THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Thursday, April 6, 1995 TAG: 9504050063
SECTION: FLAVOR PAGE: F1 EDITION: FINAL
SOURCE: BY MARY FLACHSENHAAR, SPECIAL TO FLAVOR
LENGTH: Long : 302 lines
PEANUT BUTTER is not a kid-friendly food in the Siepka household in Chesapeake. It is the enemy.
Even a tiny bit could make 3-year-old Brian seriously ill.
The last time he ate some, at age 1 1/2, Brian broke out in hives. A subsequent skin test administered by a doctor indicated Brian was allergic to peanuts.
``The doctor told me that a peanut allergy in children can be very severe, even fatal,'' said Amy Siepka, Brian's mother.
So she carries a supply of the drug epinephrine and has learned how to give Brian an injection should he accidentally ingest a peanut or peanut product.
She reads labels in supermarkets, asks questions in restaurants.
And she plays out every frightening scenario in her head.
What if he takes a bite of another child's PB&J? What if someone gives him a Nutty Buddy? What if his teachers don't take her warnings seriously, when he's old enough to go to school?
The scenario for children and adults who ingest a food to which they are severely allergic could be very scary. Sneezing, runny nose, headache, rashes, nausea and cramping could be accompanied by graver symptoms, such as swelling of the throat, difficulty breathing and a sudden, drastic drop in blood pressure that could cause unconsciousness and even death.
While as many as one-third of Americans think they have a food allergy, fewer than 2 percent really do, according to Dr. Daryl R. Altman, an allergist in Hewlett, N.Y.
``A food allergy is an adverse reaction to a food caused by the immunological system,'' Altman said. ``The immune system mistakenly identifies the allergen as something harmful.''
Most of the time, when people assume they are experiencing an allergic reaction to a food, they are actually suffering from a food sensitivity, she said.
``Food sensitivity is a garbage-can term to cover any type of adverse reaction to food,'' Altman explained. ``Beans may not agree with you. Coffee may make you hyper. Those are sensitivities, not allergies. Only when the immune system is involved does a true allergy exist.''
The symptoms
Because some allergies, like Brian Siepka's, are potentially life-threatening, ruling out or confirming the diagnosis is often vital.
At some point in our lives, virtually all of us experience a food sensitivity, experts say. The symptoms may occur occasionally or repeatedly. They may be as mild as a vague headache or as acute as the severe gastrointestinal distress that sometimes accompanies an allergic reaction.
Like a true food allergy, a sensitivity can appear or disappear with age. And, as with an allergy, the offending substance might be simple or nearly impossible to identify.
One of the most common food sensitivities is lactose intolerance. While rare in children, the condition might afflict as much as 70 percent of the world's adults, according to Edward R. Blonz, author of ``The Really Simple, No Nonsense Nutrition Guide'' (Conari Press, 1993). A deficiency in the enzyme lactase results in the inability to digest the lactose found in milk and milk products.
Thirty or 40 years ago, most cases of lactose intolerance were misdiagnosed as milk allergy. The difference between the two is that the allergy can be life-threatening.
The treatment of both conditions is similar: The patient should avoid milk. As with other food intolerances, however, adverse reactions that result from lactose intolerance can sometimes be controlled simply by drinking less milk.
Sometimes food poisoning is misinterpreted as a food allergy. Altman cited this example:
``Maybe you've been eating bluefish every Friday night your whole life and one Friday you break out in hives,'' she said. ``You might assume you've developed an allergy to the fish.''
You probably have a case of scombroid fish poisoning, Altman explained. That particular bluefish might contain contaminating bacteria that produce large amounts of histamine. When the spoiled fish is consumed, symptoms develop that resemble an allergic reaction.
The fact that some diseases look and act like allergies makes a strong case for seeking a doctor's diagnosis when symptoms are severe and persistent.
For years Robert Arehart, 53, of Virginia Beach, experienced fatigue, muscle weakness and gastrointestinal distress. After consulting three family doctors and five specialists, the conclusion was that he suffered from a wheat intolerance. But skin tests for wheat allergy were negative.
The cause of the intolerance was a mystery until a biopsy revealed that he suffers from celiac sprue, a disease that affects one out of 300 or 400 people in Ireland, about one in 2,500 in the United States.
Arehart, who has some Irish ancestry, has a sister with the same condition: The intestine lacks the enzyme necessary to absorb gluten. Failure to eliminate wheat could lead to prolonged inflammation of the intestine, which could turn into cancer.
The symptoms of Lyme disease, thyroid disease, lupus and diabetes also can be misinterpreted as allergic reactions to food, Altman said.
In addition, psychological factors may play a role in some food sensitivities.
``If you eat a peanut-butter sandwich and get a headache, you may be expecting a headache the next time,'' Altman said.
The environment in which the suspect food is eaten may affect the outcome, too. Childhood trauma connected to a certain food could lead to a repeated adverse reaction to that food into adulthood.
In his ``No Nonsense Nutrition Guide,'' Blonz points out that stress, infection and nutrient deficiencies, because they have an effect on the immune system, might make a person susceptible to an allergic reaction that might not otherwise take place.
Jim Burns, food editor of the Los Angeles Times Syndicate, is plagued by food allergies. But he sometimes gets fed up with the search for a cause.
``If you eat something that makes you feel terrible, you have to adjust whether the reaction is an allergy or just a sensitivity,'' said Burns, for whom several allergies surfaced shortly after his divorce seven years ago. ``Who cares if it's an allergy or just a sensitivity?''
Those who need to care are people who suffer from serious food allergies. Ingesting even a tiny amount of the offending substance could be catastrophic.
In Colorado, a recent two-year study of severe adverse reactions to food projected that a minimum of 950 fatal or life-threatening allergic reactions to food may occur in the United States each year.
In its consumer publication ``Food Allergy and Intolerances,'' The National Institutes of Health estimates that allergic reactions to food probably result in 50 deaths a year in this country.
Allergy vs. sensitivity
Deciding whether an adverse food reaction is an allergy or sensitivity can be tough, both for the patient and the professional.
``If every time you eat a single shrimp, you wind up in the emergency room, you probably have an allergy to shrimp,'' Altman said.
Symptoms that are subtle, delayed or seemingly not connected to a specific food are more challenging to investigate.
While some allergies are matters of life and death, overreaction is common among those who try to self-diagnose, Altman warned.
In an attempt to isolate the offending food, a person may be tempted to eliminate one food after another from the diet, without medical supervision.
``The drawback of doing this on your own is that you may wind up eating very little,'' Altman said. ``You might quickly become unhappy and start down the slope to starvation and misery. And you might be treating yourself for a condition you don't even have.''
When you consistently experience an immediate, adverse reaction to the same food, it is probably time to head to the allergist's office. There you might be asked to give a complete medical history, undergo a thorough physical exam, and take skin and other laboratory tests, if these are warranted.
In prick-skin testing, a diluted extract of the suspected food is placed on the skin, which is then scratched or punctured. If no reaction occurs, the skin test is negative. If a bump surrounded by redness forms within 15 minutes, the test is positive. But that still doesn't confirm that an allergy exists.
According to Dr. Thomas B. Edwards, an allergist in Albany, N.Y., the results of a negative skin test are better than 95 percent reliable.
``But the positive skin test is not extremely useful information because 50 percent of positive results are false,'' said Edwards, an assistant professor of medicine and head of the Division of Asthma and Allergy at Albany Medical College.
Before ordering tests, Edwards often recommends that a patient keep a thorough diet log, and then try a supervised diet that eliminates the suspect food.
The patient may subsequently be ``rechallenged,'' which means that a small amount of the food is reintroduced in a controlled medical setting. If all of this sleuthing points to an allergy, the next step is avoidance of the offending food.
``My take-home message is that there is a lot that shouldn't be done with food allergies,'' Edwards said. ``There is a tendency to blame food allergies for more of a problem than they are causing. We may not need to do as much testing as we do.''
Dietitian Gail C. Frank, a spokesperson for the American Dietetic Association, agrees, especially where children are concerned.
``A lot of what are called food allergies in children may not be allergies at all,'' said Frank, a professor of nutrition in the department of family and consumer sciences at California State University in Long Beach.
``Many of those negative responses may be the result of introducing too many foods too quickly to an immature GI tract.''
Some outgrow allergies
Parents often are too quick to assume that an intolerance of a food in infancy should lead to a lifelong avoidance of that food, Frank cautioned.
``In many cases, long-term restriction is not well-founded,'' she said. ``In two to three years, the child who showed an intolerance in infancy may outgrow the condition as the digestive tract matures and is able to handle larger proteins.''
Like many in the field, Frank advocates breastfeeding a child for the first 4 to 6 months of its life, followed by the slow and careful introduction of solids, beginning with rice cereal at 6 months.
The tendency to become allergic can be inherited. If a child has one allergic parent, he has twice the risk of developing food allergy than children without allergic parents. If both parents are allergic, a child is about four times more likely to develop food allergy.
In serious cases of food allergy, the prescription of long-term or lifelong avoidance of a food can be difficult to follow, especially if the item is used throughout the food supply in ways that are not always obvious. Peanuts, for example, often are used as a protein source; eggs are used in some salad dressings.
Food-allergy sufferers scrutinize labels in supermarkets, quiz waiters in restaurants, bring their own food to dinner parties.
Finding support
And many of them turn to The Food Allergy Network for guidance and support.
``We give people strategies for coping after they get the food-allergy diagnosis from the doctor,'' said Ann Munoz-Furlong, who founded the international, nonprofit organization a little more than three years ago in Fairfax.
Ten years ago, when her daughter was discovered to have allergies to milk and eggs, Munoz-Furlong was motivated to research ways to give her child as normal life as possible.
Now, with the help of dietitians and medical advisers, her group educates its 5,300 members in how to live with a food allergy. Through videos, newsletters and cookbooks, the network teaches how to send an allergic child to school, adapt recipes, evaluate new products and decipher unclear labels.
For instance, it might be irrelevant to most consumers to know that the food-label terms ``ghee,'' ``casein'' and ``lactoglobulin'' indicate the presence of milk. For the victim of a milk allergy, the information can be life-saving.
Recently, the allergy network sent out a special-alert bulletin. Some boxes of a national brand of balogna bearing an incorrect label were sent to 13 states. (Virginia was not among them.) The label failed to mention the presence of an ingredient derived from milk. By Federal Express, the Food Allergy Network got the word out to members whose lives might have depended on it. MEMO: FOR MORE INFORMATION
Where to get more information on food allergies and sensitivities:
Allergy and Asthma Network/Mothers of Asthmatics Inc., 3554 Chain
Bridge Road, Suite 200, Fairfax, Va. 22030-2709. Request a free
information packet that lists available publications (ranging in price
from $1 to $15) on allergies and asthma. Send a self-addressed, stamped
business envelope. This international nonprofit organization founded to
help families dealing with allergy and asthma also has a toll-free hot
line: (800) 878-4403.
American Academy of Allergy, Asthma and Immunology, 611 E. Wells St.,
Milwaukee, Wis. 53202. Request a free copy of the brochures
``Understanding Food Allergy'' and ``Adverse Reactions to Food
Additives.'' Send a self-addressed, stamped business envelope.
The American Dietetic Association, 216 West Jackson Blvd., Chicago,
Ill. 60606. Request a free copy of the Consumer Facts Sheet titled Food
Allergies. Send a self-addressed, stamped business envelope designating
ADA - Food Allergies on the front of the envelope. If you have a
specific question about food allergies or sensitivities, call the ADA
nutrition hot line at (800) 366-1655.
The Asthma and Allergy Foundation of America, 1125 15th St., NW,
Suite 502, Washington, D.C. 20005. Call the organization's hot line to
request a free packet of information on food allergies: (800) 7ASTHMA.
The Food Allergy Network (FAN), 4744 Holly Ave., Fairfax, VA 22030.
Phone: (703) 691-3179. Request a free copy of the network's bimonthly
newsletter and brochure describing other publications and videos. Send a
self-addressed, stamped business envelope. FAN is a nonprofit
organization established to help people with food allergies.
International Food Information Council Foundation (IFIC), 1100
Connecticut Ave., NW, Suite 430, Washington, D.C. 20036. By mail,
request a free copy of the brochure Understanding Food Allergy, compiled
by the American Academy of Allergy Asthma and Immunology and IFIC. A
nonprofit organization, IFIC provides information on food safety and
nutrition to consumers, government, health and food professionals.
National Institute of Allergy and Infectious Disease, Office of
Communications, 9000 Rockville Pike, Bldg. 31, Room 7A50, Bethesda, Md.
20892. This branch of the National Institutes of Health will send a free
copy of ``Food Allergy and Intolerances'' to consumers who request a
copy by mail.
MSG AND OTHER ADDITIVES
Although most Americans consume a wide variety of food additives
daily, only a few additives have been associated with adverse reactions.
These reactions are not usually caused by an allergic response to the
additive but are examples of food intolerance.
Yellow dye number 5, monosodium glutamate and sulfites are most
frequently linked to adverse reactions that can be confused with food
allergy.
The following information on the three substances is from the
brochures Food Allergy and Intolerances, a publication of the National
Institute of Allergy and Infectious Disease in Bethesda, Md., and
Understanding Food Allergy, a publication of the American Academy of
Allergy, Asthma and Immunology and the International Food Information
Council Foundation.
Yellow dye No. 5 can cause hives, but rarely. Scientists estimate
that the reaction may occur in fewer than one out of 10,000 people.
Whenever the dye is added to foods, it should be listed on the product
label.
Monosodium glutamate (MSG) has been used for many years as a flavor
enhancer. When consumed in large amounts, it can cause flushing,
sensations of warmth, headache, facial pressure, chest pains or feelings
of detachment in some people. These reactions are usually short-lived.
The Food and Drug Administration believes MSG is a safe ingredient for
the general population. When it is added to food, it should be listed on
the label.
Sulfites can occur naturally in foods or are added to enhance
crispness or prevent mold. Sulfites in high concentrations sometimes
pose problems for people with severe asthma. The sulfhur dioxide gas
given off by the sulfites can be inhaled by the asthmatic, irritating
and sometimes constricting the lungs. In 1986, the FDA banned the use of
sulfites on fresh fruits and vegetables intended to be sold or served
raw to consumers. Sulfites added to all packaged and processed foods
must be listed on the product label.
ILLUSTRATION: Color Illustration
JANET SHAUGHNESSY/Staff
THE EIGHT MOST COMMON FOOD ALLERGENS
Shellfish
Milk
Fish
Soy
Wheat
Peanuts
Egg
Tree nuts...such as walnuts
As good as fish is for us, many can't eat it because of allergies.
KEYWORDS: FOOD ALLERGIES FOOD SENSITIVTY by CNB