THE DANGERS OF DINING
Aman who is allergic to shellfish orders a hamburger and fries. Minutes after his meal, he’s gasping for breath. He finds out later that the oil used for his french fries was also used to fry shrimp.
When it comes to food allergies, knowing which foods will trigger an attack isn’t always enough, since the offenders can appear in the most unexpected places. If you have a food allergy, you literally have to be on guard all the time and prepared to deal with an attack.
Food allergies occur when your body’s immune system mistakenly identifies food proteins as enemies rather than friends. When you eat an offending food, your immune system launches an attack. Depending on the food and your individual system, the result may be congestion, digestive complaints, itchy skin, swelling of the mouth and hands, or even difficulty breathing. Even healthful foods such as low-fat milk or wheat are capable of triggering an allergy attack.
Food allergies are most common in children. Kids usually outgrow them, but some allergies, mainly those involving peanuts and shellfish, can last a lifetime, says Talal M. Nsouli, MD, clinical associate professor of allergy and immunology at Georgetown University School of Medicine and director of the Watergate Allergy and Asthma Center, both in Washington, D.C. Foods that commonly cause allergies include eggs, soy, wheat, peanuts, and shellfish, although almost any food is capable of causing allergies, Dr. Nsouli says.
Food allergies usually run in families. “Both my son and daughter have allergies,” says Patricia David, MD, MSPH, president of Healthy U in Columbus, Ohio, who is also a preventive medicine specialist. In fact, if one of your parents has a food allergy, you have a 20 to 30 percent chance of developing one yourself. And if both of your parents have food allergies, your risk climbs to 40 to 70 percent.
It’s not clear what causes food allergies. One theory, says Dr. Nsouli, is that infants and children who eat problem foods before their immune systems have fully matured may develop lifelong allergies to those foods. For this reason, doctors often recommend that infants should not be given solid food until they’re 6 months old or cow’s milk until they are at least a year. In addition, parents should refrain from giving their children eggs until they reach age 2 or fish and peanuts until they are 3 years of age.
Another way to prevent food allergies in children is to breastfeed them as infants. Breastfed babies get the intestinal flora from their mothers’ milk that helps build their immune systems and therefore protects them from allergies, says Jose Saavedra, MD, medical and scientific director of Nestlé Nutrition USA, and associate professor of pediatrics at Johns Hopkins University School of Medicine and Bloomberg School of Hygiene and Public Health in Baltimore.
Ear infections are one of the most common reasons for office visits to pediatricians, and they’re also the leading reason for surgery on children in the United States. They’re frustrating to treat because, despite taking antibiotics, some children get ear infections over and over again.
Food allergies may play a key role in ear infections. The reason is that children who are allergic to foods often have frequent congestion. As fluids and bacteria accumulate in the tube connecting the nose and middle ear, infections are much more likely to occur.
In a study done by Talal M. Nsouli, MD, professor of allergy and immunology at Georgetown University, and his colleagues, 81 of 104 children with recurrent ear infections were found to have food allergies. In fact, when Dr. Nsouli put the children on diets without the offending foods, most experienced significant improvements. When the children who had improved were allowed to eat the foods again, 94 percent got another ear infection.
Any child who has recurrent ear infections should go to an allergist.
People with mild food allergies may be able to eat small portions of an offending food every once in a while. But some people’s allergies are so severe that even a trace of the food can lead to a potentially life-threatening condition called anaphylaxis. For those with serious allergies, the problem foods “should be avoided like poisons,” Dr. Nsouli says.
Because it’s often hard to know exactly what is in the foods you eat, doctors advise that people with severe food allergies carry self-injecting syringes loaded with epinephrine. This medication can stop anaphylactic attacks almost instantly.
“My son has a peanut allergy, and while I was researching his allergy, I found a study done in Spain that said the probiotic lactobacillus has been shown to decrease allergy symptoms,” says Patricia David, MD, MSPH, president of Healthy U in Columbus, Ohio. So I started giving him some foods containing probiotics. When I took him to the allergist a year later, he no longer had a life-threatening anaphylactic reaction—now he only gets a rash if he’s exposed to peanuts,” she says. “I am not advocating that everyone do this, especially when it comes to an allergy as serious as a peanut allergy, but it certainly shows that probiotics can help with food allergies. If you keep the good bacteria in your gut in full force, they may help keep milder allergic reactions at bay,” she says. Rather than purchasing probiotic supplements or drinks, Dr. David recommends getting probiotics from food sources, such as yogurt, buttermilk, and soy milk. Look for products containing lactobacillus or bifidobacteria.
Even though there is no cure for food allergies, there are many things you can do to prevent attacks. For starters, read labels carefully. You can’t assume that a product doesn’t contain the offending ingredient, Dr. Nsouli says. If you’re allergic to peanuts, for example, it’s obvious that peanut butter is verboten. But many other foods, including plain M&Ms candies, also contain hidden peanuts, in the form of peanut powder.
To make things more complicated, food companies may throw consumers a curveball by periodically changing ingredients in their products. Just because a food doesn’t contain an offending ingredient today doesn’t mean that it never will. So keep reading labels.
If all food labels used everyday language, such as “milk,” for example, or “wheat,” avoiding certain foods would be easy. But in the complex world of food processing, and with the complex names given to processed foods, it’s not always easy to tell what you’re getting. That’s why people with food allergies often need a crash course in food vocabulary. If you’re allergic to dairy foods, for example, you’ll soon learn that ingredients such as casein and whey are just as dangerous as a glass of milk. Be sure to ask your doctor for a complete list of the products and ingredients—and all their odd names—that you’ll need to avoid, Dr. Nsouli says.
Even when you know what foods to avoid, eating in restaurants can be tricky since you can’t control what goes into each dish. To be sure you know what you’re getting, ask your waiter to quiz the cook. Ask about oils, spices, and any other ingredients that you may be concerned about.
One way to make sure your dinner doesn’t take you by surprise is to make it clear to the people preparing your food just how serious your food allergy is. Explain that it’s not only certain ingredients that can make you ill but even what those ingredients have touched, like grills, spoons, and mixing bowls. “Warn them,” Dr. Nsouli says. Once they understand how serious your condition really is, they’ll pay closer attention to what goes on your plate.
Some foods are very easy to eliminate from your diet because there are so many substitutes available. People who are allergic to cow’s milk, for example, often switch to soy or rice milk, says Dr. Nsouli. (These products are often fortified with calcium, so you get the benefits of milk without the problems.) Other foods are more difficult to replace. Even though you can substitute rice flour for wheat flour, for instance, it has a noticeably different taste and texture than bread made with wheat flour. You may want to try rye, millet, or barley flour instead. You’ll just have to experiment to find foods that satisfy your taste buds without upsetting your system.