Submitted questions are reviewed by the editorial staff and those that are relevant to the general allergic population will be published online. We are unable to provide specific medical advice intended for an individual patient.
Q. Are there any new treatments for food allergy other than avoidance?
A. Unfortunately, not at this time. Currently, there are other therapies being studied, such as oral immunotherapy, but these have not been approved yet. We anticipate in the future though, there may be other options. For now, the recommendation is for you to strictly avoid the foods that you are allergic to.
Q. My daughter is food-allergic to all tree nuts. Our pecan trees are pollinating right now and she seems to be having a runny nose and coughing. Can she be allergic to this tree pollen as well, and do I need to keep the epinephrine injector close by?
A. While pecan tree pollen may share some proteins with its corresponding nut, most likely your daughter will not be allergic to that tree pollen just because she has a tree nut allergy. A cross reactivity between nut proteins and the pollen from the nut-producing tree has not been described in the literature.A person who is allergic to certain tree pollen (not typically nut-bearing trees, though) may have what is called "oral allergy syndrome" when they eat walnut in particular, and some other tree nuts. Symptoms include mouth itchiness, and nausea, and are less likely to progress to more severe symptoms - and sometimes have cough from drainage or allergic asthma- during the tree pollen season.So, the most likely possibility is that your daughter - in addition to her food allergy to tree nuts - has environmental allergies to tree pollen, but would be unlikely to need her epinephrine for this problem. Consider discussing this further with your allergist. Of course, epinephrine should always be on hand, in the event an accidental ingestion of nuts causes a severe reaction.
Q. I am looking for guidance in regards to a peanut allergy question. I am a high school nurse who has several students with peanut allergies. Would you recommend instituting a peanut free zone , in regards to eliminating peanuts in the school cafeteria?
A. Thank you for your question. This is indeed an issue raised frequently in schools, with commercial airline carriers, and in other public venues. There is little evidence to support that peanut protein (the part of peanut responsible for causing allergic reactions) remains airborne to any significant level, making the risk of inhalation of peanut protein purely theoretical. For the majority of those peanut allergic to have a serious allergic reaction, the peanut protein would need to be ingested, either in the form of peanut-containing food or food contaminated with peanut. As such, care should be taken that the food eaten by the child does not contain peanuts and has not been prepared or served with utensils used to serve peanut-containing foods.In terms of peanut protein lingering on surfaces within the cafeteria, the allergic child would need to gather sufficient protein from a surface to either ingest or absorb via skin to cause an issue. That said, the latter (contact of peanut protein on exposed skin) would only rarely cause a systemic or generalized reaction, but could cause a local allergic rash. Accidental ingestion of peanut protein from contaminated surfaces may be of greater concern with younger children and toddlers who have frequent hand to mouth behaviors. One would expect that the degree of such exposure with older children and adolescents would be much less, and likely prevented by proper hand washing prior to eating. The same rationale would apply to the child s seat in the classroom and on the bus.Hand washing or use of hand sanitizer before and after meals promotes general hygiene and is encouraged. However, the risk of ingestion of peanut protein from another student s hand is quite low under normal circumstances.Certainly, it is important that an adolescent be trained in the use of his or her own injectable epinephrine device. It is also critical that other caretakers receive training in the event that the child is unable to self-administer at the time of reaction. If there are select personnel who are consistently present and available at the school on a daily basis, training these members ensures that someone is available to help the child in the event of a suspected reaction.
Q. I have an allergy to fish, but am concerned that I am missing out on the potential health benefits of eating fish. Could I take Omega-3 supplements made from fish oil?
A. The protein content in fish-derived Omega-3 fatty acid supplements is thought to be minimal, and likely denatured. A recent review did not uncover any reports of allergic reactions. In a study to answer this question, Mark et al tested 6 fish-allergic patients in 2008 to 2 different brands of fish oil supplements. All had negative skin tests and food challenges in this study (Mark BJ, Beaty AD, Slavin RG. Allergy Asthma Proc 2008; 29:528-9). However, as only 2 brands of fish oil were tested in so few people, these results should be interpreted with caution, especially if you are extremely allergic to fish. If you are very sensitive, it would be recommended to first see an allergist who could skin test you to the product, and then administer a food challenge to be absolutely certain.
Q. My grandson has a severe peanut allergy. I want to plant some ornamental peanuts as landscape plants. They are sterile hybrids that do not produce any seeds or nuts. Will they be a problem?
A. Ornamental peanut plants (Arachis glabrata) have become popular for use as lawn ground cover. This distant perennial cousin of the common peanut, Arachis hypogaea, grows low to the ground and produces dense green foliage with small yellow flowers. Since it does not tolerate cold weather, the plant most commonly is grown in Florida and provides a hardy substitute to grasses commonly used in lawns. Its advantage over the common peanut is that it grows from rhizomes that spread underground. The peanut plant used to grow peanuts, on the other hand, produces legume pods underground that become the ground nuts that are used for food. Since the ornamental variety does not produce such pods, there is no risk that the plant would lead to an allergic reaction even if your grandson dug it up. Additionally, peanut allergens are not found in the foliage of peanut plants. Therefore, feel free to plant ornamental peanuts, enjoying the flowers and fullness of the ground cover without the worry of peanut allergic reactions.
Q. I had a question regarding mushroom compost that I just purchased for our vegetable garden. After adding many bags of mushroom compost to the top soil, I noticed that one of the components was peanut meal. I have a daughter with peanut allergy. I am assuming I need to shovel all the dirt out and not let her eat anything that we grow in that area. I can't find any information on this topic, and also wonder about other produce/mushrooms that may be grown in this medium. I don't think I've ever seen produce or mushrooms with a may contain peanut" label."
A. The contaminiation of soils with food ingredients is not rare in agriculture, and fortunately no reports of food reactions from the inclusion of these allergens in compost media have thus far been published. Direct contamination of the foods present in the area is, however, possible. Washing foods does not ensure the elimination of contaminating food allergens in the soil. Also boiling or roasting is not completely safe when considering heat-resistant contaminating allergens such as peanut allergens. Thus, in this case we suggest having your daughter avoid eating vegetable foods present in the field at the time of the fertilization. However, it is not necessary to avoid foods grown in this medium.
Q. My son recently had an allergic reaction to peanut butter, causing immediate wheezing and requiring a visit to our local ED, so his primary care physician ordered some allergy blood tests. The tests showed that my son is allergic to peanuts, but also to wheat and milk. I was told I need to remove peanut, milk and wheat from his diet. Currently he eats wheat and drinks milk every day without any trouble. Do I really need to take these foods out of his diet? Will I harm him if I don t?
A. Your son should definitely continue to strictly avoid all foods containing peanut and maintain two epinephrine auto-injectors at all times. The good news is that he does NOT have to remove milk or wheat from his diet if he is able to eat these foods without symptoms. While food allergy is becoming more common, so is the over-diagnosis of food allergy. Your doctor likely ordered a test looking for allergic antibodies, called IgE, to a panel of foods. Another test that can be done to aid in the diagnosis of food allergy is allergy skin prick testing. It is very important to know that patients can have a positive blood or skin test to a food, however, without having an allergy to that food (i.e. false positive). A diagnosis of food allergy is best made when someone has both a positive allergy test to a specific food and a history of reactions that suggests an allergy to the same food. The gold-standard or best test to diagnose food allergy is an oral food challenge performed by an allergist. Your son s positive blood test to peanut, paired with his recent reaction, confirms peanut allergy but positive blood tests alone do not indicate food allergy.Sometimes providers order another type of antibody test to foods, called IgG, to foods. This unproven test does not ever indicate allergy and can lead to inappropriate diagnosis and unnecessary food avoidance diets.If you think your child may have a food allergy or if you have limited your diet based upon possible food allergies, I suggest you consult with an allergist. Allergists are pediatricians or internal medicine doctors that have completed two to three additional years of specialty training on diagnosing and treating allergic conditions.
Q. My three-month-old son has tried seven different formulas in addition to me breastfeeding him, and still has severe vomiting and eczema. He has just seen an allergist, who recommends I stop breastfeeding him and switch him to Neocate or EleCare formula while she completes her workup. However, I am myself allergic to corn and am concerned because these products have corn components. My question is, if my son turns out to be allergic to corn, can he use those formulas safely?
A. The corn component in the hypoallergenic formulae is corn syrup, derived from corn starch which has been processed to remove any impurities. Thus, this corn starch does not have any corn protein in it. As far as we know, the allergy to foods is caused by a response to the protein part of the food. Reassuringly, experts in the area of food allergy who helped to answer this question have not had patients react to these formulae. Also, it is not established that children inherit the exact same allergy as their parents. For all the above reasons, the child is not expected to have an allergic reaction to the hypoallergenic formula. It is advisable that the introduction of this formula be done at the allergist office, on an oral food challenge protocol, so any side effects suspected to be due to the formula can be carefully evaluated.
Q. Is celiac disease the same as a wheat allergy? In contrast, a wheat allergy is an overreaction of the immune system specifically to wheat protein. When a person with wheat allergy ingests wheat protein, it can trigger an allergic reaction that may result in a range of symptoms such as skin rash, itching, swelling, trouble breathing, wheezing, and loss of consciousness. Wheat allergy can be potentially fatal. Patients with wheat allergy must strictly avoid wheat, and must have quick access to epinephrine in event of an allergic emergency.
A. Celiac disease (also called celiac sprue) is caused by an abnormal immune reaction to gluten in the small intestine. Gluten is a protein found in various grains. When individuals with celiac disease eat gluten-containing products such as barley, rye, and wheat, damage occurs in the lining of the small intestine. People typically experience symptoms such as abdominal pain, bloating, or diarrhea as a result, and may be at risk of malnutrition and complications such as osteoporosis and anemia.Blood tests are frequently used to identify patients with high likelihood of having celiac disease. To confirm a diagnosis of celiac disease, a biopsy of the small intestine is obtained by a GI specialist.If a patient with eliminates gluten from the diet, the small intestine will start to heal and overall health improves. Medication is not normally required.Wheat allergy is most common in children. Many children outgrow wheat allergy in early childhood. Many patients with wheat allergy can consume other grains. However, some patients with wheat allergy are also allergic to other grains. You should discuss foods that can be safely consumed and foods to avoid with your allergist.
Q. My allergist has performed skin tests which have been of some help. Have you information on the various kinds of blood tests available for possible food allergies?
A. There are two kinds of food allergy blood test. One is IgE based and reflects the most common allergic reactions. One can choose each food to be tested, shrimp, salmon, orange, peanut, etc. Another type of food test measures IgG antibodies to foods. This is controversial with unclear clinical significance since people can have these type of positive tests without any clinical problem.
Q. If someone is allergic to olives, should olive oil also be avoided? Does the oil contain trace proteins from the olive, or just the fat?
A. In an extensive review of the literature, serious allergy to the olive fruit as a food has fortunately been rarely reported. There are three case reports of people who reacted to the ingestion of olive fruit, one report describing an allergy to olive fruit developing after pollen allergy shots, and one case of airway disease in an olive-oil mill worker. Skin allergic reactions - such as contact dermatitis or hives - to olive oil have been reported uncommonly. In contrast, olive trees commonly cause seasonal allergy symptoms from inhaled olive tree pollen, something which typically occurs in specific growing regions.A little background on the manufacture of olive oil is also in order: olives are cleaned and ground into a paste which releases the oil, and then the paste is mixed to allow small oil drops to combine into bigger ones. The extracted olive oil is then separated from the fruit water and solids. Given this process, which is considered a "cold press" extraction, it is conceivable that the resulting olive oil could contain olive proteins. However, the infrequent reports of olive fruit or olive oil allergy might be related to the fact that the protein content of an olive itself is very low, approximately 2%. Of the patients reported in the literature having olive fruit food allergy, few were reported to have any reaction to olive oil. So in conclusion, the answer to the above questions is as follows: if the person has a certain diagnosis of an olive fruit allergy (via skin tests and/or an oral food challenge), the likelihood of olive oil allergy is low (very little protein content). However, to be safest, the same type of diagnostic testing can then be done with olive oil.
Q. During her college year in South Carolina, my 20-year-old daughter was bitten by ticks on three separate occasions. With the most recent bite, after the tick was removed for several days she noticed local itching and a rash at the site of the bite. Recently she has developed a series of unexplained allergic reactions that always seem to start 3-5 hours after a meal. Typically, about 4 hours after eating she complains of a stomachache, itching of her skin all over, hives and swelling of her lips and tongue. One time, the mouth and tongue swelling were so severe we took her for treatment in the emergency room because we were concerned she would be unable to breathe. On that occasion, the doctors treated her with epinephrine. We pinpointed that these reactions seem to occur after eating any beef, lamb or pork but not when she avoided those foods. However, now she continues to have these reactions, hours after eating, but despite avoidance of beef, lamb and pork. We are puzzled. Are these serious reactions caused by foods or something else?
A. Based on the brief description of your daughter's medical reactions it is possible that she developed allergy to galactose-alpha-1,3-galactose (called "alpha-gal"), a carbohydrate found in beef, lamb, and pork food products. Systemic allergic reactions related to this allergy have been widely reported and can even present as anaphylaxis, a potentially life-threatening allergic reaction with difficulty breathing, decreased blood pressure, and other symptoms requiring emergency treatment and epinephrine.Strangely, this has been a problem for individuals living in the southeastern United States who have received bites from the lone star tick (Amblyomma americanum) found in this part of the country. Although not completely understood why, patients who have received bites from these ticks are at greatest risk for developing allergy to alpha gal. The alpha gal is contained in all red meats. In some cases affected patients also have delayed allergic reactions to beef or pork gelatin or even cow's milk, which may contain alpha gal. Typically with this type of allergy there is an unexpected 3 to 5 hour delay between meals and the beginning of the generalized allergic reaction. For this reason, it has been difficult for doctors and patients to make a connection with these foods. As in your daughter's case, it may not be adequate just to avoid red meat to prevent reactions. It also may be necessary to stay away from products such as beef and pork gelatin and sometimes milk products.Allergic reactions are caused by allergic antibody (IgE antibody). This unusual and complex problem is best evaluated by a board certified allergist in your area, who can perform testing for allergic antibodies to alpha gal, beef, pork and lamb. Once a diagnosis is established, strict dietary avoidance of all causative foods is effective treatment.
Q. Does the recent rise of childhood allergies, asthma and immune disorders coincide with their consumption of bottled water instead of tap water? That is, assuming our entire tap is now slightly toxic; wouldn't that prime the kids immune systems, so that they are less vulnerable?
A. The timing of your question couldn't be better, as a new study in the Annals of Allergy Asthma & Immunology looked at exposure to certain chemicals found in tap water, specifically dichlorophenols which are used for water chlorination. However, their conclusions might lead to an exact opposite answer to your question! Researchers at Albert Einstein College of Medicine in New York City used a nationally representative sample of more than 2,000 people ages 6 years and older in the National Health and Nutrition Examination Survey 2005-2006. They assessed the association between exposure to dichlorophenols and allergic sensitization measured by allergen-specific serum IgE levels after adjusting for sample weights and potential confounders. High urine levels (75th percentile and up) of dichlorophenols was associated with sensitization to foods. Keep in mind "sensitization" in this study does not equate to someone with a food allergy diagnosis per se, as this information is not available here. While no one knows for certain whether these chemicals are causing increasing food allergies seen in the United States, this research is indeed provocative.
Q. My 5-year-old daughter is allergic to wheat, egg and peanut. At my allergist's office, others are allowed to eat in the waiting room, without restrictions. My concern is that the food could get on the chairs or in the carpet and she could have a life-threatening reaction as a result. What are the risks to her, and how can I best address my concerns with her allergist?
A. Two issues exist here: 1) medical and 2) perceptual. Medically there is minimal risk to food allergic patients from casual exposure to foods as would happen if someone were eating in the waiting room. Contact with food-covered chairs and airborne food allergen does not cause a life-threatening reaction. Such exposure is part of daily life, so there is no completely avoiding it. A food has to be ingested to cause such a severe reaction. To that end, we would discourage food sharing.The general perception is that casual food exposure does pose a risk. For that reason, many offices do ban eating in the waiting room. After all, we don't permit cats to wander the halls, nor do we grow ragweed in the planters, so why permit food? The answer is that food is not an aeroallergen/airborne, so these are not causing the same level of risk. Allergic patients do expect an allergy office to be a safe haven from allergies, regardless of whether it is medically necessary.A bigger concern is the anxiety created regarding the hazards of exposure to certain foods. This anxiety can lead to psychological trauma to the child, and to problems when parents insist that schools ban certain foods, children sit at food-free tables and so on. The best way to know the risk level to your child is to have a "proximity challenge" done at the time of diagnosis. This can reduce anxiety and allow you to see the exact dangers posed by exposure to food - both to the food by air, and also by applying a small amount on the skin. Such testing is best done in an allergist's office. For those who feel uncomfortable with such testing, the allergist can also offer to have your child taken directly to an examination room on arrival so they don't have to sit in a waiting room where food is being consumed.Bottom line: it is easy to ban all eating. It is much harder to address the underlying anxiety that leads to the concern. The best outcome for all is to deal with that directly, by doing appropriate testing in an allergist's office.
Q. I am a 44-year-old man with a known shellfish allergy for more than 20 years.
A. I have always been told that due to my severe reaction to shellfish I was also allergic to iodine. Now, I need to have a procedure that requires injecting me with an intravenous iodine-based contrast, and I told my doctor that I am hesitant to have this procedure due to my shellfish allergy. My doctor has tried to assure me that my shellfish allergy has nothing to do with me being allergic to iodine. What is your opinion? Years ago doctors believed that shellfish allergy stemmed from increased amounts of iodine present in the shellfish, so patients with a shellfish allergy were told to avoid iodine. But we now know that having a reaction to an iodine-based contrast dye is not at all the same as an allergy to shellfish.If you are allergic to shellfish, specific proteins found in these foods are the allergens, not iodine. There is about a three percent chance that if you are allergic to shellfish you will have a reaction to contrast dyes, but this percentage is about the same in people with no known shellfish allergy. In other words, allergic people can react to multiple different things! If your doctor believes you need this procedure to make a definitive diagnosis, you should undergo the procedure. Ask your doctor to speak to the radiologist prior to scheduling the procedure and explain your fears. The radiologist may recommend pre- medicating you prior to the procedure, in an effort to alleviate your anxiety and any possibility of an allergic reaction.For your shellfish allergy, you should always carry a prescription epinephrine self-injector, and be comfortable with using this in the event of a reaction.
Q. Is it true that if you are allergic to poison ivy, you are also allergic to mangos?
A. Urushiol is a chemical found in the oil of mango sap. Urushiol is also found in poison ivy and poison oak. Therefore, people who have a history of reactions to poison ivy and poison oak should be cautious when handling mangoes.Contact with urushiol causes an itchy, blistering skin rash in some people, called allergic contact dermatitis. Touching mango tree leaves, bark, or the skin of mango fruit can lead to itching, red skin, hives, and blisters that typically begin 1-2 days after exposure.People who are sensitive to contact with urushiol can usually eat mango fruit without problems, because the pulp of the mango fruit does not contain urushiol.Suggestions for sensitive people include:
Q. Sometimes my mouth tingles when I eat melons - is this a food allergy? And could these symptoms become more dangerous?
A. You are describing a kind of allergy called oral allergy syndrome (also called food-pollen allergy syndrome), tied to the fact that some fruit and vegetable proteins are genetic cousins to certain pollens, like ragweed. So people allergic to pollen may experience symptoms when they eat related foods - such as cantaloupe or watermelon with ragweed allergy, or apples or carrots with birch tree - especially during the pollen seasons.The most common symptom of this disorder is a little tingling of the lips or itching in the mouth. Fortunately, most of the time it doesn't go beyond an annoyance. Unlike proteins in peanut or shrimp, known to cause serious allergic reactions, these fruit and vegetable proteins break down quickly when exposed to enzymes in your mouth or stomach so they are unlikely to be absorbed into your bloodstream and cause a more generalized reaction. There are reports that the severity could increase, but is it common? No.As with all allergy symptoms, however, I would advice someone who experiences these symptoms to see an allergist. An allergist can help you predict which additional foods might potentially cause problems, based on pollen skin test results. Because they break down quickly, oral allergy food proteins are not often detected in standard food allergy skin tests. But if you take the fresh fruit to the appointment and do a skin test with that, it may be positive.
Q. My daughter gets hives and has trouble breathing with even the slightest amount of peanut. Her allergy was recently confirmed by allergy testing. I am pregnant and am avoiding eating all peanut products as I've been told this can decrease the chance of my newborn developing this allergy. Is this true? What other foods should I avoid during pregnancy?
A. Recent data has found that maternal avoidance of allergens during pregnancy does not affect the risk of development of allergy. Avoiding certain foods during breast feeding may reduce eczema, possibly. Also for infants with a family history of allergy, it is recommended to exclusively breast feed for 4 months and avoid solids until your infant is at least 4-6 months of age, to decrease the risk of eczema and cow's milk allergy. For infants not exclusively breast-fed, extensively (Nutramigen, Pregestimil) or partially 'hydrolyzed' formulas in the first few months, are better than whole protein milk or soy formula. After 4-6 months, specific allergy avoidance doesn't affect development of allergy.
Q. I work in a preschool where there is a child with a history of an anaphylactic allergy to eggs. Given this child s allergy, our preschool has decided to ban other children from bringing any food containing eggs. However, there are times when the other children might bring baked goods with eggs in the ingredient list. We clean all of the eating surfaces after every meal. Would this child s egg allergy worsen with exposure to other children eating baked goods containing egg? Are we doing the right things to protect this child, and at the same time, are all of our precautions necessary?
A. While it is not uncommon for children to be allergic to hen s egg, it is unlikely that casual exposure as you described would cause a reaction. In most cases it is necessary for someone to actually eat egg protein to have a reaction. If the mother of this child insists that such exposure would place her child at risk, I would ask that the child be evaluated by an allergist who can determine precisely how sensitive the child actually is. This would most likely require either an oral challenge with egg, or at the very least a proximity challenge in which the child is exposed to egg on a surface, in the air or whatever other exposure the mother is concerned about. Without that information it is impossible to accommodate her concerns or the child s health issue.
Q. I am a school nurse and have benn asked if cross contamination can occur from board games for children with food/skin allergens. The school's parent-teacher organization is questioning if they should provide new board games versus buying them used and/or taking donations. I am not sure how long allergens can remain on an item, hence my email to you. What would you recommend?
A. Yes, food allergens can certainly remain on objects. Skin contact by touching an object contaminated with the food may cause a reaction in the rare individual who is highly allergic. Washing the objects (in this case, games) with water & soap has been found to be sufficient. This would also apply to the hands of the players, particularly if they just ate that food. However, applying this precaution in the whole school might be unnecessary and may create phobia.
Q. Have you ever heard of anyone who has developed hives, swelling and anaphylaxis 3-6 hours after eating certain forms of red meat? This recently happened to me after eating sausage for dinner. I ate around 6pm and awakened from my sleep with severe abdominal cramps. I thought the sausage had disagreed with my stomach. When I got up to go to the bathroom, I felt itchy, noticed my face was red and my eyes and lips were swollen, with small hives all over my body. By the time I arrived at the local emergency room, my blood pressure was very low and I was hospitalized for anaphylaxis. I have never had an allergic reaction to a food, and before this recent episode, I ate sausage on a regular basis. The doctor and nurses in the ER stated that it was quite unusual to have an allergic reaction to a food so long after eating it.
A. According to a study conducted by researchers from the University of Virginia, red meat allergies may be much more common than previously thought, and may even induce potentially life-threatening anaphylaxis in some people. This recent study suggests that as many as half of all unexplained food allergies may be attributed to a mammalian meat allergy. Mammalian meats include beef, pork and lamb. The researchers tested 3 groups of people across the Southeast United States with a history of anaphylaxis without known cause, for an immune reaction to galactose-alpha-1,3-galactose (also known as alpha-gal), a kind of sugar found in mammal meats. The study found that between 20-50% of the participants tested positive for allergy to alpha gal. 42% of those tested showed signs of meat allergy. If you think you might have such an allergy, consider being evaluated by a board certified allergist and discuss having further testing done.