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Food Allergies and Intolerance

Symptoms

Food Allergies and Intolerance Confusion about food allergy and food intolerance leaves the door open for misinterpretation. You may think the terms are synonymous, making them interchangeable. Yet they are two very different conditions that require different approaches. Misunderstanding food allergy and food intolerance may lead to unnecessary dietary restriction. Read on to clear up the confusion.

Anatomy of an Allergy
A food allergy, sometimes called food hypersensitivity, is a reaction mounted by your immune system to an allergen in food, which is almost always a protein. Your body mistakenly regards a harmless food protein as a threat to your body's well-being, and does what it can to repel it.

The first time you or your child consumes the allergen, it won't be readily apparent that the body is defending itself against the food's protein. There will be none of the myriad signs of food allergy, such as hives, swelling of the mouth and nose, or abdominal cramps. The second and third times around will be different, however. That's because after the initial encounter with an allergen, your body produced antibodies against it as a way to defend itself against subsequent "invasions."

Once the body has produced the antibodies to halt a particular allergen, you'll feel the effects of food allergy. After eating, the body releases massive amounts of histamine and other chemicals in response to allergens that trigger food allergy symptoms. According to the Food Allergy Network, it may take just seconds for an allergen to wreak havoc, but most likely the signs of food allergy appear within two hours. Sometimes it's a day or two before the allergen makes itself known with some of the symptoms listed below. Talk with your doctor if you or your child experience any of the following after eating:

• Abdominal pain and  bloating
• Asthma or wheezing
• Chronic coughing
• Cramping
• Diarrhea
• Hives
• Itching and/or tightness in the throat
• Itchy eyes

• Nasal congestion or runny nose
• Nausea
• Rashes (eczema)
• Shortness of breath
• Sneezing
• Swelling of the lips, mouth,  tongue, face, or throat
• Vomiting

Foods can produce many of the same symptoms without triggering an immune response. For instance, foodborne illness is culpable for diarrhea and vomiting, two signs of food allergy. Before you blame food allergy, your doctor must confirm that your immune system is involved, since this is the hallmark of food allergy.

Avoiding Anaphylaxis
Anaphylaxis or anaphylactic shock is a severe reaction to food—most commonly peanuts, tree nuts, fish, shellfish, and eggs—that can involve several parts of the body and any number of the symptoms of food allergy. The problem occurs when too many bodily reactions occur simultaneously, essentially overwhelming your system. As a result, blood pressure drops dangerously low and your heart may beat abnormally. Without treatment, anaphylactic reactions can be lethal. Children with asthma are at greater risk for fatal or near-fatal reactions from food.

Oral Allergy Syndrome
People with hay fever symptoms may also be allergic to certain raw fruits and vegetables, nuts, and seeds. The condition is called Oral Allergy Syndrome (OAS). OAS is caused by a cross-reaction of allergens in the pollen of birch, alder, hazel, grass, ragweed, mugwort, and in certain foods. Eating fresh fruits and vegetables can leave you with itchy or swollen lips, tongue, throat, or the roof of your mouth. OAS may be more irritating than life threatening, since it tends to cause problems in the mouth, lips, and throat, rather than all over the body. OAS symptoms disappear without treatment.

The following raw foods can produce OAS. Cooking typically destroys the allergens responsible for the condition.

• Apple
• Apricot
• Banana
• Carrot
• Cantaloupe
• Celery
• Cherry
• Fennel seed
• Hazelnut (filbert)

• Honeydew
• Orange
• Parsley
• Peach
• Pear
• Potato
• Sunflower seed
• Tomato
• Watermelon

DiagnosisFocus on Food Allergy
In newborns and older infants who are allergic to the protein in cow's-milk-based infant formulas, the signs of food allergy will include diarrhea, vomiting, and a failure to grow properly. Your child may also bleed from his intestinal tract and be colicky. Switching to soy formula doesn't always remedy the situation, since many babies who are sensitive to cow's milk protein are also allergic to the protein in soy-based formulas and other soy products. If your child exhibits any of the symptoms mentioned above in "Anatomy of an Allergy," talk with your pediatrician immediately about the best course of action. Your baby may need a hydrosolate formula such as Nutramigen, Pregestimil, or Alimentum, or an amino acid infant formula such as Neocate or Neocate One+ brand.

As your child matures and you begin offering solid foods between four and six months of age, you may suspect certain foods are troublesome for your child. To get to the bottom of food allergies, keep a detailed log of what and how much your child eats, document the symptoms produced by each food, and how long the symptoms take to develop. If your child is cared for by someone other than yourself, have her track all the same particulars, too. Include vitamin and mineral supplements your child takes on the list. Don't rely on your memory to record what your child consumes. Write it down as soon as he's finished eating or drinking. Save labels from processed foods since they could contain ingredients that trigger food allergy.

Keeping a food diary is a step in the right direction, but don't try to manage food allergies on your own. Food allergy diagnosis requires a detailed medical history; physical exam; elimination diets that include avoiding the suspected foods; and, possibly, tests to rule out other conditions. Bring your child and his food log to a doctor who has intensive training in allergy and immunology for a full evaluation. Board-certified physicians who are allergy experts are reliable health professionals.

Diagnosing Food Allergy
Don't be too quick to diagnose a food allergy in your child, and don't let others be, either. Make sure that your board-certified physician conducts more than one of the following tests before confirming food allergy.

• Medical history
• Skin prick test
• Blood test
• Elimination diet
• Food challenge

Beware of the following tests; allergy experts say they have little, if any, scientific merit:

• Cytoxic blood test
• Sublingual provocation
• Intradermal provocation
• Food immune complex assay

Managing Food Allergy
There's only one way to manage food allergy and that's avoidance. Once you know which food triggers an immune response in you or your child, steer clear of it. Some children are so sensitive to allergens that getting a whiff of an offending food, or kissing someone eating a food with the offending allergen, can be potentially fatal. For instance, something as simple as sniffing the steam created by cooking fish can cause a reaction in fish-allergic people. That's why it's a good idea to avoid keeping foods that trigger allergy in the house, even if you have other children who can eat these products without consequence.

Keep It Healthy
There's a problem with avoiding foods with known allergens, however. In eliminating foods, you must amend your child's diet to make it adequate to fuel his rapid growth. Getting rid of milk because of an allergy means your child's calcium and vitamin D consumption will drop off to the point of jeopardizing bone development.

It becomes particularly difficult to manage your child's diet when she is allergic to more than one thing. Working with a registered dietitian (R.D.) can help, especially when your doctor recommends elimination diets and food challenges. An R.D. helps you to carry out the food restrictions your child must follow, while developing an eating plan that is tailored to your child's dietary needs. Find a registered dietitian in your area by contacting the American Dietetic Association. The organization offers a free, nationwide referral service.

Read Labels
Carefully reading food labels is critical for avoiding allergens. Depending on your child's allergy or allergies, there are dozens of offending ingredients you must avoid. The Food Allergy Network provides excellent label-reading resources. Still, food labels may sport unfamiliar ingredients; may not fully explain all ingredients; and manufacturers may change ingredients without warning, so don't take food labels for granted. One troubling labeling loophole: Manufacturers may list natural flavorings as an ingredient without spelling out their specific ingredients. Genetically modified foods pose a slight risk to highly allergenic individuals since the FDA doesn't require labels to state that foods include genetically modified ingredients. Some genetically modified foods may contain allergenic proteins from other foods that are not among the major allergens.

Before feeding processed foods with questionable ingredients to your child, call the company to clarify exactly what the product contains. When there is any doubt that a food is unsafe for any reason, don't buy it.

StrategiesCurb Cross-Contamination
Watch for the warning "may contain ..." on processed foods. Manufacturers add that statement to alert you to the potential risk of cross-contamination. Cross-contamination occurs when machinery used to make one type of food that doesn't contain potential allergens is then used to produce another product that could contain allergenic ingredients. When manufacturers fail to properly clean the equipment, cross-contamination can occur. For example, when tiny fragments of nuts make their way into a nut-free cereal, the person eating it is prone to an allergic reaction. The same is true for deli meats purchased at the supermarket. Cheese and deli meats, such as ham, that contain added casein, a milk protein, are often sliced with the same equipment used for other milk-free deli products.

Dining Out Dilemmas
Cross-contamination is also an issue in restaurants, making dining out with an allergic child no easy task. For example, French fries that are cooked in the same oil as fried fish are benign for most people but problematic for those hypersensitive to fish. Meat seared on the same grill as a tuna steak poses a similar problem.

Then there are the ingredients used to concoct restaurant foods. Nuts used in cheesecake crusts and pasta sauces such as pesto are potentially problematic; so, too, is the peanut butter or other "secret" ingredients used to thicken soups and sauces. And when the chef decides to get creative, watch out. One night Tom and I met friends for dinner at a local restaurant. Joe, who is allergic to nuts, ordered the same pork tenderloin dish as I did. Mine came first to the table. His entree arrived a minute or so later, looking slightly different. He was just about to take a bite when I realized the difference between the two meals: chopped nuts. Someone in the kitchen had garnished his meal with nuts. The kicker is that nuts were never mentioned in the description of the dish. If they had been, Joe would have steered clear of that entree.

Allergy experts advise extreme caution when eating away from home. To avoid hazardous dining-out situations, always ask the wait staff about the ingredients in restaurant food, and let them know what foods you or your child must avoid. If your waiter seems to lack confidence in his answers, ask him to query the chef about how the dish is prepared and to alert the chef to your needs. Many chefs will be as accommodating as possible. Stick to plain foods such as broiled chicken or steak, and avoid deep-fried and grilled foods. Try to dine out early in the evening (which is easy to do with kids) and stay away from restaurants on Friday and Saturday nights. This will help you get the special meal you need for you or your child with a minimum of mistakes and aggravation.

Top Allergenic Foods
Eight foods account for 90 percent of all allergic reactions, says the Food Allergy Network. Peanuts are the leading cause of food allergies, affecting about 3 million Americans. Overall, an estimated 6 to 7 million Americans suffer from one or more food allergies.

When feeding infants new foods, watch for any of the following food allergies. Introduce just one food at a time so that you can track your child's sensitivity. Feed that single new food for about five days, unless your child is bothered by it.

• Peanuts
• Tree nuts such as walnuts and pecans
• Shellfish, including shrimp, crab and lobster
• Fish

• Eggs*
• Milk*
• Soy*
• Wheat*

*According to the American Dietetic Association, these allergies may disappear with time. Even though experts say cow's-milk allergy is the most common food allergy among children, kids tend to outgrow it by their fourth birthday.

At Day Care
Alert the staff at your child's day care center or kindergarten about his food allergy. Do what you can to educate them about your child's needs and about the importance of avoiding food allergy in general. A bit of planning can go a long way toward avoiding problems when your child is away from home.

Make a list of foods that provoke allergies in your child and write down emergency information about what to do when your child is negatively affected by food products. For example, not only is peanut butter problematic in the form of a sandwich, it can also be dangerous to a child with peanut allergies when used to make projects such as birdfeeders. Make sure all of his babysitters and teachers have the facts. Any medications your child needs should travel with him. A MedicAlert bracelet or necklace for your child is also a good idea.

Heading off allergiesFoiling Food Allergies in Children
If Mom, Dad, or both parents has a history of any type of allergy, including hay fever and asthma, it translates into a greater allergy risk for the children, including sensitivity to food.

The good news is that you can head off food allergies in children at risk. Avoiding allergies is based largely on delaying the introduction of the most offensive foods—peanuts, shellfish, fish, tree nuts, eggs, milk, soy, and wheat.

You can't change your baby's genetic tendency toward food allergies, but you may be able to minimize allergies. Try these tactics to reduce his chances of developing food allergies by following this advice from the American Dietetic Association and the American Academy of Pediatrics (AAP).

Breastfeed Your Baby
Among the myriad benefits of breast milk, putting off food allergy and reducing asthma risk ranks high. Breastfeeding provides the most protection against food allergies during the first three years of your child's life. Why? Breast milk bolsters your baby's immune system. It also provides your infant with antibodies that combine with potential allergens and prevent them from being absorbed into baby's bloodstream. By contrast, infant formula contains proteins that may be allergenic to your infant, especially when allergies run in the family. Breastfeeding moms of children prone to food allergies should eliminate all nuts, including peanuts (technically a legume); eggs; and milk from their diets. That's because the proteins from these foods can make their way intact into breast milk and cause problems in baby. Women who decide to eliminate milk need supplemental calcium and alternate protein and vitamin D sources, too.

Wait Until Six Months to Introduce Solid Foods
Experts say it's OK to give baby food at four months, but you should wait an extra two months to give your baby the edge on food allergy. This extra time allows your infant's intestinal tract to mature that much further. Here's the recommended schedule for more foods.

• Begin offering orange vegetables such as sweet potatoes and carrots at seven months. Wait five to seven days before trying a new food to see if baby is sensitive.
• Move on to green vegetables when baby tolerates the orange varieties. Serve up spinach, green beans, and peas. Read the labels of baby foods to avoid milk-based additives.
• Next, offer fruits, but only one at a time. Steer clear of products with potentially problematic additives including tapioca or food starch.
• At nine months, start giving baby grains and other vegetables such as oats, corn, and potato. Save wheat for last since it's allergenic in many people.
• Start adding meat at one year of age.
• Wait until your child's first birthday to offer cow's milk or soy beverages and products made from milk and soy.
• Hold off until two years of age to give eggs to your child.
• Steer clear of peanuts, tree nuts, fish, and shellfish until at least three years of age.

Looks Pretty, Tastes Good, Causes Problems
Artificial flavors and colors in processed foods can bother hypersensitive kids. Benzoic acid, sodium benzoate and tartrazine yellow, also known as FD&C yellow no. 5, can result in asthma and rashes; yellow no. 5 can be allergenic to people with aspirin sensitivity. Sulfites pose a hazard as well. They're used on a number of processed foods, including shrimp, and on certain fruits and vegetables. Sulfites can trigger asthma and anaphylactic shock in susceptible children and adults. Hydrolyzed vegetable protein contains monosodium glutamate (MSG), which has negative effects on certain people. Tragacanth is a gum that has resulted in some severe allergic reactions.

Make Iron-Fortified Rice Cereal Your Baby's First Solid Food
Stick with rice cereal for the first month, since it's less likely than other grains to be allergenic. Read labels carefully. Even single grain infant cereals may contain malt, which your baby should avoid early on.

Getting over It
Your child may outgrow food allergy. As a child's digestive tract matures, there is less absorption into the bloodstream of certain, but not all, allergens. A child's immune system becomes stronger with the passing years, allowing it to block antigens from wreaking havoc on the body, too.

There's a good chance that your child will outgrow allergies to milk, soy, eggs, and wheat. For example, after reaching age one, it's possible for children allergic to formula made from cow's milk or soy to be tested for their reaction to milk or soy beverages. But there is little likelihood that sensitivity to peanuts, tree nuts, fish, and shellfish will disappear with time.

How will you know when your son or daughter is old enough to try a food your doctor initially diagnosed as allergenic? Don't take it upon yourself to see whether your child has recovered from a food allergy. Discuss the possibilities of reintroduction with your pediatrician or allergist. Trying out the foods at home is dangerous for your child. And don't count on your doctor reintroducing foods that have in the past caused an anaphylactic reaction in your child, such as peanuts. You shouldn't, either.

Allergies and Asthma: What's the Connection?
Asthma is the chronic inflammation of the airways, which results in episodic wheezing, shortness of breath, tightness in the chest, and coughing that's more likely to occur at night and in the morning. It's the most common ongoing disease of childhood. Out of the 17.3 million Americans who have asthma, an estimated 4.8 million of them are children, according to the Centers for Disease Control. Asthma is on the rise in this country and worldwide.

The primary goal of asthma management is to reduce airway inflammation. Children who live with smokers and/or who are subjected repeatedly to other air pollution are more likely to have the symptoms of asthma. Sulfites and other food additives can trigger asthma attacks, as can food allergies. Youngsters with asthma and food allergies run a greater risk of having anaphylactic reactions.

Food intoleranceFocus on Food Intolerance
Food intolerance does not involve the immune system, but it can be just as bothersome as a food allergy. Youngsters often outgrow food allergies, but a food intolerance may hang around forever. On the bright side, you may not have to completely eliminate "intolerable" foods as long as they don't also trigger allergic reactions. Food allergy and food intolerance can produce some of the same symptoms, so it may be difficult to differentiate the two when trying to figure out what's going on.

Milk Allergy
Milk protein is a common allergen in young children, yet milk allergies are actually quite rare in adults. That's because upwards of 85 percent of youngsters allergic to milk outgrow their sensitivity by the age of four.

If you think your child is allergic to milk, consult your doctor immediately. Removing all dairy foods and processed foods with milk-based ingredients without competent dietary advice is risky. Dairy products provide calories, protein, calcium, and a wide variety of vitamins and minerals essential to a young child's growth and development. Milk is the only dairy product that consistently provides vitamin D, which promotes strong bones by helping the body absorb calcium. Kids who cannot drink milk can count on fortified foods such as 100 percent fruit juice for calcium. However, despite their calcium content, these foods lack vitamin D. That's why you should work with a registered dietitian to plan a healthy diet for your youngster whenever food allergy is an issue.

Lactose Intolerance
Due to the absence of adequate lactase, people with lactose intolerance cannot properly break down lactose, the carbohydrate present in milk and other dairy foods. Lactase is the enzyme the small intestine makes to digest lactose. Symptoms ranging from mild gas to severe diarrhea that appear within minutes to hours after eating dairy products characterize the condition. Some people are so sensitive to lactose that they have trouble digesting processed foods that contain whey, casein, and whey protein concentrate, all of which contain small amounts of lactose. Certain medications even have a lactose base that makes them intolerable for some super-sensitive individuals. While the symptoms of lactose intolerance are uncomfortable, they pass within a few hours and are far less serious than those caused by milk allergy.

When it comes to lactose intolerance, quantity counts. Many people can tolerate small amounts of milk products without any side effects but become uncomfortable when they eat large quantities of cheese or ice cream, or drink lots of milk on an empty stomach.

Lactose intolerance ranks high on the list of common food intolerance in adults. When it comes to children, premature babies are at greater risk for lactose intolerance. An unborn baby's ability to process lactose develops during the third trimester. Since premature babies do not finish their term in utero, they are born with reduced lactase activity.

It's unlikely that your baby would have lactose intolerance if he or she was a full-term, healthy infant, but he could develop it with age. In fact, lactose intolerance is rare in African-Americans under the age of three and in Caucasians less than five years old.

A child of any age can develop a temporary form of lactose intolerance after intestinal infections. Youngsters who have conditions including chronic diarrhea may also be unable to properly break down the lactose found primarily in dairy products.

You or your child can still enjoy dairy foods even when you cannot tolerate lactose. Lactose-reduced foods such as Lactaid milk, Lactaid cottage cheese, and Lactaid ice cream are either free of lactose or contain minute amounts that won't produce stomach upset in nearly all lactose-sensitive people. Another option for reducing lactose in dairy foods is over-the-counter drops of the enzyme lactase that can be stirred into foods such as milk, cottage cheese, yogurt, and pudding. Tablets containing lactase can be consumed along with more solid foods such as pizza, lasagna, and ice cream to make them more tolerable.

Looking for Lactose
Dairy foods are the most concentrated lactose sources, but they are not all created equal. Try smaller amounts of lower-lactose foods to avoid symptoms of lactose intolerance.

Food Lactose (in grams)

---

Mozzarella cheese, part skim. 1 ounce .08-. 9 Cheddar cheese, sharp, 1 ounce .4-6 Ice cream, ½ cup 2-6 Cottage cheese, 1 cup 1.4-8 Yogurt, 1 cup 4-17 Milk, 8 ounces 9-14 Evaporated milk, 8 ounces 24-38 Sweetened condensed milk, 8 ounces 31-50

Gluten Enteropathy
An inability to tolerate gluten is not common among children, but when it happens, it has serious repercussions.

Gluten enteropathy is the official name for a condition also known as celiac disease. In gluten enteropathy, the body cannot process gliadin, a part of the protein gluten, which is a constituent of many grains. When a child with gluten enteropathy consumes gluten, it damages the cells of the intestinal lining, which leads to inadequate nutrient absorption. As a result, the body does not properly absorb fat, carbohydrate, protein, vitamins, and minerals, and that leads to malnutrition. Weight loss and a failure to grow properly, nausea, and diarrhea are all hallmarks of gluten enteropathy. Children with gluten enteropathy run a significant risk of developing a host of medical problems, including abnormal bone formation and anemia, that could permanently affect their growth and development. Any child who has been diagnosed with gluten enteropathy should have a registered dietitian as part of her treatment team.

The treatment for gluten enteropathy is total avoidance of gluten, which would mean leaving out wheat, barley, oats, and rye products from the diet. Unfortunately, that's easier said than done, especially when it comes to processed foods. Many processed foods contain gluten in forms you wouldn't recognize. For example, modified food starch, vanilla extract, and vegetable protein all have gluten as an ingredient. However, several companies make many types of tasty gluten-free breads, pasta, and other grains that are suitable substitutes.