How to manage food allergy with confidence

Up to 10% of the population have true food allergy, while 50-90% of people who believe they have food allergy may not. An accurate diagnosis is important so the condition can be managed properly when appropriate, but not needlessly..

One of the most informative lectures I heard recently was about food allergy, a common problem that patients and even physicians don’t always understand.

I welcomed the chance to hear from an expert to help me counsel my patients. I also have a personal interest since my grandson has food allergies; when he visits me, I have to be careful not to feed him foods he may react to.

The speaker, Kirsten Bennett, Ph.D. is a registered dietitian (RD) who specializes in counseling patients with food allergies. She presented data from research studies as well as from her clinical practice, and I’m sharing some of what she said with you.

How to manage food allergy with confidence-watercresswords.com

 

What is food allergy?

You may assume that any symptom due to eating a food is an allergy but there are many ways food can make us sick, including allergy, intolerance, toxic effects, and infection.

Dr. Bennett explained the difference between food allergy and food intolerance. (The other two will not be discussed here)

Allergy– is immune-mediated, meaning the immune system produces and releases antibodies after exposure to a food; celiac disease is due to food allergy.

Intolerance– does not involve the immune system, no antibodies are produced; this occurs in lactose intolerance.

Some foods such as wheat and milk can cause both allergy and intolerance.

cup of milk, plate of bread
Milk and wheat can cause allergy and intolerance.

So how do you know the difference? You can’t, without an appropriate medical evaluation, so it is important to see a physician if you suspect a food allergy.

Up to 10% of the population have true food allergy, while 50-90% of people who believe they have food allergy may not. An accurate diagnosis is important so the condition can be managed properly when appropriate, but not needlessly.

What causes food allergy?

The BIG 8 cause 90% of food allergy. These are

  1. Milk
  2. egg
  3. peanut
  4. fish
  5. shellfish
  6. soy
  7. wheat
  8. tree nut

 

 

 

 

 

Symptoms of food allergy

Almost any symptom can occur with allergy but the most common are

  • Rash with or without itching
  • Swelling of the face, lips, eyes
  • Watery, itchy eyes
  • Nasal drainage and/or congestion
  • Hoarse voice
  • Cough, wheezing, difficulty breathing
  • Nausea, vomiting, diarrhea
  • Dizziness, fainting
  • Low blood pressure, fast heart beat
  • Feeling of “impending doom”

 

 

 

 

How to diagnose food allergy

Although blood and skin testing may be helpful, the history is the first and most important step to identify food allergy. The evaluation may start with the answers to these 9 questions-

  • What are the symptoms?
  • What food was eaten that may have caused the symptoms and was it eaten before?
  • How much of the food was eaten?
  • Was the suspect food cooked or raw?
  • Has the food ever been eaten without symptoms?
  • Was else was the person doing or ingesting at the same time, such as exercise, medications, etc.?
  • Have the symptoms occurred without eating the food?
  • How were the symptoms treated and how long did they last?

What You Need to Know About Diagnostic Allergy Testing

by David Stukus, MD,Assistant Professor of Pediatrics in the Section of Allergy/Immunology at Nationwide Children’s Hospital, in Columbus Ohio.

 

 

Goals in  managing food allergies

Allow the child (or adult) to live as normal a life as possible while avoiding foods that might cause allergic symptoms.

The fear of a serious food allergic reaction can cause a family to forgo normal activities and keep a child isolated. Dr. Bennett suggested these tactics to minimize food allergy anxiety.

Family of 4 sitting at a dining table.
Read food labels carefully to avoid inadvertently eating foods that cause allergy.

At home 

  • Cook as a family ; Learn how to cook meat and other protein foods
  • Take children grocery shopping and engage them in food selection
  • Use at least 3 elements of the plate model for meal planning
  • Gather together and celebrate food and eating together
  • Practice manners and table talk
  • Make the home kitchen a safe sanctuary
  • Enjoy the food journey

Travel

  • Take foods along that are safe
  • Identify possible allergy risks in travel itinerary -Restaurants

At school 

  • What does the school staff and administration know about food allergies?
  • Start a conversation Provide reference materials or community resources
  • Create a plan for inclusion
  • Partner with the school
  • Universal supports for all children

Find more Tips for Maintaining a Healthy Lifestyle from Kids With Food Allergies.org

 

Be prepared for an emergency allergic reaction.

Anaphylaxis

The greatest danger of any allergy is anaphylaxis, a life-threatening allergic reaction that impairs breathing and heart function.

a heart monitor showing a heart tracing EKG
Minutes matter with allergy emergencies

Anyone who cares for a person with food allergy needs to know what to do in case of a reaction. Schools and work places should have a plan for dealing with such emergencies.

Create and Maintain an Action Plan for school/work-

Develop an individualized Health Care Plan  – which includes strategies for food avoidance as well as an Emergency Action Plan with specific actions to be taken in the event of accidental or purposeful ingestion of the allergenic food.

Maintain a current and backup supply of emergency medication

  • Epinephrine (Injectable)
  • antihistamine

Document specific instruction on transport to ER/ED (emergency room) for follow-up care
Emergency medications and plan need to be accessible at all times.


exploring the HEART of food allergy

I also addressed food allergy in this book review post.

Food Without Fear- a book about food allergy

The book “Food Without Fear” by Dr. Ruchi Gupta addresses food allergies, intolerances, and sensitivities. It covers topics such as the food reaction spectrum, the top food allergens, and managing food allergies in different settings. It also provides comprehensive resources and explores using epinephrine in allergy emergencies. The book aims to help individuals understand and…

Keep reading
Dr. Aletha

Dr. Charles Krauthammer- a physician to know- in memoriam

As a physician, I am intrigued and inspired knowing Dr. Krauthammer completed medical school and residency after and despite sustaining a spinal cord injury which caused quadriplegia (paralysis from the neck down, preventing use of his arms and legs).

I don’t remember the first time I read an article by Charles Krauthammer but once I did, I never missed a chance to read more. Dr. Krauthammer passed away from cancer in 2018 and I among many mourn his passing.

His Washington Post syndicated column appeared in my local newspaper on Saturdays;  I would read it aloud at breakfast so my husband and I could discuss it. Invariably, there would be one or two words or phrases we didn’t understand so I would look up the definition- this despite  both of us having graduate degrees.  We were alternately entertained, enlightened, and enthralled by his way with words.

As a physician, I am intrigued and inspired knowing  Dr. Krauthammer completed medical school and residency after and despite sustaining a spinal cord injury which caused quadriplegia (paralysis from the neck down, preventing use of his arms and legs).   (This no doubt made his treatment and recovery from cancer surgery all the more difficult.)  In his memoir, he explained how a caring professor did whatever it took to help him get through medical school after his injury, including lectures at his bedside while he was still hospitalized.

DR. CHARLES KRAUTHAMMER-IN MEMORIAM-WWW.WATERCRESSWORDS.COM

He did not use “M.D.” or the title “Dr.” after he changed his career from psychiatry to journalism, but I think he should have, he earned it.  He mostly wrote about politics and social issues but occasionally would address medical issues. (These and others in this post are affiliate links to Dr. Krauthammer’s books and others.  )

Here are excerpts from a sampling of  articles that deal with medical topics;  I encourage you to read them in their entirety.

 

 

After watching videos in which  The price of fetal parts was discussed over lunch, Dr. Krauthammer wrote

“Abortion critics have long warned that the problem is not only the obvious — what abortion does to the fetus — but also what it does to us. It’s the same kind of desensitization that has occurred in the Netherlands with another mass exercise in life termination: assisted suicide. It began as a way to prevent the suffering of the terminally ill. It has now become so widespread and wanton that one-fifth of all Dutch assisted-suicide patients are euthanized without their explicit consent.

ultrasound image of a 4 month old fetus
a prenatal ultrasonographic image of fetus at the four-month point in its gestation; public domain image used courtesy of the CDC/ Jim Gathany

There is more division about the first trimester because one’s views of the early embryo are largely a matter of belief, often religious belief. One’s view of the later-term fetus, however, is more a matter of what might be called sympathetic identification — seeing the image of a recognizable human infant and, now, hearing from the experts exactly what it takes to “terminate” its existence.

The role of democratic politics is to turn such moral sensibilities into law. This is a moment to press relentlessly for a national ban on late-term abortions.”

 

 

 

After Another massacre, another charade  he said this about guns and laws about them.
gun metal barrel
Photo by Somchai Kongkamsri on Pexels.com

“So with the Roseburg massacre in Oregon. Within hours, President Obama takes to the microphones to furiously denounce the National Rifle Association and its ilk for resisting “common-sense gun-safety laws.” His harangue is totally sincere, totally knee-jerk and totally pointless. At the time he delivers it, he — and we — know practically nothing about the shooter, nothing about the weapons, nothing about how they were obtained.

In the final quarter of his presidency, Obama can very well say what he wants. If he believes in Australian-style confiscation — i.e., abolishing the Second Amendment — why not spell it out? Until he does, he should stop demonizing people for not doing what he won’t even propose.”

 

In this tongue-in-cheek (pardon the pun)  post Food fads: Make mine gluten free he “preaches skepticism” about most current dietary advice.

“Exhibit A for medical skepticism, however, remains vitamin C. When Linus Pauling, Nobel laureate in chemistry (not nutrition), began the vitamin-C megadose fad to fend off all manner of disease, the whole thing struck me as bizarre. Yes, you need some C to prevent scurvy if you’re seven months at sea with Capt. Cook and citrus is nowhere to be found. Otherwise, the megadose is a crock. Evolution is pretty clever. For 2 million years it made sure Homo erectus, neanderthalensis, sapiens, what have you, got his daily dose without having to visit a GNC store.

Sure enough, that fashion came and went. But there are always new windmills to be tilted at. The latest is gluten.

various types of bread
Photo by Pixabay on Pexels.com

Now, if you suffer from celiac disease, you need a gluten-free diet. How many of us is that? Less than 1 percent. And yet supermarket shelves are groaning with products proclaiming their gluten-freedom. Sales are going through the roof.”

Exploring the HEART of health with Dr. Charles Krauthammer

I enjoyed listening to  Dr. Krauthammer’s memoir THINGS THAT MATTER: Three Decades of Passions, Pastimes, and Politics  

Charles Krauthammer-THINGS THAT MATTER
available as an audiobook from the iTunes Store

His book is a collection of  his more memorable opinion pieces as well as a memoir of his life, including medical school, his life-changing injury, psychiatric medical practice, his  journalism career, hobbies (chess and baseball) and life with his family.

According to Amazon-

Now, finally, the best of Krauthammer’s intelligence, erudition and wit are collected in one volume.”

Dr. Aletha
in memoriam

In his last piece for The Washington Post, barely two weeks before his death, Dr. Krauthammer wrote,

“I leave this life with no regrets. It was a wonderful life — full and complete with the great loves and great endeavors that make it worth living. I am sad to leave, but I leave with the knowledge that I lived the life that I intended.”

I am sad he left, but grateful that he shared his “intelligence, erudition, and wit” with the world.  May we all find the loves and endeavors that make life worth living and live intentional lives as well as he did.

 

Tributes to Dr. Krauthammer, a few of many

from the NATIONAL REVIEWCharles Krauthammer, R.I.P.

from THE NEW YORK TIMES – The Example of Charles Krauthammer

from the WEEKLY STANDARDThe Quick Wit of Charles Krauthammer

Please share this post and share about your recollections of  Dr. Krauthammer’s work.