image for food allergy article The term food allergy is often misapplied, leading many people to believe that they are "allergic" to certain foods when a more accurate term would be “food intolerance.” In fact, food allergy symptoms are caused either by a hypersensitivity reaction or by simple food intolerance to specific components of a food. Symptoms of adverse reactions to food range from a simple rash to life-threatening anaphylaxis . Identification and avoidance of any foods that trigger a reaction is the only "cure" available for food allergy.

The American Academy of Allergy and Immunology reports that 30% of adults believe they are allergic to certain foods. However, studies have shown that true food allergy is really quite rare, affecting less than 2% of the population. Part of the confusion lies in the definition of food allergy.

What Is a Food Allergy?

There is unfortunately no precise definition for the term food allergy. Instead, medical professionals use the term food hypersensitivity . This refers to a specific allergic reaction that involves the immune system, is triggered by a particular food, and is reproducible. In other words, the same symptoms—for example, wheezing or rash—must occur each time the food is eaten.

Food intolerance, which is estimated to occur in about 16% of the population, is an adverse reaction to a food and doesn't involve the immune system. Food intolerance may be inconsistent; reactions to the suspected food may vary in severity with each exposure, or may not occur at all.

What Causes a Food Hypersensitivity Reaction?

Food hypersensitivity is triggered by allergens—food components (usually proteins) that react with the immune system. Many different allergens can be present in the same food. Cow's milk; eggs; shellfish (shrimp, crab, or lobster); peanuts; tree nuts (walnuts, cashews, Brazil nuts); fish; soy; wheat; and even sesame seeds are the allergens most likely to trigger food hypersensitivity reactions.

Food hypersensitivity, especially to cow's milk, is seen more often in children (about 5%) than in adults (less than 2%). Many children outgrow food hypersensitivities in later years, with sensitivity to milk, egg, and soy the most likely to wane over time. People who are sensitive to fish or nuts, however, will probably have to avoid those foods forever.

Why Do Reactions Occur?

People who are "allergic" to certain foods are simply more sensitive to the allergens found in these foods. Allergic reactions to food result from the actions of a specific groups of proteins called antibodies . Antibodies, an important part of the body's defense system, are activated when the offending food is eaten. Their role is to recognize foreign invaders (antigens)—in this case, allergens—and to get rid of them.

Certain types of antibodies, known as IgE, are more highly reactive, and perhaps more abundant, in people with food hypersensitivity.

When IgE antibodies encounter a food allergen to which they are sensitized, they attach themselves onto the food proteins. This attachment causes the immune system to release mediators—chemical messengers that travel through the bloodstream to alert other organs to the presence of an unwelcome protein guest.

Release of these mediators causes the uncomfortable—or occasionally dangerous—symptoms of an allergic reaction. The extent of the reaction depends on the quantity of food eaten, age and health status, and the route taken by the mediators. The three most common reaction sites include:

Skin

Symptoms of allergic reaction in the skin include rash, urticaria (raised, red, and extremely itchy welts also known as hives ), and angioedema , which is a swelling of the skin that results from leakage of fluid into tissues. Angioedema affects the skin and mucosal tissues of the face, lips, mouth, and throat, larynx, extremities, and genitalia. Itching and eczema (an itchy, scaly skin rash) are also common but usually occur several hours to days after the offending food is ingested. Urticaria and angioedema are most commonly immediate reactions, typically occurring within minutes (sometimes seconds) of food ingestion.

Gastrointestinal Tract

Mediators that travel to the GI tract may cause symptoms along its entire length: swelling of the lips, itchy mouth or throat, nausea and vomiting, cramps and bloating, abdominal distention or intense abdominal pain, and diarrhea .

Respiratory Tract

Symptoms that affect breathing may include asthma , rhinitis (stuffy, swollen, or runny nose), wheezing, or difficulty breathing.

Anaphylactic Shock

Anaphylactic shock is an extremely severe and life-threatening type of allergic reaction. The symptoms occur in rapid succession, progressing from itching or throat swelling to difficulty breathing, hypotension , and loss of consciousness or even death, if appropriate treatment is not immediately instituted.

Food Intolerance

Adverse reactions to food that occur outside of the immune system are defined as food intolerances. Distinguishing food intolerance from food hypersensitivity is often difficult for the lay person, because the symptoms are quite similar. Food intolerances can be attributed to a number of different causes, including:

  • Chemical additives including aspartame, dyes, nitrites, MSG, sulfites, and tartrazine
  • Pharmacologic causes or reactions to naturally-occurring, drug-like substances in foods such as caffeine, alkaloids (found in mushrooms), or goitrogens (in cabbage)
  • Enzyme deficiency, such as lactose intolerance (the inability to produce the enzyme lactase, which digests lactose sugar in milk)
  • Psychological disorder, such as food aversion
  • Idiosyncratic, meaning "cause unknown"

Diagnosing Food Hypersensitivities

Diagnostic tests must be conducted to determine if a true food allergy is present. These might include:

  • Skin prick test—Extracts of suspected food antigens are dropped on the skin and the area is pricked or scratched through the drop. A "positive" result (raised bump) proves that immune cells in the skin are reacting to the antigen.
  • Immunoassay, radioallergosorbent test (RAST), and fluorescent enzyme immunoassay (FEIA) test—This blood test indicates the presence of IgE, the antibody most active in food hypersensitivity reactions. The test can help identify which foods to avoid by matching up specific food antigens and IgE antibodies.
  • Challenge test—The patient is fed suspected foods under carefully controlled conditions, and any reactions are noted. This is dangerous, however, if he is at risk for an anaphylactic shock. The challenge test is only performed in certain situations.
  • Food diary—If the diagnosis remains in question, the patient may be asked to keep a food diary for 1-2 weeks, writing down all foods eaten and noting any reactions. Any suspected foods are then eliminated to see if the symptoms clear up.
  • Patch testing—While this type of test is still being researched, there is some evidence that applying foods under a dressing for 48 hours may indicate a food sensitivity.

What Are the Treatment Options?

Dietary modification is the usual method of treating food hypersensitivity with elimination of the allergy-causing food. An elimination diet can become very limited, so the assistance of a registered dietitian (RD) should be enlisted. He can explain the diet and ensure that nutrition requirements are being met.

There are no existing cures for food hypersensitivity. Although allergy injections and antihistamine medications work for pollen or inhaled allergens, these remedies don't work against food hypersensitivities or food intolerances. Strict avoidance of the offending foods is the only treatment. This is a serious challenge; all restaurant dishes and food label must be examined.

When food hypersensitivity occurs, acute treatment may be required. In the face of anaphylaxis, such action may be life-saving. Immediate administration of epinephrine is necessary to stop the reaction. Further treatment in an emergency room or doctor’s office is generally required. This may include antihistamines, steroids, or both.

While an initial anaphylactic reaction may not be severe, the second may be fatal because it occurs after the body has had time to build up antibodies specific to the offending food allergen. Consultation with an allergist is necessary to determine if you are at risk for this reaction. Most persons who have had significant anaphylactic reactions should always carry an automatic injector device, such as the Epi-pen or Twinject, that allows them to rapidly treat symptoms while awaiting transport to an emergency facility.

Skin and respiratory reactions may sometimes be treated with antihistamines or asthma inhalers. All hypersensitivity reactions in which there is swelling of the mouth or throat must be rapidly evaluated by qualified medical personnel after the use of an epinephrine auto-injector to ensure that the swelling does not obstruct breathing.