| Food Allergies |
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Often, patients come in telling us what foods they are allergic to on the basis of allergy testing done years
previously. On history, they avoid these foods, but have no problems when they are eaten accidentally. It’s
quite possible that they are not allergic to those foods at all. Allergy testing is very accurate when we test for
dust mites, mold, and pollen. But it's less accurate when we test for foods, especially to foods that a patient
doesn’t even think they’re allergic to. Years ago, many allergists, even those board certified by the American
Board of Allergy & Immunology, would give patients instructions to avoid foods just on the basis of skin test
results. Luckily, this is rarely done today. The most reliable way to confirm a food allergy is with a food
challenge. This test involves giving a capsule to a patient which contains either the food which they suspect
or something harmless (a placebo). To ensure the objectivity and validity, the patient (and often the doctor)
doesn’t know which capsule they receive.
Reactions can range from immediate itching or swelling of the lips and/or tongue, to hives, coughing, and
wheezing. These usually happen within a few minutes after eating the food, sometimes up to an hour. But
some true food allergies cause stomach cramping and diarrhea hours later. Unfortunately, there are no safe
and effective forms of allergy shots or allergy drops for food allergy at this time.
Food allergies can be life-threatening, especially if one is allergic to peanuts, shellfish, or tree nuts (walnuts,
pecans, etc) Besides avoiding these foods, the doctor should prescribe an injector device with epinephrine
(adrenaline) to be available at all times. There are two reliable devices: EpiPen® and Twinject. Epinephrine
doesn’t have a long shelf life; the devices leave the factory with an 18-24 month expiration date. Make sure
that the one you buy has at least 12 months left until it expires. You often get the freshest EpiPen® or
Twinject at 24 hour pharmacies. Twinject has a $20 rebate at www.twinject.com . Having said all that, if
anaphylaxis occurs and all you have is an expired device, good research shows that it’s still worthwhile using
it.
A careful distinction must be made between "food allergy" and "food intolerance". Many people have
lactose intolerance, which causes gastrointestinal symptoms upon eating milk products. Lactose is the
sugar in milk, and if you don’t have the enzyme to digest it, these symptoms can arise. Other examples of
food intolerance include headaches from drinking wine or a runny nose from eating spicy foods.
previously. On history, they avoid these foods, but have no problems when they are eaten accidentally. It’s
quite possible that they are not allergic to those foods at all. Allergy testing is very accurate when we test for
dust mites, mold, and pollen. But it's less accurate when we test for foods, especially to foods that a patient
doesn’t even think they’re allergic to. Years ago, many allergists, even those board certified by the American
Board of Allergy & Immunology, would give patients instructions to avoid foods just on the basis of skin test
results. Luckily, this is rarely done today. The most reliable way to confirm a food allergy is with a food
challenge. This test involves giving a capsule to a patient which contains either the food which they suspect
or something harmless (a placebo). To ensure the objectivity and validity, the patient (and often the doctor)
doesn’t know which capsule they receive.
Reactions can range from immediate itching or swelling of the lips and/or tongue, to hives, coughing, and
wheezing. These usually happen within a few minutes after eating the food, sometimes up to an hour. But
some true food allergies cause stomach cramping and diarrhea hours later. Unfortunately, there are no safe
and effective forms of allergy shots or allergy drops for food allergy at this time.
Food allergies can be life-threatening, especially if one is allergic to peanuts, shellfish, or tree nuts (walnuts,
pecans, etc) Besides avoiding these foods, the doctor should prescribe an injector device with epinephrine
(adrenaline) to be available at all times. There are two reliable devices: EpiPen® and Twinject. Epinephrine
doesn’t have a long shelf life; the devices leave the factory with an 18-24 month expiration date. Make sure
that the one you buy has at least 12 months left until it expires. You often get the freshest EpiPen® or
Twinject at 24 hour pharmacies. Twinject has a $20 rebate at www.twinject.com . Having said all that, if
anaphylaxis occurs and all you have is an expired device, good research shows that it’s still worthwhile using
it.
A careful distinction must be made between "food allergy" and "food intolerance". Many people have
lactose intolerance, which causes gastrointestinal symptoms upon eating milk products. Lactose is the
sugar in milk, and if you don’t have the enzyme to digest it, these symptoms can arise. Other examples of
food intolerance include headaches from drinking wine or a runny nose from eating spicy foods.