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Published on April 29, 2014

Getting Schooled about Food Allergies

Awareness and Knowledge are Keys to Better Outcomes

Understanding Food Allergies

May is National Asthma and Allergy Awareness Month, so what better time than now to learn more about food allergies.

Join board-certified allergist Amee Majmundar, M.D., as she discusses food allergies and their triggers, how people are diagnosed and the treatments options available.

The presentation will take place at 6:30 p.m. Thursday, May 22, at Palos Health & Fitness Center, 15430 West Ave., Orland Park. Registration is required; register online or call (708) 226-2300.

More than 12 million people in the United States have food allergies, with children being the fastest growing group. 

“We’ve seen a near doubling in food allergy diagnoses over the last decade,” says Amee Majmundar, M.D., an Orland Park allergist. “This is a relatively young person’s disease, and there’s a lot we can do. It’s one condition where parents and children like to take ownership of the disease as opposed to avoidance or fear.”

Schools are becoming more involved in the process, too. Food allergies affect 1 in 13 children, meaning there is the possibility of two children per classroom having some form of food allergy.

In November, President Barack Obama signed into law the School Access to Emergency Epinephrine Act, which encourages schools to plan for severe asthma and allergic reaction emergencies by stocking epinephrine auto-injectors.

“This lends a lot of support to parents of children with food allergies,” says Dr. Majmundar, who notes this primarily addresses first-time allergic reactions. “This measure supports children who never had a previous reaction. Their first event could occur while at school.” 

Signs of a reaction

Food allergy reactions typically occur in any of these four areas of the body:

  • Skin, by producing itchy red bumps (hives); eczema; redness and swelling of the face or extremities; and itching and swelling of the lips, tongue or mouth. Skin reactions are the most common type of reaction.
  • Respiratory tract, by producing a runny or stuffy nose, sneezing, coughing wheezing and shortness of breath.
  • Cardiovascular system, by causing lightheadedness or dizziness.
  • Gastrointestinal tract, by causing abdominal pain, nausea, vomiting or diarrhea.

Anaphylaxis is a more widespread form of allergic reaction that involves two or more of the body systems listed above. This is a potentially life-threatening reaction that also can cause swelling of the airways, difficulty breathing, a drop in blood pressure, loss of consciousness, and in some cases, even death.

Dr. Majmundar suggests that fatalities related to anaphylaxis have generally been in delay of epinephrine administration.

“This is truly the life-saving maneuver. Epinephrine has an immediate effect, while other allergy medications, such as Benadryl, have a relatively longer onset of action. That’s a huge difference,” she says. “So if there is ever a hesitation of what to do, and you know someone is allergic and showing severe and or rapidly evolving symptoms, then epinephrine should be administered.”

Once epinephrine is given, it is important for the person having the reaction to seek urgent medical care and get to the nearest emergency department.

What causes a food allergy?

Food Allergy Research & Education (FARE) explains the immune system’s job is to identify and destroy germs, such as bacteria or viruses, which make you sick. A food allergy results when the immune system mistakenly targets a harmless food protein – an allergen – as a threat and attacks it with IgE antibodies by releasing histamine as a form of “protection.”

Dr. Majmundar says there are a couple of possible explanations for the increasing number of food allergies:

  • The presentation of allergens too early in life. Allergists feel strongly about not introducing certain foods until certain ages.  Recommended milestones include cow’s milk at 12 months of age, eggs at 24 months and shellfish and nuts until 3 to 5 years of age. “The more highly allergic the family history, the more these milestones are emphasized,” Dr. Majmundar explains. 
  • Hygiene Hypothesis: This is the theory that children who live in rural areas and therefore exposed to less sterile environments would be less likely to become allergic to food, pollens and dust than their urban counterparts. 

“Allergies are a deviation the immune system takes because of the lack of preoccupation to these bacteria at a young age,” Dr. Majmundar says.

Eight foods account for 90 percent of all food allergy reactions in the U.S. Those foods are:
  • Nuts
  • Fish
  • Eggs
  • Milk
  • Soy
  • Wheat
  • Shellfish
  • Tree nuts

Dr. Majmundar says milk and egg allergies are seen at the beginning of life and are the two most likely allergens to be outgrown. “While there is no cure for food allergies as of yet, the cornerstone of therapy is avoidance. Studies show 50 percent of children by age 5 and 70 percent by age 7 should outgrow allergies to milk and eggs if these foods are not ingested. It’s really a very striking, positive direction.”

Elementary schools are the place to focus most when it comes to food allergies. “You have a younger group of children with a higher risk of cross-contamination and accidental exposure,” Dr. Majmundar says. “It’s also the formative time where awareness hasn’t yet set in on the part of the child.”

Schools in the surrounding area also are working to better educate their teachers and students about food allergies. In some cases, nut products have been removed from vending machines, school parties and treat bags. At lunch time, students with allergies are allowed to sit at separate tables from offending food items.

"More often, I find in my practice that the parents have taken the remarkable role of educator and advocate for their child,” Dr. Majmundar says.

Diagnosis and treatment

If your child shows signs of having a food allergy, contact your pediatrician.  You may request a referral to an allergist. To diagnose an allergy, a doctor will ask for a description of the symptoms, how often they occur, how long it takes symptoms to show after eating the suspicious food and if there is a family history of allergies or conditions like eczema and asthma. 

Next, an allergist will try to identify the possible food allergy by performing one or more of the following tests: trial elimination diet, skin testing, blood testing or a supervised office-based food challenge. 

“The most sensitive indicator is the skin test. Within 15 minutes, you will see a reaction that is controlled and local,” Dr. Majmundar says.

Once the allergen is diagnosed, the cornerstone of therapy is avoidance.

“The fear is the not knowing. It creates a sense of anxiety,” Dr. Majmundar says. “Once you are proactive and see an allergist, you get the correct information and it really kind of demystifies the whole thing.”

Seasonal allergies and the connection to the foods we eat

Flowers are blooming, grass is growing and the trees are coming out of their winter hibernation. And many of us may be suffering from nasal allergy symptoms since it’s peak season for many part of the United States. But that doesn’t mean we should stay inside.

“Pollen is an outdoor entity. You can’t really avoid it,” Dr. Majmundar says. “I’m very much against the idea of children with allergies or asthma staying indoors on high pollen count days or windy days. These conditions should never be a crutch for you to not leading as normal a life as possible, and that includes exercising and being healthy.”

But here’s something to look out for. Did you know that for some people with seasonal allergies and pollen allergies, eating certain foods can trigger an allergic reaction? This Oral Allergy Syndrome causes your immune system to treat the pollens found in fruit the same way it does when it tries to force the airborne pollen from your system. Your immune system attacks the intruder by creating a cross-reaction, and you may be left with an itchy mouth and tongue.

“A lot of people feel like they have these random allergies, but it really isn’t random. It makes a lot of sense,” Dr. Majmundar says. “If you are highly allergic to ragweed and you eat a banana and your throat starts itching, it’s real and there is a connection.”

Here’s a list of some fruits that may be connected to your seasonal allergies. 

Ragweed: Bananas, avocado, melons, kiwis

Birch Pollen:  apples, peaches, plums, cherries

Grass: peaches, celery, tomatoes, oranges