The primary way to manage a food allergy is to avoid consuming the food that causes you problems. Carefully check ingredient labels of food products, and learn whether what you need to avoid is known by other names.
The Food Allergy Labeling and Consumer Protection Act of 2004 (FALCPA) mandates that manufacturers of packaged foods produced in the United States identify, in simple, clear language, the presence of any of the eight most common food allergens - milk, egg, wheat, soy, peanut, tree nut, fish and crustacean shellfish - in their products. The presence of the allergen must be stated even if it is only an incidental ingredient, as in an additive or flavoring.
Some goods also may be labeled with precautionary statements, such as “may contain,” “might contain,” “made on shared equipment,” “made in a shared facility” or some other indication of potential allergen contamination. There are no laws or regulations requiring those advisory warnings and no standards that define what they mean. If you have questions about what foods are safe for you to eat, talk with your allergist.
Be advised that the FALCPA labeling requirements do not apply to items regulated by the U.S. Department of Agriculture (meat, poultry and certain egg products) and those regulated by the Alcohol and Tobacco Tax and Trade Bureau (distilled spirits, wine and beer). The law also does not apply to cosmetics, shampoos and other health and beauty aids, some of which may contain tree nut extracts or wheat proteins.
Avoiding an allergen is easier said than done. While labeling has helped make this process a bit easier, some foods are so common that avoiding them is daunting. A dietitian or a nutritionist may be able to help. These food experts will offer tips for avoiding the foods that trigger your allergies and will ensure that even if you exclude certain foods from your diet, you still will be getting all the nutrients you need. Special cookbooks and support groups, either in person or online, for patients with specific allergies can also provide useful information.
Many people with food allergies wonder whether their condition is permanent. There is no definitive answer. Allergies to milk, eggs, wheat and soy may disappear over time, while allergies to peanuts, tree nuts, fish and shellfish tend to be lifelong.
Be extra careful when eating in restaurants. Waiters (and sometimes the kitchen staff) may not always know the ingredients of every dish on the menu. Depending on your sensitivity, even just walking into a kitchen or a restaurant can cause an allergic reaction.
Consider using a “chef card” - available through many websites - that identifies your allergy and what you cannot eat. Always tell your servers about your allergies and ask to speak to the chef, if possible. Stress the need for preparation surfaces, pans, pots and utensils that haven’t been contaminated by your allergen, and clarify with the restaurant staff what dishes on the menu are safe for you.
Symptoms caused by a food allergy can range from mild to life-threatening; the severity of each reaction is unpredictable. People who have previously experienced only mild symptoms may suddenly experience a life-threatening reaction called anaphylaxis, which can, among other things, impair breathing and cause a sudden drop in blood pressure. This is why allergists do not like to classify someone as “mildly” or “severely” food allergic - there is just no way to tell what may happen with the next reaction. In the U.S., food allergy is the leading cause of anaphylaxis outside the hospital setting.
Epinephrine (adrenaline) is the first-line treatment for anaphylaxis, which results when exposure to an allergen triggers a flood of chemicals that can send your body into shock. Anaphylaxis can occur within seconds or minutes of exposure to the allergen, can worsen quickly and can be fatal.
Once you’ve been diagnosed with a food allergy, your allergist should prescribe an epinephrine auto-injector and teach you how to use it. You should also be given a written treatment plan describing what medications you’ve been prescribed and when they should be used. Check the expiration date of your auto-injector, note the expiration date on your calendar and ask your pharmacy about reminder services for prescription renewals.
Anyone with a food allergy should always have his or her auto-injector close at hand. Be sure to have two doses available, as the severe reaction can recur in about 20 percent of individuals. There are no data to help predict who may need a second dose of epinephrine, so this recommendation applies to all patients with a food allergy.
Use epinephrine immediately if you experience severe symptoms such as shortness of breath, repetitive coughing, weak pulse, hives, tightness in your throat, trouble breathing or swallowing, or a combination of symptoms from different body areas, such as hives, rashes or swelling on the skin coupled with vomiting, diarrhea or abdominal pain. Repeated doses may be necessary. You should call for an ambulance (or have someone nearby do so) and inform the dispatcher that epinephrine was administered and more may be needed. You should be taken to the emergency room; policies for monitoring patients who have been given epinephrine vary by hospital.
If you are uncertain whether a reaction warrants epinephrine, use it right away; the benefits of epinephrine far outweigh the risk that a dose may not have been necessary.
Common side effects of epinephrine may include anxiety, restlessness, dizziness and shakiness. In very rare instances, the medication can lead to abnormal heart rate or rhythm, heart attack, a sharp increase in blood pressure and fluid buildup in the lungs. If you have certain pre-existing conditions, such as heart disease or diabetes, you may be at a higher risk for adverse effects from epinephrine. Still, epinephrine is considered very safe and is the most effective medicine to treat severe allergic reactions.
Other medications may be prescribed to treat symptoms of a food allergy, but it is important to note that there is no substitute for epinephrine: It is the only medication that can reverse the life-threatening symptoms of anaphylaxis.
Managing food allergies in children
Because fatal and near-fatal food allergy reactions can occur at school or other places outside the home, parents of a child with food allergies need to make sure that their child’s school has a written emergency action plan. The plan should provide instructions on preventing, recognizing and managing food allergies and should be available in the school and during activities such as sporting events and field trips. If your child has been prescribed an auto-injector, be sure that you and those responsible for supervising your child understand how to use it.
In November 2013, President Barack Obama signed into law the School Access to Emergency Epinephrine Act (PL 113-48), which encourages states to adopt laws requiring schools to have epinephrine auto-injectors on hand. As of late 2014, dozens of states had passed laws that either require schools to have a supply of epinephrine auto-injectors for general use or allow school districts the option of providing a supply of epinephrine. Many of these laws are new, and it is uncertain how well they are being implemented. As a result, ACAAI still recommends that providers caring for food-allergic children in states with such laws maintain at least two units of epinephrine per allergic child attending the school.
Can food allergies be prevented?
In 2013, the American Academy of Pediatrics published a study that supported earlier research suggesting that feeding solid foods to very young babies could promote allergies. It recommends against introducing solid foods to babies younger than 17 weeks. It also suggests exclusively breast-feeding “for as long as possible,” but stops short of endorsing earlier research supporting six months of exclusive breast-feeding.
Research on the benefits of feeding hypoallergenic formulas to high-risk children - those born into families with a strong history of allergic diseases - is mixed.
The timing of introduction of certain foods is also being investigated as a means of prevention. The general practice in the United States and other Western countries is to delay the introduction of highly allergenic foods, such as peanuts, tree nuts and seafood, until after age 3. There is newer but not yet proven data suggesting that introducing these foods in a baby’s first year may help the child tolerate the food.
The bottom line is that the timing of when to introduce foods remains confusing and somewhat controversial.
Clinical studies are ongoing in food allergy to help develop tolerances to specific foods. Ask your board-certified allergist if you or your child may be a candidate for one of these studies.