Almost 10% of Americans will be diagnosed with a food allergy at some time in their lives. Most of these do occur in kids, and many of these food allergies will be outgrown, particularly milk, egg, soy and wheat. Other common culprits, however, are peanuts, tree nuts, seeds, fish and shellfish.
Peanuts, tree nuts (walnut, pecan, almond, cashew, etc) and shellfish are associated with the highest likelihood of causing severe (anaphylactic) reactions and are often not outgrown. It is estimated that less than half of kids will outgrow a peanut or tree nut allergy, so careful avoidance of these foods, sometimes for life, may be necessary.
The way we diagnose food allergies is with a skin prick test using a diluted extract made from a given food. This is an extremely reliable way to identify which food someone is allergic to. Once this diagnosis is made, we then check a blood level to the particular food allergen. This is important because we need to see if there is a baseline blood level that is detectable which we can recheck every 1-2 years to watch for the food allergy to be outgrown. Only about 85% of people have a detectable blood level if they are allergic to a food (which is why we don’t rely on it to initially diagnose a food allergy), but if there is a detectable level, it can be followed over time, usually every year. When this level gets below a certain threshold, this correlates with a high level of likelihood that the person has outgrown his or her food allergy. This is usually a better approach than just repeating the person’s skin test every year.
Having a food allergy means that it needs to be carefully and completely avoided to keep from having another allergic reaction. The best way to avoid food allergens is to read food labels and avoid eating “homemade” foods where food ingredients are not known for certain. Baked goods, casseroles and breads often contain variations of ingredients that can pose a high risk for the allergic individual.
Carrying an epinephrine auto-injector is critical for someone with a food allergy as this is the only known lifesaving medication available. Oral antihistamines such as Benadryl can help with hives, but this will not prevent throat constriction, chest tightness or low blood pressure (shock) which can occur in an allergic reaction and lead to death. Epinephrine (Epipen or Auvi-Q) works within 3-5 minutes to begin reversing symptoms but comes in a 2-pack since some people will need a second dose 3-5 minutes later if the first dose is not working. Recurrence of symptoms 30-60 minutes later can happen after the epinephrine wears off. For this reason, it is very important to go to the emergency room or call EMS once the epinephrine auto-injector is used. Some people also need breathing treatments, IV fluids, etc. which can be administered in the ER, if necessary.
A great resource to refer to online is foodallergy.org, acaai.org or aaaai.org for information on food allergies, avoidance measures, restaurant safety, local support groups or handouts to share with friends, family members or schools regarding food allergies.
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