Food allergy doesn’t have to make meals out a nightmare

By Dr Mike Dilkes

IF YOU are one of the three per cent of the population with a food allergy, you’ll know about it. Symptoms are distinctive, and often debilitating, including a tingling and itchy mouth and throat, hives and swelling around the eyes, lips or tongue. An allergic reaction happens when the immune system overreacts to a particular food trigger, such as nuts or shellfish.

Each time the trigger is eaten, the immune system detects danger and acts quickly to stop the culprit from entering the body. Chemicals are released in the body, sparking a sometimes extreme reaction.

Many people may complain of bloating, nausea and headaches after eating some foods – but this is not to be mistaken for an allergy. It’s far more likely these people are suffering an intolerance, the symptoms of which can be painful, and even distressing, but not life-threatening.

Food allergies tend to run in families, and are thought to be caused by genetics. They are more common in children, though most outgrow them when they are past school age.

Referrals to specialist allergy units are hard to come by, leaving many pushed from pillar to post in search of a diagnosis.

But diagnosis is essential – symptoms that are mild on the first reaction can be serious the next time, so there’s no way of telling when a more serious, and perhaps even fatal attack may happen.

My guide below will arm you with the essential information needed to give you the best chance of diagnosis. Then, use my fail-safe, sciencebacked tips for controlling it, leaving you free to eat in peace.

GETTING A DIAGNOSIS

FIRST, it’s worth considering a list of the most common foods that cause allergies. This includes cow’s milk, eggs, tree nuts – such as almonds, cashews, hazelnuts and walnuts – and peanuts, which aren’t actually a nut but a legume, part of the pea family. Wheat, soy (including soya milk, tofu, and soy found in ready meals and other foods such as beef burgers), fish and shellfish are also common culprits.

If you or a family member are experiencing reactions like those described above to these or other foodstuffs, keep a detailed note of all flareups: every single thing that was eaten around that time, and what happened physically.

Take this list to your GP to help them act quickly and organise the most accurate and appropriate testing. If you do get a referral to a specialist allergy centre, there are two tests the doctors are likely to perform.

First is a skin prick test. During the test, a nurse or doctor will prick a piece of food with a needle then immediately prick it into the skin, usually on the inside of the forearm. After ten minutes, the area is examined for any reaction.

If you are taking allergy drugs like antihistamines or steroids, this test will not work. You need to avoid taking them for a week, if possible.

The other way of testing for food allergy is using a blood test looking for specific immune cells called IgE antibodies which are produced in reaction to individual foods.

It’s often called ann allergen specific IgE antibody test. Some GPs may perform this test b e f o r e ma k i n g a referral.

To confuse matters, some private clinics offer another type of blood test called total I g E. But t hese should be avoided, as they are non-specific and not at all helpful.

Some allergy specialists will suggest you try an elimination diet – cutting out the food thought to have caused the allergic reaction before reintroducing it. If the symptoms disappear when the food is withdrawn but return once the food is introduced again, this normally suggests a food allergy or intolerance. It should always be done under supervision of your doctor. Other more bizarre tests I’ve heard of include vega testing, which claims to detect allergies by measuring changes in your electromagnetic field, and kinesiology testing, which claims to detect food allergies by studyi ng your muscle responses, and hair analysis. Another, so-called leukocytotoxic tests, are claimed to detect food allergies by checking for the ‘swelling of white blood cells’. These are not backed by science, and should be avoided.

HOW TO COPE WITH FOOD ALLERGIES

FOOD allergies are relatively straightforward, in a way. You just need to avoid eating what you’re allergic to.

You may have heard about people who are allergic to peanuts having a fatal reaction after having even the most microscopic amount, or even reacting to particles of peanut in the air.

All allergies exist on a spectrum, and these are the most rare, severe cases – and I will address these over the page.

For the vast majority of food allergy sufferers, taking care about what you eat will be enough to avoid discomfort.

1 EAT OUT, BUT WITH CAUTION

PEOPLE with allergies can still enjoy a meal out, providing appropriate precautions are taken.

It goes without saying that food labels should be read carefully and questions asked. According to the Food Standards Agency, food businesses in the UK (including restaurants, cafes, takeaways and food manufacturers) must tell you if they use common allergens.

But only 14 of the most common allergens are i ncluded i n this requirement, so if your allergy is very common, you’ll need to ask specific questions.

This list includes celery, cereal s , shellfish, eggs, fish, milk, mustard, nuts, sesame seeds, soy

DID YOU KNOW? Simple breathing exercises can calm the anxiety and stress associated with allergies, easing symptoms.

beans and compounds called sulphites found in dried fruit and alcohol. Places where food is eaten must provide allergen information in writing, such as on a menu. However, freshly handmade food for sale, such as a sandwich, does not have to feature a written label with allergen information.

On pre-packaged food, phrases such as ‘may contain’ warn customers there could be small amounts of an allergen but this s is not a legal requirement.

You can also sign up to alert emails from m t he Adverti s i ng Standards Agency and Allergy UK – both offer a free newsletter about f oods t hat has been withdrawn or recalled because of a label- ling problem or food od allergy risk. 2 BE WARY OF RED WINE AND SAUERKRAUT SOME highly allergic people may also experience symptoms with foods they are not technically allergic to. In particular, foods that are high in a chemical called tyramine.

This is because tyramine is a similar compound to histamine, the chemical released by the body that causes allergic symptoms. Although this is not technically an allergy, the symptoms can be distressing for those with severe allergies.

These foods include red wine, fish and fermented foods such as sauerkraut. Allergic people also often react to the chemicals in white, rose and red wines. 3TRY TAKING ANTIHISTAMINES IN MILD to moderate cases, oral antihistam antihistamines can help to reduc reduce the affects of a food reaction, should yo you accidentally eat s something you’re allergic to. These are available from the pharmacist, with stronger doses prescribed by the G GP. Some antihista t amines, such as alim alimemazine and prometh methazine, aren’t suitable fo for children under the age of two. If your child is under the age of t wo and needs medication, discuss with your GP who will advise about antihistamines that are safe for infants. Avoid mixing antihistamines with alcohol, especially if you’re driving as even non-drowsy types can make some people feel tired. 4YOU MAY NEED TO CARRY AN EPIPEN FOR severe reactions – known as anaphylaxis – a shot of a chemical called adrenaline should be given via an EpiPen or equivalent (see next page) injector pen.

Adrenaline works by narrowing the blood vessels to counteract the effects of low blood pressure, opening up the airways to help ease breathing difficulties. 5 YOU’RE PROBABLY NOT ALLERGIC TO GLUTEN DESPITE what many believe, there is no such thing as a gluten allergy.

Those who experience symptoms such as bloating, constipation or feeling generally uncomfortable after eating gluten are most likely suffering an intolerance. Here, the body is unable to effectively digest gluten, rather than a fault within the immune system as seen in allergies. It is an important distinction to make to ensure allergic people get the life-saving diagnosis they need.

However there is another condition, called coeliac disease, that does relate directly to gluten.

The immune system is involved here but it is still not an allergy. See the box below for more details about coeliac disease.