BABY STEPS:Learning about food allergies one step at a timeVeronica Li

DISCLAIMER

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The purpose of this book is solely to provide useful information to help develop a basic understanding of food allergies. This book has been checked by a professional to ensure all the provided information is correct. However, this book should not be used to diagnose or treat any medical condition. Please consult a doctor, physician or other related expert for proper diagnosis or treatment. References are provided for informational purposes only and do not constitute endorsement of any websites or other sources.

Table of Contents

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4

5

6

8

11

12

13

14

16

18

19

21

22

Acknowledgements

Message from the Author

Introduction: What are Food Allergies?

Possible Food Allergens

Symptoms

Anaphylaxis

Other Food-Related Conditions

Dealing with Food Allergies

Diagnosis

Treatment Methods

List of Related Conditions

Index

Sources

If you would like to go to a specific page, click below on either the page number or the page title. Other links in the book will be in a different colour compared to the rest of the text in the paragraph.

Acknowledgements

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Firstly, I would like to thank my mother. Due to my allergies, she had to learn how to cook special meals for me. To this day, she still has to cook every one of my meals by herself. My allergies make it much harder for her to take care of me, but she has been strong the whole time and helped me grow up as a happy, healthy child. I would not be who I am today without you, Mom. I love you.

I would like to thank my father for always showing his concern and care for me. I know he has been through so much because of my allergies, always being concerned about my health. Thank you, Dad. Don’t worry too much because I will take good care of myself. I love you.

Dr. Marco H.K. Ho of Queen Mary Hospital for providing very helpful information on the topic. I would also like to thank him for helping me deal with my allergies for so many years.

The Hong Kong Allergy Association for promoting this book. I would not have the chance to share this to a wider audience without the association’s help.

Mr. Shortt, my personal project supervisor, for guiding me in the direction I need to go and reminding me of the most important parts of the project. I would not do as well without your help.

Valerie for being my best friend and taking some photographs for me. Thanks for taking some time to take the photos; they turned out great.

Last but definitely not least, I would like to express my gratitude to all my family and friends for their continuous support.

Message from the Author

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I was diagnosed with food allergies at a very young age. Instead of having allergic reactions to only one or two foods, though, it turns out I was allergic to nuts, peanuts, dairy, seafood, egg, shiitake mushrooms, kiwi and eggplant. (On top of that, I have eczema, a type of skin allergy, and nose allergies. That, however, is another story.)

Some allergic reactions were pretty serious. Every time I ate anything dairy-related, I ended up vomiting and even suffocating because my airways were blocked. I have had my share of near-death experiences, and thankfully I am still alive!

Some other people were not as lucky as me. When I revisited Canada a few years back, I went to see the doctor who had been taking care of me when I was very young. He told me that there had been a recent case where a girl had an allergic reaction, but she did not receive proper treatment in time and passed away. I was shocked by the story. Evidently, some people needed to know more about food allergies, especially how severe they could be.

This is my reason for writing this book. I may not be a specialist in this field, but I put a lot of research and effort into this book. I have also had professionals check this book to ensure the information being provided is correct. While researching for this project, I have learned a lot, and I hope you, the reader, will be able to learn a lot as well from this book. Thank you for reading this message and I would really appreciate it if you could share this so more people can learn about food allergies. Thank you!

-Veronica Li

INTRODUCTION What are Food Allergies?

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Imagine your immune system is a microscopic army. It fights against any invaders, such as viruses, trying to enter your body. Normally, your immune system only attacks and removes harmful substances.

When a person has food allergies, this army does not only attack harmful substances; it also identifies certain food proteins as invaders, triggering a reaction.

There are two types of allergies: immediate-onset and delayed-onset. Delayed-onset allergies are allergies that occur after two hours of eating the allergy-inducing food. T-cells, a type of white blood cell, are the cause of these allergies. This type of food allergy is common in all age groups. It can affect just about any body system, and it involves more foods as well, making it more difficult to determine the foods causing the responses. Doctors will most likely have to carry out multiple oral challenge tests* to determine the causes of these allergies.

2006 figures show that about 11 million people in the United Stated alone suffer from food allergies. This number includes 5 million children, and the number has likely grown. This begs the questions: what are food allergies, and how do they affect us?

*Go to page 16 to learn more about oral challenge tests and diagnosis.

A Basic Explanation

A Scientific Explanation

mast cell

IgEAllergen

Histamine

Step 1. IgE attachesto mast cell.

Step 2. Allergenattaches to IgE.

Step 3. Burst mastcell released histamine.

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Immunoglobulin E (IgE) causes immediate-onset allergies, allergic reactions that happen within two hours after eating the problem food. Like the non-immediate reactions, IgE-induced reactions appear in many forms, such as hives or a stuffy nose. In particular, these reactions usually affect the skin, airways and digestive tract.

When an IgE reaction happens, the IgE attaches itself to a cell called a mast cell. Mast cells contain a substance called histamine. When IgE connects to the mast cell, it makes the mast cell burst, releasing histamine that triggers the allergic response.

This type of food allergy is more common in children than in adults, but it can be more dangerous. The worst-case scenario is anaphylaxis, a potentially fatal response that affects the skin as well as the airways. (To know more about anaphylaxis, please refer to page 12.)

Histamine is connected to other types

of allergies as well, so doctors usually provide antihistamine

to reverse symptoms of allergies.

Possible Food Allergens

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Peanut

Tree nuts

Seafood

Despite the name, peanuts are actually legumes, such as peas and soy, and not nuts. Peanut allergies are highly common for all age groups, and only 20% of children with this allergy outgrow it. Refined peanut oil is tolerated, but crude peanut oil is not always tolerated. If you want to be more careful, avoid peanut oil in general.

This category of food consists of cashews, hazelnuts, pistachios and so on. Unlike peanuts, however, tree nut allergies are not commonly outgrown. Since tree nuts are closely connected to each other, people are more likely to have multiple tree nut allergies rather than being allergic to only one tree nut. Therefore, it is often advised to avoid nuts altogether if you have tree nut allergies.

Seafood allergies are usually divided into two smaller categories: allergies to finned fish and allergies to shell-fish. Fish allergies are only outgrown by 2% to 5% of children. Approximately one out of two people have more than one fish allergy, so people with fish allergies should usually avoid all finned fish.

An allergen is something that causes an allergic reaction. The following list of potential food allergens is sorted into two categories: common and less common.

Common Allergens

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Egg

About one in 200 children are allergic to soy, but they generally outgrow this allergy. Since soy sauce and soy oil do not contain a lot of soy protein, they are typically tolerated.

Like milk allergies, about one in fifty children are allergic to egg. Usually, egg white is what causes allergies, but the whole egg should beavoided because the egg yolk and egg white are hard to separate. Egg is normally tolerated after five years of age.

Wheat allergies affect about one in 250 children, most of which outgrow these allergies by the age of five. About twenty percent of children are allergic to other grains. Gluten, a mixture of two proteins, is the cause of allergies to grains in general. Buckwheat tends to cause the more severe reactions out of all the types of wheat.

Milk allergies affect more young children than older children and adults, as it often outgrown. About one in fifty children are allergic to cow’s milk. Being allergic to cow’s milk also raises the possibility of being allergic to other mammalian milks, but people can also be allergic to other mammalian milks without having a cow’s milk allergy.

Dairy/Milk

Seeds, such as sesame seeds, have the potential to cause severe allergic reactions. However, the severity of the reaction depends on the amount of the allergy-inducing protein in the food.

Wheat

Soy

Seeds

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Meat

Vegetables and Fruit

Being allergic to one type of poultry, such as chicken, raises the chances of other poultry allergies, like allergies to duck or turkey. The same situation applies to mammalian meats. For instance, a person allergic to beef is more likely to be allergic to pork as well compared to a person without beef allergies.

Children typically have allergic reactions to only one type of fruit or vegetable, even though most vegetables and fruits have similar proteins. In the case of pollen-food-related syndrome, a person allergic to airborne pollen has mild allergic reactions when eating raw fruit and vegetables, but there are no problems when the food is cooked.

“Spices” refer to a wide range of flavouring agents, any of which have the potential to cause allergies. However, estimates say less than one out of fifty people are allergic to spices. The chances of spices inducing allergies may depend on the processing method of the specific spices, or how much of the spice is used in cooking.Please consider the fact that hot spices typically cause burning sensations that are usually not a sign of allergies.

Food additives rarely cause any allergic responses. In fact, colours, whether natural or artificial, are not known to cause any reactions at all. However, some additives, such as MSG (Monosodium Glutamate, or E621), can trigger some allergic symptoms, such as headaches, nausea, and even vomiting. This is not exactly considered a food allergy*, though.

Spices

Additives

*Please refer to page 13.

Less common allergens

Symptoms

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Depending on the severity of the reaction, there can be a variety of symptoms. These symptoms can be divided into three categories: gastrointestinal issues (concerning the digestive tract), skin-related issues and respiratory issues (concerning breathing).

Food allergies can definitely affect the digestive system, upsetting the gastrointestinal tract. Signs of this are abdominal pains, diarrhea or constipation. When there are gastrointestinal symptoms, it is hard to diagnose food allergies. This is because many foods are eaten before the symptoms occur, making it hard for experts to identify the food causing the problems. The gastrointestinal problems may also have occurred due to other factors and not due to a food allergic reaction.

Since skin allergies are often connected to food allergies, some symptoms can be skin-related as well. Hives, or urticaria, are an example of such a symptom. The irritated skin normally resembles mosquito bites; the wheal is the swelling in the center and the flare is the red area around the swollen section. Sometimes, the swelling is greater, or there are many hives forming together into larger shapes. Hives can also precede a more severe allergic reaction, although they usually disappear without any following symptoms. Angioedema is also a form of swelling skin. The most common areas that swell during a food allergic reaction are the eyelids, ears and lips. Respiratory allergies are also closely linked to food allergies. Symptoms can show up in the form of nasal conditions. For example, excessive sneezing or a blocked nose can be possible symptoms of food allergies, although they are usually unrelated to issues with food. Wheezing is another sign that reactions such as asthma will occur. Sometimes, direct inhalation of airborne, uncooked allergens can cause such symptoms.

For a list of related diseases and disorders, please refer to page 19.

Anaphylaxis

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Anaphylaxis is the most severe immediate allergic reaction. It can be caused by different triggers, and food allergies is one of them. Signs of this reaction show up in multiple parts of the body, even parts that had not been in direct contact with the allergen. The signs include throat swelling, a hoarse voice, quickening breath or difficulty to breathe, trouble swallowing and blue skin or lips.

The worst form of anaphylaxis is an anaphylactic shock. When an anaphylactic shock happens, it causes impaired circulation, so organs start to lack nutrients and oxygen. The blood flow to the brain also becomes poor, leading to disorientation and unconsciousness. Blood pressure also drops because the heart is pumping much faster to try to circulate blood properly.

There are also other forms of anaphylaxis. For example, some people suffer from food-associated, exercise-induced anaphylaxis, a special form of anaphylaxis that only happens if the individual exercises immediately after eating a specific food.

If you are unsure if a reaction is anaphylaxis, answer these two questions: Was food eaten before symptoms arose? Were any previous reactions to any eaten food very severe? If the answer to both questions is yes, it is safer to treat anaphylaxis when you are unsure than to wait until obvious symptoms occur. Otherwise, it may be too late to treat it.

If anaphylaxis occurs, immediately call the emergency hotline number. Next, use an EpiPen (or similar adrenaline injector) on the person’s thigh. The adrenaline will help improve blood circulation and breathing. If the person has collapsed, do not help the person to a sitting position, or rest the person’s head on a pillow. Instead, let the person lie down on the floor. This will ensure circulation is not affected any more than it already is.

Other Food-Related Conditions

13

In some cases, people experience what they believe are “allergic symptoms” when they are actually experiencing another food-related condition altogether. Here are some examples of such conditions.

Food Intolerance - Many people confuse this with food allergies, but food allergies and food intolerances are different conditions. Food allergies are caused by the immune system, whereas food intolerance is the inability to properly digest a certain component of food. One of the most common forms of this is lactose intolerance, an inability to digest milk sugar.

Food Poisoning - When a person ingests spoiled food, it causes similar reactions to those of food allergies. Nausea and vomiting are examples of such symptoms. The easiest way to determine whether a person went through an allergic reaction or food poisoning is to see if the same symptoms arise after eating the same food multiple times. For instance, if someone threw up after eating fish but normally eats fish without any signs of allergic symptoms, the fish was probably spoiled. If the allergic symptoms kept occurring in different situations where the person ate fish, the person is most likely allergic to fish.

Reactions to Food Chemicals - Sometimes there are chemicals in food that can induce reactions unrelated to food allergies. For example, cutting an onion can cause a person’s eyes to water, or a person can develop “symptoms” similar to signs of food allergies from caffeine intake.

Reactions to Food Additives - As mentioned before, food additives, such as flavourings and preservatives, can sometimes cause food allergies. However, this is not necessarily considered a food allergy because, essentially, food additives are not considered as foods.

Ingredients: White flour, sugar, vegetable oil, semi-sweet chocolate, nonfat milk, whole eggs.Contains dairy, egg, gluten, soy.

May contain traces of peanut.

Dealing with Food Allergies

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It can be very tough to manage food allergies, but with these few tips, living with food allergies will be much easier than it seems.

1. Always read food labels. Whenever you purchase food, always remember to check the food labels, even if it is something you have bought and eaten many times before. This is because ingredients can change, or there can be cross-contamination due to changes in the manufacturing process of the food. Take a look at the sample food

label on the right. Besides checking the ingredients, always look out for the keywords “contains” and “may contain”.

2. Always carry your medicine with you. There are times when you might accidentally come in

contact with food you are allergic to. In the case of an allergic reaction, especially if the food has caused a severe allergic reaction before, it is crucial to have an adrenaline injector (like the EpiPen on the right) to keep you alive.

3. Know how to use the adrenaline injector. This not only applies to you but the people closest to you as well. This is because you would most likely be unable to inject the adrenaline on your own if you were suffering a severe food allergic reaction. Someone other than you will need to know how to respond in such a case.

In the case of food allergies,

cross-contamination is when tolerated food comes in contact with a food allergen. This

can cause allergic reactions.

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4. Tell others about your food allergies. Whether they are your friends, your teachers or your co-workers, they need to know about your allergies. They need to know about the severity of your allergies, so they can help you avoid dangerous situations.

5. Avoid excessive contact with someone who had just eaten something you are seriously allergic to. Sometimes, even the smallest traces of an allergen could be life threatening. Again, communication is key. Always remember point 4, and chances of secondhand contact with an allergen will be much lower.

6. Be extra careful when going out to eat. When you are ordering at a restaurant you have not visited before, always ask the waiter to check if the dish contains anything you are allergic to. You should also ask about the oil the staff uses to cook the food if you are allergic to a specific oil, since there could be cross-contamination during the cooking. Tell the waiter about your food allergies. If the restaurant staff do not provide this information, it is safer to not order than to take a risk. The same goes for eating anywhere else for the first time.

7. If someone else is cooking, make sure they take extra precautions with your food. An example of this is making sure they using separate pots, pans and utensils specifically for you, so cross-contamination can be avoided.

8. Take special care when traveling. When you travel abroad, there will be many more complications. For instance, you need to make sure you are able to tell the people you meet there about your food allergies. You (as well as the people accompanying you) might have to learn how to do so in another language, so people such as waiters and hospital staff can communicate with you. If you have to cook, you will also need to learn how to read food labels there, since the brands and food in general will most likely be different.

Diagnosis

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There are quite a few ways to help diagnose food allergies.

One of these methods is a blood test. The general concept of the procedure is that the patient’s blood is drawn and contained in a test tube. The IgE parts of the blood are kept in the test tube, and the test tube is filled with a food protein. Since the protein can glow in the dark, professionals can measure the amount of “glow” in the mixture to see if IgE reacts to the protein. Please take note that the results of this test only indicate whether or not a person’s body produces IgE antibodies to specific foods, but does not fully indicate whether the food induces an allergic reaction or not. In the case of children taking this test, only one third of them testing positive are actually allergic to the tested food. As for negative test results, one out of twenty people testing negative can still develop an allergic response to the tested food.

Another method is a skin prick test. A specialist pricks the surface of the patient’s skin and allows an extract of a suspected allergen to enter the patient’s body through the pricked skin. A positive result resembles a mosquito bite; the skin swells and reddens if there is an allergic reaction to the food extract. Test results can be affected by medications such as antihistamine and steroid cream for the skin, so the patient should temporarily stop taking medications before taking a skin prick test.

To make sure the result is accurate, saltwater is used as a

control, since nobody is allergic to it. If the skin still swells

up, it means the results might not be accurate, since the skin

is responding even without an allergen triggering it.

17

The flaw in both of these tests is that positive results only mean the immune system can react to the food; this is not the same as the possibility of an allergic reaction. This is why you need to make sure an experienced specialist is the one evaluating the test results.

Oral challenge tests also help diagnose allergies. Under professional supervision, the patient is fed tiny amounts of a suspected food allergen, or a substitute of the suspected allergen. The professional then checks for any reactions and gradually increases the amount of the food if reactions do not occur. To ensure bias is prevented, neither the professional nor patient knows that the test food is until later. This is a more accurate way to diagnose food allergies, since it is obvious whether there is a reaction or not. However, this is also a riskier method, because there might be a severe reaction. This is why supervision is mandatory.

Another more accurate method to diagnose food allergies is to examine a patient’s medical history. Using this method, a doctor can determine whether the problem is caused by food allergies or by another factor. Firstly, though, the doctor needs to know a list of suspected food allergens, as well as the consistency of the allergic responses. This can help determine the problem food, especially in cases when a patient experienced a reaction after eating multiple different foods.

Writing a diet journal will be very useful. A diet journal is for recording what was eaten, as well as any experienced symptoms that followed. Even simple snacks should be included in a diet journal. Keeping food labels is also recommended to help identify the allergy-inducing food. Sometimes, gathering details will be difficult, since it might require asking restaurant staff or manufacturing companies. Still, try to gather as many relevant details as possible. This journal has to be very detailed in order to help the doctor make a more accurate diagnosis.

Treatment Methods

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Unfortunately, there are no widely practiced cures for food allergies yet. Some treatment methods do exist, but they are fairly new and are not yet widely practiced.

The only widely used “treatment” method is an elimination diet. This means the food causing the allergies is completely removed from the person’s diet, and then reintroduced later on. This sounds simple enough, but you should not attempt an elimination diet on your own. Instead, consult a specialist or a nutritionist first. Specialists can help you remove a food from your diet while ensuring your diet does not lack any nutrients. They can also help with reintroducing the food after making sure you have developed a tolerance to the food.

There are two other methods called oral desensitization and anti-IgE therapy that have successfully increased tolerance to foods. Although they have been proven to work, they are still new, and professionals do not have sufficient information on these new treatment methods to widely use them. Therefore, at the moment, elimination diets are the best option. If you are still interested in knowing more about oral desensitization and perhaps other methods of food allergies, please ask an allergist or other related expert.

List of Related Conditions

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Here is a short list of diseases and disorders related to allergies. This is by no means a complete list of all related diseases; it is only a start.

Allergic proctocolitis Infant condition. Bloody stools due to allergic reaction, usually to cow’s milk through breast milk or formula.Asthma Respiratory illness that can be triggered by allergies. Allergies trigger release of histamine, leading to airways being irritated, swollen and blocked by formation of excessive mucus. Individuals experiencing asthma have trouble breathing and, in severe occasions, suffocate.Atopic dermatitis Form of eczema. Inherited from relatives with any allergies. Can occur as either a food allergy symptom or as a separate allergy. A dry and itchy rash that can last for weeks, months and even years. Can appear in multiple forms, from boiling skin to flaking, cracks or crusts in the skin.Celiac disease Food intolerance to gluten, a substance in wheat and grains. Inherited disease. Autoimmune disease, meaning the immune system attacks part of the body. In this case, the immune system attacks the lining in the intestines, making the body react abnormally to gluten.Eczema Type of skin allergy involving itchy skin. Scratching often occurs, leading to redness, flaking or crusting skin. Severe eczema can lead to infected and blistering skin.Enteropathy Child condition. Swelling or inflammation inside small intestine, causing poor growth and diarrhea.

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Eosinophilic esophagitis Eosinophils cause swelling in the esophagus, making it difficult to push food down to the stomach. Diagnosed after infant years and in later childhood.Eosinophilic gastroenteritis Eosinophils affect stomach and small intestines, causing bad absorption of food and poor growth in children.Food protein-induced enterocolitis syndrome (FPIES) Infant condition. Inflammation in intestines, leading to vomiting, diarrhea, poor growth. Ingestion of allergen causes severe vomiting, bad blood circulation, and, in some cases, blue skin. Diarrhea and bloody stools also possible. Allergy tests are usually negative. Heiner’s syndrome Highly uncommon milk allergy in babies. Allergy test results are negative for this condition. Causes lung failure and bleeding.Hives Also known as urticaria. Irritated skin resembles mosquito bites. Swelling in center is known as a wheal, and surrounding red area is a flare. Appearances of hives may vary slightly (please refer to page 11).Idiopathic anaphylaxis Type of anaphylaxis with an unknown trigger.Lip-licking eczema Special case of eczema. Lip-licking causes cracked skin, potentially allowing food proteins into skin and creating an allergic reaction.Pollen-food-related syndrome An allergy syndrome caused by raw fresh fruits and vegetables. Affects mouth and tongue. Trigger of food allergy is substance in raw fruits and vegetables similar to pollen.

Eosinophils are a type of white

blood cell. Their function in the body is unknown,

but they seem to be connected to

allergies.

Index

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Adrenaline injector, epinephrine injector, EpiPen

Airways, breathing, respiratory

Allergen, allergy-inducing

Allergic reactions, allergic responses

Anaphylaxis

Asthma

Cross-contamination

Diagnosis

Diseases, disorders

Food intolerance

Gastrointestinal, intestines, stomach

Histamine

Hives, urticaria

Immune system

Immunoglobulin

IgE, immunoglobulin E IgG, immunoglobulin G

Skin, skin allergies

Signs, symptoms

Treatment

12, 14

4, 6-7, 11-12, 19

7-10, 12, 14-17, 20

6-14, 16-17, 19-20

7, 12, 20

11, 19

14-15

6, 16-17

19-20

13, 19

19-20

7, 16, 19

7, 11, 20

6, 13, 17, 19

6-7

7, 16, 186-7

7, 11-12, 16, 19-20

7, 10-13, 17

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Click on a page number to go to that page. If there is a group of pages (e.g. 11-12), clicking on the page group will lead you to the first page in the group.

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July 2012. E-mail.

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Print.

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