A food allergy is an allergic reaction to a particular food.
Food allergies are commonly triggered by certain nuts, peanuts, shellfish, fish, milk, eggs, wheat, and soybeans.
Symptoms vary by age and may include rashes, wheezing, a runny nose, and, occasionally in adults, more serious symptoms.
Skin prick tests, blood tests, and an elimination diet may help doctors identify the food triggering the allergy.
The only effective treatment is to eliminate the food from the diet.
(See also Overview of Allergic Reactions.)
Many different foods can cause allergic reactions. Allergic reactions to foods may be severe and sometimes include an anaphylactic reaction, which may be life-threatening.
Food allergies may start during infancy. Children may outgrow a food allergy. Thus, food allergies are less common among adults. But if adults have food allergies, the allergies tend to persist throughout life.
Food allergies are sometimes blamed for such disorders as hyperactivity in children, chronic fatigue, arthritis, and depression, as well as poor athletic performance. However, these associations have not been substantiated.
Other reactions to food
Some reactions to food are not an allergic reaction.
Food intolerance differs from a food allergy because it does not involve the immune system. Instead, it involves a reaction in the digestive tract that results in digestive upset. For example, some people lack an enzyme necessary for digesting the sugar in milk (called lactose intolerance).
Other reactions to a food may result from contamination or deterioration of the food.
In some people, food additives can cause a reaction that resembles but is not an allergic reaction. For example, some preservatives (such as metabisulfite) and dyes (such as tartrazine, which is a yellow dye used in candies, soft drinks, and other foods) can cause symptoms such as asthma and hives. Similarly, eating certain foods, such as cheese, wine, and chocolate, triggers migraine headaches in some people.
Causes of Food Allergy
Food allergies typically develop because the immune system malfunctions and misinterprets a food protein as dangerous. When the immune system is exposed to allergens, it produces a type of antibody called immunoglobulin E (IgE). (Allergens are molecules that the immune system can identify and that can stimulate a response by the immune system). The IgE antibodies trigger cells of the immune system to release substances (such as histamine, prostaglandins, and leukotrienes) that cause swelling or inflammation in the surrounding tissues. Such substances begin a cascade of reactions that continue to irritate and harm tissues. These reactions range from mild to severe.
Almost any food or food additive can cause an allergic reaction. The most common triggers vary by age group.
Infants and young children with food allergies tend to be allergic to the most common allergy triggers (allergens), such as those in the following:
Eggs
Milk
Wheat
Peanuts
Soybeans
For older children and adults, the most common triggers are allergens in
Nuts
Seafood, including shellfish
Being exposed to other allergens that are similar to those in foods (such as pollen) may trigger the production of antibodies to substances in food, resulting in a food allergy. This process is called sensitization. For example, children with peanut allergy may have been sensitized to peanuts when topical creams containing peanut oil were used to treat rashes. Also, many people who are allergic to latex are also allergic to bananas, kiwis, avocados, or a combination. Latex and these fruits contain similar allergens.
Food allergies are more common among children whose parents have food allergies, allergic rhinitis, or allergic asthma.
Alpha-gal syndrome
Alpha-gal syndrome is a rare form of allergy to red meat. Alpha-gal is a sugar that occurs in most mammals but not in fish, birds, reptiles, or people. Lone star ticks, which are present mostly in the southeastern United States, have alpha-gal in their saliva. When a lone star tick bites a person, it transmits alpha-gal to the person. Sometimes the immune system then produces antibodies to alpha-gal, resulting in an allergy to alpha-gal. Because alpha-gal is present in many red meats (such as pork, beef, lamb, and venison) and in foods produced from mammals (such as dairy products and gelatin), people with these antibodies may have an allergic reaction to these foods.
Symptoms of alpha-gal syndrome include an itchy rash, indigestion, constipation, nausea, and anaphylactic reactions. Unlike other food allergies, symptoms of alpha-gal syndrome frequently do not occur until 3 to 8 hours after eating.
Oral allergy syndrome
Oral allergy syndrome (pollen food allergy syndrome) occurs in people who are allergic to pollen. Certain proteins in pollen are similar to some proteins in food. Thus, people with oral allergy syndrome also have an allergic reaction to foods that contain these similar proteins (called cross-reactivity). The foods involved are often nuts and raw fruits and vegetables. People can usually eat these foods if they are cooked because heat changes the protein structure so that the food proteins no longer resemble the pollen proteins.
People who are allergic to certain pollens are often also allergic to specific foods as follows:
Birch pollen: Apples, almonds, carrots, celery, cherries, hazelnuts, kiwi, peaches, pears, and plums
Grass pollen: Celery, melons, oranges, peaches, and tomatoes
Ragweed pollen: Bananas, cucumbers, melons, sunflower seeds, and zucchini
When the food is eaten, the mouth and throat feel itchy. Although severe allergic reactions (anaphylactic reactions) are unlikely, they can occur.
Doctors can usually diagnose oral allergy syndrome when people who have pollen allergies have allergic symptoms after eating certain foods. Skin prick tests are sometimes done to confirm the diagnosis.
Eosinophilic gastroenteropathy
Eosinophilic gastroenteropathy is an unusual disorder causing pain, cramps, and diarrhea. The number of eosinophils, a type of white blood cell, is increased in the blood and the digestive tract. People may have a protein-losing enteropathy (in which too much protein leaks into the intestines, usually as a result of a separate long-term condition such as Crohn disease) and a history of allergies (in which the immune system over-reacts to a trigger).
Eosinophilic esophagitis may occur in people with eosinophilic gastroenteropathy or occur in isolation. Eosinophilic esophagitis is characterized by chronic inflammation of the esophagus and deposition of eosinophils in the esophagus. It may cause difficulty swallowing, food getting stuck in the throat or, in children, feeding intolerance and abdominal pain. Diagnosis is based on the results of an endoscopy and biopsy.
Symptoms of Food Allergy
Symptoms of food allergies vary depend on which food causes the allergy and how old the person is.
In infants, the first symptom of a food allergy may be a rash such as eczema (atopic dermatitis) or a rash that resembles hives. The rash may be accompanied by nausea, vomiting, and diarrhea. By about age 1 year, the rash tends to develop less often, but children may start to react to inhaled allergens (such as pollen) and have asthma symptoms. They may wheeze, feel short of breath, or get a runny nose when they eat the food that triggers their allergy. By about age 10, children rarely have asthma symptoms after the food is eaten.
When food allergies persist in older children and adults, reactions tend to be more severe. In adults, food allergies cause itching in the mouth, hives, eczema, swelling (angioedema), and, occasionally, a runny nose and asthma. Food allergies sometimes cause symptoms such as light-headedness or fainting.
For some adults with a food allergy, eating a tiny amount of the food may trigger a sudden, severe reaction. A rash may cover the entire body, the throat may swell, and the airways may narrow, making breathing difficult—an anaphylactic reaction, which can be life threatening.
For some people, allergic reactions to food (especially wheat or shrimp) occur only if they exercise immediately after eating the food (called exercise-induced allergic reactions).
Some allergic reactions to food take hours to develop and cause symptoms such as abdominal pain, nausea, cramping, and diarrhea.
Diagnosis of Food Allergy
Sometimes only a doctor's evaluation
Sometimes skin prick tests or an allergen-specific immunoglobulin test
An elimination diet
Doctors suspect a food allergy based primarily on the person’s history. Usually in adults, the allergy is obvious. But diagnosing a food allergy in children may be difficult. Some food allergies may be difficult to distinguish from many other digestive problems, such as irritable bowel disease.
If a food allergy is suspected, one of the following tests is done:
Skin prick tests with extracts from various foods may be done if a food allergy is suspected. A drop of each extract is placed on the person’s skin, which is then pricked with a needle through the drop. A skin reaction to a food tested does not necessarily mean that a person is allergic to that food, but no skin reaction means that an allergy to that food is unlikely.
Alternatively, an allergen-specific immunoglobulin (IgE) test may be done. The immune system produces a different type of IgE in response to each allergen. For example, the IgE that is produced after pollen is inhaled differs from the IgE that is produced when nuts are eaten. For the test, doctors withdraw a sample of blood and determine whether IgE in the person's blood binds to a specific allergen used for the test, such as one for peanuts. If binding occurs, the person has an allergy to that allergen.
If either test identifies a particular food, that food is eliminated from the diet. If eliminating the food relieves symptoms, the food is given to the person again to see whether symptoms develop after it is eaten. When possible, this step is done as part of an oral challenge test. The oral challenge test is done to confirm the diagnosis.
In an oral challenge test, the person is given another food (such as milk or applesauce) in 2 batches: one with the suspected food in it and one without the suspected food in it. Then the doctor observes as the person eats the food:
If no symptoms develop after the suspected food is eaten, the person is not allergic to the food.
If symptoms develop after the suspected food is eaten and not after the other food is eaten, the person is probably allergic to the suspected food.
Other ways to identify a food allergy include elimination diets:
A diet that eliminates only the food or foods suspected of causing the allergy
A diet that consists only of foods not likely to cause an allergic reaction
An elimination diet may be the only test used to diagnose a food allergy or may be used after a skin prick test or an allergen-specific IgE test.
For the first type of elimination diet, the person stops eating all foods that may be causing the symptoms for about 1 week.
The second type of elimination diet, which consists only of food not likely to cause allergic reactions, can be tried instead of the first type of diet. The second type of diet involves the following:
Following a diet prescribed by the doctor
Eating only the foods and liquids specified in the diet and only using pure products (which excludes many commercially prepared foods)
There are several possible elimination diets, which vary in the foods that are eliminated and allowed. For example, one diet may eliminate beef and lamb and allow chicken. Another may eliminate lamb and poultry and allow beef.
Following an elimination diet is not easy because many food products have ingredients that are not obvious or expected. For example, many rye breads contain some wheat flour. Eating in restaurants is not advisable because the person and the doctor need to know the ingredients of every meal eaten.
If symptoms are not relieved after 1 week, doctors may recommend a different elimination diet.
If no symptoms occur, foods are added back one at a time. Each added food is given for more than 24 hours or until symptoms appear, and thus the allergen is identified. If the person has had very severe allergic reactions to food, the doctor may ask the person to eat a small amount of a food in the office. The doctor then observes the person’s reaction to the food.
Did You Know...
Treatment of Food Allergy
An elimination diet
Sometimes medications to block the allergic reaction
Sometimes allergen immunotherapy (desensitization)
People with severe food allergies should carry antihistamines to take immediately if a reaction starts. Antihistamines are useful for relieving hives
People with food allergies must eliminate the foods that trigger their allergies from their diet.
Other medications for food allergies
monoclonal antibody manufactured to block the activity of IgE (which is produced by the immune system and causes the allergic symptoms). Omalizumab is not used to treat an acute allergic reaction but is used as a way to limit allergic reactions, particularly during desensitization treatments. The medication is given by injection.
Allergen immunotherapy (desensitization)
If an allergen cannot be avoided, desensitization immunotherapy is a process that tries to teach the person's immune system not to react to that allergen. The person is given progressively larger doses of the allergen. The first dose is so small that even an allergic person will not react to it. However, the small dose starts to get the person's immune system used to the allergen. Then the dose is gradually increased. Each increase is so small that the immune system still does not react. The dose is increased until the person is not reacting to the same amount of allergen that once caused symptoms.
Immunotherapy for food allergies is typically given by mouth. It is most widely used for peanut allergy in people who are 4 to 17 years old but may extend to other common allergens.
For peanut allergy, people are given a powder of peanut allergen by mouth. On the first day, 5 gradually increased doses are taken in a health care facility. A doctor must observe the first day's treatment because exposure to a high dose of the allergen too soon can cause a sometimes dangerous allergic reaction. People then take a dose every day. The dose is increased every 2 weeks until the maintenance dose is reached. This process usually takes about 5 months. Each time the dose is increased, the first dose must be taken in a health care facility. Eventually, people take the maintenance dose indefinitely.
People must continue to take peanut allergen powder daily to remain desensitized. Also, they still need to maintain a strict peanut-free diet, but desensitization reduces the risk of severe allergic reactions (including anaphylaxis) to peanuts consumed unknowingly.
Prevention of Food Allergy
For many years, doctors have advised against feeding young infants foods that commonly trigger an allergic reaction (such as peanuts) as a way to prevent food allergies (see also Starting Solid Foods in Infants). However, evidence suggests that regularly feeding infants foods that contain peanuts may help prevent them from developing a peanut allergy. More study of this approach is needed.
Parents should talk to their pediatrician about the best way to prevent peanut allergy in their child.
