Healthy Living - January 8, 2019

Last week many Americans heard the shocking news that an eleven year-old boy died after inhaling fumes from fish cooking at his grandmother's apartment in New York City. Apparently, he did have both a history of asthma and food allergies, but did not actually eat any of the fish at that time. Many were surprised to learn that this rare event is even possible, and it serves as a cautionary tale for all who have personal experience or loved ones with food allergies.

Let's put this tragedy into proper perspective: First, a food allergy is defined as a process that triggers an immune reaction, and is quite different for the less serious but more common problem of food intolerance. Examples of the latter include the indigestion that many experience after certain foods such as beans or dairy products, or experiencing insomnia after consuming caffeine. An immune reaction is much more serious, and involves having a specific protein in food trigger a chemical reaction that releases histamine from our blood-stream with potentially fatal results. The symptoms of a true allergy can include itching, hives, sneezing, difficulty swallowing, wheezing, loss of blood pressure, and death. Common culprits include peanuts (approximately 1.3% of population), tree nuts (0.5%), shellfish (1.2%), fish (0.4%), milk/eggs (1%).

Just how big of a problem are true food allergies in the US? According to the American Academy of Allergy, Asthma and Immunology, food allergies affect about 8% of children and about 4% of adults in the United States, and account for over 200,000 emergency room visits per year. It is estimated that over $25 billion are spent treating food allergies, and at least 20 children die annually. Statistics for adult deaths are less accurate, as the cause of death can be attributed to other cardio-pulmonary complications, but some experts estimate it to be as high as five times the childhood rate.

So what can be done about food allergies? If you suspect a problem, a visit with an experienced primary care provider or an allergist would be a place to start. The first step might be a prescription for a shot called an 'Epi-pen' to provide potentially life-saving treatment for the next episode. One characteristic of food allergies is that the immune response will often get stronger with a repeat exposure. Next, in addition to taking a detailed history, this clinician can order allergy labs such as skin or blood tests. Unfortunately, these tests are not black and white. Frequently blood tests will have 'false positives' and may not uncover the true culprit. Keeping a food diary can be very useful, and if all else fails, an 'elimination diet' may be advised to identify the allergen. This is when a person starts eating a very simple (and boring!) low-allergenic diet of only 2-3 foods such as lamb and rice, then gradually introduces one food/ one spice at a time over weeks or months to see if the new additive is tolerated.

If a trigger is identified, not only will avoidance be a good strategy, but an allergist may be able design a program of supervised introduction of this food over time in a way that will avoid the immune over-reaction. This is now being done for many with severe peanut allergy, and may prove to be a superior long-term option since avoidance is often more difficult than it sounds. For example, peanuts or peanut oil can be unknowingly consumed at a restaurant, or trace amounts may be present in foods processed at a site where peanuts are also a commodity.

This recent episode is an important reminder that 'one man's food is another man's poison'. It is up to us to take the right steps to prevent another tragedy