Food allergies can be concerning for anyone, but for some, they can be deadly. So, when food companies release food for sale to the public without labeling potential allergens on their packaging, this poses a major food safety problem. For some people, just inhaling a food item can cause a severe allergic reaction. This is why proper food labeling is so important. This is also why our food allergen lawyer is here to help you.
If you or a loved one have been affected by undeclared food allergens or have become ill due to mislabeling of food products, you may be entitled to compensation. Protect your rights and make sure you obtain the justice that you deserve for your injuries by contacting our highly skilled team food allergen lawyers at The Lange Law Firm, PLLC today.
Any food can cause an adverse reaction in any person who may have the allergy. However, there are eight types of food account for about 90 percent of all reactions. These are:
For some people, an allergic reaction to a particular food may be uncomfortable, but not severe. For other people, an allergic food reaction can be frightening and even life-threatening. Food allergy symptoms usually develop within a few minutes to two hours after eating the offending food.
The most common food allergy signs and symptoms include:
In some people, a food allergy can trigger a severe allergic reaction called anaphylaxis. This can cause life-threatening signs and symptoms, including:
Emergency treatment is critical for anaphylaxis. Untreated, anaphylaxis can cause a coma or even death.
Most food-related symptoms occur within two hours of ingestion; often they start within minutes. In some very rare cases, the reaction may be delayed by four to six hours or even longer. Delayed reactions are most typically seen in children who develop eczema as a symptom of food allergy and in people with a rare allergy to red meat caused by the bite of a lone star tick.
Another type of delayed food allergy reaction stems from food protein-induced enterocolitis syndrome (FPIES), a severe gastrointestinal reaction that generally occurs two to six hours after consuming milk, soy, certain grains and some other solid foods. It mostly occurs in young infants who are being exposed to these foods for the first time or who are being weaned. FPIES often involves repetitive vomiting and can lead to dehydration. In some instances, babies will develop bloody diarrhea. Because the symptoms resemble those of a viral illness or bacterial infection, diagnosis of FPIES may be delayed. FPIES is a medical emergency that should be treated with IV rehydration.
Not everyone who experiences symptoms after eating certain foods has a food allergy or needs to avoid that food entirely; for instance, some people experience an itchy mouth and throat after eating a raw or uncooked fruit or vegetable. This may indicate oral allergy syndrome – a reaction to pollen, not to the food itself. The immune system recognizes the pollen and similar proteins in the food and directs an allergic response to it. The allergen is destroyed by heating the food, which can then be consumed with no problem.
The primary way to manage a food allergy is to avoid consuming the food that causes you problems. Carefully check ingredient labels of food products, and learn whether what you need to avoid is known by other names.
The Food Allergy Labeling and Consumer Protection Act of 2004 (FALCPA) mandates that manufacturers of packaged foods produced in the United States identify, in simple, clear language, the presence of any of the eight most common food allergens – milk, egg, wheat, soy, peanut, tree nut, fish and crustacean shellfish – in their products. The presence of the allergen must be stated even if it is only an incidental ingredient, as in an additive or flavoring.
Some goods also may be labeled with precautionary statements, such as “may contain,” “might contain,” “made on shared equipment,” “made in a shared facility” or some other indication of potential allergen contamination. There are no laws or regulations requiring those advisory warnings and no standards that define what they mean. If you have questions about what foods are safe for you to eat, talk with your allergist.
Be advised that the FALCPA labeling requirements do not apply to items regulated by the U.S. Department of Agriculture (meat, poultry and certain egg products) and those regulated by the Alcohol and Tobacco Tax and Trade Bureau (distilled spirits, wine and beer). The law also does not apply to cosmetics, shampoos and other health and beauty aids, some of which may contain tree nut extracts or wheat proteins.
Avoiding an allergen is easier said than done. While labeling has helped make this process a bit easier, some foods are so common that avoiding them is daunting. A dietitian or a nutritionist may be able to help. These food experts will offer tips for avoiding the foods that trigger your allergies and will ensure that even if you exclude certain foods from your diet, you still will be getting all the nutrients you need. Special cookbooks and support groups, either in person or online, for patients with specific allergies can also provide useful information.
Many people with food allergies wonder whether their condition is permanent. There is no definitive answer. Allergies to milk, eggs, wheat and soy may disappear over time, while allergies to peanuts, tree nuts, fish and shellfish tend to be lifelong.
Be extra careful when eating in restaurants. Waiters (and sometimes the kitchen staff) may not always know the ingredients of every dish on the menu. Depending on your sensitivity, even just walking into a kitchen or a restaurant can cause an allergic reaction.
Consider using a “chef card” – available through many websites – that identifies your allergy and what you cannot eat. Always tell your servers about your allergies and ask to speak to the chef, if possible. Stress the need for preparation surfaces, pans, pots and utensils that haven’t been contaminated by your allergen, and clarify with the restaurant staff what dishes on the menu are safe for you.
Never attempt to diagnose or treat a food allergy on your own. Find an allergist to help you determine if you have a food allergy, and how to treat it. Diagnosing food allergies can be as complicated as the medical condition itself. Symptoms of food allergy can vary from person to person, and a single individual may not always experience the same symptoms during every reaction. Food allergic reactions can affect the skin, respiratory tract, gastrointestinal tract, and/or cardiovascular system, and people develop food allergies at various ages.
Diagnostic food allergy testing offers clues about the causes of symptoms, but it cannot determine whether someone has a food allergy with absolute certainty without a challenged study. Still, when a food allergy is suspected, it’s critically important to consult with an allergist who can determine which food allergy tests to perform, determine if food allergy exists, and counsel patients on food allergy management once the diagnosis has been established.
To make a diagnosis, allergists ask detailed questions about the history of allergy symptoms. Be prepared to answer questions about the specific foods and the quantities you consumed, the length of time that it took for symptoms to develop, the symptoms themselves, and how long they lasted. The allergist will usually order a blood test (such as an ImmunoCAP test) and/or perform a skin prick food allergy tests, which indicate whether food-specific IgE antibodies are present in your body.
Skin prick tests are conducted in a doctor’s office and provide results within 15 – 30 minutes. A nurse or the allergist administers these tests on the patient’s arm or back by pricking the skin with a sterile small probe that contains a tiny amount of the food allergen. The tests, which are not painful but can be uncomfortable, are considered positive if a wheal (resembling a mosquito bite bump) develops at the site.
The blood tests, which are less sensitive than skin prick tests, measure the amount of IgE antibody to the specific food(s) being tested. Results are typically available in about one to two weeks and are reported as a numerical value.
Your allergist will interpret these results and use them to aid in a diagnosis. While both of these diagnostic tools can signal a food allergy, neither is conclusive. A positive test result to a specific food does not always indicate that a patient will react to that food when it’s eaten. A negative test is more helpful to rule out a food allergy. Neither test, by its level of IgE antibodies or the size of the wheal, necessarily predicts the severity of a food allergic reaction.
Together with the patient’s history, an allergist may use these tests to make a food allergy diagnosis. In some cases, an allergist may wish to conduct a double-blinded, placebo-controlled oral food challenge, which is considered to be the gold standard for food allergy diagnosis. However, the procedure can be costly, time-consuming, and in some cases is potentially dangerous, so it is not routinely performed.
During an oral food challenge, the patient is fed tiny amounts of the suspected allergy-causing food in increasing doses over a period of time under strict supervision by an allergist. Emergency medication and emergency equipment must be on hand during this procedure.
Oral food challenges also may be performed to determine if a patient has outgrown a food allergy.
The best way to prevent food allergies, according to a new report by the American Academy of Allergy, Asthma, & Immunology (AAAAI) is to expose babies to more foods early, rather than delaying them. The recommendations, based on several studies and expert opinions, are a complete reversal of the guidelines of a decade ago.
The report also presents research showing how gradual and early exposure to a variety of foods can prevent food allergies rather than cause them. The recommendations also mean that women who are pregnant and mothers who are breastfeeding are freer to eat what they want.
The American Academy of Pediatrics published guidelines in 2000 recommending that infants not consume milk until they were 1 year old, eggs until age 2, and peanuts, tree nuts, fish, or shellfish until their third birthdays. There was no evidence that delaying those foods prevented eczema and food allergies, so in 2008 those guidelines were changed.
But it was unclear when and how to begin giving those foods to young children. As a result, many parents were confused about how to protect their children and remained cautious. Mothers-to-be cut certain foods out of their diets and left them out as they began nursing.
The 2013 report recommends that basic foods like rice or oat cereal, fruits, and vegetables should be introduced when babies are between 4 and 6 months of age, according to these new guidelines. The AAAAI recommends that allergenic foods like eggs and cow’s milk be given for the first time at home, rather than at day care or in a restaurant and can be introduced after an infant has successfully tolerated a few of the basic complementary foods.
Introducing foods early can actually prevent food allergy in infants and children. Two studies found that there was a higher rate of wheat allergy in 5-year-olds who had not been fed wheat until after they were 6 months old. Another found that delaying wheat in the diet until the age of 6 months did not protect against wheat allergy.
In adolescence, teens face peer pressure — all the while their brains are developing and their hormones surging. Adding food allergies to the mix ratchets up the risk-taking potential, since not all teens willingly speak up about their food triggers. There is much that parents and peers can do to help allergic teens navigate the sometimes-treacherous path to adulthood.
While deaths from severe anaphylactic reactions are uncommon, when they do occur, we know it’s most often among adolescents and young adults, particularly in reaction to peanuts and tree nuts. Certainly not all teenagers take risks when it comes to their allergies, but several commonalities emerge among those who do.
A 2006 survey of adolescents and young adults with food allergies determined that 17 percent of its participants were at “high risk” because they did not always carry epinephrine and ate foods that “may contain” their allergen. Three years later, a bigger survey of food-allergic college students at the University of Michigan, Ann Arbor found that only 21 percent of participants said they owned an auto-injector. Also concerning was the large number of students — 60 percent — who reported a previous allergic reaction (though not anaphylaxis) but also said they continued to willingly consume their food allergen.
Few large studies have explored which factors could help predict whether or not a child will achieve tolerance—that is, outgrow an allergy. Between June 2009 and February 2010, Dr. Ruchi Gupta and colleagues (Ann & Robert H. Lurie Children’s Hospital, Chicago) surveyed the families of 40,104 children nationwide—the largest study of this kind to date. The researchers analyzed data for nine common food allergies: milk, peanut, shellfish, tree nuts, egg, fin fish, wheat, soy, and sesame.
The study, published online in the Annals of Allergy, Asthma and Clinical Immunology in July 2013, found that 3,188 children surveyed currently had a food allergy, while 1,245 had outgrown one. Key findings of this FARE-funded study include:
Other factors that contributed to outgrowing an allergy included having a history of only mild to moderate reactions, being allergic to only one food, and having eczema as the only symptom. Conversely, children with severe symptoms (trouble breathing, swelling, and anaphylaxis) and multiple food allergies were less likely to achieve tolerance.
Dr. Gupta and her team conclude that, while more studies over longer periods of time are needed to confirm these findings, this data can improve the management of food allergies and aid in counseling food allergy families.
In the elderly, the prevalence of food allergies is estimated at 5% to 10%,1,2 but is likely underestimated and underdiagnosed, and, thus, undertreated. A study reported that 24.8% of geriatric nursing home patients (mean age of 77) were positive (skin test) for food allergens.3,4 It’s speculated that 25% to 30% of adults self-diagnose food allergies, but the true prevalence is approximately 5% in industrialized countries.4,5 Notably, food allergies can develop at any time and aren’t limited to manifestation in the pediatric population. Foods commonly associated with adult food allergy are fruits, vegetables, tree nuts, peanuts, and seafood (shellfish), but aren’t limited to these foods. The prevalence of fruit and vegetable allergies are thought to be a result of cross-reactivity with aeroallergens (oral allergy syndrome) to birch, ragweed, and grass.
In the elderly, confounding factors for food allergy development include decreased stomach acid (leading to decreased protein digestion and increased in vivo exposure to absorbed allergenic epitopes) and an age-related decrease in total serum immunoglobulin E (IgE).
Conversely, alcohol consumption greater than 14 units per week significantly increases total serum IgE concentrations, which correlates with positive food allergen tests. These various factors may induce de novo sensitization to food allergens, increasing the need for continuous screening and diagnosis. In the geriatric population, typical diagnostics may be insufficient to detect a food allergen but should continue to be the starting point as shown in Table 1. Self-diagnosis needs to be eliminated because the subsequent self-management may lead to nutritional inadequacy, potential nutrient deficiencies, and increased frailty from over-restricting food intake.
Malnutrition, another significant concern in the elderly, plays a critical role in immune system maintenance and efficiency. The three micronutrients of concern are vitamin D, zinc, and iron. An insufficiency or deficiency in calcitriol, the active form of vitamin D, may negatively affect food-related IgE reactions (nonlinear association). Poor zinc bioavailability (absorbed from food) and in vivo homeostasis may further alter the immune efficiency, favoring the development of food allergies. Iron deficiency also has been associated with immune system issues, decreasing antibody responses and increasing the risk of food allergy. In these cases, correcting any deficiencies through vitamin and/or mineral supplementation should improve outcomes and possibly reduce the incidence of any deficiency-related allergies. Blood measurements for zinc, iron, and vitamin D are easily obtainable. (Note: zinc measurements may not indicate a deficiency and should be coupled with risk factors and symptoms.)
Symptoms of food allergies can range from mild to severe. A person experiencing anaphylaxis will seek immediate medical attention that results in an easier diagnosis. However, the elderly are less likely to experience anaphylaxis, making detection more difficult. The elderly report mild symptoms that are often nonspecific and can be related to numerous causes.
Health care professionals may not identify the reported symptoms as potential food allergies. Symptoms can involve the skin, nasal passages, eyes, mouth/lips, ears, gastrointestinal tract, or respiratory and cardiovascular systems. The specific symptoms can be incorrectly mistaken for problems with medication(s), sleep deprivation, environmental allergies, gastrointestinal issues, viruses, autoimmune disorders, or attributed to general aging effects. Undiagnosed food allergies (and celiac disease) can contribute to malaise, malabsorption, and inflammation, further exacerbating the risk of frailty. The keys are an accurate diagnosis and appropriate management in the elderly.
Many of the things we think we know about food allergy are really just myths—stories that are commonly known but aren’t based on science. This handout will help you learn the facts about food allergies.
Myth Number 1: Food allergies are very common
Fact: Although 25 percent of people think they’re allergic to certain foods, studies show that about only 6 percent of children and 1 to 2 percent of adults have a food allergy.
Myth Number 2: Most people with food allergies are allergic to strawberries and tomatoes
Fact: Babies and young children are most often allergic to milk, eggs, wheat, soybean products and peanuts. Older children and adults are most often allergic to peanuts, tree nuts (like walnuts, almonds and cashews), fish and shellfish.
Myth Number 3: Some people are allergic to sugar
Fact: A condition is called a food allergy when the immune system (the part of the body that fights infections) thinks a certain protein in a food is a “foreign” agent and fights against it. This doesn’t happen with sugars and fats.
Myth Number 4: Milk allergy is very common and causes diarrhea in adults
Fact: Many adults have trouble digesting the sugar in milk. This is called “lactose intolerance.” It isn’t a true allergy.
Myth Number 5: People with food allergies are allergic to many foods
Fact: Most people with food allergies are allergic to less than four foods.
Myth Number 6: Food allergy makes people hyperactive
Fact: The most common “sudden” symptoms of food allergy are hives (large “bumps” on the skin), swelling, itchy skin, itchiness or tingling in the mouth, or a metallic taste, coughing, trouble breathing or wheezing, throat tightness, diarrhea and vomiting. There may also be a feeling of “impending doom”—a feeling that something bad is going to happen, pale skin because of low blood pressure, or loss of consciousness (fainting). The most common chronic illnesses associated with food allergies are eczema and asthma.
Myth Number 7: Allergy to food dye is common
Fact: Bad reactions to food dyes are rare. They may occur in less than one of 100 children and in less than one of 500 adults.
Myth Number 8: Food allergy is lifelong—or is always outgrown
Fact: Allergies to milk, eggs, soybean products and wheat are usually “outgrown.” However, allergies to peanuts, tree nuts, fish and shellfish are rarely outgrown. Once a true food allergy is diagnosed, it may be very hard to avoid the food causing it. If you have an allergy, you must read the labels on all the prepared foods you eat. Your doctor can help you learn how to avoid eating the wrong foods.
Getting ready for a trip? Whether you’re traveling for business or pleasure, planning ahead is key to making your trip safe and enjoyable. This advice will help get you started.
Passengers with peanut/tree nut allergies who reported taking these actions had significantly lower odds of reporting a reaction:
(1) requesting any accommodation
(2) requesting a peanut/tree nut-free meal
(3) wiping their tray table with a commercial wipe
(4) avoiding use of airline pillows
(5) avoiding use of airline blankets
(6) requesting a peanut/tree nut-free buffer zone
(7) requesting other passengers not consume peanut/tree nut-containing products
(8) not consuming airline-provided food
Food Oral Immunotherapy (OIT) — One of the hottest topics presented in recent years at our national meetings and medical journals involves a very measured and specific introduction of the allergenic food to the patient in an orderly manner. The research patients will eat a tiny dose of the food they are allergic to (like peanut powder for example), and gradually increase this amount over a short period of time until they reach a target dose amount. This is usually maintained every day and then at periodic intervals, the food is continually increased. In recent presentations of the data, the OIT studies have been able to temporarily desensitize many patients, but there have been more reactions during the building-up phase and “target dose” phase compared to some other treatments. Since these studies are still ongoing, it is not known how “permanent” the effect of this treatment may be once the daily ingestion is stopped. Long-term effects of these treatments are also not known as well as the duration required.
Food Sublingual Immunotherapy (SLIT) — Much like ingesting a small amount of the food in OIT, this research uses a tiny drop of liquid containing the food, which is held under the tongue and then swallowed. Patients may start with a small number of drops each day and increase this over time. The results of these studies don’t seem to be as robust as the OIT, but tend to have fewer adverse reactions.
Epicutaneous Immunotherapy (EPIT) — This new technology is similar to using a nicotine patch if you’re trying to quit smoking. Patients receive a patch that contains the food allergen. It is placed on the skin and releases small amounts of the allergen into the skin. Over time, theoretically, this exposure leads to the desired changes in the immune system.
Modified Food Allergens — The immune system of an allergic person recognizes specific proteins in an allergenic food (kind of like if I was “allergic to sandwiches” but my immune system only reacts to the lettuce in that sandwich). In the case of peanut allergy, we know that parts of the peanut protein which have names like “Ara h2” are the parts that the immune system develops a strong response to in some individuals. Through the power of biotechnology, researchers have been able to modify the areas of recognition so that the immune system could develop tolerance in the presence of other signals (like probiotic bacteria). In other words, in the example above, if I was allergic to “sandwiches” but my immune system only recognized the lettuce, this research would involve shredding the lettuce to change it into a form that is not as easily recognized by my immune system, and then give the sandwich to me battered and fried (addition of another signal like the bacteria).
Food Allergen-Coupled Cell Transfer — A new technology used to “attach” peanut proteins to immune cells and then administer these cells back into the body has shown some promise in mouse models but is still far from human research. Researchers developed this technology by first studying it in models of autoimmune disease and then applying it to allergic diseases. The idea behind this research is that the food-coupled immune cells are placed back into the body where these cells degrade and then are used by the immune system to “re-train” it to be tolerant to the food.
Traditional Chinese Medicine — The use of a mixture of Chinese herbs has been studied in the prevention of a severe allergic reaction (anaphylaxis) in patients with peanut and tree nut allergies. These herbs by themselves may alter the immune system to become “less allergic” in simple terms. In clinical studies thus far, the side effects of these herbal formulations are fairly mild.
Probiotics — Beneficial bacteria that may induce changes in our immune system have been looked at in studies to prevent and treat atopic dermatitis (eczema) and in relation to these conditions, also food allergies. Studies in mouse models have had mixed results. My own research during my fellowship was focused on probiotics that could increase certain beneficial types of immune cells, but the results were mixed.
Anti-IgE Medication — If you didn’t already know, the “allergy antibody” is called IgE. This is a protein that our immune system makes which remembers the substances we are allergic to. Studies examining the use of medications that target the IgE antibody have shown some statistical benefit in increasing the threshold dose that would cause a reaction in an allergic person, but these studies are limited. These medications not only reduce the amount of specific IgE in the blood, they can also change the ways our immune cells can interact with the IgE. In recent trials, the use of the anti-IgE medication in conjunction with a specific food OIT has been ongoing.
An important thing to keep in mind is that these therapies are still in research phases and may not be the ultimate “best treatment” for food allergies. Some therapies may not be able to achieve a “permanent” acceptance of the food allergen (what we call tolerance), but may only allow the body to “temporarily” be ok with some exposure while the treatment is being taken (what we call desensitization). There is also a possibility that reactions could occur during therapy, or that unpredictable side effects could arise (after all, you are putting a substance you’re allergic to into your own body).