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Food Allergies & Treatment

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Food Allergies & Treatment

IMPORTANT LINKS:

There was a 20% increase in the number of patients diagnosed with new food allergy between 1997 and 2007. Food allergy is a very common problem for both children and adults. The most common food allergies are to cow’s milk, egg, peanut, tree nuts/seeds, wheat, fish and shellfish. It is possible to be allergic to any food.

What is Pollen-Food Allergy Syndrome?

Pollen-Food Allergy Syndrome (PFAS), also known as Oral Allergy Syndrome (OAS), is a type of food allergy that causes allergic reactions typically in the mouth and throat. It occurs when certain proteins in fresh/raw fruits, vegetables, and nuts cause a reaction in people who are allergic to pollen. This happens because the proteins in these foods are similar to the proteins found in pollen.

Typical symptoms of PFAS:
  • Itch or tingle of the lips, mouth, tongue, and/or throat

These symptoms typically appear within a few minutes of eating the offending food and usually resolve within an hour. Severe reactions are rare but can occur, including life threatening allergic reactions. In some cases epinephrine (e.g. epi-pen), may be used to treat serious allergic reactions.

Common Pollen and Cross-Reactive Foods (examples, not comprehensive):
  • POLLEN TYPE: Birch
    CROSS-REACTIVE FOODS: Apples, Carrots, Celery, Cherries, Hazelnuts, Kiwi, Peaches, Pears, Plums
  • TYPE: Ragweed
    FOODS: Bananas, Cucumbers, Melons (watermelon, cantaloupe, honeydew), Zucchini
  • TYPE: Grass
    FOODS: Celery, Melons (watermelon, cantaloupe, honeydew), Oranges, Peaches, Tomatoes
  • TYPE: Mugwort
    FOODS: Carrots, Celery, Coriander, Fennel, Parsley, Peppers, Sunflower seeds

* Of note being reactive to one of these foods, does not mean you will necessarily react to others in the same column.

Managing PFAS:
  • Avoidance: The best way to manage PFAS is to avoid the foods that trigger symptoms.
  • Cooking or Processing: Cooking the food can break down the proteins that cause the reaction. Canned, baked, or microwaved fruits and vegetables may be safe to eat.
  • Immunotherapy (Allergy Shots): Treating the underlying allergy to pollen can often treat the corresponding food allergy.

 

Conclusion:

Pollen-Food Allergy Syndrome can be managed with careful avoidance and preparation of foods. Understanding which foods may cross-react with your pollen allergies is key to preventing uncomfortable symptoms. If you have any questions or concerns about PFAS, please speak with your healthcare provider.

Note: This page is for informational purposes only and should not replace professional medical advice. Always consult your doctor for personalized guidance and treatment.

Food Allergies: Frequently Asked Questions

Symptoms vary on a case by case basis. Classic symptoms include skin reactions such as hives, itching, flushing/redness of the skin and swelling, as well as the possibility of nausea/vomiting and diarrhea. You can also have respiratory symptoms such as shortness of breath, chest tightness, or wheeze. Some patients experience a decrease of blood pressure, which may result in dizziness or loss of consciousness.

There are two ways to test for food allergy. Usually the first step to test for food allergy is by performing skin testing. Alternatively one could perform a blood test. To perform skin testing, we gently scratch the skin with a plastic tip that deposits protein from whatever foods are being tested. Then we wait……15 minutes later, we read the results, and have a discussion with our patients. You can get the results the same day of testing.

Oral Immunotherapy FAQs:
The cost varies depending on how many visits are required, and the length of each visit. Most commercial insurances cover the cost of the desensitization. Patients are responsible for deductibles and co-pays. Our administrative staff can provide you with the insurance codes needed for you to discuss coverage with your insurance carrier.
When one tolerates 3 peanut M&Ms (equivalent to 2 ½ peanuts).
While there are some individuals who are unable to complete the desensitization, studies report that the vast majority of individuals are successful, although there are often “bumps along the way.”
Home doses can be missed for a maximum of 3 days, without the need to contact the office on how to proceed. After missing doses for 3 days, one may need to have the next dose administered in the Allergy office.
It depends. A very minor “cold” with no fever does not interfere with routine dosing. However, if fever or gastrointestinal symptoms (nausea/vomiting/diarrhea) are present or if one feels very unwell, phone the office for advice as to whether or not a dose should be taken or skipped.
Yes, there are several precautions. Avoiding sports/exercise and hot showers just prior to and for 2 hours after each dose is important, since those activities increase the likelihood of developing an allergic reaction. If the dose is given in the evening, one should be awake for at least one hour prior to bedtime. For school age children, a good time to consume the daily peanut dose is once home from school, after eating a carbohydrate snack.
The specific time is not important, but doses should be given approximately at the same time each day.
It is important to consume a large carbohydrate meal or snack before doses are given. Appropriate foods include bagels, sandwiches, pancakes, waffles etc. Daily administration of a probiotic such as culturelle may prove to be beneficial and is advised.
If asthma symptoms (cough/wheeze/chest tightness/shortness of breath) begin shortly after consuming the prescribed dose of peanut, this could be the manifestation of an allergic reaction to the peanut dose recently consumed. If the asthma symptoms are very minor, administration of the rescue asthma inhaler (albuterol/Xopenex) and a quick onset antihistamine such as Zyrtec or Benadryl may suffice. However, if symptoms are more than very minor, the epinephrine auto injector should be administered, in addition to administering the rescue inhaler.
The second visit occurs on the day after the initial visit. During this visit, the highest dose of peanut administered on Day #1 is repeated under medical supervision. The second visit usually lasts 1 ½ to 2 hours. During the next two weeks, the same dose of peanut administered in the office on Day #2 is self-administered at home under very specific instructions. An epinephrine auto-injector and quick onset oral antihistamine must be available at all times.
Routine medication should be continued. However, if one has asthma or other allergies, they should be well controlled during the initial visit and step-up dose visits.
Treat the reaction the same way that you would treat any food allergic reaction. If symptoms are mild, such a mild rash/hives, itchy mouth/throat or mild stomach ache, administer a quick onset antihistamine by mouth (cetirizine/Zyrtec or diphenhydramine/Benadryl). If mild symptoms are progressing, include difficulty breathing or anaphylaxis, administer the epinephrine auto-injector (such as EpiPen or Auvi-Q) and contact the rescue squad for transport to the emergency room. Please notify our office, since the peanut dose may need to be adjusted.
The most common symptoms are an upset stomach, nausea, and less frequently, vomiting. Itching of the mouth/throat may occur. Rarely anaphylaxis may occur. Some patients are found to have an increased number of cells known as eosinophils in their esophagus (Eosinophilic Esophagitis). It is unknown whether this is an incidental finding or caused by the peanut desensitization.
Initially the goal is for individuals to tolerate 2 ½ peanuts daily, which is equivalent to approximately 3 peanut M&M’s. Once this goal has been achieved and tolerated for a period of time, consideration will be given to raising the daily dose of peanut consumed. These decisions are individualized. The program requires approximately 16 oral immunotherapy/desensitization visits in the office, and takes 7-8 months to accomplish. In order to maintain the increased oral tolerance of peanut accomplished by Oral Immunotherapy, one must continue to consume one’s specified dose of peanut on a daily basis.
Every two weeks, a step-up dose is administered in the office under medical supervision. The individual is monitored for 1½ to 2 hours in the office after each step up dose. The dose of peanut is never increased at home. If someone is experiencing any peanut allergy symptoms, the peanut dose may not be increased, or may even be decreased.
The initial Oral Immunotherapy office visit lasts approximately 4-5 hours. At 20-30 minute intervals, increasing doses of peanut flour (mixed in either juice, pudding, yogurt etc.) are administered by mouth.
To participate in the peanut desensitization program, a child must be at least four years old and mature enough to notify the parent/physician of the onset of symptoms suggestive of an allergic reaction, during the desensitization process.
Allergy & Asthma services are available at our Danbury, New Milford, Norwalk and Ridgefield offices.

Resources & Information

American Academy of Allergy, Asthma and Immunology
611 East Wells Street
Milwaukee, WI 53202
1-800-822-2762

Allergy and Asthma Foundation of America
Washington, DC 20036
1-800-7ASTHMA

Allergy and Asthma Network / Mothers of Asthmatics, Inc.
2751 Prosperity Avenue, Suite 150
Fairfax, VA 22031
1-800-878-4403

American College of Allergy, Asthma and Immunology
85 West Algonquin Road, Suite 550
Arlington Heights, IL 60005
1-800-842-7777

The Food Allergy Network
10400 Eaton Place, Suite 107
Fairfax, VA 22030
1-703-691-3179

National Institute of Allergy and Infectious Diseases
31 Center Drive, MSC 2520
Bethesda, MD 20892
1-301-496-5717

The Complete Peanut Allergy Handbook
Author: Scott H. Sicherer and Terry Malloy

Understanding and Managing Your Child’s Food Allergies
Author: Scott Sicherer

The Peanut Allergy Answer Book: 2nd Edition
Author: Michael C. Young

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