Food Allergy The Problem


Let's start with introducing food allergy. People tend to get confuse between food allergy and food intolerance. So what exactly is food allergy? It is an abnormal response to food triggered by immune system of our body. [7] When the substance which triggers allergy or known as allergen is introduced, cells will produced a lot of Immunoglobin E (IgE) as a defensive response. [1] However, only some people get allergies since their body is responding abnormally and their allergic can be very severe, it is even fatal! As a saying goes, 'one man's food is another man's poison'. So, what are the available treatments for people who can face death just because of food?

Possible Solution

Controlling diet

Food allergy is caused by allergen. Allergen is similar with antigen which is often referred as chemical present on the surface of cell and recognised by the immune system. Antigen induce the production of antibodies but allergen differs in a way that it causes allergic reaction in particular individual.[1] Since this involve the natural reaction in the body, there is no cure to food allergy. Therefore, the best way in treating food allergy is by controlling the diet.

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Figure 1 Immunological mechanisms of allergen-specific immunotherapy

"The best way for consumers to protect themselves is by avoiding food items that will cause a reaction."- Stefano Luccioli, M.D., senior medical advisor in the Food and Drug Administration's (FDA) Office of Food Additive Safety (OFAS) [7]

Provided that a person already know which type of food they are allergic to, avoiding consumption food which contains even the smallest extract of the allergy will help. Rotation or 'rotary diversified' diet is one of the system to control food allergies by eating food family or biologically related food on the same day and wait for at least four days before eating the same food family again.[3] Examples of food families are grain family, mustard family, legume family, mollusks and crustaceans.

Rotation diet works by limiting food-allergic people from being exposed to allergen. Antigenic food tends to cease to be a problem after being rotated on a long enough cycle. This rotation diet is also a useful tool to diagnose food which a person is allergy to especially if a person is suspected to have multiple allergies.

Eliminating completely the food which a person is allergic to may not work as expected to. Allergies to substituted food may develop as in replacing the original problematic food in diet as any food, if eaten repeatedly by allergy-prone individual could cause food allergy.[10, 2]

Figure 2 Sample Rotation Diet

I found that controlling diet is the most effective solution to food allergy. It involves the effort and discipline of the individual himself under the supervision of a doctor. Taking rotation diet as an applied diet, it helps our immune system to repair itself by minimizing adverse food reactions and restrain cumulative effects. Rotation diet also works to identify hidden food allergy as allergy-prone individual tends to have multiple allergies.

Their body can build tolerance towards food which they are allergic to naturally without any help of commercial foreign chemical. Besides, most of the allergies to food are not 'fixed' and tend to disappear after a period of months up to decade hence should be able to be control with a special diet.[3] This suits the phrase 'prevention is better than cure'.

Social and Economic Implications

There are people with allergy to food refuse to believe they are having problem and therefore reluctant to stick with treatment or medication. Even though food allergy has no specific treatment to cure the patients but drugs can be used to suppress the symptoms. Adhering to special diet and drug schedule is a simple way but hard to religiously follow by affected people. Any allergy symptoms which are too violent will affect their effectiveness in doing job. Some people with many symptoms such as indigestion and diarrhoea, aches in joints, headaches and extreme fatigue will face difficulties to concentrate thus lowers their productivity.

In the animated film, "Cloudy with a Chance of Meatball", a scene where peanut allergy is featured portray a slightly wrong idea. In the scene, it shows that one of the characters went into anaphylactic shock after touching peanut brittle. Nevertheless, she insists to stay instead of rushing to get an epinephrine shot. This may give the wrong idea especially to food-allergic children that anaphylaxis can happen by only touching the offending agent and it is safe to prolong the medication intake. In fact, people with peanut anaphylaxis should carry their self-injection epinephrine every time.[6]

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Allergic response can be triggered by food additives or genetically-modified foods. Food manufacturers may be blame when this allergic response which is too violent to be handled or causes death. Later, this will lead to serious social impact on society. Avoidance to allergenic foods by sensitized individuals will be easier if manufacturers provide unambiguous ingredient listings on food labels.[3]

Besides that, there will be impact on economy when there are many people being affected by food additives being added to food. Food industry will have to find other alternatives in order to avoid their marketing to drop. Serious food allergic response that require adherence to treatment too would cause huge financial burden and economic impact.

Advantages and Limitations

By controlling their own diet, it is easier for allergy-prone individual to carry out their daily routines like normal people because they just have to take a closer look to ingredients used in cooking. Other than that, this special diet involves no consumption of drugs which reduces the intake of commercial chemicals into their body. In addition, they can save costs for medications and hospitalizations.

Rotation diet which is suggested helps people with food allergy to get optimum nutrition for their body. Having variety of food is more likely to provide balance nutrition intake although they have to avoid certain foods. This in turn also prevents boredom with meals because satisfaction is also important in order to care for one's health.

Nevertheless, having to alternate food everyday according to the food family can be troublesome. They have to avoid eating out and do more cooking to stick to their schedule or diet. As suggested, people with allergy should reintroduce food which trigger mild allergy into their diet. However, some people may not know the moderate amount needed. If, in some occurrence, they consume a large amount of food with allergen, it can bring harmful effect to their condition.

Alternative solutions

Drug Treatment

Even though it is suggested that food-allergic individual should adhere to their special diet or avoid foodstuffs which have offending agents, there are people who unwilling or unable to do so. Other than that, there may be people who inadvertently consume food substance to which they are allergic to. Therefore, in these cases, drug treatments are needed to overcome their allergic response.

Figure 3 The illustration with bronchitis reveals general inflammation and the presence of mucus. anaphylactic reactions which is severe allergic reactions that is rapid onset, medications is important as the response may be fatal.[4] As the onset of anaphylaxis reaction occurs within seconds or minutes of exposure to allergen, breathing can stop and body may slip into shock. Heart failure caused by bronchospasm can be avoided by using epinephrine. If a person has been prescribed by the doctor with self-injectable epinephrine, they should carry the injection device all the time since life-threatening reaction of anaphylaxis may happen without notice.[9] The function of epinephrine or adrenaline is to increase heart rate, contracts blood vessel and dilate air passage whenever the symptoms of allergy shows up.[11] Other than bronchospasm, epinephrine or adrenaline is used to overcome symptoms such as urticaria, localized angioedema, swelling of lips, eyelids and tongue.[12, 2]

EpiPen® is one of the products of autoinjector which is designed to deliver a precise dose of epinephrine. There are two ways of administrating epinephrine into the body; subcutaneous or under the skin and intramuscularly or into muscle.[12] The doses of this drug should be taken repetitively at 10 to 15 minutes intervals in shock state.[3] For an asthma symptoms, 20 minutes of interval is suggested in order to sustain advantageous effect and before the effect wear off.[8]

For less severe symptoms of allergies, antihistamine is the drug prescribed by the doctor to alleviate the symptoms. Antihistamines are used in allergic rhinitis or hay fever cases, allergic skin disorders and migraine caused by allergy to food.[5] This drug therapy focused on treating symptoms of histamine reactions together with other inflammatory mediators from mast cells. It works in a way to prevent the binding of histamines to its receptor sites hence preventing actions of released histamines. Weal formation on skin and itching symptoms are suppressed by the action of antihistamines. The effectiveness of this drug is higher if being taken in a couple hours before the anticipated exposure to allergens.[12] It is even suggested that allergy-prone individual take antihistamines before meal to obviate the response of allergy.

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There are three ways fighting with the food allergy. First is by avoiding the allergens, next is by treating the symptoms with medications and lastly is to stop the allergic reaction with allergy shots. Putting the allergic response into a halt would be better but how does it happen?

Allergy immunotherapy or commonly known as allergy shots is similar to vaccination program which stimulates the ability of immune system.[5] It involves the stimulation of immune system with gradually increasing doses of purified extract of substance to which a person is known to be allergic.[8] The objective of this program is to modify or stop the allergy by reducing the strength of Immunoglobin E response. In other words, immunotherapy induce immunologic tolerance in our body.[14]

Figure 4 Photograph of an allergy victim being tested for allergic reaction by injection. of particular allergen is done by two way that is by sublingually (under tongue) or subcutaneous (under skin).[13] This immunology desensitization can improve the quality of life of people living with allergy. It can reduce the need of medications, severity of symptoms or even eliminate the allergy altogether. It takes about 6 to 12 months to become effective with injection continue to be administered for 3 to 5 years.[14]

The drawback of this program is the possible adverse reactions occurred. Itchiness, swelling, and redness may occur at the site of injection. In some rare cases, anaphylaxis could happen and must be treated immediately. Therefore, subcutaneous immunotherapy is only restricted to specialist centre.[15] On the other hand, sublingual immunotherapy has a milder side effects such as oral pruritus, mild itching and throat irritation.

Source Evaluation

The Food Allergy & Anaphylaxis Network (FAAN was established in 1991 and has 18 years of involvement in legislation regarding food labeling. The association has worked with policymakers on initiating laws focusing on food labeling, schools, emergency medical services, restaurants and airlines. Its publications are checked by 12 members of Medical Advisor Board which is comprised of leaders in food allergy research for scientific accuracy. Therefore, I believe the source is trustable and valid. In addition, other sources also came up with same facts as in the web such as from FAAN and which is from founded by The Malaysian Society of Allergy and Immunology.

Another source that I used is a book written by Dr. H. Morrow Brown. The writer of 'All About Asthma and Allergy' is a consultant allergist who is internationally recognised for his many researches into the causes and effective treatments of asthma and allergy. I also refer to a book entitled 'The Complete Guide to Food Allergy and Intolerance' which is also written by allergy expert, Drs Jonathan Brostoff. Since these sources are written by people who have experienced in this field, the information are very reliable.