CHAPTER
17

Food Allergies

In This Chapter

  • The difference between food allergies, intolerances, and sensitivities
  • The eight top allergens that plague American children and adults
  • Live-threatening food allergies
  • How you can learn to eat out and enjoy life with food afflictions

A true food allergy can be seriously life threatening, which can make eating a little scary sometimes, especially when it involves children. Many people believe they’re allergic to a certain food when in reality they merely have an intolerance or sensitivity to that specific food. The difference is that a food sensitivity or intolerance won’t produce a reaction that could be deadly.

In this chapter, we’ll take a look at the real differences between a true food allergy and a food intolerance or sensitivity. We’ll discuss what it means to live with such issues, and how you can still eat healthy and enjoy food outings with family and friends.

What Is a Food Allergy?

A true food allergy is when the body mistakes certain food proteins as harmful invaders and mounts an immunologic attack by producing antibodies, histamines, and other defensive mechanisms. The immune system attacks the proteins or other molecules in food after that food is digested and absorbed into the bloodstream.

Food allergies will always involve antibodies, but they may not always produce symptoms. When they do, it's called an asymptomatic allergy. When a person produces antibodies and has symptoms, it’s known as a symptomatic allergy. In either case, food allergies can only be determined by testing for antibodies. A specific food allergy can be determined by eating, touching, or inhaling that particular food, which will cause your immune system to overreact. For example, if you have a peanut allergy, your body’s immune system will recognize peanuts as intruders and will overcompensate by generating antibodies known as Immunoglobulin E (IgE). These IgE antibodies are directed to initiate a chemical release within certain cells, which then produces an allergic reaction.

Allergic reactions can be mild, such as sneezing or hives, or they can pose a greater risk by causing anaphylaxis, which requires immediate medical action. Most individuals with severe food allergies must carry a device called an EpiPen, which contains epinephrine, to counteract anaphylaxis. In an emergency, the epinephrine is injected into the thigh of the individual going into anaphylactic shock. Without the epinephrine, their throat may swell up and actually cut off air passageways, leading to death. Other less serious symptoms that may result from an allergic reaction include itchy eyes, throat, or nose; wheezing; congestion; skin rash; abdominal pain; vomiting; and diarrhea.

DEFINITION

Anaphylaxis is a severe and life-threatening reaction that affects the whole body. The onset of anaphylaxis can happen within minutes or even seconds after exposure to an allergen. The chemicals released in response to the allergen can cause a person to go into shock. Blood pressure will drop suddenly and airways can narrow, making it difficult to breathe.

When a food protein is seen as a threat by the immune system, the body takes action but symptoms may not always occur instantly. Symptoms may be immediate or occur up to 24 hours after the food's consumption. If a reaction occurs immediately, it’s easier to recognize which food caused the reaction. However, if that food caused a delayed reaction and symptoms don’t appear until a day later, it can be challenging to identify because other foods have been consumed during that timeframe.

How do you determine which allergen caused a reaction? Determining a food allergy requires a physical examination, a complete health history, and diagnostic allergy testing. One of the most common tests for food allergies is the IgE skin-prick test, which uses food extracts to determine an allergic reaction. Usually a minimal amount of the specific allergen is injected into the skin with a small needle prick. If the area that was pricked becomes swollen or resembles a mosquito bite, it’s recorded as a positive result for that specific allergen. This test is safe and effective and is usually done by an allergist, a physician who specializes in allergies and immunology. When a skin test isn’t possible, an IgE blood test can also be performed to check the blood for certain antibodies to determine if there’s a food allergy.

NOTABLE INSIGHT

True food allergies are not all that common. A majority of people who classify themselves as having a food allergy are really experiencing a food intolerance or sensitivity. The percentage of people in the United States who believe they have a food allergy is about 15 percent. However, the actual number of people who do have food allergies is about 3 to 4 percent. If you feel you have issues with a specific food(s), it’s important to see your doctor to determine the real cause so it can be treated properly.

What Is a Food Intolerance?

A food intolerance occurs when there’s a reaction to a food, but it doesn’t involve an immune system response as with a true food allergy. It’s often referred to as a non-IgE allergy. Instead, a digestive system response occurs when the person consumes a food that the gastrointestinal tract (GI) is unable to properly digest or break down. Reactions normally occur soon after ingestion, and can include gastrointestinal symptoms such as gas, cramps, bloating, nausea, stomach pain, vomiting, diarrhea, and heartburn. Other non-GI symptoms can also occur, such as headaches.

Many factors can contribute to a specific food intolerance. They can be caused by the lack of a specific enzyme such as lactase in lactose intolerance; or the culprit can be an intolerance to a certain chemical ingredient in foods such as added food coloring or sulfites. People with lactose intolerance can’t tolerate any type of milk-related foods or beverages because they lack enough of the enzyme lactase, which is responsible for helping break down the milk sugar lactose. When lactose is not broken down properly, the result is usually GI upset. Keep in mind that this is not a milk allergy but an intolerance, which is very different. Examples of other less common intolerances include fructose and gluten intolerances.

Food intolerances can sometimes be difficult to diagnose. However, they usually can be discovered through trial and error to pinpoint which food is causing the symptoms. An elimination diet is helpful in uncovering the culprit, as well as a blood test and/or skin prick test to rule out a food allergy.

NOTABLE INSIGHT

Some people can experience an oral allergy syndrome, which is an allergic reaction to fruits and vegetables. People who have hay fever or are allergic to ragweed are more susceptible to this syndrome. Certain fruits and vegetables can cause tingling, itching, or swelling of the lips, tongue, and throat as well as itchy eyes, runny nose, and sneezing. If you find you suffer from this, pinpoint the foods that cause the reaction and avoid them. It definitely doesn’t mean all fruits and vegetables will cause a reaction, so avoid those that do and continue to include other fruits and vegetables in your daily diet.

What Is a Food Sensitivity?

How do food allergies and food intolerances differ from food sensitivities? A food sensitivity is a non-IgE allergic response like a food intolerance. The difference is that food sensitivities do have an immune response. Unlike food intolerances, sensitivities can affect more than just the GI tract. Symptoms can include acid reflux, nausea, abdominal cramps, diarrhea, headaches, joint pain, fatigue, and a whole host of other issues.

Unlike allergies and intolerances, food sensitivities are often difficult to identify without testing because reactions can be delayed up to several days and can be dose-dependent, meaning an individual can sometimes tolerate a certain amount of the food causing the sensitivity. With food sensitivities, someone may consume a food with no apparent symptoms and then sporadically show signs of acid reflux, headaches, nausea, abdominal cramps, and other issues without being able to figure out why. This makes diagnosing specific food sensitivities pretty difficult. Tools such as an oral food challenge or trial elimination diet are often used to diagnose this issue.

A well-known food sensitivity that most of us have heard about is gluten sensitivity, which includes celiac disease and non-celiac gluten sensitivity (NCGS). This is not a gluten intolerance but a gluten sensitivity. Many Americans experience food sensitivities, and many of these sensitivities can be the result of another disorder, such as irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), celiac disease, acid reflux, obesity, migraines, and many other conditions related to the foods we eat.

Lifestyle Eating and Performance

One definitive way to find out whether you’re suffering with food sensitivities that may be causing chronic health problems is called a Mediator Release Test (MRT). An MRT is a simple blood test that measures your immune reaction or sensitivity to a whole host of foods, food additives, and chemicals. The MRT eliminates the guesswork by measuring delayed hypersensitivity responses to 150 different foods and chemicals.

This type of testing can often help identify culprits that a person cannot figure out any other way. The “hub” of the immune system is the gut. When people consume a food that are sensitivity to, the immune system sends out chemical mediators, such as histamine, cytokines, and prostaglandins, which can produce damaging effects to body tissues and cause the development of a wide array of symptoms and other major health issues. The MRT can help identify the possible foods that are triggering IBS, migraines, fibromyalgia, and other chronic health conditions. Depending on the types of mediators released, different areas of the body are affected. For example, for some people consuming a particular food will cause migraines, yet for others it may cause arthritis or acid reflux.

Identifying the harmful substance(s) is only the first step toward improving symptoms and issues. Once foods and/or substances are identified, the next step involves following an individualized Lifestyle Eating and Performance (LEAP) eating plan. To do this, you must work closely with your health-care practitioner and a registered dietitian nutritionist (RDN) who is LEAP certified. It’s an effective protocol that combines the patented MRT with the skills of a certified LEAP therapist to produce a patient-specific diet. This specific diet plan identifies a list of safe foods to eat so that symptom improvement can begin immediately. Most individuals quickly overcome symptoms once the sensitivity is identified and the cause is eliminated. Many patients have been able to successfully eliminate chronic health problems within two to four weeks.

NOTABLE INSIGHT

You can speak with your doctor concerning LEAP therapy and MRT testing or visit nowleap.com. Many therapists will counsel via phone, so you don’t need to even reside in the same area.

The Top Eight Food Allergies

Known as the Big 8 or the top eight food allergens, the allergies associated with these allergens account for 90 percent of all food-related allergic reactions, and include wheat, eggs, fish, shellfish, dairy, peanuts, tree nuts, and soy.

To help Americans who suffer from food allergies, the FDA passed the Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA), which applies to all foods regulated by the FDA. This law requires food manufacturers to clearly label and identify in simple terms all eight major food allergens, or any protein derived from these foods, including any common names and their food sources. For example, if a label lists “starch,” it must also specify whether or not the starch was made from or contains any wheat. As a result, food labels can now help consumers with allergies identify offending foods more easily so they can avoid them.

WAKE-UP CALL

The FDA estimates that anaphylaxis from food results in 30,000 emergency room visits, 2,000 hospitalizations, and 150 deaths annually.

Wheat

A wheat allergy is not the same thing as gluten intolerance or celiac disease. With celiac disease, the lining of the small intestine is damaged when any food with gluten (including wheat) is consumed, causing a host of symptoms and serious medical issues. With a wheat allergy, antibodies are produced in response to the consumption of wheat-containing foods. The protein found in wheat causes the immune system to overact and triggers an allergic response. Wheat allergies are most common in children and many outgrow it by age 3, according to the Food Allergy Research and Education organization.

A wheat allergy can be challenging as there are so many food products and beverages that contain hidden sources of wheat, such as beer, ketchup, and soy sauce, just to name a few. A wheat-free diet can include other whole grains that don’t contain wheat, such as corn, oats, quinoa, rice, barley, and amaranth. If you’re allergic to wheat, you’re not necessarily allergic to all grains, only to the ones that contain wheat and wheat products. Just because a grain isn’t labeled as wheat doesn’t mean it doesn’t contain wheat, so check all food labels and do your research.

Grains that contain wheat include:

Bulgur

Couscous

Durum

Einkorn

Farina

Kamut

Seitan

Semolina

Spelt

Triticale

Wheat berries

Wheat grass

Dairy

A dairy allergy is most commonly found in infants and children. According to Food Allergy Research and Education, it’s estimated that about 2.5 percent of children younger than 3 years of age are allergic to milk. Reactions to a dairy allergy can include hives, wheezing, vomiting, diarrhea, abdominal pain, watery eyes, or a skin rash around the mouth. People who have an allergy to cow’s milk may also react to milk from other animals like goats, as the protein in their milk is similar to that found in cow’s milk. However, allergy testing is the best way to determine what can or cannot be tolerated.

Note that an allergy to milk is not the same as lactose intolerance. When a food allergy to milk occurs, the immune system reacts to the milk’s protein by producing an allergic response. People who have lactose intolerance are simply missing a key enzyme that breaks down lactose. There’s no immunologic response in people who are lactose intolerant; they just are unable to digest the milk protein, which normally causes GI symptoms. While these symptoms are uncomfortable, lactose intolerance is not life-threatening nor an allergy.

WAKE-UP CALL

If you have food allergies, it’s vital to avoid cross-contamination. Anything you use, such as a toaster, cutting board, mixing spoon, etc., that may come in contact with an allergen should be thoroughly cleaned before being used for a nonallergen food. Avoiding cross-contamination can save you from having an allergic reaction.

Sources of milk can include:

Casein

Diacetyl

Ghee

Half-and-half

Lactalbumin

Lactoferrin

Lactose

Lactulose

Rennet casein

Sour milk solids

Whey

Fish

About 40 percent of people with a fish allergy experience the onset as an adult and usually have the allergy for life. Finned fish, including tuna, salmon, and halibut, are the most common fish allergens.

Most people who have a fish allergy are also allergic to more than one type of finned fish, so many physicians recommend avoiding all finned fish varieties. If you have a fish allergy, you need to always check food labels and ingredients lists for fish ingredients.

When a finned fish is cooked, its proteins are released in steam and become airborne. If you have an allergy to finned fish, it’s advised to stay away from an area where fish is being cooked. Be extra careful if you do choose to visit a seafood restaurant. Even though you’re not having fish, your nonfish meal could food be easily cross-contaminated by fish products. Symptoms include sneezing, hives, skin rash, headaches, or even anaphylaxis.

Unexpected sources of fish ingredients can include:

BBQ sauce

Bouillabaisse

Caesar and other salad dressings

Imitation fish or shellfish

Worcestershire sauce

Shellfish

Most shellfish allergies are lifelong with the onset occurring in adulthood. It’s estimated that approximately 7 million people are allergic to shellfish. Shellfish are categorized as either crustaceans or mollusks. Crustaceans include shrimp, prawn, crayfish, crab, and lobster. Mollusks include clams, mussels, oysters, squid (calamari), cuttlefish, abalone, octopus, snails, sea urchin, and scallops.

In most cases, people are only allergic to one type of shellfish. For example, you might not be able to eat shrimp, yet you can eat octopus. However, for people with an allergy to any shellfish, it’s recommended to avoid the entire category. It’s important to work with your allergist to determine what’s safe for you.

Fish with fins don’t come from the same family as shellfish, so a person with a shellfish allergy isn’t necessarily allergic to finned fish as well. Depending on the severity of your allergy, even touching shellfish or being near shellfish when it’s cooked can cause a severe reactions like stomach cramping, vomiting, trouble breathing, hives, dizziness, confusion, or anaphylaxis.

Tree Nuts

Tree nuts include walnuts, almonds, cashews, pistachios, hazelnuts, macadamia, pine nuts, and Brazil nuts. Tree nuts differ from peanuts in that they grow on trees and not in the soil. Having an allergy to a specific tree nut increases your chances of being allergic to other types. It’s recommended to avoid all nuts if you have a tree nut allergy, including peanuts, as there’s a high chance of cross-contamination when these nuts are processed and manufactured. Nuts can be added to many different foods, so it’s essential to read food labels carefully.

Allergic reactions can include abdominal pain, nausea, difficulty swallowing, itching of mouth, throat, eyes, or skin, as well as difficulty breathing. It can also lead to anaphylaxis.

FOODIE FACTOID

The FDA deemed the coconut should be labeled as a tree nut in 2006. Botanically a coconut is a “drupe,” which is a fruit with a hard covering enclosing the seed. It’s not botanically a nut, but is related to palm trees. There’s disagreement between botanists and scientists as to the correct classification. However, some research suggests most people who are allergic to tree nuts can eat coconut. As with any food, be sure to check with your allergist or physician before adding coconuts into your diet.

Peanuts

One of the most common food allergies is to peanuts. This type of allergy is increasing in young children—between 1997 and 2008, peanut allergies in children more than tripled. The reaction to peanuts can be very severe and potentially fatal. Even the smallest amount of peanuts can cause a reaction. Contact with peanuts, such as touching a nut, is less likely to cause an extreme reaction. However, if the peanut residue comes in contact with the nose, mouth, or eyes, it’s more of a concern and can possibly produce a more severe reaction.

Many people with peanut allergies carry EpiPens with them at all times and are required to strictly avoid all products containing peanuts. With any allergy, it’s always important to read the ingredient list on food labels to ensure a product doesn’t contain that specific ingredient. Peanut allergies generally have shown to be lifelong allergies. However, 20 percent of children with a peanut allergy have outgrown it.

Peanuts should not be confused with tree nuts. Peanuts grow underground and belong to the legume family, which includes peas, lentils, soybeans, and beans. Studies show that if you have a peanut allergy, you’re more likely to also be allergic to tree nuts. However, if you have a peanut allergy, it doesn’t necessarily mean you’re allergic to other legumes such as beans and soy. The main reason some people with peanut allergies are also allergic to tree nuts is mostly due to cross-contamination during processing.

Because of the FDA’s FALCPA law mentioned earlier, manufacturers must list if a food contains peanuts. However, anyone with allergies should continue to read all labels on all packages carefully. When in doubt, don’t eat it. Symptoms can include a tingling sensation in the mouth or throat, nausea, congestion, rash, hives, or even anaphylaxis.

Eggs

Egg allergies are the second most common allergy seen in children. The American College of Allergy, Asthma, and Immunology estimates that 2 percent of children are allergic to eggs but many will outgrow it by age 16. It’s actually the white of the egg that contains the proteins to which the body is reactive, but it’s recommended to avoid eggs entirely if you have this allergy.

People with egg allergies should avoid eggs from ducks, geese, quails, and turkeys, in addition to chicken eggs. Reactions from an egg allergy occur after eating eggs or foods that contain eggs, and they occur within a few minutes to a few hours. Symptoms can include hives, nasal congestion, skin rashes, vomiting, digestive issues, and in very rare cases, anaphylactic shock.

Food products that can contain eggs:

Albumin

Baked goods

Dried or powdered eggs

Eggnog

Fresh pasta

Lecithin

Marshmallows

Mayonnaise

Meringue or meringue powder

Soy

Soybeans belong to the legume family and include plants that have seeds or pods. A soybean allergy is considered one of the more common food allergies, and is seen in greater amounts in infants and children. Food Allergy Research and Education suggests that approximately 0.4 percent of children are allergic to soy, with most outgrowing it by the age of 10.

If you have a soy allergy, you’re not necessarily allergic to other legumes. However, soybeans are used in a variety of processed food products, so it’s important to thoroughly read food labels. Symptoms of an allergic reaction to soy can include tingling of the mouth, hives, itchy skin rash, wheezing, difficulty breathing, diarrhea, vomiting, nausea, abdominal pain, and/or swelling in the lips, mouth, or throat.

Foods that may contain soy include:

Baby formula

Baked goods

Edamame

Miso

Natto

Nutritional supplements

Salad dressings

Soy milk

Soy sauce

Tamari

Tempeh

Textured vegetable protein

Tofu

The list of hidden soy can be very long, so checking an item's ingredients is essential.

Fortifying Your Diet

When you suffer from any type of food allergy, intolerance, or sensitivity and must leave out certain foods or food groups from your daily diet, it’s important to fortify your diet with the nutrients you’re missing from those foods. This is why working with a dietitian is essential when you have these issues. Not only can a dietitian help you avoid the foods you need to avoid, but he or she can help you replace them with foods that will continue to keep your diet healthy and well balanced.

Dairy Alternatives

Replacing dairy products is fairly easy due to the huge variety of dairy-free alternatives available in the marketplace. When selecting a product, one of the most important factors besides taste is fortification. Remember the dairy group contains vital nutrients like calcium and vitamin D. If you’re unable to consume milk-based products, you need to get those nutrients elsewhere. Ensure the products you choose contain and/or are fortified with calcium and vitamin D.

Dairy-free alternatives can include:

Almond cheese

Almond milk

Coconut milk

Coconut oil

Grain-based milk

Honey butter

Nondairy, trans fat-free margarines

Rice milk

Soy milk

Vegan cheese

Egg Substitutes

Omitting eggs from your diet may seem pretty easy, especially if you think of eggs as a breakfast food. However, eggs are a common leavening agent, binder, and emulsifier, and are used in a staggering amount of recipes and food products available. Americans typically don’t need to replace protein from eggs, as we tend to get sufficient protein from other sources as well as vitamin B12 and magnesium.

Egg binder replacement alternatives in baked goods include:

Agar

Arrowroot

Baking soda

Buttermilk

Commercial egg replacement powder

Ground flaxseeds

Mixtures of flour and oatmeal

Puréed fruits, such as bananas or applesauce

Soy lecithin

Tofu

Yogurt

Gluten-Free Foods

There are so many gluten-free products available on the market now, in addition to foods that are naturally gluten-free. Products such as breads, pastas, and baked goods can be close in texture and taste to their wheat-containing counterpart. Going gluten-free no longer has to be a food death sentence! But if you have celiac disease or a gluten intolerance, it’s essential that you learn to read food labels and ingredient lists because there are thousands of gluten-containing ingredients, even if they’re not labeled as gluten.

Gluten-free foods and ingredients include:

Amaranth

Arrowroot

Brown or white rice

Buckwheat flour

Chia flour

Chickpea flour

Coconut flour

Corn flour

Cornmeal

Hemp flour

Lupin flour

Maize flour

Millet flour

Oat flour—certified GF

Potato flour

Potato starch flour

Quinoa flour

Sorghum flour

Soya flour

Tapioca flour

Teff

FOODIE FACTOID

In 2013, the FDA issued a regulation that now defines the term “gluten-free” for food labeling, making gluten-free claims consistent and reliable across the food industry. Whether a food is manufactured to be gluten-free or it’s naturally gluten-free, it can use the gluten-free labeling claim as long as it meets all FDA requirements resulting in less than 20 parts per million of gluten per serving for a gluten-free food.

Dining Out with a Food Allergy

Dining out should be an enjoyable experience. However, when a family member or friend has a serious food allergy, dining out has the potential to become a very dangerous experience. Today’s restaurant guest with food allergies has more options for dining out. Most large chain restaurants provide allergen training for their staff, which makes them better able to accommodate patrons with food allergies. This training can include staff at the corporate office, as well as those who have determined what allergens are present in all of the supplier ingredients and have worked with the chefs to know if recipes and procedures need to be changed.

Smaller facilities may not have as strong training protocols in place and there may be much variability. Many restaurants post their menus and ingredient lists online. Other facilities may note on the menu which items can be substituted in place of an allergen. Finally, there are many food allergy support groups and websites that provide a list of suggestions for dining out.

The Restaurant Selection Process

Choosing where to eat is always the first question when dining out. Ask friends who have food allergies where they’ve had a good dining experience. You need to take charge when venturing out to a new restaurant when you have an allergy. Never be afraid to ask your server questions before ordering or to order foods prepared in certain ways. Keep in mind that cross-contamination can always be an issue, so don’t hesitate to ask how certain foods are cooked or what they’re cooked in. Never assume!

It’s a Team Effort

It takes a team effort to help create an allergy-friendly meal at a restaurant. From the restaurant being proactive and providing adequate allergy training for staff, to your careful restaurant selection, to you clearly communicating your health needs, it all leads to an enjoyable and safe food experience. You should always feel comfortable with the restaurant’s staff and know that they’re able to understand and meet your health needs. If not, don’t eat there! Also, don’t put yourself knowingly at risk if you have severe food allergies.

The Least You Need to Know

  • Food allergies, food intolerances, and food sensitivities are all different.
  • If you have a food affliction, you should work with a registered dietitian or nutritionist to learn what foods to avoid while still consuming a healthy and well-balanced diet.
  • Many foods have hidden ingredients, so never assume that a food doesn’t contain an allergen or a food to which you are sensitive or intolerant. Learn as much as you can concerning the foods you have problems with, so you know how to avoid them in all cases.
  • Food allergies, sensitivities, and intolerances do not need to ruin your social life. With some determination and research, you can be prepared and still enjoy eating out.
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