are allergic to. If the waiter is unable to give you that information, ask to speak to the cook or chef or the manager. If you are still unsure about the food choices, or if the restaurant is incapable of telling you whether cross-contamination is prevented at the establishment, you might want to consider choosing another restaurant.
• Talk to your doctor about ways to prevent reactions to your specific condition.

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Prevent food allergies in your children
The American Academy of Allergy, Asthma, and Immunology (AAAA&I) recommends that parents do the following to try to prevent a child from getting food allergies:

• Wait until the child is at least 6 months old before introducing solid foods and at least 12 months old before introducing milk (other than breast milk) and other dairy items, like yogurt and cheese.
• Avoid eggs until the child is at least 24 months old, particularly egg whites.
• Fish, peanuts, and tree nuts should not be introduced until at least the age of three.

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What to do when you experience a bad reaction
If you are experiencing an emergency, don’t wait. Call 911 or go directly to your nearest emergency facility.

Make an appointment with your doctor to discuss — ahead of time — how to handle reactions. Your doctor can outline a strategy just in case you do consume something that causes an adverse reaction.

When you anticipate traveling or are planning a trip that you know will have foods that you are not accustomed to, talk with your doctor before your visit to make sure that you are well prepared as to what to eat and how to eat. Also, be sure that your medications are up to date and readily available.

If you suffer from food allergies, your doctor may prescribe an epinephrine pen that you can inject directly when you feel a reaction coming on in order to give yourself some time to get to a hospital. Remember that even when you have given yourself epinephrine, you need to see a doctor to make sure that you are fine. Also, remember to get a medical alert bracelet or necklace to help alert others if you are having a reaction and are unable to communicate.

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Find out what’s causing the illness
If you think you have a food allergy or intolerance, keep a food diary for one or two weeks, or as long as specified by your doctor. By documenting what foods you are consuming and by identifying any adverse reactions afterward, you will be better able to pinpoint the cause of the problem. Your doctor may ask you a series of questions regarding the preparation of the food, the length of time after eating that you noticed a reaction, the type of reaction you had, how much of the food you ate, whether anyone else around you got sick, whether you took any allergy medications and whether they helped relieve some of your symptoms, whether you ate other foods along with the suspected allergy-trigger food, and whether you have a history of reactions to the same, or a similar, food.

Remember that you know yourself better than anyone, so you need to be aware of the specifics regarding your intake of a food that is suspected of causing a reaction. Your doctor may also recommend a trial elimination diet to see whether any other foods, outside the suspected allergen, cause the same or a similar reaction. Your doctor may also complete a RAST test (radioallergosorbent test), which is a blood test that is used to confirm the presence of an allergen. A skin-prick test may also be used to test whether you are truly allergic to a food.

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Sources:

1. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Food Safety Office, 2007. www.cdc.gov/foodsafety/.
2. The Food Allergy and Anaphylaxis Network. Fairfax, VA, 2005. www.foodallergy.org.
3. The American Academy of Allergy, Asthma, and Immunology. “Food Allergies and Reactions.” Milwaukee, WI, 2003.  http://www.aaaai.org/patients/advocate/2003/fall/reactions.stm.
4. The National Institute of Allergy and Infectious Diseases. U.S. Department of Health and Human Services: National Institutes of Health. “Food Allergy: An Overview.” Bethesda, MD, July 2007. http://www3.niaid.nih.gov/topics/foodAllergy/PDF/foodallergy.pdf.
5. Healthwise Knowledgebase. Healthwise, Incorporated. Boise, ID, 2008. www.healthwise.org.
6. American Dietetic Association, “Food Safety.” In The Nutrition Care Manual, 2008.
7. Medline Plus. National Library of Medicine. Bethesda, MD, 2008. www.medlineplus.gov.
8. National Restaurant Association. ServSafe Coursebook, 3rd edition. Chicago, IL, 2004, pp. 2-1 to 4-14.
9. Celiac Sprue Association. “Celiac Disease Defined.” Omaha, NE, 2008.  http://www.csaceliacs.org/celiac_defined.php.