It’s a sad fact that for some of us, tempura shrimp can never be on the menu. Are you allergic to crustaceans or nuts or perhaps to dairy products? A debilitating food allergy can trigger a life threatening reaction in your body…or it could just leave you feeling flatulent.

It varies from individual to individual, says Dr. Neelika Malavige, Senior Lecturer and specialist in Immunology, University of Sri Jayewardenapura, “Although individuals with ‘true’ food allergies should avoid the food they are allergic to at all times, sometimes accidental exposure may occur especially during parties or weddings,” she cautions.

“There are some individuals who have had very serious food allergies, who never eat outside their home because of the possible accidental exposure to the particular food,” adds Dr. Malavige. But can careful management and precautions lessen the need for such extreme measures? This week Mediscene speaks with Dr. Malavige about the causes, diagnosis and management of food allergies.

How do food allergies commonly manifest?

Food allergies can manifest in many different ways. The commonest symptoms would be abdominal pain, vomiting, urticaria (hives), difficulty in breathing, sneezing and wheezing that occur immediately after eating the particular food item. All of these symptoms may not occur at the same time and someone can just have abdominal pain and vomiting or just urticaria after they eat the particular food. However, some food allergies can cause very serious symptoms and can be life threatening. If the above mentioned occur together it can be very dangerous and if left untreated, may progress to loss of consciousness and death. Urticaria or abdominal symptoms occurring together with respiratory symptoms are dangerous. However, most food allergies are not that serious.

It is also important to realise symptoms that are not due to food allergies. For instance, urticaria occurring many hours or the following day after consumption of a particular food is not due to allergy to that food. A person who is allergic to a particular food item would have to develop the symptoms every time they consume the food. Itchy bumps (urticaria) occurring on most days of the week that persist for more than 6 weeks is called chronic urticaria and this condition is not due to food allergy. The cause of this is a different mechanism.

Sometimes food allergies may cause diseases such as atopic dermatitis (eczema). In these instances, the patient may not notice the eczema worsening immediately after consumption of the food. Food allergens such as milk and eggs usually only trigger atopic dermatitis in small children. Eczema in older children and adults is usually not due to allergy to any food.

What causes a food allergy? 

Our immune system plays an important role in defending our body against bacteria, viruses and fungi. However, sometimes this wonderful immune system starts doing wrong things and starts reacting against harmless things such as food. Food allergies occur when this happens.

Are some foods more likely to cause allergies than others?

Yes. Among the animal proteins that commonly cause food allergies in Sri Lanka, cow’s milk and eggs are the commonest followed by seafood, beef and pork. Some people in Sri Lanka do have nut allergies but it is far less common than in the West. The commonest cause of plant food allergies here are wheat, banana, papaya, mango (unripe), wood apple and certain green leaves.

What is the difference between food allergy and food intolerance?

It is very important to differentiate food intolerance from food allergies. Food intolerance can occur due to different mechanisms such as lactose intolerance. This is not a food allergy. Individuals who have food intolerance usually have symptoms such as abdominal discomfort, bloating, flatulence and diarrhoea, which may occur several hours after consuming the food or even the next day. Symptoms that occur due to food allergies usually occur within at least one hour after consuming the food and very rarely may occur after two hours of consuming the food. Food allergies can be life threatening, whereas intolerance to food is usually not.

Are children more likely than adults to develop a food allergy or can food allergies manifest later in life as well?
Yes. Children are more likely to develop food allergies, especially to cow’s milk and eggs. However, the good thing is that children tend to outgrow these allergies as they grow older. Most babies who are allergic to cow’s milk or eggs outgrow it by 3-4 years.

Adults can develop food allergies for the first time. Unfortunately, in adults, the food allergies rarely disappear.

What are some of the myths you’ve come across regarding food allergies?

Most of the misconceptions about food allergies are related to asthma. While asthma can be triggered due to food allergy and food allergy can be a definitive cause of asthma, this is not the case in all asthmatics. However, due to the belief that certain food items are bad for those suffering from asthma, they are completely avoided. This can have an adverse effect, especially in children, as some of the most nutritious food is excluded from their diet.

In an age where a lot of us eat pre-packaged and take-out food, are there more cases of people reacting adversely to food additives and colourings?

Yes. Some people are allergic to food colouring and preservatives. These reactions too can be very severe. Certain flavour enhancers such as monosodium glutamate (MSG, E621) can particularly cause serious reactions. Other food colourants and preservatives can also cause reactions especially in individuals suffering from asthma.

What are the treatment options for someone with a food allergy?

The most important thing would be to confirm that the person actually has a food allergy. Studies carried out all around the world have shown that only 2-6% of individuals are truly allergic to the food they believe that they are allergic to.
If a person is truly allergic to a food, then there is no option but to avoid it.

They should also be trained and made aware of the early symptoms of food allergy so that they can take the proper medicine. They should also be made aware of recognising more serious symptoms. Currently, there is no treatment to get rid of food allergies anywhere in the world. There are many studies being carried out about this, and the results have been promising. Therefore, we might have a cure for food allergies in the near future.

How can food allergies be best managed?

If someone with food allergies is accidently exposed to food, it is very important not to panic. If the person only develops itching of the mouth, urticaria or just abdominal pain, he/she should take an antihistamine immediately. In most instances, this is adequate and no other medication is necessary. However, if it is known that the person has previously had a very severe reaction to the particular food, it’s best to take him/her to hospital, after administration of antihistamines. However, if the person is suffering from a very serious reaction, he/she should be taken to hospital immediately for emergency treatment.

In many other countries, individuals with serious allergies are given adrenalin pens, which they are supposed to have with them at all times. These pen-like devices can be used by anyone in an emergency situation and have saved many lives. This is because serious allergic reactions can develop very rapidly, sometimes within minutes, and there might not be enough time for the person to be taken to hospital. Unfortunately in Sri Lanka these devices are not freely available. Although allergies were not that common many decades ago, their incidence is increasing rapidly in all countries. Therefore, this is something we need to think about.

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