Food Allergy in Adults and Children – Part 1
Food Allergy is an immune system response to a food that the body mistakenly believes is harmful. Once the immune system decides that a particular food is harmful, it creates specific antibodies to it in an attempt to protect the body. The next time the child eats that food, the immune system releases massive amounts of chemicals (including histamine) in order to protect the body.
These chemicals trigger a cascade of allergic symptoms that can affect breathing, the heart, the skin, or the gastrointestinal tract. Most food allergies trigger reactions such as itching, hives, and swelling, but in some cases a more serious response known as anaphylactic shock can occur. This leads to a loss of consciousness or even death.
Scientists estimate that between six and seven million Americans suffer from true food allergies. Many food allergies disappear as the child gets older; about a third of cases disappear in one to two years if the child carefully avoids the offending item. However, allergies to peanuts, nuts, fish, and shellfish often do not disappear with time. Many different common foods may trigger an allergic reaction, including citrus fruits, dairy products, wheat, eggs, fish, cola drinks, artificial coloring, shellfish, berries, tomatoes, pork, and nuts. Infants prone to allergies may be especially sensitive to milk and milk products, wheat, eggs, and citrus fruits.
Allergic reactions can be caused by even very tiny (even undetectable) amounts of the food. For example, a child who is allergic to peanuts could go into anaphylactic shock after eating a food that only has been touched by peanuts. Food additives also may cause problems. About 15 percent of children who are allergic to aspirin are also sensitive to Yellow Dye # 5 (tartrazine).
Although a child can be allergic to any food, the following eight foods account for 90 percent of all food-allergic reactions: milk, egg, peanuts, tree nuts (such as walnuts or cashews), fish, shellfish, soy, and wheat. Milk There are a number of hidden sources of milk that can be of concern to children with food allergies:
• Deli meats Meat slicers are frequently used for both meat and cheese products and so could contaminate sliced meats.
• Casein Some brands of canned tuna fish contain a milk protein derivative called casein. Many nondairy products also contain casein, listed on the ingredient labels. Some meats also may contain casein as a binder.
• Steaks Many restaurants put butter on steaks after they have been grilled to add extra flavor. The butter is not visible after it melts.
• Goat’s milk Because goat’s milk protein is similar to cow’s milk protein it may cause a reaction in milk-allergic individuals. Goat’s milk is not a safe alternative for children allergic to cow’s milk.
• Coffee drink foam Eggs and/or milk are used to create the foam topping on specialty coffee drinks; they are also used in some bar drinks.
Kosher symbols may help parents determine if a product is milk-free. A system of product markings is used to indicate whether a food is kosher (produced in accordance with Jewish dietary rules). A “D” or the word “dairy” on a label next to “K” or “U” (usually found near the product name) indicates the presence of milk protein; a “DE” on a label indicates that the food was produced on equipment shared with dairy. If the product contains neither meat nor dairy products it is Pareve (Parev, Parve). Pareve-labeled products indicate that the products are considered milk-free according to religious specifications. However, under Jewish law, a food product may be considered Pareve even if it contains a very small amount of milk, which means it could potentially have enough milk protein in it to cause a reaction in a milk-allergic individual.
A number of ingredients that may seem to include milk or dairy products in fact do not and can be eaten by a child with a milk allergy. These include:
• calcium lactate
• lactic acid
• calcium stearoyl lactylate
• oleoresin
• cocoa butter
• sodium lactate
• cream of tartar
• sodium stearyl lactate
Eggs Influenza vaccines are grown on egg embryos and may contain a small amount of egg protein. The pediatrician should be notified before giving a flu shot to a child who is allergic to eggs. The recommendations of the American Academy of Pediatrics (AAP) acknowledge that the MMR vaccine can be safely administered to all children with egg allergy. The AAP recommendations are based in part on overwhelming scientific evidence supporting the routine use of one-dose administration of the MMR vaccine to egg-allergic patients, even among children with a history of severe, generalized anaphylactic reactions to egg.
Other egg sources include egg substitutes and pasta. Some commercial brands of egg substitutes actually contain egg whites. Most commercially processed cooked pastas (including those used in prepared foods such as soup) contain egg or are processed on equipment shared with egg-containing pastas. Boxed, dry pastas are usually egg-free. Fresh pasta also is usually egg-free. Read the label or ask about ingredients before eating pasta. Peanuts Children who are allergic to peanuts need to be particularly careful about the food they eat, because these types of nuts can cause severe allergic reactions in the tiniest doses. Although once considered to be a lifelong allergy, recent studies indicate that up to 20 percent of children diagnosed with peanut allergy may outgrow it.
All too often, peanuts are hidden in many foods so that it can be difficult to tell which ones contain nuts. All labels should be checked carefully. To be safe, children who are allergic to peanuts should avoid chocolate candies unless there is absolutely no risk of cross-contact during manufacturing procedures. African, Chinese, Indonesian, Mexican, Thai, and Vietnamese dishes often contain peanuts or are contaminated with peanuts during preparation of these meals. Many brands of sunflower seeds are produced on equipment shared with peanuts. In addition, foods sold in bakeries and ice cream shops often come in contact with peanuts. Therefore, experts recommend that peanut-allergic individuals avoid these types of foods and restaurants.
In addition, peanuts may masquerade under other names; for example, mandelonas are peanuts soaked in almond flavoring, and arachis oil is peanut oil. Most experts recommend peanut-allergic patients also avoid tree nuts (such as pecans or walnuts) as well (see below). Because many nut butters are produced on equipment used to process peanut butter, these butters are a somewhat risky alternative.
Studies show that most allergic individuals can safely eat peanut oil but not cold pressed, expelled, or extruded peanut oil, sometimes referred to as “gourmet oils.” If a pediatrician has prescribed injectable epinephrine (Epipen) it should always be carried by the child. Tree nuts Tree nuts can cause severe allergic reactions, so if a pediatrician has prescribed injectable epinephrine (Epipen), it should always be carried with the child. Patients who have been diagnosed with an allergy to specific tree nuts should avoid all tree nuts to be safe; most experts advise tree nut-allergic patients to avoid peanuts as well.
In addition, tree nuts may be contained in a wide variety of products. Mortadella may contain pistachios, and natural and artificial flavoring may contain tree nuts. In fact, tree nuts have been used in many foods including barbecue sauce, cereals, crackers, and ice cream. In addition, hacky sacks, bean bags, and draft dodgers are sometimes filled with crushed tree nut shells. A coconut is actually the seed of a drupaceous fruit and is not considered a tree nut. Therefore, coconuts are not typically restricted in the diet of a child who is allergic to tree nuts. However, some people have reacted to coconut, so potential reactions should be discussed with a doctor before introducing coconut to the child’s diet. Likewise, nutmeg is obtained from the seeds of the tropical tree species Myristica fragrans and is considered to be safe for a child with a tree nut allergy.
Fish/shellfish Allergic reactions to fish and shellfish are commonly reported in children and can be severe. It is generally recommended that all types of fish should be avoided by children who have had an allergic reaction to one species of fish or positive skin tests to fish. The same rule applies to shellfish. Fish-allergic individuals should be cautious when eating away from home and avoid fish and seafood restaurants because of the risk of contamination in the food-preparation area of their “nonfish” meal with a counter, spatula, cooking oil, fryer, or grill that was exposed to fish. In addition, fish protein can become airborne during cooking and cause an allergic reaction. In fact, some people have had allergic reactions just by walking through a fish market.
It is not always easy to spot fish or shellfish in food. For example, caponata, a traditional sweet and sour Sicilian relish, can contain anchovies, while Caesar salad dressings and steak or Worcestershire sauce often contain anchovies. Likewise, surimi (imitation crab meat) often contains fish. On the other hand, some products that may seem fish-related are not. Carrageenan (Irish moss) is not fish but a red marine algae that is used in a wide variety of menu items (particularly dairy foods) as an emulsifier, stabilizer, and thickener. It
appears to be safe for most children with food allergies.
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