Food Allergy: What You Need to Know

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What Is Food Allergy?

Food allergy is an immunoglobulin (Ig)E- or non-IgE-mediated immune response

to food protein. This column will focus on IgE-mediated food allergy

represented by immediate hypersensitivity (Gell-Coombs Type I), which can

include anaphylaxis and can be life-threatening. Non-IgE-mediated reactions

are thought to be cell mediated (allergic eosinophilic

esophagitis/gastroenteritis, food protein-induced proctocolitis, food

protein-induced enterocolitis syndrome, food protein-induced enteropathy

[including celiac disease], and food-induced pulmonary hemosiderosis).

Adverse reactions to foods are sometimes confused with food allergies, but

these reactions are nonimmunologic. Nonimmunologic food reactions can be

metabolic (lactose intolerance), pharmacologic (chemical migraine triggers

such as tyramine, aspartame, monosodium glutamate, nitrates/nitrites,

alcohol, coffee, and chocolate), or toxic (scombroid poisoning or food

poisoning) in origin. Lactose intolerance can be managed with replacement of

the enzyme lactase. Symptoms of scombroid poisoning, associated with

bacterial histamine build-up in contaminated fish such as tuna or mackerel,

can appear similar to an allergic reaction; affected patients respond well

to antihistamines.[1] In contrast to food allergy, food poisoning often

occurs in clusters and is not reproducible.

The High and Increasing Prevalence of Food Allergy

*Demographics.* Food allergies affect up to 8% of children and 3%-4% of

adults.[2,3] Food allergies account for 29%-50% of all cases of

anaphylaxis,[4,5]which in turn cause 150-200 deaths annually

[6] (6-7 times more than deaths from insect stings).[7] No gender or racial

disparities have been noted in food allergy, except for Hispanic children,

who have a lower rate of food allergy than white or black children.[8]

*Prevalence. *Food allergy is growing. From 1997 to 2007, the prevalence of

reported food allergy increased 18% in children under the age of 18 years.

[8] Peanut allergy has tripled in children under the age of 18 years in a

similar time frame, from 0.4% in 1997 to 1.4% in 2008.[9] Peanut allergy now

affects 0.6% of the population and is the most common cause of fatal

food-induced anaphylaxis.[9,10] Adverse reactions to food additives, such as

coloring or preservatives, are rare and estimated to affect be between 0.01%

and 0.23% of the general population.[11-13]

Virtually any food can cause an allergic reaction. The most common allergens

in childhood are cow's milk (2.5%), egg (1.6%), peanut, soy, wheat, tree

nuts, fish, and shellfish.[2,14] In adults, the most common allergens are

peanut, tree nuts, fish, and shellfish.

--

Ortiz, MS, RD

*The FRUGAL Dietitian* <http://www.thefrugaldietitian.com>

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