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Nutrition

Get excited about nutrition, and learn as you go with these information-packed resources on a wide variety of nutrition-centric topics! Our bistroMD experts review the importance of the macronutrients protein, fat, and carbohydrates, as well as how to make them work most efficiently for you.

Strategies to Reduce Risk of Food Allergies

Food allergies can have harsh consequences if you don't know what to watch out for. Check out these tips to make sure you are doing the best you can for your health.

Strategies to Reduce Risk of Food Allergies


What's all the fuss about food allergies? Food allergies can have serious consequences and are on the rise: reports estimate incidence of 4-8% of children and 2% of adults in the US - about 15 million people. Why this is happening is not clear yet.

Food allergy, intolerance or sensitivity – what's the difference?

A food allergy is a type of adverse reaction that causes a specific immune response and can be reproduced with exposure to the food. Food allergies can result in an immediate, life-threatening response. When someone with a milk allergy consumes any food containing milk, they have an immune reaction – anything from hives to anaphylaxis. Anaphylaxis requires immediate medical care.

Food allergies are often confused with food intolerances or sensitivities. The specific immune reaction seen in food allergy, does not occur in either of these two responses– whether it's lactose intolerance with bloating and diarrhea from milk consumption, or jitteriness from caffeine intake – different pathways are involved. For some food sensitivities, the pathway is not known.

Typical Food Allergy Symptoms

Hives, swelling of the lips, tongue, throat, or other parts of the body, wheezing, mouth itch, cough, nausea/vomiting or anaphylaxis may occur within minutes to hours of eating a food containing an allergen.

Most Common Food Allergens:

● Cow's milk
● Egg
● Wheat
● Soy
● Peanut
● Tree nuts (such as almonds, walnut, pecans)
● Fish
● Shellfish (such as shrimp, crab, lobster)

Many children will outgrow milk, egg, wheat and soy allergies. Peanut, tree nut, fish and shellfish allergies are less likely to resolve. Food allergies can develop at any time, but generally milk, egg, wheat, soy, peanut and tree nut allergies develop early in life, while shellfish and fish develop later.

Infants with at least one first-degree relative, parent or sibling with allergic disease are considered "at risk".

Recommendations that may reduce the risk of food allergies developing for those at-risk:

● Exclusive breastfeeding for the first 4 months
● Hydrolyzed infant formulas –formulas where the proteins are already broken down into smaller parts – are recommended if not exclusively breastfeeding
● At this time, there is not enough evidence to support restricting the mother's intake of potential allergens during pregnancy and breastfeeding (except any that they are allergic to)
● Introduction of foods, including potential allergens, is not restricted after 4 to 6 months, unless the infant is already experiencing allergic reactions

A recent, landmark study (LEAP study) involving peanut allergy may shift the emphasis on this last recommendation – recently released interim guidelines say:

"Healthcare providers should recommend introducing peanut-containing products into the diets of ‘high-risk' infants early in life (between 4 and 11 months of age) in countries where peanut allergy is prevalent because delaying the introduction of peanut can be associated with an increased risk of peanut allergy."

Many questions remain however, and finalized guidelines are expected in 2016. Following the recommendations does not guarantee a food allergy will not develop. Expectant mothers and parents of infants who have a family history of food allergies or who have allergies themselves, should consult with their physician to determine the best plan of action and minimize risks.

It's important to know that first exposure may be unknown. If a food allergy is suspected, prompt medical care is needed. Further medical evaluation is also important to ensure normal weight gain and development, and avoid restricting the diet more than is necessary.

For people who already have a peanut allergy, the LEAP study doesn't change a thing. Once any food allergy is present, avoidance of the allergen(s) is essential as there are no cures. Appropriate medical care, vigilance, and being prepared for unintentional exposure are critical.

Strategies to reduce the risk of food allergies causing a reaction:

● Get educated and stay informed: take advantage of food allergy resources: foodallergy.org and www.niaid.nih.gov
● Read all food labels, checking ingredients every time, as they can change. Some experts recommend a triple check – at the store, before the food is put away at home, and before it is consumed. A call to the manufacturer can clarify any uncertainties.
● Avoid foods with unknown ingredients.
● Be aware of cross-contamination possibilities.
● Educate and communicate with family members, caregivers, schools and co-workers

People with food allergies must have an emergency plan and be prepared for unintended exposure – it can happen even to the most conscientious person! Individuals with food allergies should:

● Carry emergency medicine at all times, and replace before it expires
● Wear a medical ID
● Seek medical help immediately.

Living with a food allergy requires heightened awareness every day. Being informed and finding support from others can go a long way to making the path easier.

Disclaimer: The content provided in this article is not intended to replace the individual medical advice of your doctor.

Authored by: Karen Lindell, MS, RDN

References

Jackson KD, Howie LD, Akinbami LJ. Trends in Allergic Conditions Among Children: United States, 1997–2011. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics. NCHS Data Brief. 2013(121). www.cdc.gov/nchs/data/databriefs/db121.pdf. Accessed 11/23/2015.

Gupta, RS, Springston EE, Warrier MR, et al. The prevalence, severity, and distribution of Childhood Food Allergy in the United States. Pediatrics. 2011(128):e9-17. http://pediatrics.aappublications.org/content/128/1/e9.long. Accessed 11/22/2015.

National Institute for Allergy and Infectious Diseases. Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of the NIAID-Sponsored Expert Panel, 2010. http://www.jacionline.org/article/S0091-6749%2810%2901566-6/fulltext#sec3. Accessed 11/22/2015.

American Academy of Pediatrics. What you need to know about the new guidelines for the diagnosis and management of food allergy in the U.S. http://www2.aap.org/sections/allergy/Allergy_guidelines_final_1.pdf. 2010. Accessed 11/22/2015.

Food Allergy Research and Education: www.foodallergy.org. Accessed 11/22/2015. National Institute for Allergy and Infectious Diseases. Food Allergy: An Overview. NIH Publication No. 12-5518, 2012. http://www.niaid.nih.gov/topics/foodAllergy/Documents/foodallergy.pdf. Accessed 11/22/2015.

Fleischer DM, Sicherer S, Greenhawt M, et al. Consensus Communication on Early Peanut Introduction and the Prevention of Peanut Allergy in High-risk Infants. Pediatrics. 2015(136):600-604. http://pediatrics.aappublications.org/content/136/3/600. Accessed 11/22/2015.

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