On Cracking the Nut of Food Allergies
May 16, 2014
LANDSTUHL REGIONAL MEDICAL CENTER, Germany -- As a continuing goal of the Landstuhl Regional Medical Center Allergy Clinic, it is important for people to not only be personally aware of food allergies among our population, but to reach out and educate others on the importance of knowing the basics when allergies are concerned.
The LRMC Allergy Clinic staff endeavors to be a part of the process in establishing patients' food allergies and having the ability to provide in-depth education on how to control and treat related symptoms and reactions.
While food allergies seem to only affect 5 to 10 percent of the population, it is still crucial that awareness is accounted for among every potential patient, according to Lt. Col. (Dr.) Kirk Waibel, a LRMC Staff Allergist. There are a wide variety of patients that are treated at the allergy clinic for both food and non-food related allergies. However, when it comes to food allergies, he says that the clinic tends to see more children than adults because food allergies are more likely in children.
There are certain indicators that lead to allergy concerns. Many begin with severe eczema (an intense skin irritation involving dry, itchy areas), followed by the hay fever, and possibly the development of asthma. Waibel said the process of these diagnoses occurring in this cycle is called the "Allergic March," and patients who experience any of these phenomenons are more likely to develop a food allergy.
There are eight major food allergens that affect patients, which include milk, egg, peanut, tree nut, soy, wheat, fish, and crustacean shellfish. These foods seem to apply worldwide, but different areas are more apt to developing certain allergens over the other. Particular allergies seem to develop in different countries generally pertaining to the most common food eaten there.
For example, in China there tends to be a higher rice allergy among the population, whereas in the United States there seems to be a higher milk or egg allergy. Waibel said there has been no substantial evidence found that points to the reasoning of this development. Because the population of the KMC is mostly a "westernized culture," milk, soy, wheat, eggs, peanuts and tree nuts tend to appear as the most common food allergies.
One of the main difficulties of living and/or traveling throughout Europe and having a food allergy is the language barrier. It can be difficult for patients who are not fluent in German to have the ability to translate allergies, or to simply feel comfortable enough to converse.
In 1994 the U.S. passed a Consumer Protection Act requiring companies to label foods with any of the eight common food allergens that are in the product, making it easier for patients to be aware of what they are consuming. Other countries do not yet have these mandates, but Waibel hopes the process of creating translations of the foreign food labels in an attempt to make travel less stressful for patients becomes a global initiative.
Although food allergies are more common in children, they can also develop later in life and result in a reaction as an adult. Adults are not as prone to developing more than one food allergy. Children, on the other hand, are more apt to develop an allergy to multiple foods.
"Approximately 30 percent of children who have one food allergy will develop another food allergy, sometimes unrelated, but usually within the top eight common food allergens," said Waibel.
Despite this possibility, he says patients should not be restricted from eating other foods from the "top eight" group. This circumstance also applies to "high-risk patients." This refers to children whose parents have (or have previously had) an allergy to a particular food. There should be no restriction to what foods the children of these patients are eating. Once there is an elimination of certain foods due to being nervous a reaction may occur when one has never occurred, Waibel said there is a possibility of creating nutritional issues for the child.
It is advised to not worry about a food allergy until a reaction occurs. From this point, depending on the severity of the reaction, the child should be seen by a doctor. During the process of diagnosing an allergy, the patient should first see their primary healthcare provider who will evaluate the patient's symptoms and determine if they need to see an allergist. This step of taking the full story about what happened is highly recommended, Waibel said, because it will provide the family practitioner the ability to take proper action while treating the patient to their specific needs. If there is a concern based on the story for a food allergy, the next step is to have the provider seek the medical expertise of an allergist.
In order to establish if there is an allergy to a certain food, the patient's history is evaluated to ensure that the reactions and symptoms are consistent. Then a skin or a blood test for the specified allergy is given, depending on the suspicion of which food allergy is present.
Following these steps, allergists are then able to diagnose the allergy and develop a manageable treatment. The first and most important step is to try to avoid the food of concern. If this is unavoidable and a severe reaction occurs, patients are advised to use an epinephrine auto-injector, which Waibel said could potentially be a lifesaving immediate treatment.
He said a patient or caregiver should never leave a medical professional's office without being properly trained on the auto-injector's use. A common misconception of correct treatment for anaphylaxis (a serious allergic reaction that involves more than one body system) is to take antihistamines such as Benadryl. While this can calm any skin symptoms, it does not treat anaphylaxis, leaving the patient at high risk for a severe reaction or even death.
According to Waibel, symptoms of a reaction to a food can occur the first time the child ingests the food, but more often than not the reaction will arise after multiple instances. Over 90 percent of reactions have some type of skin irritation symptom that appears, making this one of the most common symptoms to look for during a reaction.
This could be anything from itching, flushing, or hives on the skin. While it is common for children with an allergy to milk, egg or soy to have outgrown this by 5 years old, about 80 percent of the population does not outgrow a peanut allergy, and about 90 percent do not outgrow a tree nut allergy. Unfortunately, patients with a shellfish allergy generally carry it for life.
While studies and research have shown there are no current preventions to food allergies, Waibel said there is no reason to limit children from trying all common allergenic foods who have never had a reaction. The most important element of food allergies is education and awareness. He said the continuing goal of the LRMC Allergy Clinic is to continue educating the community on food allergies and to steer them in the correct direction to ensure beneficiaries are receiving the most appropriate help and expertise for their concerns.
Waibel said ideally children with food allergies should never feel segregated or bullied by other classmates. Food allergy is a stressful diagnosis to both the patient and their family, but by spreading awareness to families, friends, teachers and our population, he said we can help relieve the strain these patients must deal with on a daily basis.