In the middle of the night in Atlanta, I received a mad call from my daughter in Chicago. "Daddy, I'm so sorry to wake you up, but Michael just ate a slice of cashews, and now his face is swollen and he breaks out in a rash all over his body." As soon as I realized that her voice was not just part of a bad dream, I gave orders to my doctor: “Give him Benadril and immediately take him to the emergency room!”
As a 25-year-old certified allergist, I learned that my grandson had a potentially serious allergic reaction and that his symptoms might get worse - much worse. Fortunately, by the time they arrived at the hospital, the swelling had subsided and his hives had resolved.
Although the diagnosis of my grandson was easy to do, food allergies can be one of the most unpleasant and difficult allergy problems faced by doctors, patients and families. If you are considering an unlimited amount of foods and supplements that we consume today, the variable time between food intake and the allergic reaction, as well as the various and often subtle symptoms, seems wonderful when the food that causes the allergy is actually identified.
Food allergies in children: an alarming trend
Ask anyone who raised children 25 years ago, if they have ever heard of food allergies, then the likely answer is no. But today, who does not know a child, if not several children, who have severe food allergies? Pediatricians and allergists observe first-hand that food allergies in infants and children have increased to the extent of the epidemic over the past few decades. Studies have shown that in the age group up to 18 years, the prevalence of registered food allergies increased by 18% from 1997 to 2007. Approximately 4% of Americans are estimated to have food allergies. This is more than 12 million people. The prevalence of food allergies is even higher - from 6% to 8% in infants and children under 3 years old.
Any type of food can trigger an outbreak, but the Big 8 accounts for more than 90% of all cases: milk, eggs, peanuts, nuts, fish, shellfish, soybeans and wheat. Sesame is quickly becoming another common cause of allergies, especially in people with Mediterranean diets. The good news is that the incidence of documented food allergies decreases with age, probably due to the development of tolerance in children who are allergic to milk, wheat, soy and eggs. Of the 2.5% of children who are allergic to milk, approximately 80% will “outgrow” their allergies by five years. Children allergic to peanuts or nuts are not so lucky. Recent studies have shown that only 10% to 20% of children will lose their allergies as they age.
Pediatric food allergies: instantaneous outbreak. In the two main types of allergies, an “immediate hypersensitivity reaction” becomes most likely, probably because you immediately see the symptoms (be it hives or a tumor). The other species is precisely named “delayed hypersensitivity reaction”. Otherwise, known as an IgE-mediated, immediate allergic reaction is best understood and most easily diagnosed. But it can also be the most serious. When proteins in an allergenic food come in contact with an IgE antibody (located in the skin, intestines and airways or in the blood), a cascade of cellular events occurs, leading to the release of histamine and many other chemical mediators. The rapid release of histamine and other chemicals causes an allergic reaction. . An outbreak that usually occurs within a few minutes after a meal can be relatively light or severe. Mild symptoms may include rash, generalized itching and redness of the skin, swelling of the face or eyelids, abdominal cramps, vomiting and / or diarrhea. They can be treated with a fast-acting antihistamine and, as a rule, undergo a course of a few minutes to several hours. The most severe reaction is called anaphylaxis, which can occur instantaneously or a few minutes after ingestion. As a rule, the sooner the symptoms occur, the more severe the reaction can be. Symptoms of anaphylaxis can include those listed above, but can also develop quickly in breathing difficulties and cramps (due to narrowing of the bronchi and swelling of the airways), lowering blood pressure, leading to shock and even death. Epinephrine (also known as epinephrine), which is available for self-injection in the form of epipin and other autoinjectors, should be immediately given and repeated if necessary. Foods that usually cause serious reactions include peanuts, tree nuts, fish, sesame seeds, milk and eggs. The most serious reaction that I have ever observed was the result of taking one pine nut. This tiny seed (it's not really a nut) turned a healthy teen into a critically ill patient in a matter of minutes. Fortunately, the patient recovered, but anaphylaxis can be fatal if not treated immediately and aggressively. If your child has ever had an immediate allergic reaction to food, you should consult a certified allergist. In order to identify or confirm the food that causes the symptoms, the allergist will most likely conduct several tests, either through the skin or through the blood. From there, you and your allergist can come up with a plan to eliminate food from your child’s diet and discuss how to prevent and manage future reactions.
Delayed allergic reactions: subtle, but not exceptional
Although less dangerous in terms of immediate health, a “delayed allergic reaction” can be much more difficult to diagnose and treat. As the name implies, it may take several hours or even days after a meal to identify symptoms, which makes it difficult to establish cause-effect relationships. Typical symptoms can include several organ systems and can be quite subtle in their presentation. In addition to the classic symptoms of allergy (such as nasal congestion, runny nose, and rash), delayed reactions can also manifest very vague and non-specific symptoms, such as frequent headaches, recurrent or chronic abdominal pain, fatigue and lethargy, dark circles under the eyes, pain in the legs and recurring infections of the ear or sinus.
Part of the difficulty in diagnosing these nutritional reactions is that there is no reliable allergy test that can accurately identify or predict an outbreak delay. Skin testing and blood tests do not help, as they only measure the IgE antibody, which is responsible for immediate reactions. The studies have not yet identified the antibody or antibodies responsible for the delayed reactions, although there was considerable interest and research into the possible role of IgG antibodies. Blood tests to measure this antibody are available, but its reliability as a predictor of delayed allergy has not yet been established.
So how can you tell if your child’s symptoms are the result of what he or she is? The best method we have now is to eliminate the suspect food (or drink) from your child’s diet in four weeks. If you notice a significant improvement in symptoms, you are ready for the problem phase: serve food for several days in a row. If the symptoms begin to recur, you can be sure that causal relationships have been established. Even after you avoid the culprit, it may still take several weeks for the symptoms to completely disappear, so be patient.
Of course, milk and other dairy products are the most common cause of this kind of reaction. Over the years, many teenagers have entered my office with parents complaining of stomach discomfort and deep fatigue. By the time they came to me, they usually took various tests and saw several doctors, including gastroenterologists, and often diagnosed with irritable bowel syndrome. Hearing about my saga and symptoms, and seeing dark circles under the eyes and a pale, pale complexion, I can usually say that it is a milk allergy. Fortunately, many responded sharply to a few weeks after the milk. They could not believe that innocent acts of drinking milk and eating dairy products could make them feel so bad, and that avoiding these products could restore their good health and vitality in such a short time.
Food Allergies Cross-reactivity
If you are like me, you may have a food allergy, which is directly related to your sensitivity to pollen from trees and weeds. Called "oral allergy syndrome", this condition manifests itself when there is cross-reactivity between the pollen of trees or weeds and the corresponding products that have a common allergen. For example, due to the fact that ambrosia pollen and food in a pumpkin family have a common allergen, people who are allergic to ragweed can show symptoms after a meal, such as melons (watermelon, cantaloupe and honeymoon), zucchini, cucumbers and bananas. Since I am allergic to ambrosia pollen, I cannot eat melons or ripe bananas without developing a strong itch in my throat. If you are sensitive to birch pollen, you can respond to apples, pears and apricots. Celery can be a problem for those who are allergic to pollen hormone.
The typical symptoms, which are usually mild and transient, are itching of the throat, mouth, and tongue. This itchy throat often causes sufferers to pull their tongue against the soft palate, creating a characteristic "hoarse" sound. The vast majority of patients experience symptoms within five minutes after ingestion. Depending on the season, a particular pollen season may affect the presentation. The positive effect of this condition, which is the most common food allergy in adults, is that the symptoms are caused only by the intake of raw or uncooked fruits or vegetables. The heating process that occurs during cooking destroys the allergic protein, so you can eat boiled, baked, fried or roasted fruits and vegetables without causing symptoms.
Allergy in babies
Because of their age, newborns and babies may be particularly sensitive to food allergies. Symptoms may include colic, irritability, excessive spitting and vomiting, a rash (including eczema or urticaria), nasal symptoms (such as congestion and runny nose), cough or wheezing and other gastrointestinal symptoms (diarrhea, bloody stools or constipation). There may also be poor weight gain. Allergies in babies before the first age almost always cause food, most often cow's milk. However, the baby should not drink milk directly so that the symptoms break out: the proteins in cow's milk can penetrate the baby’s system through some commercial formulas, as well as through mother's milk during feeding. A small percentage of milk-allergic children are also allergic to soy.
In recent years, researchers have devoted themselves to understanding the alarming growth of food allergies, especially in infants and children. What they found prompts allergists and doctors to drastically revise recommendations on how and when we introduce products for babies. For many decades, a time-tested and well-proven approach has been to postpone the introduction of highly allergenic foods into the infant's diet, in order to prevent the appearance of food allergies. For example, solid foods are usually not recommended for up to six months, cow's milk for up to one year, eggs for up to two years, and peanuts, nuts and fish for up to three years. There is also the generally accepted idea that one breastfeeding during the first six months of life will minimize or delay the onset of food allergies and other allergies (including asthma), as well as atopic dermatitis or eczema.
However, the latest medical evidence debunks these age-old theories. Indeed, the recommendation to postpone the introduction of products for babies as a means of preventing food allergies may be the wrong approach in general. Recent studies have revealed very reliable scientific evidence that widespread practice of delaying the introduction of cow's milk, eggs, peanuts and other foods may increase the risk of developing an allergy to baby foods. And, more importantly, there is evidence that the early introduction of allergenic products can actually prevent the development of allergies to this food. For example, a recent study found that children in England are ten times more likely to be allergic to peanuts than children in Israel. One very strong hypothesis explaining this discovery is that Israeli babies are introduced into peanuts, usually through Bamba (a flavored peanut snack, which is used as a teething food), at about six months of age. On the other hand, children in England, as a rule, are not introduced into peanuts in any form for up to three years. This study is just one of many that strongly suggest that early introduction to certain foods can help children reduce desensitization, thereby reducing the risk of developing food allergies.
Management of severe allergies
Historically, the treatment of serious allergies to food has been to avoid contact with the allergen and receive antihistamines and adrenaline. Withdrawal symptoms are indeed difficult and often impossible, as evidenced by the large number of accidental swallowing and allergic reactions that led to an ambulance visit. Even with strict measures to prevent the potential danger of sudden and life-threatening outbreaks can lead to extreme anxiety in both the child and the parents.
Fortunately, medical studies have shown that oral immunotherapy can lead to a significant degree of desensitization or tolerance to this food in most allergic patients. However, this form of therapy is associated with significant risk and should only be carried out with a vigilant examination of an allergist who is certified on board, who are experiencing induction of oral tolerance. Currently in the United States, this form of desensitization is being conducted at several highly regarded medical centers.
Future without allergies
Since all the time and money is invested in research into food allergies, in medicine there is anxiety about the possibility of new breakthroughs in the near future, both in prevention and in treatment. For example, I am optimistic that a safe and effective treatment is close.
