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According to the Centers For Disease Control and Prevention, 6% of adults and 8% of children in the United States suffer from some form of food allergies. With so much misunderstanding around the topic, UPMC Allergist Dr. Nathaniel Hare offers his best advice on tackling the potentially deadly condition.
One of the most common misconceptions among the public revolves around the difference between an allergy and an intolerance.
"An adverse reaction to a food that involves your immune system is an allergy. If it's not your immune system reacting, it's an intolerance," Hare explained.
"For example, if you have lactose intolerance, you're missing the enzyme needed to digest the milk sugar properly, so it doesn't get digested properly and you end up with GI tract symptoms."
"With a milk allergy, it's a completely different mechanism. Your immune system is reacting to a protein, and that's typical for most food allergies," Hare explained.
"90% or so of allergy reactions from food in the U.S. are caused by six to eight food groups, which include milk, egg, peanut, wheat, soy and tree nuts," he said.
"Typical symptoms of an allergic reaction can include respiratory symptoms, skin symptoms like hives, and you can get GI stuff like nausea, vomiting, diarrhea."
The most common form of severe allergic reaction that people are familiar with is anaphylaxis, according to Hare.
"The main treatment for a life threatening reaction such as anaphylaxis is an epinephrine auto injector, like an Epi-pen," he explained.
If symptoms do not improve within five minutes of administration, use a second dose and call 911 or visit the nearest emergency room, however more often than not, this is not necessary, Hare advises.
"As long as an adult can be with you for the next six hours and you get better by yourself with one dose, you don't have to go to the emergency room," he said.
Food protein induced enterocolitis syndrome (FPIES) is another, rare allergic reaction that typically affects only infants and toddlers, according to Hare. The condition can cause projectile vomiting, extreme lethargy and dehydration.
"The top three food allergies for those under five are milk, eggs, and tree nuts, the allergist explained.
Food allergy testing can be done as early as infancy and can be done by either a skin test or a blood test, according to Hare.
"Most kids will outgrow milk and egg allergies, while around 20% of kids will outgrow peanut allergies, and about 8% will outgrow tree nuts," he explained.
But for those who do not outgrow their allergies, there are treatments available to lessen their effects.
"Option one, is just don't eat it, but depending on what study you read, around 10% of kids still end up in the emergency room every year," Hare said.
Over the last 10 years or so, allergy shots have grown in popularity as a way to desensitize the immune system to its allergens.
Essentially, the shots retrain the immune system by introducing a low dose of the allergen and gradually increasing it over time, Hare explained.
"If you need it for food, it's called oral immunotherapy," he said.
"You can also put it under your tongue, then swallow it after holding it there for two minutes, which is called sublingual."
Hare said that the oral immunotherapy (MIT) generally works better than the sublingual route.
"It typically works for 80% of kids versus the sublinguals, which is more like 60%."
And, in the past couple of months, a new method has been added to the arsenal of those at risk due to food allergies.
"Xolair has been on the market for probably 20 years as an allergic asthma medication, but it recently got FDA approval for treatment for food allergies," Hare said.
"Basically, it increases the threshold of how much of an allergen would cause a reaction, so if you have an accidental exposure, hopefully you don't have any problems," he explained.
"And it works for multiple food allergies, long-term across the board, regardless of how many you have," Hare said.
Though ingestion is the most common cause of reactions from food allergens, those with the condition should be mindful of other ways they're exposed to the deadly proteins.
"Typically, you have to eat the food to have health problems, but occasionally, you'll get a reaction if it's on your skin," Hare explained. And adverse reactions can, depending on the type of food, happen simply by smelling it.
"If you're allergic to peanuts, and you open up a jar of peanut butter across the room, you're smelling fat that's evaporating across the room, there's no protein traveling with it, so you're not going to have an allergic reaction, but if you're in a restaurant that serves peanuts and the dust crosses the room, that has the proteins in it, then you'll have a reaction," Hare explained.
"Seafood is an example of one where if you cook it, the proteins you're allergic to can get up in the steam and cause an allergic reaction from across the room," he said.
And just because someone has never had a severe reaction to a known food allergy, does not mean they should let their guard down.
"If you have a life threatening allergy to food, any exposure where you ingest it has the potential to cause a serious reaction," Hare said."
"There's no such thing as a mild food allergy. People can have a history of milder reactions, but if you're allergic, you have a risk of serious reactions anytime you eat it," he explained.
Hare stresses that articles such as this are simply a guide to educate the reader and should not be taken as medical advice.
Instead, he urges anyone with medical concerns, no matter how small, to bring them to the attention of their primary care physician as soon as possible.