Diagnosing food allergies can be a tricky thing to do! When your immune system over-reacts to a special protein found in a food, you have a food allergy. Sometimes symptoms occur simply by touching, breathing or eating a tiny amount of the food.
My previous post discussed how the immune system makes immunoglobulins as a response to reacting with an allergen, thus this reaction is at the heart of diagnosing food allergies.
True food allergies are reactions that always generate symptoms, usually within minutes to hours. Although any food may cause an allergy, over 90% of significant food allergies are caused by cow’s milk, egg, wheat, soy, peanut, tree nut, fish, shellfish.
The majority of food allergies do not lead to the life-threatening reactions most of us associate with the disease. As an ENT surgeon, many of my patients with significant food allergies show symptoms such as nasal swelling, ear/sinus infections, excess mucus production, cough, hoarseness and skin rashes.
The typical symptoms that I see in my patients may not be noticeable immediately even though the immune reaction has indeed started to occur!
I treat many children who have had chronic ear infections and conductive hearing loss due to food allergies. Once the foods have been identified, most of my patients are able to continue to eat the foods; however, a significant reduction in the amount eaten in needed.
Although ear tubes may not be avoided in many patients, I believe all efforts to reduce swelling around the eustachian tube should be attempted. Therefore, managing food allergies in young patients may be important for preventing recurrent ear infections.
People who think they are allergic to a particular food frequently just developed an intolerance. Symptoms of food intolerance and food allergy are similar but differences between the two are important to know because food allergy reactions can be life-threatening.
Although allergic reactions can happen a few hours after eating a trigger food, they usually occur within minutes. Diagnosing food allergies in these patients can be quite easy. The most common food allergy symptoms include:
- Hives or itchy, red skin
- Itchy or stuffy nose, itchy, teary eyes, or sneezing
- Angioedema or swelling
- Vomiting, stomach cramps or diarrhea
Food allergies may cause a severe reaction called anaphylaxis, whose signs include:
- Tingling in the hands, feet, lips or scalp
- Wheezing, tightness in the chest or trouble breathing
- Throat tightness, a lump in the throat, or hoarseness
If you experience any of these symptoms, you should immediately call 9-1-1 emergency!
Many physicians believe if food is eaten and no obvious reaction occurs in a short period of time, then an allergy does not exist. As I discussed above, I see patients on a daily basis with some repeated ear nose and throat symptoms due to allergic reactions; therefore, I do not agree with this belief. Many factors are involved in properly diagnosing food allergies.
Many of my young patients with food allergy symptoms do not show a sudden flare-up of symptoms, but they simply make more swelling and mucus. Obvious nasal drainage does not immediately occur; therefore, it can be difficult to see that more has slowly been made.
I agree that these food allergies do not cause the alarming allergic reactions classically associated with major allergies. However, I stand by the fact that these reactions count as real allergies.
My patients also suffer from chronic eczema, an extremely common skin rash. Although the exact cause of eczema is not known, a variety of foods can trigger a flare. When patients show eczema rashes in several stages of new itchy areas and old discolored, scaly areas, it becomes difficult to see new flare-ups shortly after eating an offending food.
Many unproven, non-standardized tests exist as methods to reportedly diagnose food allergies. Generally, physicians do not recommend these tests, which are expensive because they are frequently not covered by insurance. A list of non-recommended food allergy tests can be found here.
Recommended methods for diagnosing food allergies include a combination of the things listed below:
1. Allergy assessments begin by taking a detailed history.
2. Blood testing
3. Skin prick testing
4. Food challenge test
Each of these techniques deserves a separate blog for discussion! A simple summary is just not possible; however, the test names are pretty self-explanatory. My main goal in this post is to highlight that many food intolerances and reactions are tested by non-standard techniques. The four techniques listed above are pretty much the gold standard.
The first step to managing a food allergy is getting a correct diagnosis. Self-diagnosis can lead to unnecessary dietary restrictions and inadequate nutrition, especially in children.
When diagnosed with a particular food allergy, part of the treatment plan is strict avoidance of that food if severe reactions occur. Most of my patients do not need strict avoidance but a simple reduction in the amount eaten. I often tell the parents of my allergy patients that they need to “reduce and rotate” the foods.
Parents assess food in terms of the health benefits to their kids. I understand the desire to avoid eating processed less healthy foods; however, if a “healthy” food leads to an allergic reaction, that food should not be consumed daily!
A common example I see in my practice is a banana allergy. Yes, I know many young kids love bananas; however, if there is a reaction you have several management options. I suggest parents only provide 1/2 of the amount normally eaten or serving the banana every few days instead of daily. This explains my concept of ‘reduce and rotate” management for less severe food allergy reactions.
No cure exists for food allergies, and no medications prevent reactions. Education and close monitoring and management by a physician stand as the best options.
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