As May 9-15 2021 is Food Allergy Awareness Week, there is an opportunity to raise awareness food allergies and anaphylaxis. Fortunately, the incidence of food anaphylaxis that is fatal to a person is low and increases the risk of death slightly.1,2 However, because food allergy anaphylaxis can be fatal, it is important to highlight food allergy awareness in order to provide appropriate treatment and counseling for patients.
Food allergies are allergic reactions that involve the immune system. For food allergies – particularly food allergic reactions that are mediated by immunoglobulin E (IgE) – there are specific food proteins that are the basis for the body to increase the immune response. In the most common type of food allergy, IgE antibodies target specific proteins in food that are mistakenly perceived as a threat. Food-specific IgE antibodies are formed that bind to receptors on mast cells, basophils, macrophages, and dendritic cells, and when the allergens reach cell-bound IgE antibodies in susceptible individuals, mediators are released causing allergy symptoms. There are also non-IgE or mixed IgE-mediated reactions, but the immunological basis of IgE-mediated is key to understanding how food allergies work.
Research from 2019 shows that at least 10.7% (> 26 million) of US adults are allergic to food, whereas 19% of US adults believe they have a food allergy.3 Having a confirmatory test with a strong clinical history is important to avoid undue burdens of quality of life and to provide appropriate counseling, medication, and diet management, if necessary.
Anaphylaxis is a multisystemic, severe, and potentially life-threatening allergic reaction. Symptoms can vary from confusion and agitation to swelling of the lips and mouth, difficulty breathing, wheezing, hypotension / weak pulse, and / or itching or redness all over the body. Epinephrine is the treatment of choice for this reaction. Many patients with food allergies have epinephrine autoinjectors. Epinephrine is generally not needed for mild hives – but if there are concerns about respiratory symptoms or persistent vomiting or abdominal pain, epinephrine is usually needed. Delayed administration of epinephrine has been cited as the most common cause of death from food allergies.4.5 In addition, as we enter the summer months, patients and providers need to be aware that epinephrine autoinjectors can lose potency within hours if stored in a heated car.6
Any food can cause an allergic reaction. However, eight types of food cause about 90% of all reactions: milk, wheat, eggs, peanuts, tree nuts, fish, crustacean shellfish, and soy.7 For those affected, education in the treatment and prevention of food allergic reactions is essential – which is why patients should be provided with assistance in reading and understanding food labels.8 This is especially true for children with food allergies, who should be encouraged to start reading food labels as soon as they can read at home from a caregiver.
There are many organizations that can provide assistance with food allergy education, diagnosis, treatment, and advocacy. This includes, but is not limited to:
- American Academy of Allergy, Asthma & Immunology (AAAAI)
- American College of Allergy, Asthma & Immunology (ACAAI)
- World Allergy Organization (WAO)
- Food Allergy Research & Education Organization (FARE)
- Kids With Food Allergies (KFA), a division of the American Asthma and Allergy Foundation
This organization has a variety of online resources that are also available to patients and providers.9,10,11,12,13
Eevar Benjamin Rossavik, DO, is the chief resident of pediatrics who will soon join the faculty of his program to become a pediatrician. He has special interests in allergies, asthma and immunology.
Doctors and experts are interested in responding to these articles, or submitting their own articles to HCPLive, can contact the editorial team here.
- Turner PJ, Jerschow E, Umasunthar T, Lin R, Campbell DE, Boyle RJ. Fatal Anaphylaxis: Mortality Rate and Risk Factors. J Allergy Clin Immunol Pract. 2017; 5 (5): 1169-1178. doi: 10.1016 / j.jaip.2017.06.031
- Umasunthar T, Leonardi-Bee J, Hodes M, et al. Incidence of fatal food anaphylaxis in people with food allergies: a systematic review and meta-analysis. Allergy Clin Exp. 2013; 43 (12): 1333-1341. two: 10.1111 / cea.12211
- Gupta RS, Warren CM, Smith BM, et al. Food Allergy Prevalence and Severity Among US Adults. JAMA Netw Open. 2019; 2 (1): e185630. Published 2019 January 4. Doi: 10.1001 / zamanetworkopen. 2018.5630
- Chooniedass R, Temple B, Becker A. Use of epinephrine for anaphylaxis: Too infrequent, too late: Current practices and guidelines in health care. Ann Allergy Asthma Immunol2017; 119 (2): 108-110. Doi: 10.1016 / j.anai.2017.06.004
- Lieberman P. Biphasic anaphylactic reactions. Ann Allergy Asthma Immunol. 2005; 95 (3): 217-258. doi: 10.1016 / S1081-1206 (10) 61217-3
- https://www.aaaai.org/about-aaaai/newsroom/news-releases/epipens-heat#:~:text=Epinephrine%20autoinjectors%20(EAIs)%20have%20recommended,59%20%E2%80% 93% 2086% 20degrees% 20Fahrenheit% 20permitted