The Real Deal on Food Allergies
Food allergies are real, and can make your child very sick. The idea that food can be dangerous is scary, especially when children start to go to school or share meals away from home. But sometimes concerns about food allergies go overboard.
But the truth is, food allergies are common, and becoming far more common. So it’s important to know what’s real about food allergies, and what is a persistent myth.
True allergies to food affect about 1 in 25 preschoolers. This has increased somewhat, probably by about 20%, over the last 10 years. However there are many children (and adults) who think they’re allergic, but really aren’t. And among people who do have allergy, the vast majority of reactions are mild.
If you have a reaction to a food, that means there is an allergy. “Allergy” refers to a specific kind of immune-mediated reaction. Symptoms of true allergy occur very soon after ingestion, and are consistent including: hives, difficulty breathing, vomiting, or diarrhea.
There are many other kinds of “adverse reactions” to foods that are not allergies. These include lactose intolerance, Celiac disease, heartburn, eczema, and many non-specific perceived changes in behavior. It’s important to make the distinction between a true allergy and other kinds of reactions because only true allergies have the possibility of leading to life-threatening reactions.
6 Common Food Allergy Myths
True allergies can be diagnosed by blood tests or skin tests.
This is untrue. True allergy is a clinical diagnosis—you have to document the actual allergic reaction that occurs. Testing can sometimes be useful to confirm the diagnosis, but it doesn’t make the diagnosis. Even the best, state-of-the-art testing done by allergists can have false positive and false negative results. And the internet is rife with sites promoting quacky, weird tests that are even less accurate. Many people think they have allergies because of bad testing that has been misinterpreted. If your child can eat a food and doesn’t have an allergic reaction, he is not allergic—no matter what any “testing” shows.
Any food can cause allergy.
That’s theoretically true, but the vast majority of food allergies are triggered by one of “the big eight”: milk, egg, soy, peanut, tree nut, fish, shellfish, and wheat. Extensive testing beyond these foods, without a history of a suggestive reaction to a specific food, is much more likely to falsely label an allergy than to uncover a true problem.
Any child with allergy can have a life-threatening reaction.
Most people with allergy have the same reaction with every ingestion—if they had hives last time, they’ll probably get hives again. However, it is possible for even mild reactions to be followed by more-serious ones, so parents and school do have to be alert.
A history of asthma or recurrent wheezing is an important risk factor for life-threatening food reactions among allergic individuals—even if wheezing or asthma hasn’t been triggered by foods in the past, anyone who has both a true food allergy and a history of asthma is at higher risk of a very serious reaction. Additional risk factors include a history of a prior life-threatening reaction to anything, or an allergy to peanut, tree nut, egg, fish, or shellfish.
Life-threatening reactions can occur through air or skin contact.
Peanut allergy alone accounts for about 80% of the deaths from food allergy in the United States, causing about 160 fatalities a year. For comparison, lighting strikes each year kill about 50-100 people.
Although it’s theoretically possible, all documented serious reactions have occurred from eating the food. “Peanut dust” in the air or touching peanut-contaminated surfaces has caused skin and eye and nose symptoms only. The best way to protect allergic kids is to prevent ingestion. Don’t allow sharing of foods, utensils, drinks, or cups, and wipe down eating surfaces to prevent cross contamination. Foods in the environment don’t cause serious reactions unless they contaminate other foods and get eaten.
Food allergies are permanent.
Most kids with egg, milk, and many other allergies will usually outgrow them. However, allergies to peanut, treenut, fish, and shellfish may have only about a 20% chance of resolving. Recent research into egg allergy specifically has shown that small, limited exposures to egg (typically, baked into food) can make it more likely that a child with true egg allergy will outgrow it.
Avoiding foods early in life helps prevent allergy.
This is a persistent, lasting myth that is completely untrue. In fact, delayed introduction of foods increases the risk of allergy. Pregnant and nursing moms should not avoid any foods, unless they themselves are allergic.
What if My Child Actually Has a Food Allergy?
Food allergies can lead to severe or life-threatening problems, though these kinds of reactions are rare. If you suspect your child has a food allergy, work with your pediatrician or a board-certified allergist to clarify what’s going on, and develop a plan. You’ll need instructions on how to avoid the trigger(s), and an action plan for what to do if an ingestion occurs. Make sure to share these instructions with the school and all caregivers, and make sure there is always access to the emergency medications that have been prescribed. With knowledge and reasonable precautions, food allergies can be managed, and parents do not need to live in fear.
Food allergies: Myths and facts
© 2012 Roy Benaroch, MD
PS. Because it was JUST on SNL this weekend I thought I would also include this funny digital short about faking allergies to get out of stuff you don’t like. Cheers!-Alexis