Learn about avoiding frequent emergency room visits by taking preventive measures. Statistics
Food allergies affect 12 million people in the United States. And with the largest number of sufferers under the age of 17, more attention must be placed on the treatment for allergies to protect this vulnerable population.
There are eight foods that account for 90 percent of all food-related allergic reactions in the U.S.: milk, eggs, peanuts, tree nuts (walnuts, almonds, cashews, pistachios, pecans), wheat, soy, fish, and shellfish. And, although there is no cure for food allergies, there is much that can be done to protect yourself and your family members such that the situation is so out of control that you have to visit the emergency room.
Cause
There are two types of immune system reactions which can typically cause food allergies or sensitivities, IgE and IgG. IgE reactions typically occur quickly, in two hours or less. IgG reactions can take up to 48 hours to occur. IgG is much more difficult to figure out on your own.
Proactive Allergy Treatment
Step 1: Avoidance / Process of Elimination
The proactive treatment for allergies often begins by process of elimination. Your physician will ask you a series of questions with the intention of narrowing down the possibilities of what may be the cause of your allergies. Based on your answers to these questions, you can then begin the process of elimination. If your food allergy reactions are not too severe, you can usually find the culprit by eliminating the suspected food for a few weeks to see if your symptoms go away. If the symptoms do go away, then introduce that food back into your diet for a day or two and see if your symptoms return. If they do, you can feel confident that you have found the food that is causing your problems and needs to be eliminated from your diet.
However, in many cases, the food allergy reaction is too severe to actually consume the food in question. That is when the physician will undergo several tests in their office to narrow down the cause of your allergy. The severity of your reaction will likely determine which test the physician uses.
Step 2: Allergy Blood Test / RAST test
If your doctor feels your allergic reaction is too severe for a skin test, they will likely try a blood test instead. Blood tests measure the presence of food-specific IgE in your blood. With a blood test, the doctor looks for antibodies in the blood that can be tied to a certain food. The most common food allergy blood test is RAST (radioallergosorbent test). With the RAST test, the doctor is measuring IgE in the blood against the suspected allergen. The results may take days to arrive from the lab and is measured in units known as KU/L; the higher the KU/L number, the greater chance of a reaction to the tested food. The KU/L unites are classified from Class 0 (no allergy) to Class 6, (a high allergy). Unfortunately, the results are not clearly accurate and many patients require additional skin testing.
The RAST test is more expensive than another test known as the ELISA (Enzyme-Linked Immunosorbent assay) test, which is often more accurate and is less costly. The ELISA test utilizes the immune system and chemicals to detect a reaction in the patient’s body.
There are a number of advantages to RAST testing over skin testing. RAST testing can be used when individuals are severely allergic and the skin test may cause too much of a reaction and is often used when the patient has extremely sensitive skin. Skin tests can be easily conducted in the doctor’s office and the turnaround time for the results is much shorter because nothing needs to be sent to a lab.
Step 3: Allergy Skin Test
In allergy skin tests the doctor places the suspected allergens below the skin intentionally to see if a reaction develops or not. Get an appointment with your physician to schedule a skin test if you can't figure out the food allergy by process of elimination. Remember not to take any anti-histamines for 15 days before your scheduled skin test.
Skin test can be either a "scratch test" which is a superficial scratch on the skin or "intra-dermal test" which is a injection of small amount of allergen under upper surface of the skin. Generally there are 25-30 pricks done at one time and the results are available within half hour of the test. The test is typically done on the patient’s forearm and histamine and saline are also applied along with the allergen so there is a positive and negative control. Itchy lumps (wheal) of 5 – 10 mm may occur, with redness (flare) around the wheal. With wheal of 3mm and flare of 7mm or larger, it is assume that there is a allergy present and the results are considered positive. But wheal size is relative depending on the age of the patient, so caution must be taken when testing children. With children, the wheal and flare size may be smaller than the target of 3mm and 7mm, respectively, but it still may be considered a positive result. The wheal may last for up to 30 minutes and the skin normalizes thereafter, however another misconception is that the more severe the skin reaction, the more the individual is allergic to that particular food. This is not necessarily the case and the test should not be interpreted that way.
Both skin and blood test are sometimes unreliable and may produce false positives. Just having a positive (i.e. IS allergic to specific food) or negative (i.e. IS NOT allergic to specific food) indication in the test is not conclusive.
Step 4: Food Challenge
With this method, the doctor will give you a small amount of the food in question and wait for a reaction. If there is no reaction, then you will be asked to continue to eat a little more until a reaction is noted. Your physician might advice against a food challenge if one has a high number on the skin or blood test.
However, in all cases the end result in of these tests is avoidance. The most reliable treatment for allergies is avoiding the food that is causing you problems. At the same time, you will want to take additional precautions. Unfortunately, there are numerous ways to ingest the food you are allergic to without your knowledge, particularly when dealing with young children with food allergies. When they are at school or at a friend’s house, they may not be aware that they are eating a food that could cause them harm, and the person serving them may not be aware either.
Step 5: Medical Alert Bracelet
Ingesting food which one is highly allergic to can cause anaphylactic reaction or lead to unconsciousness. It is highly recommended that people with anaphylactic reaction to certain foods wear a medical bracelet. This bracelet can save lives, as it has medical conditions and allergies engraved on the bracelet, along with emergency contacts. Paramedics and first responders look for these bracelets, and it will serve as a daily reminder for you and your children to make others aware of your allergies.
Step 6: Allergy Action Plan
As with all emergencies, a well thought-out plan should be put in place and communicated to everyone in the family, caretakers, and schools. In the event of an allergic reaction, this plan will guide those treating the individual through the process on what steps to take, what medication to administer, and who to contact.
http://www.sbcms.org/about/board/All...lan.7-1-08.doc Step 7: Lifestyle change
Your goal in the treatment of allergies should be lifestyle change, and you should focus on eating more organic food, breast feeding and no solids until 6 months old, and limit the use of plastic and increase use of glass and stainless steel products due to release of toxic chemicals from plastics.
Step 8: Not avoid medication:
If you feel that you are getting an allergy attack then depending on the type of reaction (more below), one should use medication at first sign of an allergy attack. If you are in a situation where you are evaluating whether to take medicine or not then you are better off taking the medicine than avoiding it.
Reactive Allergy Treatments with Allergy Medicine (Minor reaction)
If you experience mild reactions to food allergies and occasionally are exposed to the food you are allergic to, there are over-the-counter allergy medicines that will ease the symptoms.
Option #1. Benadryl is the most common oral antihistamine that helps relieve allergy symptoms. It does this by blocking the histamine that is causing the symptoms. Be aware that there are side effects of using antihistamines, such as drowsiness and that “fuzzy head” feeling, so it should not be taken when you are driving or need to be alert.
Option #2 Albuterol Sometimes it is difficult to distinguish whether the allergy reaction occurred due to food allergy or environmental allergies. If you have continuous runny nose and sneezing then use of Albuterol along side Pulmocort might be advised by your doctor.
Option #3 Pepto Bismol: If your food allergy causes an upset stomach, Pepto Bismol is a good over-the-counter medication to help ease the stomach cramps.
Emergency Allergy Treatments (Major reaction)
Your reaction may be more severe than what can be addressed with over-the-counter medications. In this case, call 911 or have someone drive you to the nearest hospital or urgent care facility. Taking a antihistamine prior to leaving can help reduce the severity of the symptoms and if you have one available, use an inhaler such as Albuterol or Primatene Mist to ease the difficulty in breathing. If you feel faint, lie down with your legs higher than our head to improve blood flow. Once you reach the hospital, oxygen may be given to get your breathing back to normal.
The biggest fear lies with those that have severe reactions to food allergies is anaphylaxis. This is life-threatening as it causes the throat to swell and makes breathing very difficult. Other warning signs are trouble speaking, wheezing, hives, nausea or vomiting, and fast heartbeat or pulse. Immediate attention is required.
Step 1. epinephrine (Epi-Pen) Epinephrine It is given as a shot to ensure it enters the bloodstream quickly and starts working fast. Monitor how the epinephrine is working, as it may take a second dose, if the first did not do the job.
Step 2. 911 - In either case, you should head to the nearest emergency room or call 911, as the individual may have additional symptoms that should be treated immediately.
Step 3. Albuterol – If you have a severe respiratory / breathing problem, the doctor might give you Albuterol to help with breathing. Albuterol is a bronchodilator that increases airflow to the lungs by relaxing the muscles in the airway. If your allergies are severe enough to cause difficulty breathing, Albuterol should be kept on hand at all times.
Step 4. CPR Furthermore, if the patient is still having trouble breathing, CPR should be given until emergency responders come.
Controversial Allergy Treatments under Research
There are several new allergy treatments under research, but most have not yet shown that they are effective in diagnosing and treatment of the food allergy and so are still controversial.
Option #1. Cytrotoxity
The “cytrotoxicity” testing is conducted by adding a small bit of the food to the individual’s blood sample. If white blood cells die, then it is assumed that the individual is allergic.
Option #2. Proactive Challenge / SLIT
Another questionable test is the “provocative challenge”. A diluted portion of the food sample is either placed under the individual’s tongue or injected into their skin. If symptoms appear, you are likely allergic.
Option #3. Immune Complex Assay
Still another, the “immune complex assay”, tests a group of people to see if certain antibodies are linked to food allergies in specific groups. Again, these are inconclusive and should be used with caution.
In summary, there is no cure for food allergies but there is research under progress that gives us hope that there will be cure within the next decade. In the meantime, make sure that you don't avoid medication such that you can reduce the number of visits to the ER.
Food Allergy Treatment and Prevention 
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