Let's learn more about food allergies. Don't be afraid to know these things!

Today we are going to talk about something that is important to many people, and sometimes a little scary. That is food allergies, or as we say in English, ``Food Allergies''. Have you ever experienced a sudden attack of nausea, difficulty breathing, or stomach upset after eating a food? Maybe it has happened to you. Let's see what these really are, why they happen, and how we can be careful.

What are Food Allergies?

Simply put, a food allergy is when your body mistakenly identifies a harmless food as "harmful" and reacts to it. Think of it like your body's defense system, which sees a normal food and goes, "Oh, this is an enemy!" So, they do what they think is "protecting" you, and you develop symptoms. These can include hives, swelling, stomach pain, vomiting, diarrhea, and difficulty breathing .

Sometimes this condition can be very dangerous. We call it `(Anaphylaxis)`. This is when the airways swell and you can't breathe, or your blood pressure suddenly drops very low. If you suddenly have swelling of your face, mouth, lips or throat, difficulty breathing or swallowing, or feel faint, you should call 911 or go to the nearest hospital emergency department immediately. This is not a joke, okay?

Are there different types of food allergies?

Yes, there are several main types. When we usually say "food allergies," we mean allergies that cause immediate and sometimes severe reactions to things like peanuts, tree nuts, and cashews. Your doctor may call these "true allergies" or "IgE-mediated allergies." This "IgE" is a type of antibody in our body. These are the ones that do the "misidentification" as mentioned earlier.

There is also a type called `(Oral allergy syndrome)`. This also belongs to the `(IgE-mediated)` type. However, in this case, there is only a local reaction on the lips and inside the mouth. This is very rare to progress to `(Anaphylaxis)`.

In addition, there are also types of food reactions called `(Non-IgE-mediated)`. That is, those that are not related to `IgE` antibodies. Some examples are:

• `(Food protein-induced enterocolitis syndrome - FPIES): This mainly involves vomiting and diarrhea.
• Eosinophilic esophagitis: This is inflammation of the esophagus .
• Eosinophilic gastritis: Inflammation of the stomach occurs.
• `(Food protein-induced proctitis)`: This is something that usually happens to young children, and symptoms include a little blood passing in the stool.

What are the most common food allergies?

There are several foods that cause the most allergies around the world, as well as in our country. These are the main ones:

• Peanuts
• Tree nuts like cashews, almonds, walnuts(eg almonds, walnuts, pistachios, hazelnuts, pecans, cashews, Brazil nuts)
• Milk ( especially cow's milk)
• Eggs
• Fish
• Shellfish ( like shrimp, crab, squid)
• Soy
• Wheat
• Sesame

These foods account for about 90% of all food allergies. However, it is important to remember that you can be allergic to any food, even if it is not on this list . Some people are allergic to fruits and vegetables as well.

What symptoms can occur with a food allergy?

The symptoms of a food allergy can vary from person to person. For some people, it can be very mild, while for others, it can be very severe. Here are some of the most common symptoms:

• Hives or skin rash: These suddenly become red, itchy, and swollen, like a mosquito bite. These are very itchy.
• Itchy skin: Itching all over the body can be harmless.
• Swelling of the face, lips, mouth, or tongue: This is a slightly more alarming sign.
• Itchy mouth and throat: Itching sensation in the throat when eating.
• Hoarse voice: Sudden change in voice.
• Difficulty swallowing: Feels like something is stuck in the throat.
• Wheezing: A whistling sound coming from the chest.
• Shortness of breath or difficulty breathing: This is also an emergency.
• Coughing: You may have a continuous cough.
• Abdominal pain: The stomach hurts and feels like it's being turned over.
• Vomiting
• Diarrhea
• Lightheadedness or fainting: This may be due to low blood pressure.
• Runny nose
• Sneezing

The most important thing: Let's say you had a mild reaction to a certain food before. But the next time you eat the same food , you could have a very severe reaction. So, if you experience severe symptoms (especially difficulty breathing, swelling of the face), go to the hospital immediately.

How long does it take for symptoms of a food allergy to start?

Typically, symptoms begin to appear within two hours of eating the food you are allergic to. Sometimes they can start within minutes. Very rarely, symptoms appear hours later.

Why do these food allergies occur?

It's a bit of a complicated story, but in simple terms, it's like this. When you have a food allergy, your immune system , the system that protects us from disease, mistakenly identifies a protein in a food as "harmful." It reacts to it as if it were a virus or bacteria.

So, when you eat a food you are allergic to, this immune system kicks in and starts a series of mechanisms to get rid of the "harmful" thing (allergen) from your body. That's when all the symptoms mentioned above appear. Sometimes this reaction can be severe enough to be life-threatening.

Who is more likely to develop food allergies?

Some people are more likely to develop food allergies for the following reasons:

• If you have other allergies: For example, if you are allergic to pollen or dust, you may also be allergic to food.
• If you have eczema or asthma: Some people have eczema, asthma, and allergies all at once. This condition is also called ``Atopy''.
• If someone in your family (mother, father, siblings) has allergies, asthma, or eczema: There may be a genetic predisposition.

What are the possible complications of food allergies?

The most dangerous complication of food allergies is the aforementioned `(Anaphylaxis)` condition. This can cause swelling in multiple body systems, uncontrolled vomiting, severe difficulty breathing, and a severe drop in blood pressure (anaphylactic shock). Severe `(Anaphylaxis)` can even lead to death. Therefore, you need to be very careful about this.

How do doctors diagnose food allergies?

If you think you have a food allergy, you should definitely see a doctor. He or she will ask you about your symptoms and, if necessary, order allergy testing . It's a good idea to have the following information ready when you visit your doctor:

• What foods trigger your symptoms (if you know).
• Whether the food was eaten raw or cooked.
• How much of that food did you eat when the symptoms appeared?
• What symptoms are you experiencing, and how severe are they?
• How long does it take for symptoms to start after eating?
• Were there other factors that could have affected your symptoms? (e.g., were you having a viral illness at the time? Were you exposed to another allergen – like pollen?)
• Did you try any treatments at home, and did they help you recover?
• Do symptoms always occur when you eat this food, or only sometimes?
• How long have these symptoms been present?
• Do you have any other known allergies (to food, pollen, dust, animals, etc.)?
• Do you have eczema or asthma?
• Does anyone in the family have allergies, asthma, or eczema?

These details will be a great help to the doctor in understanding the problem properly.

What are the tests for food allergies?

If the doctor thinks it is necessary, he or she may perform the following tests:

• Allergy skin test: This involves applying a very small amount of the substance you think you are allergic to to your skin (usually your arm or back), pricking the skin with a very small needle, and then waiting for 15-20 minutes to see if there is any reaction (redness, swelling).
• Allergy blood test: This involves taking a sample of your blood and checking it for IgE antibodies against the foods you think you are allergic to.
• Food challenge test: This is done very carefully, under the supervision of a doctor, and only in a hospital. In this, you are given gradually increasing amounts of the food you suspect you are allergic to. This is done to see if you have a reaction. Since this is a bit risky, medical supervision is a must.

How are food allergies treated?

In fact, the best way to manage food allergies is to avoid your allergen. That means not eating that food. However, there are now several treatments that can reduce the risk of an allergic reaction. These include injections, oral medications, and sublingual medications.

Also, it is very important to keep emergency medications, especially an `(Epinephrine)` auto-injector (e.g. `(EpiPen®)`, `(Auvi-Q®)`, handy in case you accidentally eat a food you are allergic to.

Omalizumab injections

Your doctor may give you a shot called Omalizumab (brand name Xolair®) once or twice a month. Or you can train yourself to inject it. This can help reduce the risk of a reaction if you are unknowingly exposed to a food you are allergic to.

Oral immunotherapy (OIT)

Oral Immunotherapy (OIT) is a program that helps you or your child gradually build up a tolerance to a food you are allergic to. Under the supervision of a doctor, you are given gradually increasing amounts of the food you are allergic to over a period of months. The goal is to become "bite-proof" so that even small amounts of the food you are allergic to will not cause a severe reaction. Some people can eat previously allergic foods without any problems after OIT treatment.

Sublingual immunotherapy (SLIT)

Sublingual Immunotherapy (SLIT) is similar to OIT. It involves giving your body a small amount of the allergen every day to build up your tolerance to it. But instead of eating it, you place a liquid or tablet containing the allergen under your tongue and let it dissolve.This ``(SLIT)`` treatment must be done under the supervision of a doctor to ensure safety.

Emergency medications

If you have an allergic reaction after accidentally eating a food you are allergic to, your doctor may recommend the following medications:

• An epinephrine auto-injector (e.g., EpiPen® or Auvi-Q®) : Your doctor will advise you to use it at the first sign of a severe allergic reaction (anaphylaxis). It is essential to keep this with you.
• Corticosteroids : These types of steroids work by reducing inflammation.
• Antihistamines : These can help stop or slow down allergic reactions. However, they are not prescribed to prevent reactions from food allergies.

What if I have a food allergy?

If you or your child has a food allergy, you should make it a habit to read food labels and avoid foods that may contain the allergen . You can talk to an allergist to discuss treatment options and what to do if you have a reaction. He or she may also recommend repeated allergy tests from time to time to see if your child's allergies have decreased or if the treatment has developed a tolerance.

Allergic reactions are unpredictable. So, even if you have a mild reaction one time, the next time it can be severe. Also, there is no test that can tell you exactly how severe a reaction you will have to a food without eating it. So, don't be complacent just because something minor happened before, and always be cautious.

Do food allergies go away?

Sometimes yes. Most young children outgrow milk and egg allergies by the age of 6. However, allergies to peanuts, tree nuts, shellfish, and fish are very rare (less than 20%).

Can food allergies be prevented?

Although there is no surefire way to prevent food allergies, you can try these things to reduce your child's risk of developing allergies:

• If you are breastfeeding (unless you are also allergic to those foods) , include peanuts and other common allergens in your regular diet.
• Ask your baby's doctor when and how to introduce new foods. He or she may recommend introducing foods that may cause allergies early, or under the supervision of a doctor, depending on your baby's other health conditions.
• Once your child has safely introduced foods that they may be allergic to, continue to feed them a variety of foods they are not allergic to (including nuts, milk, and eggs). This can reduce the risk of developing allergies later on.

How can I take care of myself or my child?

To prevent yourself or your child from unknowingly eating a food you are allergic to, do the following:

• Check the ingredients label of pre-made foods. This can be a bit difficult in Sri Lanka, but try your best. In foreign countries, if the food contains any of the 9 common allergens, it should be listed on the label. Also be aware of words like "may contain" or "made on shared equipment".
• Always check the label when you buy food at the store, when you bring it home, and before you eat it.
• Start talking to your child at an early age about being careful about what they eat and not sharing food with others that you don't know is safe.
• When eating out, be very careful at restaurants. Ask if the food contains anything you are allergic to. But remember that they may not be able to give a 100% guarantee.
• Let everyone around your child know about his allergies and what foods are safe for him to eat.
• Talk to your child's school or daycare about their allergy and find out what plans they have to prevent unknowingly exposing them to the food they are allergic to.
• Plan well when traveling and other times you are away from home. Take safe food with you, or find safe places to eat in advance.
• If you have any questions about what you can and cannot eat, ask your doctor.

Be prepared in case of an allergic reaction:

• Always carry an epinephrine auto-injector with you. Ask your doctor how to use it properly.
• Make sure your child's school or daycare has a Food Allergy & Anaphylaxis Emergency Care Plan from your child's doctor. This explains what to do if your child has an allergic reaction.
• Provide your child's school or daycare with an epinephrine pen and any other medications your child may need.

When should I see a doctor?

If you think you or your child may have a food allergy, see a doctor immediately. He or she can refer you to a specialist and give you guidance on what to do next.

When should I go to an Emergency Treatment Unit (ETU) ?

Without medical treatment, allergic reactions can be life-threatening.If you experience any of these symptoms, go to an emergency room immediately or call 1990:

• Swelling of the face, lips, tongue, or throat
• Difficulty breathing
• Chest tightness
• Hives (hives)
• Numbness in the hands, feet, or lips
• Weakness, dizziness, or fainting
• A strange fear, a feeling of impending doom

What questions should I ask my doctor?

It may be helpful to ask your doctor some questions like these:

• Are there any treatment options for me/my child?
• What should I do if I/my child has an allergic reaction or accidentally eats something I am allergic to?
• What are some ways to prevent unknowingly being exposed to an allergen?
• How do I use this medicine?
• When do I need `(Epinephrine)`?
• Do you have an allergy action plan?

How common are food allergies?

Studies show that between 6% and 11% of adults have food allergies. Also, about 8% of children suffer from food allergies.

It could be your child, or it could be something you’ve just been diagnosed with. However, a food allergy can be a life-changing experience. Having to avoid certain foods, wondering what you or your child can eat, and the fear of never eating out at a restaurant again can all be overwhelming. However, for most people, this constant fear doesn’t last forever.

There are more options than ever for those who need to be extra careful when eating out. There are apps and online groups that can help you find safe foods to stock your pantry. Many people find restaurants and food they trust and frequent. Living with an allergy gets easier when it becomes a part of your daily life.

Finally, take-home message:

A food allergy is something to be afraid of, but if you are properly informed about it and take the necessary steps, you can live a normal life.

• Identify exactly what foods you are allergic to. Seek medical advice.
• Always read food labels. If in doubt, avoid the food.
• Always carry an epinephrine auto-injector (if you are at risk of severe allergic reactions) and know exactly how to use it.
• Inform your family, friends, and school/work colleagues about your allergy.
• Don't be afraid to ask questions. Seek advice from your doctor or a nutritionist.

Remember, you are not alone. There are many people living with food allergies. Get the help and support you need. Take care!

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