March / 2009
Your Health

Living with food allergies
by: Keith Hautala

Jessica Turner was enjoying dinner with her husband at a Mexican restaurant in Nicholasville one night last September when she started to have symptoms of a serious allergic reaction.

�My throat felt like it was going to swell shut,� Jessica says. �I have always suffered from seasonal allergies, but these reactions were totally different.�

So, Jessica, a 27-year-old administrative professional at the University of Kentucky, made an appointment to see UK HealthCare�s board-certified allergist Dr. Beth Miller. Miller immediately ordered an allergy skin test.

�The best strategy for living with allergies is to avoid the things you are allergic to,� says Miller, who is also chief of the Division of Allergy and Immunology in the UK College of Medicine. �The first step is to find out what those things are, and a skin test is the fastest way to do that.�

Allergies are a disorder of the immune system, which normally functions to protect the body from disease. An allergic reaction is basically a false alarm, where the immune system misidentifies an ordinarily harmless substance as a hostile foreign invader.

Allergy tests
In a food allergy skin test, tiny doses of many different potential allergens are administered through skin pricks. Jessica received 77 pricks on her back. The tests confirmed a number of food allergies�including corn, dairy, and tomatoes. The Mexican meal that produced such a bad reaction contained all three.

The next step for Jessica was to practice an elimination diet to determine exactly which foods cause her trouble. The diet eliminates most common foods at the beginning, then gradually reintroduces them, a few at a time. Foods that cause a strong reaction must be avoided entirely. Others can be eaten in small amounts.

�I still do a moderation diet,� Jessica says. �It is very easy to stick to if I cook at home. It takes me a little longer to do the grocery shopping, since I have to read every ingredient list.�

The most common food allergens are milk, eggs, peanuts, tree nuts, fish, shellfish, soy, and wheat.

Unfortunately, many of those are common ingredients in prepared and processed foods, often turning up in unexpected places. That�s why, Miller says, it�s important for people with food allergies to know exactly what is in their food.

�For people with severe food allergies, eating even the tiniest amount of the wrong thing�less than a single peanut�can create a medical emergency within minutes,� Miller says.

Allergy emergency
Anaphylaxis is the medical term for a severe, life-threatening type of allergic reaction. The blood vessels dilate, causing a dramatic drop in blood pressure. At the same time, the airways become constricted, causing wheezing and difficulty in breathing. Without treatment, the patient can go into shock and die.

Early signs of an allergy emergency can include swelling or hives, itching, shortness of breath, nausea, vomiting, or diarrhea. People who experience a sudden onset of these symptoms, especially while eating or shortly thereafter, should seek emergency medical attention.

Patients can save their own lives with a timely shot of adrenaline. A device called an epinephrine autoinjector, about the size of a large ballpoint pen, allows patients to give themselves an emergency injection to keep their blood pumping until they can get to the emergency room. Doctors prescribe the device for patients with severe allergies, so they can carry one with them at all times. Miller cautions that the epinephrine autoinjector is for emergency use only.

�Nothing works better for food allergies than avoidance,� she says.

Jessica says she feels a lot better now that she knows which foods to avoid, and that the change in her lifestyle has been minimal. She even still eats Mexican food on occasion.

�Eating in a restaurant is still a little tricky,� she adds. �But if I am uncertain of the ingredients, I eat very slowly and in small portions to see if I will have a reaction.�

Keith Hautala is an information specialist with the University of Kentucky Chandler Medical Center.