Over 12 million Americans have a food allergy, and this number is rising. One clear example, the number of children with peanut allergies recently doubled over a 5-year period. Scientists aren't completely sure why the numbers are increasing, and are working hard to find out. But many would agree that more robust research budgets are needed to study all aspects of food allergies, including treatment and prevention.

And the stakes are high, since Americans currently make 30,000 visits to the emergency room for food allergy every year. Thankfully, one thing that research has demonstrated is that immediately injecting epinephrine - a hormone which suppresses the immune system - into the thigh muscle is the best treatment for severe allergy reactions and anaphylaxis.

Teens and young adults are at highest risk for fatal allergic reactions to food, often because they aren't in the presence of a mindful parent, or perhaps that they tend to consume food more quickly. By studying teens' behaviors, researchers have identified ways to decrease their risk through food avoidance and education, by teaching them to identify the signs of anaphylaxis, to carry epinephrine at all times and to be able to properly inject it.

Anaphylaxis can occur with many different symptoms, and can develop in just a few minutes or hours later. The most common symptoms are usually hives or general itchiness, flushing skin and/or swelling of the lips, tongue or throat. Shortness of breath, abdominal pain or vomiting, and feelings of lightheadedness (due to drop in blood pressure) are other common signs.

If you have a teen with food allergies, or a child that will soon be a teenager, they should know to avoid certain foods, and hopefully feel comfortable asking questions and reading labels. It is equally important that you take the time to go over these symptom details and the proper identification and treatment of acute reactions. And make sure they always have epinephrine available to them at all times.

Yes, this may mean some ongoing inquiries or continual education for your child. But remember, many teens and young adults feel as if they are invincible and/or don’t always plan ahead, so these reminders could save their life!

Labels: allergens, allergic reaction, allergy free, anaphylaxis, big eight, dairy allergy, food allergy, peanut allergy, tree nuts allergy, wheat allergy

The Allergy Free Shop exists to provide parents and caretakers with allergen-free foods and products for those with food allergies and sensitivities. We also strive to provide resources that help to provide guidance to those just beginning their education about specific food allergies affecting their children.

Prevalence

Dairy allergy is one of the most common in young infants, with 2-3% of children under three years of age allergic to cow's milk proteins. It is now standard procedure for a doctor to suggest not giving an infant cow's milk until they are at least 12 months old. Be careful of giving your child formulas with milk products in them, especially if milk allergy runs in your family. Many infant formulas that claim to be milk-free do in fact have derivatives of milk in them.

Chronic gastrointestinal distress, vomiting and severe diarrhea are all symptoms of milk allergy. Hives, swelling and other allergic reactions may accompany the reaction. Breastfeeding is generally the best alternative if allergies run in your family. If you have already started on formula, try a soy based formula instead. Some of the soy formulas do have a significant amount of iron in them which may also be upsetting to your child. There have been conflicting studies linking soy formula to peanut allergies. It may be necessary to try out several formulas before finding a good match. Watch out for "lactose-free" labels, because that's not necessarily an indication of a milk-free product.

It should also be noted that lactose intolerance is not milk allergy. Instead, it is a problem in the digestive system caused from not producing enough of the lactase enzyme to break down the lactose sugar into simpler sugars. People who experience lactose intolerance have the crampy, abdominal pain that can turn into nausea and diarrhea. Lactose intolerance can be lifelong or temporary - especially following an intestinal illness, or even a round of antibiotics. In the US, lactose intolerance is most common among African Americans, Asians and Native Americans.

Prognosis

If your child is allergic to milk, don’t despair, as most children do in fact grow out of their milk allergy. Virtually all infants who develop a cow’s milk allergy do so in the first year of life, with almost 80% "outgrowing" their milk allergy by the age of 16. The bad news, however, is that the prognosis for a child with milk allergy appears to be worse than it was 20 years ago. Now only do kids have more allergies, but a growing number do not outgrow their allergies, and those who do, do so later than before. Doctors have found that a child’s blood levels of milk (and egg) antibodies - the immune chemicals produced in response to allergens - were a reliable predictor of disease behaviors. The higher the level of antibodies, the less likely it was that a child would outgrow the allergy any time soon.

But until tests confirm this, or more likely - accidental ingestion with no adverse reaction whatsoever - it is certainly best to stay away from milk and milk products entirely. 60% of cow's milk-allergic infants experience IgE-mediated reactions, or the more classical "immediate" reactions affecting the skin (hives and eczema), gastrointestinal tract (crampy abdominal pain and vomiting), and the respiratory tract (nasal congestion, sneezing and wheezing). Nearly 25% of these milk-allergic infants retain their sensitivity into the second decade of life, and 35% go on to develop other food allergies.

Non IgE-mediated milk allergy affects primarily the gastrointestinal tract resulting in a number of different allergic disorders: milk-induced enterocolitis syndrome, proctocolitis syndrome, allergic eosinophilic esophagitis, etc., which can lead to poor growth and failure to thrive. There is a chance your child will test negative to dairy on an allergy test, yet still show symptoms of an allergy. In this case, the non-IgE milk-allergy may be at play, or lactose intolerance may be the culprit.

More recently diagnosed food allergies, for still-unknown reasons, behave more unpredictably and more aggressively than cases diagnosed in the past. Some doctors believe we may be dealing with a different kind of disease process than we did 20 years ago. Why this is happening is an unknown at this point.

Avoiding Milk Products

Reading labels is a must for a milk-allergic child! The Food Allergy Labeling Consumer Protection Act (FALCPA) was passed in 2004, requiring that labels be marked such that a 7 year old could read and understand the ingredients and that all allergens be declared even if they are in the spices or flavoring. For more information on this important law, please see: http://www.foodallergy.org/Advocacy/labeling.html

Of course, milk is in virtually all cheeses, butter, creams and yogurt. The lactose free milks do still have milk protein, so avoid them. They are made such that the lactose-intolerant individual can digest them, but are not made for the milk-allergic. Stick with milk substitutes, such as soy and rice milk.

Casein and whey are other names that milk can be called on a label. There are other names that also indicate the presence of milk, and your allergist can provide for you a complete list of milk products and ingredients to avoid.

Some other advice on eating at restaurants: you may want to avoid Mexican restaurants (too great a chance that grated cheese can cross-contaminate), Italian restaurants (same for parmesan cheese), Chinese (lactose is in many of the sauces), and breakfast restaurants (milk and butter are often used on the griddles).

Also be on the lookout for lactose in many popular inhalers, used in these medications to bulk up tiny medication particles. Other medicines (such as 10 mg tablets of Singulair) contain lactose which can adversely affect the milk allergic. Many over the counter medications also contain lactose, so make sure you read the label prior to purchase! Talk with your pharmacist should you have questions.

Allergy Free Shop offers a wide variety of foods that are Dairy Free. Some of our best sellers are Enjoy Life's Boom Choco Boom dairy-free chocolate bars, Vance's Dari Free chocolate powder, and Home Free dairy-free chocolate chip cookies. You can view our entire stock of over 700 Dairy Free foods and beverages here.

Our goal is to provide you with a wide variety of allergy-free products for you and your children, a place where you can find EVERYTHING that you need in one place. And with ongoing vigilance, and armed with an understanding of your child's or loved one’s food allergy, you CAN avoid exposure and reactions to Milk allergens!


Hugh A. Sampson, M. D., "Food Allergy News", The Food Allergy & Anaphylaxis Network (FAAN), June 2004.

Johns Hopkins Children's Center, Science Daily, December 2007.

Justin Skripak, M.D., Jessica Savage, M. D., Elizabeth Matsui, M.D., Journal of Allergy and Clinical Immunology, November and December 2008.

Labels: allergens, allergic reaction, allergy free, big eight, dairy allergy, food allergy, ingredients

The Allergy Free Shop exists not only to provide parents and caretakers with allergen-free foods and products for those with food allergies and sensitivities, but also to provide educational information that can help provide guidance and product options to those just beginning their research and education about specific food allergies affecting their children.

Prevalence And Treatment Of Food Allergies

To begin with, any food protein which triggers an allergic response is termed a "food allergen." It is estimated that up to 12 million Americans have food allergies or reactions to food allergens, and the prevalence is rising. Six to eight percent of children under the age of three have food allergies and nearly four percent of adults have them.* And food allergies cause roughly 30,000 emergency room visits and 100 to 200 deaths per year in the United States.**

Treatment consists of either immunotherapy/desensitization, or in many cases avoidance, in which the allergic person avoids all forms of contact with the food to which they are allergic. Although there are promising areas of food allergy research, including anti-IgE antibody and specific oral tolerance induction, as of now there is no "cure" (other than immunotherapy) for many people with food allergies. Individuals diagnosed with a food allergy may choose to carry an autoinjector of epinephrine (such as a Twinject or EpiPen), wear some form of medical alert jewelry, or (with the guidance of their doctor) develop an emergency action plan. This is due to the potential serious reactions that are possible to many people with food allergies.

Common Symptoms of Food Allergy Reactions

The most common type of food allergy reaction is called a "Classic immunoglobulin-E (IgE)-mediated" or Type-1 Immediate-Hypersensitivity Reaction. These allergic reactions have an acute onset (from seconds to one hour) and may include symptoms such as Angiodema, or soft tissue swelling, usually involving the eyelids, face, lips, tongue, larynx and trachea, which can obstruct the upper airway and make breathing difficult; hives; nausea, vomiting, diarrhea, stomach cramps and/or abdominal pain; wheezing; scratchy or itchy mouth, throat, eyes or skin; nasal congestion; shortness of breath and difficulty swallowing.

In very serious cases the reaction can progress to Anaphylaxis, which is a severe, whole-body allergic reaction which requires immediate medical attention and response, and that can even result in death without acute medical intervention.

Anaphylaxis, or "Anaphylactic Shock", is defined as a systemic reaction involving several different bodily systems, and includes hypotension, or a sudden drop in blood pressure, a loss of consciousness, and the shutdown of vital bodily functions as the individual goes into shock. Many different food allergens have been reported as triggers for Anaphylaxis, but the most common allergies associated with this type of reaction are peanuts, nuts, egg, milk and seafood.

Potential Causes And Types of Food Allergy Reactions

Food allergy has been diagnosed in all types of individuals, but is thought to develop more easily in patients who display atopic syndrome. Atopic syndrome is a common combination of diseases in people who exhibit "localized, and immediate, hypersensitivity to allergens" through eczema, allergic conjunctivitis and rhinitis, and asthma. A family history of allergic diseases is often indicative of atopic syndrome, and these combinations of allergic reactions are strongly correlated to family heredity.

Conditions caused by food allergies are classified into 3 groups according to the mechanism of the allergic response. The first is the "classic" response described above, the IgE-mediated reaction, or Type-I Immediate-Hypersensitivity Reaction.
The second category is called "IgE or non-IgE mediated" eosinophilic esophagitis, gastritis and gastroenteritis reactions, which refers to acute inflammation of the esophagus, stomach or intestines caused by reactions to allergens by white blood cells, which control mechanisms associated with allergy and asthma. The last category is includes other "non-IgE mediated" reactions, such as milk-soy protein intolerance (MSPI); or conditions like food protein induced enteropathy (a pathology of the intestines), found in the common condition of Coeliac Disease, which is an adverse immune reaction to the protein gluten.

The Big Eight Food Allergies

The term "Big Eight" refers to the most common food allergies.*** They account for over 90% of the food allergies found in the United States. They are:

Egg Allergy
Dairy Allergy
Peanut Allergy
Tree Nut Allergy
Seafood Allergy
Shellfish Allergy
Soy Allergy
Wheat Allergy

Outside the U.S. the list of top allergens tends to vary somewhat from country to country, but milk, eggs, fish, shellfish, peanuts, tree nuts, sesame, soy and wheat tend to be in the top 10. Allergies related to seeds, especially sesame, appear to be rising in most countries. There are also other more rare food allergies, including corn, rice, flour, various vegetables and fruit allergies and even red meat allergy, among others.

There are other conditions which can require food allergen avoidance but are not technically allergies, such as lactose intolerance, which is actually an enzyme deficiency, not an allergy; various causes of irritable bowel syndrome (IBS); or rarer conditions such as C1 esterase inhibitor deficiency, or hereditary Angiodema. We will address some of these conditions in upcoming blogs.

Diagnosis Of Food Allergy

If you suspect a food allergy, the best method for diagnosing the condition is by visiting an allergist. The allergist will review the patient's history and the symptoms or reactions that have been noted after food ingestion. If the allergist feels the symptoms or reactions are consistent with food allergy, he/she will perform allergy tests, which may include skin prick testing (Non-IgE mediated allergies cannot be detected using this method, however), which can provide quick and usually conclusive results, diagnostic blood tests (also not effective for Non-IgE mediated allergies), or food challenges, often conducted in a hospital environment due to the potential risk of Anaphylaxis. Other tools for diagnosis of eosinophilic or non-IgE mediated reactions can include endoscopy, colonoscopy and biopsy.

This Educational Series

There are various strategies and theories regarding prevention and treatment of many food allergies, and as we continue through our educational series on the "Big Eight," we will focus on each food allergy separately, addressing the potential causes, relevant statistics, prevalent scientific opinion and research, and the treatment for each of the individual allergy categories. We will also provide information and links to our new and existing food choices and other products that we offer at Allergy Free Shop that address each specific allergen. Through this informational series, we hope that we can help you better understand - and respond - to your child's individual allergy-free needs!

In our next "Big Eight" post: Peanut Allergy.



* National Institute of Allergy and Infectious Diseases (July 2004), National Institutes of Health. pp. 35.

** Food Allergy Facts and Statistics. Food Allergy & Anaphylaxis Network. 2007.

*** "Food Allergy Facts & Figures". Asthma and Allergy Foundation of America. March 28, 2007.

Labels: allergens, allergy free, anaphyaxis, dairy allergy, food allergy, peanut allergy, tree nuts allergy, wheat allergy

Many families will leave the cooking and cleaning to others this Thanksgiving holiday, and be dining at restaurants or other people's homes instead. But failure to establish a clear line of communication between patron and establishment when dining out or with your host when eating with friends and family, along with surprise ingredients sometimes found in traditional dishes, are frequent causes of allergic reactions. And sometimes even clear communication can result in errors, such as restaurant staff that provide answers to ingredient questions with incomplete or inaccurate information.

If your family is planning on dining out this year, know how to avoid high risk situations. Here are some examples:

Creative Chefs

Thanksgiving is a holiday filled with traditional dishes - ones that many have known and loved for years. But never assume that a dish contains only traditional ingredients. In an effort to add new or unique flavors to dishes, chefs will often experiment with other surprise ingredients, so don't be caught off-guard when ordering. For example, many whipped potato side dishes contain walnuts in them. Other examples of unexpected ingredients sometimes found in traditional Thanksgiving dishes:

- Cranberry sauce: pecans, wheat
- Gravy: peanut butter, soy, Worcestershire sauce (fish)
- Mashed potato: cheese, cream cheese
- Pumpkin pie: peanut butter
- Stuffing: almond, crab, oysters, shrimp
- Sweet potato casserole: eggs, milk, pecans, walnuts

Buffet Style Restaurants

As is always the case, you can avoid problems by steering clear of help yourself dining styles, where serving utensils are sometimes shared between dishes or food is accidentally dropped into other food containers. If you do find yourself in a buffet style restaurant, work with the manager and order from the menu instead. If you are in someone's home, make arrangements to serve yourself first.

Fried Foods

You should avoid fried foods, as they are often all prepared in the same cooking oil. For example, if a fryer was used to fry shrimp, and the same oil is later reused to fry chicken, the chicken will then contain shrimp protein, and could cause an allergic reaction in someone who is allergic to shrimp.

Desserts

A study of allergic reactions to peanuts or tree nuts in restaurants found that 43% of the reactions were caused by desserts*. For example, many wait staff may not have an all-inclusive knowledge of which desserts contain nuts, and may incorrectly inform you that an item is nut-free. Often the best choice is to avoid eating desserts completely while dining out. Instead, have a special allergen-free - and worry-free - dessert or treat waiting for you when you return home!

Establish Clear Communication

In the same study, it was found that of 106 individuals with known food allergies who suffered allergic reactions while dining out, only 45% gave prior notification about the allergy to the dining establishment*. And for at least 83 (78%) of these 106 reactions, someone in the establishment knew that the food contained the allergen as an ingredient; in 50% of these incidents, the food item was "hidden" (in sauces, batter, dressings, etc.), making visual identification impossible. So be sure to inform wait staff, and ask questions! Also be sure to keep your medications, such as an EpiPen, on hand just in case. And remember, these tips can also be applied to any other traditional dishes you may encounter throughout the year.

With some preparation and by following these tips, you can help assure yourself of an allergy-free Thanksgiving holiday. So that most importantly, you can enjoy this special time with friends and family!

*Furlong, Terence J., M.S.; The Journal of Allergy and Clinical Immunology; 01-NOV-2001; 11692117 (PubMed ID)

Labels: allergens, allergy free, dairy allergy, dining out, ingredients, peanut allergy, Thanksgiving, traditional dishes, tree nuts allergy, wheat allergy