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How to manage food allergies in world with increasing threats

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Up to 15 million Americans (8 percent of children and 4 percent of adults) suffer from food allergies.

Food allergies are a serious matter. Cross-contamination of a minute amount of a potential allergen can cause a life-threatening reaction in an allergic individual. Although most reactions are minor, in some people, the reaction can result in a severe allergic reaction called anaphylaxis and even death.

According to the FDA, food allergies result in 30,000 emergency rooms visits and 150 deaths per year.

Why it’s happening

The incidence of food allergies appears to be rising dramatically, and the cause for this increase remains unclear. One possible explanation is the so-called hygiene hypothesis – namely, our immune systems becomes overly active in a highly sanitized environment.

Another explanation is that by delaying the introduction of potentially allergenic foods to infants, the immature immune system doesn’t have a chance to develop a tolerance to these foods during the first year of life. The number of children with peanut allergies (currently about 3 percent) has increased by at least twofold over the past decade.

In 2000, the American Academy of Pediatrics recommended delaying the introduction of peanuts (and other highly allergic foods) until a child was 3 years old.

However, in June this year, new guidelines were released that now recommend early introduction of peanut products (but not whole peanuts as they are choking hazards) to infants between 4 and 11 months of age. This reversal was based on observations that delaying the introduction of peanuts and other highly allergenic foods increased the risk of food allergy.

Recently, a randomized trial published in the New England Journal of Medicine found that the early introduction (between 4 and 11 months) of peanut products to infants at high risk of food allergy dramatically reduced the risk of peanut allergy compared to delayed introduction (at 60 months).

The rate of peanut allergy in children with high risk of food allergy with early introduction was only 1.9 percent, whereas it was 13.7 percent with delayed introduction.

However, the guidelines caution that infants with a high risk of food allergy should be seen by an allergist/immunologist who can diagnose food allergy and safely implement these guidelines prior to the introduction of peanut products at home. Be sure to discuss food introduction plans with your pediatrician.

Heading it off

Additional strategies that may reduce the risk of developing food allergies include:

  • Breastfeeding an infant exclusively for the first four to six months of life with continued breastfeeding while introducing solid foods until the baby is at least a year old.
  • Providing hydrolyzed (hypoallergenic) infant formula to infants who are not breastfed and who have a family history of food allergies.
  • Delaying the introduction of solids until the baby is at least 17 weeks old (introducing solids prior to 17 weeks increases the risk of food allergies).
  • Exposing the infant to potentially allergenic foods prior to weening from breastmilk.

Check labels carefully

Anyone with a known food allergy should read food labels carefully and avoid known allergens.

Since 2006, all foods that contain two or more ingredients must identify the presence of any of the eight most common food allergens. These potential allergens must be listed either in the ingredient list OR in a “Contains” list following the ingredients.

It is also extremely important to avoid cross-contamination at home, school or in a restaurant. If the label includes a “May Contain” or “Processed in a facility with …” statements, there is the possibility of the presence of unintended allergens. That food may need to be avoided as well.

Note that labeling laws do not apply to meat, dairy or egg products or to alcoholic beverages.

Eight culprits

Food allergies result when the immune system mistakes specific proteins present in our food as foreign invaders (allergens), setting off an immune system attack.

A true food allergy results in the production of immunoglobulin E antibodies (IgE), which stimulate the release of histamine, which then causes the allergy symptoms.

Eight common food ingredients are responsible for 90 percent of all food allergy reactions. These include:

  • Milk
  • Eggs
  • Fish
  • Shellfish
  • Tree nuts
  • Peanuts
  • Wheat
  • Soybeans

These foods and any food ingredients that contain them must be listed on the food label as potential allergens.

At home, eating out

Some food allergies are more common in young children and are often outgrown (milk, egg, wheat and soy), whereas others tend to persist into adulthood (peanuts, tree nuts, seafood).

Because more than half of all fatal reactions to food allergies occur outside the home, consider preparing a chef card with details about your food allergies and food sources, as well as how to avoid cross-contamination (you can make your own chef card with an interactive pdf at: Always provide your chef card to the manager and waiter at food establishments.

Remind your server that the preparation of your food may require the use of a clean pan or blender to avoid potentially dangerous cross-contamination. Using the same cutting board, pot, strainer, cooking oil or serving utensil, or sharing a glass, straw or utensil can cause a serious reaction in an allergic individual. Occasionally restaurant foods such as buffet items are mislabeled.

In an emergency

Allergic reactions can be highly variable and unpredictable, plus mild symptoms can become serious in a very short amount of time.

Anaphylaxis is a life-threatening allergic reaction that requires prompt treatment with epinephrine. Symptoms typically involve more than one body system and may include any of the following:

  • Hives or an itchy rash of the skin
  • Swollen throat, lips and face
  • Itchy eyes
  • Swelling and itching of the palm of the hands and soles of the feet
  • Gastrointestinal symptoms such as diarrhea and vomiting

Without prompt medical intervention, anaphylaxis can rapidly progress into shock and death. Because food allergies can be life-threatening, an allergic reaction should be treated as a medical emergency, and may require an injection of epinephrine and immediately calling 911. When in doubt, seek help immediately.

If you or your family member suspect food allergy, consider scheduling an appointment with a board-certified allergist who can confirm the allergy and provide emergency instructions and prescriptions for epinephrine if needed.

Also, consider consulting a Registered Dietitian Nutritionist (R.D.N.), a food and nutrition expert who can help you avoid hidden sources of foods that contain the allergen that you are allergic to, all while ensuring that you consume a healthy balanced diet with the nutrients you require.

Sharon Himmelstein, Ph.D., M.N.S., R.D.N, is a member of the Academy of Nutrition and Dietetics ( and the New Mexico Academy of Nutrition and Dietetics ( She teaches nutrition at Central New Mexico Community College in Albuquerque.

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