Living with food allergies: A constant challenge!

Une famille cuisine ensemble

By Valérie Vaillancourt, RD, nutritionist with Nutrition Reference .

Whether you are allergic to only one food or to several, there’s no question that eating when you have a food allergy gets complicated. You always have to be careful, since a single mouthful may be enough to endanger your health. How can allergies be managed?

  • In Canada, one in two people knows someone with a serious food allergy.1
  • More than three million Canadians have food allergies, 600,000 of whom are children.1
  • Packaged food must indicate any allergens on the list of ingredients, but it’s optional to mention what it “may contain.1

What is a food allergy?

How is it that a nut can be a delicious snack for some people and a mortal danger to others? It’s because the immune system of the person with allergies is flawed and gets carried away.

Although there are many types of food allergies, the basic process is the same. When a person with allergies is exposed to the allergen, which is a specific protein, their immune system either reacts inappropriately or over-reacts. Symptoms can range from being merely uncomfortable, such as itching, irritation or inflammation, to very serious, such as swelling, low blood pressure and vomiting. And what’s the worst? A severe anaphylactic reaction can affect the respiratory system and cause generalized swelling. Without immediate treatment, anaphylaxis can be fatal.1

Regardless of the type of food allergy, there’s one golden rule that should always be followed: Avoid the allergen at all costs. And that’s where it gets complicated! It’s not easy to know if a product contains, or could be contaminated with, a substance. If more than one allergen is involved, it becomes even more complex to choose safe foods. And if this is challenging for an adult, just imagine how a child copes!

Food allergies are not a quirk but a serious health issue. Managing them means not only the person with the allergy must be very vigilant but also everyone in their surroundings.

The various types

The most well-known food allergy is caused by an antibody called immunoglobulin E (IgE). It’s the one that can cause anaphylaxis. Symptoms appear rapidly: from a few minutes up to two hours after contact with the allergen. Reactions are unpredictable and can be severe or even fatal without a shot of epinephrine. In fact, using an epinephrine auto-injector is the only effective treatment of a severe anaphylactic reaction.2

Oral allergy or pollen-food allergy syndrome is also an allergy caused by IgE. However, the symptoms are different. They’re usually limited to the perioral area (mouth, lips and throat). This syndrome affects people who are also allergic to certain types of pollen. The allergen is usually found in fruit, vegetables and various nuts and grains. Only one to two percent of people affected develop anaphylactic reactions.3

There are also allergies that are not caused by IgE. They mainly affect the digestive system of babies and usually disappear at age 12 to 24 months.

And certain allergies are mixed, meaning a combination of two types of allergic reactions. Eosinophilic esophagitis is a good example. It’s a chronic immune-mediated disease resulting in inflammation of the esophagus.

There’s also celiac disease, which is brought on by another antibody called anti-transaminase (ATG). Ingesting gluten, a protein in various cereal grains such as wheat, is the problem. A biopsy or a blood test is required to obtain a clear diagnosis.

Une personne subit des tests d'allergie

Who is at risk?

Contrary to what you might think, allergic reactions do not occur with the first exposure to the allergen. At first contact, the immune system is introduced to the substance. This is known as the sensitization phase. It’s during subsequent exposure that an allergic reaction may be triggered. That's why some people develop allergies later in life. Infants sometimes outgrow certain allergies as their immune system matures.

But what specifically makes us more at risk of developing an allergy? Four factors can be identified in the case of children:

  • Severe eczema
  • Genetics, as in having one or more parents, brothers or sisters who have an allergy such as a food allergy, nasal allergy, eczema or asthma
  • Delayed introduction of food allergens into the diet
  • A sanitized environment that is too clean, where there is little contact with various microorganisms such as bacteria and viruses

More studies are needed to determine the risk factors for adults developing food allergies. Up to now only significant hormonal changes, such as menopause, have been identified as a risk factor.

Allergens to watch out for

Most foods that contain proteins, even in tiny quantities, can trigger allergic reactions. According to studies, more than 160 foods can cause severe reactions.

The most problematic allergens vary from one country to another.4 For instance in France, celery and lupin are recognized allergens. Here, Health Canada lists nine priority allergens since they are responsible for over 90% of severe allergic reactions:

  • Peanuts
  • Wheat
  • Seafood, shellfish and fish
  • Milk
  • Mustard
  • Nuts
  • Sesame
  • Soy
  • Eggs

Understanding the labels

Since 2012, Health Canada requires that the nine priority allergens be clearly identified on the lists of ingredients for packaged food. It also allows “May contain...” on the list, but the legislation does not make it mandatory to mention that a product may have been in contact with an allergen that is not on the list of ingredients. For example, in the case of caramel that is packaged on the same assembly line as peanut butter, the manufacturer is not required to indicate “May contain peanuts” on the label. People with allergies must always remain vigilant. Often they must contact the manufacturers to verify the manufacturing process. Think about how further complicated it gets if the person reacts to non-priority allergens such as sunflower seeds or beans or if they react to more than one food!

How allergies can be managed

Numerous little things can limit the risk of exposure to allergens. People with allergies learn to apply them quickly, but their friends and families can also help them make life easier. Here are several examples:

Wash your hands before and after every meal

No soap and water available? Use a commercial wet wipe. Be careful with sanitizers, however. They don’t eliminate traces of proteins.

Verify the ingredients

When cooking, you need to ensure that allergens are not on the list of ingredients. This is true for all packaged food, including spices. Often, it’s necessary to verify the manufacturing process with the manufacturers.

Don’t take risks!

If you are making a recipe and believe you may have contaminated the food with an allergen, it’s best to start over. It’s not safe to merely fish out some nuts you added to a salad by mistake. You need to make a new salad.

No sharing

Don’t nibble on food from another person’s plate or drink from another person’s bottle. You never know if that person ate a food allergen previously. It’s true! An allergen can survive for more than an hour in saliva!

Serving food

In the case of a buffet, let the person with allergies go first. This way they are protected before utensils are used by others and there is contamination between the various dishes. You could also do away with buffets completely and do plated individual servings.

Wash everything!

No food must be sticking or dried on the surfaces of utensils, pots and dishes. Such remains would be enough to provoke an allergic reaction. Same thing for surfaces such as counters, tables, cutting boards, etc. They all must be washed with soapy water, a cleaning product or commercial wipes.

Exclusive usage

Have a toaster and other kitchen tools reserved exclusively for the person with allergies. Clearly identify a storage space for them, too. Ensure that cleaning products such as those mentioned above are always available.

Don’t be offended

If a person with allergies prefers to bring their own meal or order from allergy-friendly food services, don’t take it the wrong way! In fact, offering this option might be greatly appreciated.

Oral immunotherapy: A promising treatment!

In the past few years, oral immunotherapy (OIT) has provided a glimmer of hope to people living with numerous allergies. The purpose of this treatment is to progressively desensitize the immune system to various allergens. This way the person can dodge extreme reactions and reintegrate these allergens into their diet.

OIT is done in clinics under the careful supervision of specialists. It consists of ingesting precisely calculated microdoses of the allergen to establish the smallest quantity that can be tolerated. Then the doses are progressively increased to avoid reactions, until a normal portion of the food is reached.

Up to now, desensitization has been successful with people from age nine months to fifty-six years. However, OIT can only be provided for known allergens. It’s possible to treat up to five foods at a time.5

Dubious test results

Many companies offer various tests or analyses for identifying food intolerances such as hair analysis, lgG rate, etc. The Canadian Society of Allergy and Clinical Immunology states that there is no valid scientific data to support the use of these tests when investigating an allergy or a food intolerance.6

In spite of the fancy explanations describing these tests, they remain very controversial. Many experts have expressed serious doubts about their validity. Do you believe you’ve had an allergic reaction? Before spending your money, always consult your physician first.

In conclusion

Food allergies are not a quirk. They are an over-reaction of the immune system and can sometimes be fatal. Avoiding allergens is the only way for people with allergies to protect themselves. Developing the right reflexes and always being vigilant become essential since finding a safe diet is a constant challenge. Friends and family can also help by adopting simple facilitating behaviours.