Adverse food reaction is not always an allergy

Many types of adverse food reactions are often confused with food allergies. Allergists consider a true food allergy to be an abnormal response of the immune system to food protein.

These abnormal responses are mediated by immunoglobulin E antibodies (IgE-mediated) or by immune cells (non-IgE-mediated).

The IgE-mediated food allergies are the kind that may result in immediate hives and swelling or anaphylaxis, a potentially life-threatening reaction with multiple symptoms. Common food allergies in children include allergies to egg, milk, peanut, tree nuts, fish, shellfish, soy and wheat; however, children can develop an allergy to almost any food.

Symptoms develop typically within 30 minutes, but can occur up to two hours after ingestion, and may include hives, lip and/or eye swelling, mouth itching, throat discomfort, coughing, wheezing, difficulty breathing, vomiting, diarrhea and a drop in blood pressure, which may be lead to dizziness or fainting. These symptoms are the result of chemicals, such as histamine, which are released in the body when IgE binds to a particular food protein.

Non-IgE-mediated food allergies typically cause gastrointestinal symptoms. These symptoms may include repetitive vomiting, chronic diarrhea, blood in the stool, weight loss or difficulty swallowing. These gastrointestinal food allergies are often diagnosed either by history alone or with endoscopy by a gastroenterologist.

Food intolerance is a more accurate term when referring to adverse food reactions that do not involve the immune system and are typically not a result of food protein. For example, lactose intolerance is a metabolic disorder where the body does not have the enzyme called lactase to digest the sugar lactose present in cow’s milk. This condition results in bloating, abdominal discomfort and diarrhea. Lactose intolerance is diagnosed by history alone or with a breath test performed by a gastroenterologist. Treatment includes replacement of the enzyme lactase.

Other foods may have a pharmacologic effect due to certain chemicals. This includes sensitivities to chemicals in chocolate, tyramine, aspartame, MSG, nitrates/nitrites, alcohol and caffeine, which may trigger migraines, or symptoms such as fatigue or mood changes in susceptible individuals. These reactions are not life-threatening and there are no tests available to confirm sensitivity. A sensitivity is likely if symptoms disappear when the substance is avoided and reappear when the substance is ingested again.

Adverse food reaction may also be the result of a toxic effect, for example from mishandled or spoiled food. Gastrointestinal symptoms caused by food poisoning may appear similar to those seen in allergic reactions. However, food poisoning reactions often affect more than one individual and symptoms do not occur if the individual eats the food again.

Food allergies are best diagnosed by an allergist to avoid confusion with food intolerance using skin and blood testing. Treatment includes avoiding the trigger food and if IgE-mediated, treating accidental ingestions with antihistamines and injectable epinephrine. New therapies for IgE-mediated food allergy are currently in research.

Dr. Stephanie A. Leonard is a food allergy specialist at Rady Children’s Hospital-San Diego and an assistant professor of pediatric allergy and immunology at UC San Diego.

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Texas School Food Allergy Guidelines Set to Make an Impact

School food allergy guidelines in Texas were published today – the result of a dedicated effort by children, parents, educators, healthcare professionals, and policymakers to ensure that schools are prepared to care for kids with potentially life-threatening food allergies.

Last year, children from across Texas gathered on the steps of the capitol in Austin for a rally to call attention for the need for statewide food allergy management guidelines. Together with their parents, and supp (FAI), they reached their goal to help make schools safer for kids like them.

“We have so many kids with food allergies in Texas. Our schools need help in understanding the risks we face every day and how to better manage them. I was proud to be among the students who successfully advocated for this law,” said Madeleine Sides, age 14, who is allergic to peanuts and tree nuts.

The guidelines are the result of SB 27, a bill that was authored by Senator Judith Zaffirini and sponsored by Representative Dan Branch. “Schools should be safe havens for all children, including those with food allergies,” Zaffirini said. “These guidelines will help save lives and are a testament to the dedication of the children with food allergies and their parents who were among our most persuasive advocates for this important legislation.”

Public school districts and open-enrollment charter schools must adopt and administer policies for the care of students with food allergies at risk for anaphylaxis, based on the published guidelines, by August 1,2012.

The guidelines were developed by the Texas Department of State Health Services along with an ad-hoc committee of experts that included representatives from FAAN; FAI; the Texas School Nurses Organization; the Texas Pediatric Society; the Texas Medical Association; the Texas Allergy, Asthma and Immunology Society; school staff and school administrators.

Published research has shown that 1 in 13 children in the U.S. – roughly two in every classroom – has food allergies. Every three minutes, a food allergy reaction sends someone to the emergency room for treatment.

Mike Lade, a food allergy parent from Houston, Vice Chair of FAAN’s Board of Directors and a member of the ad-hoc committee noted, “The guidelines provide all Texas school districts with the knowledge they need to understand and manage food allergies and the risk of anaphylaxis in the school environment. Importantly, the guidelines address the steps that every Texas school can take to prevent reactions from occurring on school campuses, to recognize the symptoms of a reaction, to administer lifesaving epinephrine, and to enact emergency protocols when needed.”

Laurie Combe, school health issues chair for the Texas School Nurses Organization said, “The guidelines encourage collaboration among all stakeholders and provide a set of proven practices that will make the entire school staff more efficient and effective in keeping food-allergic students safe at school. All schools in Texas will benefit from the new guidelines.”

“Studies have shown that 16-18 percent of food allergy reactions happen in schools, and that children are at risk for having their first allergic reaction in school,” said Mary Jane Marchisotto, Executive Director, FAI. “We applaud Texas for taking a leadership role in establishing these guidelines.”

The Texas guidelines provide a comprehensive overview of food allergy and anaphylaxis, signs and symptoms of a reaction, treatment of anaphylaxis, how to develop and implement emergency care plans, training for school staff, and more. They also call for a focus on environmental controls in the school setting and provide guidance for school districts to consider obtaining non-student specific epinephrine as allowed by Texas law.

For more information about food allergy, visit www.foodallergy.org
and www.faiusa.org.

About FAAN

Founded in 1991, the Food Allergy Anaphylaxis Network (FAAN) is the world leader in information, resources, and programs for food allergy, a potentially life-threatening medical condition that afflicts as many as 15 million Americans, including almost 6 million children. A nonprofit organization based in Fairfax, Va., FAAN is dedicated to increasing public awareness of food allergy and its consequences, to educating people about the condition, and to advancing research on behalf of all those affected by it. FAAN provides information and educational resources about food allergy to patients, their families, schools, health professionals, pharmaceutical companies, the food industry, and government officials. On May 9, 2012, FAAN announced its intent to merge with the other leading food allergy organization, the Food Allergy Initiative, pending state regulatory approval. To become a member or for more information, please visit FAAN at www.foodallergy.org.

About FAI

The Food Allergy Initiative (FAI) is the world’s largest source of private funding for food allergy research. FAI’s goal is to fund research that seeks a cure; to improve diagnosis and treatment; to increase federal funding of food allergy research and to create safer environments through advocacy; and to raise awareness through education. Founded in 1998 by concerned parents and grandparents, FAI has committed nearly $77 million toward the fulfillment of its mission. FAI is headquartered in New York, with an office in the Chicago area and an active volunteer committee in the Northwest, and enjoys strong relationships with food allergy support groups and advocates nationwide.

A national 501(c)(3) nonprofit organization, FAI is supported solely by donations from dedicated individuals, corporations, and foundations. For more information, please visit FAI at www.faiusa.org.

Food Allergies with Bill & Sheila

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Food allergies: a real life issue

West Haven, Conn. (WTNH) – WEST HAVEN, Conn. (WTNH) — What may appear harmless like an egg or cracker, could be deadly for someone with food allergies. It’s Food Allergy Awareness Week, and West Haven Schools are among those providing a safe environment in the classroom and lunchroom.

School systems like West Haven take a progressive, yet sensible approach when it comes to protecting students with food allergies.

“We don’t ban food here in terms of banning saying, we have a no peanut school or .. we would be banning everything and secondly, because it gives people a false sense of security when people think there’s nothing there then there’s nothing to be done,” said Donna Kosiorowski, Supervisor for School Health Services.  
 
Instead, the focus at Pagels School and district wide is teaching kids how to live in an imperfect environment. The event was organized by Sen. Gayle Slossberg. At the core of it is a close relationship with families, the school nurse and health care providers. They make up an awareness team that draws up a blueprint for the child’s specific health needs.

Concerned mother Kim Parlee says, “prior to the school nurse, we met with the school nurse. Every year we meet with the incoming teacher, we discuss all the aspects of her day, we talk about the lunchroom, the snacks.”

Parlee’s daughter Kameryn is allergic to peanuts. She carries an epi-pen to reverse a life threatening reaction.

“Just like a weapon can take a child’s life, food can take my child’s life,” said Parlee. “It’s never just a burger or a cracker, she can’t eat it unless we read it.”
       
Eight foods account for about 90 percent of allergic reactions; milk, eggs, peanuts, tree nuts, fish, shellfish, soy and wheat.

There are a number of contributing factors to the increasing number of people now allergic to food.

Food Allergy expert Chris Bartley says,  “some are hereditary, but the hygiene factor always comes into play.  We have an an environment that has lots of chemicals, lots of immunizations or cleaning, lots of things, the basic piece of that is maybe we’re taxing our immune system, but not taxing our immune system so that we are weakening it.”

Every school in West Haven has a school nurse that monitors the safety plan for kids with food allergies. With some children, they’ve contacted the local EMS with parental permission, to share the child’s health information, just in case there’s an emergency call for that student.

Mouse tests

Food allergies pose a serious and growing problem in the West. Many foods can lead to allergic reactions and this situation is further complicated by so-called cross-reactions, whereby an allergy to one particular food can trigger allergic reactions to another food. There are no treatments available for food allergies, but the establishment of two mouse models can be used to develop and test new forms of treatment, for example vaccines.

Around 4-8% of children and 1-4% of adults in the West suffer from food allergy. The most common causes of food allergy are peanuts, nuts, soya, milk, fish, shellfish, flour and eggs, but a total of over 170 different foods have been found to result in allergic reactions. In addition, there are the allergies that arise as a result of cross reactions to other types of food. The only form of treatment is to avoid all consumption of the food that the person is allergic to. Allergenic substances that are hidden in processed foods therefore pose a particular problem for people allergic to foods.

Nina E. Vinje’s doctoral research has led to the establishment of two mouse models for food allergy to the legumes lupin and Fenugreek  (Trigonella foenum-graecum). These models have been used to test whether legumes such as soya, peanuts, Fenugreek and lupin can trigger allergic reactions in mice that are already allergic to lupin and Fenugreek respectively. It is important to establish good animal models for food allergies because the development of an allergic immune response depends on a complicated interaction between types of cells in several different organs. Vinje has made every effort to reduce the use of laboratory animals to a minimum during her project. For this reason, she used an advanced statistical method to develop the models in order to gain as much information as possible from the use of as few animals as possible.

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Health Canada reminds Canadians of importance of food allergy awareness

OTTAWA – It doesn’t take much to trigger a reaction in someone with a food allergy — ingesting a tiny piece of peanut or unknowingly eating pasta containing shrimp in a restaurant. In someone with a severe allergy to these items, this can be life-threatening.

It’s estimated, based on clinically documented cases, that about 1.8 million Canadians may be affected by food allergies, Health Canada said in a recent release. Some studies show these numbers are increasing, especially among children.

Peanuts, tree nuts, sesame seeds, soy, seafood, wheat, eggs, milk, mustard and sulphites are the food allergens most commonly associated with severe allergic reactions in Canada.

When someone ingests even a tiny amount of an allergen, a reaction may develop quickly and can become very serious. The most dangerous symptoms include breathing difficulties or a drop in blood pressure with shock, which may result in loss of consciousness, anaphylaxis and even death.

There’s no cure for food allergies, the agency said. Avoiding an allergen is the only effective way to prevent allergic reactions.

Hare are some tips from Health Canada on how to protect yourself if you have a food allergy:

— Read product labels carefully as manufacturers sometimes change the ingredients used in familiar products.

— Avoid food products that contain the specific allergens and/or derivatives of the specific allergens to which you are allergic.

— Avoid food products that bear a precautionary statement naming an allergen that you are allergic to; for example, precautionary statements like “may contain X” (where “X” is the name of a commonly known allergen).

— Avoid food products that don’t list their ingredients or food products that contain an ingredient you don’t recognize.

— When eating at a friend’s or in a restaurant, tell your host/server about your food allergy, and ask specific questions about the food being served.

— If an allergist prescribes an epinephrine/adrenaline auto-injector, learn how to use it and carry it all the time.

— Wear a MedicAlert identifier so that, in case of an accident, others know about your allergies and reactions.

— Look out for allergens listed by other names; food allergens and their derivatives are sometimes found in food under different names.

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Father of five creates top mobile allergy app

Got food allergies and need to find a place to eat, fast? There’s an app for that.

Thanks to Paul Antico, founder of AllergyEats.com, allergy sufferers or parents of kids with a food allergy can readily find dining options on the road, on vacation, or right down the street.

For the past two years since its launch, AllergyEats.com has functioned as a comprehensive online guide to allergy-friendly restaurants across the nation, with over 600,000 restaurants in its database. The corresponding smartphone application, which debuted last August, makes it even easier for users to search for food on the go. Last month, the AllergyEats app, which is free to download, received a big honor: About.com’s 2012 Readers’ Choice Awards named it the “Best Food Allergy App.”

To Antico, a Cohasset resident and father of five, three of whom have a food allergy, this is a pretty big deal.

“I was excited to get the award, and to be nominated,” the AllergyEats founder said. “In two years, we’ve established ourselves as the go-to resource [for diners with a food allergy]. This opportunity will help us expand.”

Expansion is key for the AllergyEats website and app in order to have a greater influence on restaurants nationwide, Antico explained: “For the community, the more it grows, the better.”

The mobile app is a natural extension of the AllergyEats website, said Antico. “When you’re traveling, and need to find a restaurant here, it makes sense.” Besides, the founder continued, as computer technology moves further away from personal computers toward tablet-based platforms, apps are, essentially, the future.

“I always knew I wanted to do it,” Antico said of creating a corresponding app for the AllergyEats website, adding that he has heard through his business dealings that, “In five years, every website is going to be an app. For food allergies, it had to be done.”

Antico’s work with AllergyEats led to his appointment on two allergy boards of directors: the Asthma Allergy Foundation of America (AAFA) along with its New England chapter (AAFANE).

According to the AAFA, while 3-4 percent of children have allergic reactions or sensitivities to food that they may outgrow by age four, only 1-2 percent have a true food allergy. The same small percentage of adults have a true food allergy. But the total number of food allergy sufferers in the U.S. alone is 15 million, according to foodallergy.org; 6 million of these are children.

There are eight foods that cause 90 percent of food-allergy reactions: dairy, eggs, wheat, soy, peanuts, tree nuts, fish and shellfish.

The journey toward AllergyEats began when Antico was frustrated one night driving around the area looking for a place to take his two boys to dinner. Not only did he have to deal with the usual Saturday night dinner rush, making it difficult to get seated anywhere — Antico also had to work around his sons’ food allergies.

A former Fidelity financial analyst and mutual fund manager, Antico said that it’s his nature to problem solve.

“I saw a need for something. With my background, and in my own frustration, I thought, ‘I can solve that,’ and there’s a business opportunity now.’”

Antico left Fidelity in 2008 to pursue independent ventures, including his allergy guide brainchild.

“The idea came to me six years ago, and I started [AllergyEats] four years ago, the week after I left Fidelity,” Antico recalled. While the business venture has yet to return much of a profit – “It’s been all cost, zero revenue so far,” the founder said – Antico said that he is in this for the greater good.

“It could succeed for the [food allergy] community and fail for me financially, or it works for the community and could become a profitable venture. It would be nice if it makes a return at some point, but it will only make money if it succeeds for the community.”

But the AllergyEats founder doesn’t seem too concerned about the profits.

“The irony is that, ultimately, I want the site to go under because there’s no longer a need for it.”

Antico’s hope as an allergy advocate is that, one day, restaurants everywhere will be so cognizant of the various food allergies, they will be fully prepared to cater to food allergic customers. AllergyEats functions as a portal for folks to rate restaurants and share their experiences; Antico also runs a blog section of the site where he and other AllergyEats bloggers regularly review places, often putting the pressure on restaurants that don’t meet up to their standards.

Antico said that it’s nothing personal: “I dig them constantly,” he said of certain casual dining chains. “My single goal is I want everyone to get better.”

AllergyEats, as an app and a website, serves a dual purpose to both help the food allergic community find suitable dining options and to educate restaurants that may not be up to par on their allergy-free food options. In turn, restaurants that do strive to cater to this specific need rely on the site to spread the word and attract more customers.

Some establishments are so confident, in fact, that they pass out an index card with the AllergyEats logo, website link and mobile barcode reader (which customers can scan to download the app on their iPhone or Android device) encouraging customers to use AllergyEats to rate their service.

“We’re trying to get more restaurants to carry the card,” Antico said. “We have it because it brings people to the site; plus the restaurant knows it’s going to get higher ratings and know it’s going to do well… It opens up possibilities for them.”

The major goal of AllergyEats, Antico said: “We want to help restaurants that want to get better at this.”

Smartphone users all over the U.S. can utilize the AllergyEats app on the go. But what happens when they need to find allergy-friendly food overseas? Will AllergyEats make an app for that?

Antico said that while he owns the Canadian web domain and could eventually create an AllergyEats site for that country, he is not so sure about going international just yet — although he has had a number of requests.

“I’ve gotten requests for Canada, the U.K., Australia, Israel, Egypt,” Antico listed. “In the long term, it would be great. I’d love to do it, and it might happen. But in the U.S. alone, we’ve got 600,000 restaurants [rated so far] and over 15 million food allergic individuals.”

In the meantime, Antico hopes to expand AllergyEats to include reviews of and guides for schools, hotels, airports and resorts. The first piece of that plan is the AllergyEats micro site for Disney World.

Antico said he launched the Disney section of his site because, “For many people, Disney is the first place you take your kids out to eat. They have that reputation — it’s the place to go. The whole culture at Disney… everything is always exactly perfect,” Antico explained. “They know how to treat people and figure out how to accommodate you. Some restaurants you go to say, ‘Here’s what you can eat.’ Disney asks, ‘What do you want?’”

And the look on a child’s face when he or she is asked what they want, Antico said, “is amazing. Disney is fantastic; it’s the gold standard.”

The short-term goal for AllergyEats, then? Raising national awareness, both for the site and for food allergies in general.

“We have a great, great presence in eastern Mass., but there are a lot of people who don’t know about it, even in our best market,” Antico said. “How do we reach 15 million people?”

One way is to send brochures to allergists, “the one place where all food allergic people go,” explained Antico.

To keep AllergyEats users coming back, the site offers special discounts for diners who mention AllergyEats at participating restaurants.

For all of its successes, including national attention from the recent About.com award, Antico said that he is always striving for more.

“Fidelity had a phrase from the Japanese term ‘kaizen,’ which means ‘continuous improvement,’” he said. “Over the past few years, we’ve made improvements from user comments. We need to know what people want.”

Another goal, said Antico, is to raise the AllergyEats apps’ popularity as an iTunes download. “We want the app to be higher rated on iTunes and bring people to the site,” he said. “Most importantly, we want to keep the users coming back.”

AllergyEats has received numerous endorsements from food, health and allergy organizations, including the AAFA, Gluten Intolerance Group, and Mass. Restaurant Association. For more information, visit www.AllergyEats.com

Food Allergy with Bill & Sheila

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Why do humans have allergies at all?

Depending on severity, allergies can range from annoying to deadly. Millions of Americans are familiar with the sneezing, itching and coughing that come along with spring allergies to toxins, while others suffer hives or even airway blockage if they eat the wrong food.

And we know that food allergies are on the rise, partly because of awareness but experts say something else may be going on. It’s a mystery why industrial countries see more and more children having reactions to common foods such as peanuts, tree nuts, shellfish, eggs, milk, wheat or soy.

But there’s a deeper question to ask here: Why do humans have allergies at all?

One view is that the immune response seen in allergies is the same sort of defense your body uses against parasitic worms. It’s thought that what we know as “allergy” evolved against those worms, but has become mistargeted in some people, so that common substances such as pollen and dust set them off, too.

However, common environmental and food allergens have little in common with parasitic worms. There’s an explanation for why the immune system would respond to something that’s not microbial, says Ruslan Medzhitov, professor of immunobiology at Yale School of Medicine.

In a perspective article in the journal Nature, Medzhitov and colleagues probe the question: Is there another explanation for allergies? They argue that, in fact, allergies are meant to remove harmful substances from the body.

For the case of seasonal allergies to tree or grass pollen, symptoms typically include runny nose, teary eyes and extra mucus production in the respiratory system. All of these things have the effect of trying to expel something from your body that you don’t want there.

Similarly, when you have itchy skin in contact allergies, the impulse is to scratch, which has the effect of removing offending particles in the skin. But sometimes it becomes extreme: Uncontrollable itching that’s chronic, which is no longer serve the purpose of taking offending substances off the skin.

Food allergy symptoms often include vomiting and diarrhea, which also expel unwanted substances. Anaphylactic shock, the most severe and deadly reaction, involves swelling of the mouth or throat and even breathing problems. Medzhitov explains this as an extreme form of the normal allergic reaction; it has gone out of control and may cause death in and of itself, the way that septic shock is an extreme form of natural inflammation.

Experimental treatment may help food allergies

“There are things that are meant to perform some beneficial rational function; if they get disregulated, it can cause problem,” Medzhitov said.

The unpleasant experiences also make you stop eating the food that caused the reaction, and avoid that food in the future.

But wait: Plenty of people eat peanuts and other common food allergens without incident. Why do some people have extreme reactions and others enjoy these foods in peace?

Medzhitov points out that there are certain components of the foods we eat everyday whose effects on the body we still don’t exactly know. There may be certain chemicals in some foods that have noxious effects on our cells that are slightly toxic.

He hypothesizes that some people are better at detoxifying those substances than others. And those who are deficient in those detoxifying mechanisms have instead allergies to defend themselves.

And then there’s allergies to pollutants in the air. The production of mucus in allergic people, theoretically, gives them increased protection from the particulate pollutants in the air, since they will inhale less of them. That would mean that if those pollutants are carcinogenic, the allergic person would have increased protection against certain forms of cancer over time. Or you might avoid that environment altogether, thereby also taking you out of a toxic situation.

The hypothesis that allergies protect against particular cancers does have some evidence backing it up. In fact, a 2011 study suggested that allergies may stave off gliomas, which are the most common form of brain tumor. But more research needs to be carried out to back up this idea.

So what are we to make of all of this? Even if true, we can’t use this knowledge to help people with allergies – yet. But maybe one day, says Dr. Robert Wood, Director of Allergy/Immunology at Johns Hopkins Children’s Center, who was not involved in this study.

““This is a fascinating paper that sheds new light on why some people develop allergies and others do not. It also suggests reasons why the prevalence of allergic disease, including food allergy, asthma, and hay fever, have all increased over the past 20-30 years,” Wood said. “Hopefully the theories presented here could eventually be used to design prevention strategies for allergy, but at the present time they remain just theories that will not lead to any immediate approaches to treat or prevent allergy.”

Source: cnn.com

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Food allergy: worrying reactions

Chefs don’t want to poison their patrons, you’d presume. But if you have a food allergy or intolerance, you may be familiar with the game of Spot The Killer Ingredient I play when eating out with my fiancé, who is allergic to bell peppers (which show up in the most ridiculous places, such as on top of a steak sandwich) or my mother, who has a severe potato allergy – the tiniest amount will send her into anaphylactic shock. I’ve seen waiters nod sagely when she explains this, then bring her a salad topped with crisps.

There are varying degrees of sensitivity – Allergy UK says 2% of UK adults are diagnosed with a food allergy and an estimated 45% of the population suffers from food intolerance. At their most severe, food allergies can kill. We’re paranoid enough to put “warning: may contain nuts” on nut packets – or rather, the EU Labelling Directive is clear on the need to provide comprehensive ingredients lists and indicate the presence of the 14 most common food allergens on pre-packed food. New legislation for unpackaged foods won’t come into effect until 2014 and while it’s a start, it’s hardly a complete solution.

When it comes to allergies, restaurant staff can be well-meaning but ill-informed. In separate studies by Brighton and Sussex Medical School and the Jaffe Food Allergy Institute at Mount Sinai School of Medicine in New York, restaurant workers were interviewed about their awareness of allergies. Over a fifth of the respondents in both surveys thought someone with an allergy could eat a small amount of that foodstuff (they can’t), and over a fifth thought it was fine to just pick it off a finished meal (it’s not).

Despite these and a frankly terrifying list of other misconceptions (38% of the Brits interviewed wrongly believed a glass of water could help to alleviate an allergic reaction, for example), the majority of respondents in both surveys thought they could confidently provide a safe meal for a person with a food allergy.

Then there are the people who hear “allergic” and think “fussy”. Of course, some people really are just being fussy, but the problem comes when restaurant staff take it upon themselves to decide who has a genuine allergy and who is just crying wolf.

“So many people claim to have an allergy or intolerance when they don’t, so restaurant and service staff don’t take it seriously,” says food and travel writer Nikki Bayley, who is allergic to mushrooms and jalapeño peppers. “I’ve swollen up in restaurants after asking if they’re in the recipe – including in restaurants that know she’s there to review them. “One chef decided there was some sauce I had to try. I spent an hour and a half being violently sick in their bathroom.”

“Sometimes they seem to think it’s not a big deal and I’m just being fussy,” agrees writer Camilla Chafer, who has a milk allergy. “Yes, the sauce has milk in it, now you mention it. Can’t you just scrape it off? No, I can’t. It’s not a choice and I’m not deliberately being awkward. I just don’t want to vomit or pass out in your restaurant.”

This is something restaurants need to recognise, says Alex Gazzola, author of the Food Allergy and Intolerance Ink blog. “There’s a psychological side to food sensitivity – people may feel frightened, ashamed, anxious or embarrassed.” It’s hardly pleasant being the person who kicks up a fuss or sends their meal back.

It would be far too cynical to assume restaurants simply don’t care and don’t want the hassle of catering for customers with allergies. After all, those that do it well can count on enduring customer loyalty and positive recommendations – and nobody wants to do it badly, do they? When I phone some restaurants to ask if they can cater for people with allergies, they all insist they can but, from experience, I already know otherwise.

It’s not as if staff would have to learn a million allergies and ingredients, they just need to listen when someone expresses concern about the menu. Gazzola also recommends that dishes are given clear, descriptive names (as opposed to “Chef’s Special”) and that menus be posted online so they can be studied in advance. He also advises diners with allergies to phone ahead if possible to ensure their needs can be accommodated.

Restaurants are not the sole culprits here: the worried well aren’t helping either. “I’m not saying restaurants are terrible and they need to sort their act out,” says Bayley. “People need to stop complaining about things that aren’t the matter with them.”

guardian.co.uk © Guardian News and Media 2012

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food allergy labels are often ignored by sufferers

The different allergy labels in common use may be confusing consumers instead of helping them decide whether to buy a food product, a new Canadian study shows.

“We should narrow (various allergy labels) to only one which will be clear,” said Dr. Moshe Ben-Shoshan, a professor of allergy and immunology at McGill University Health Center in Montreal, who worked on the study.

An estimated 2.5 million Canadians and 15 million Americans suffer from food allergies, which can cause reactions ranging in severity from itchiness and vomiting to breathing problems, loss of consciousness and even death.

Allergy labels are governed in the U.S. by the Food Allergen Labeling and Consumer Protection Act of 2004, and in Canada by the Food Allergen Labelling Regulations, a new version of which will go into effect in August.

Although all these labels warn that a product could harm a person with allergies, they present that message in various ways. Researchers found that some labels are less effective than others in helping consumers to avoid potentially dangerous foods.

Ben-Shoshan’s team recruited more than 2,400 subjects from the general public and from allergy registries and advocacy groups for the new study, conducted between May 2007 and March 2009. The work was funded by Health Canada, a federal agency, and AllerGen, a network of allergy experts, and published in a letter to the editor in the Journal of Allergy and Clinical Immunology.

The participants included “directly affected” households in which at least one family member had a food allergy, as well as “indirectly affected” households which supply food to others with allergies such as students and preschoolers.

They answered questions about their likelihood of buying a food product depending upon various types of allergy alerts, including “may contain” foods to which people are allergic, “manufactured in a facility” that processes such foods, and “not suitable” for people with food allergies.

Researchers found people were more likely to ignore warning labels if their households were directly rather than indirectly affected by food allergies. Those who belonged to advocacy groups were most vigilant about their food purchases.

About 44 percent of directly affected consumers from the general public said they would buy a product which warned it “may contain (peanut/tree nut/sesame).” Only about 10 percent of those recruited from allergy associations, and 16 percent of consumers indirectly affected by food allergies, said they would buy a product with this label.

Across all groups, the “not suitable” label had the greatest effect in preventing purchase of a product. Participants in households were less vigilant if only adults had a food allergy than if a child had an allergy.

Taking more personal risks?

The finding that consumers were less diligent about heeding labels when buying for their own households surprised researchers, said Ben-Shoshan.

“They may feel more responsibility when preparing food for other people,” he explained. Food purchases for an allergic person in one’s own household are also made much more frequently, which might make it harder to exercise caution, he added.

Adults may indeed take more chances with their own health than they would if the food allergy involves a child or someone outside their household, agreed Dr. Rauno Joks, chief of allergy and immunology at SUNY Downstate Medical Center in Brooklyn.

“They think they can get away with a certain amount (of restricted foods) before having a reaction,” said Joks. “I really caution them not to take chances with their health.”

The greater motivation to heed allergy labels among advocacy group members highlights the need for more awareness, he told Reuters Health.

“The more educated people are, the more likely they are to be proactive in avoiding food allergens,” said Joks, who was not involved in the study.

The findings in Canada should apply to the United States, given their similarities in labeling standards and public awareness, he added.

The disorder appears to be on the increase in several countries, especially among children. According to a 2008 study by the Centers for Disease Control and Prevention, the rate of food allergy rose 18 percent among children between 1997 and 2007.

Food Allergy with Bill & Sheila

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