Food Allergy and Intolerance

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Updated Food Allergy FAQs

 

What is Food Allergy?

Food allergy is an abnormal reaction of the immune system that occurs soon after eating specific foods. The immune system overacts to the proteins found in that food. Even a very tiny amount of the allergic food can trigger digestive problems, hives and swollen airways. In some cases, these reactions can be so severe that they cause life-threatening anaphylaxis.

According to FARE, researchers estimate that up to 15 million Americans have food allergies which affect 1 in every 13 children (under the age of 18) in the U.S.

It’s easy to confuse food allergies with food intolerance which is more common.

What is the difference between Food Allergy and Intolerance?

Food AllergyIntolerance
Usually comes on suddenlyUsually comes on gradually
Small amount of food can triggerMay only happen when you eat a lot of the food
Happens every time you eat the foodMay only happen if you eat the food often
Can be life-threateningIs not life-threatening
  

90% of Food Allergies and Intolerances are triggered by the following:

Understanding Food Allergies Video

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Symptoms of Both Food Allergy and Intolerance

Symptoms of Food Allergy vs. Intolerance

Food AllergyIntolerance
Food allergy happens when your immune system mistakes something in food as harmful and attacks it. It can affect your whole body, not just your stomach. Symptoms may include:Food intolerance is when a certain food irritates your stomach or your body can’t properly digest it. Symptoms may include:
Rashhives, or itchy skinGas, cramps, or bloating
Shortness of breathHeartburn
Chest painHeadaches
Sudden drop in blood pressure, trouble swallowing or breathing – this is life-threatening. Call 911 immediatelyIrritability or nervousness
  


Current Treatment for Food Allergies

  • Strictly avoiding problem foods
  • Working with your doctor to develop a Food Allergy & Anaphylaxis Emergency Care Plan
  • Wearing an emergency medical identification (e.g., bracelet, other jewelry) at all times
  • Carrying your medication wherever you go
  • Taking your medication at the first sign of a reaction
  • Getting to an emergency room for follow-up treatment if you have a severe reaction

Food Allergy: 2015 Guidelines

  • AVOIDING allergic foods is the recommended protocol
  • Reading food labels (Food Allergen Labeling and Consumer Protection Act of 2004)
  • Using special food allergy cookbooks
  • Consulting registered dietitians
  • Joining patient support groups
  • Creating environmental safeguards
  • Re-testing for food allergies on an annual basis with the hope to “outgrow” the allergy
  • Implementing an Anaphylaxis rescue plan

Food Allergy Treatment Challenges

Food Allergy – Epinephrine Rescue

  • Multiple epinephrine products on the market (Auvi-Q™, EpiPen® or Adrenaclick®)
  • Geographic access and rescue use
  • Limited self-administration
  • College campus risk
  • Poor prescribing for anaphylaxis
  • Nearly 70% of parents cannot effectively use EpiPen or do not have it available (Arkwright Pediatric Allergy Immunology 17(3):227-9)

Food Allergy – High Level of Anxiety Leads to:

  • Poor school performance
  • Socialization challenges
  • Extreme parental supervision
  • Home schooling for 35-40% of kids
  • Limited family existence
  • Social media involvement
  • Failed allopathic (mainstream) and homeopathic treatment efforts
  • Forced movement toward food immunotherapy

Food Allergy – School Limitations

  • Stigma of “nut free” tables
  • Recess/outdoor exposures and cross contamination
  • School 504 Plans do not focus on safety
  • Other parents in school environment have a poor perception
  • Food allergy parents’ “airborne antigen” concerns often overstated
  • Anaphylaxis rescue plans are varied and poorly followed
  • School nurses are often not present

Food Allergy Treatment Landscape

  • For over 100 years, the only treatment is to avoid allergic foods
  • Poor early recognition of food allergies – general practitioners are unsure with early cases and secondary exposures often result in severe reactions
  • Poor deployment of rescue treatment plans leads to resultant mortality
  • “Fear and Liability” slow progress of any treatments

Food Allergy Treatment Evolution and Therapy Timeline

  • Late 1990s – Dr. Scott Nash
  • 2003 – Dr. Hugh Sampson – blood allergy predictive markers for reactions
  • 2007 – Initial omalizumab study halted
  • 2009 – Dr. Hugh Sampson – advances in pathophysiology and treatment
  • 2009 – Private practice restrictive models of oral immunotherapy (OIT)
  • 2010 – Stanford Alliance for Food Allergy Research (SAFAR), Mt. Sinai, John Hopkins all develop “clinical” study centers for food treatment
  • 2013 – First published randomized, placebo controlled studies for peanut allergy (non US)


How TPIRC is Changing the Landscape

Dr. Randhawa started dose escalation therapy protocols for milk, egg, tree nuts and peanuts in 2008 (Food Allergy Treatment FAQ’s)

  • The only Food Allergy Center nationwide physically located within a hospital
  • Comprehensive safety measures
  • Dosing accuracy
  • Comprehensive diagnostic testing
  • Team approach including dietitian, gastroenterologist, and allergist
  • No patient selection limitations
  • Treatment involves food desensitization

Current TPIRC Treatment Highlights

  • 2009-2013: Experience developed with milk, egg, soy
  • 2011-2013: 21 peanut graduates
  • May 2013 – March 2015
    • 391 new patients
    • 2,720 visits
    • 2,460 food challenges
    • 137 peanut graduates tolerating 2 tablespoons of peanut butter equivalent daily
    • Coverage of all tree nuts, numerous seeds, milk, egg, soy and wheat

 TPIRC’s Clinical Care and Treatment Goals

    • Provide ample access to patients for intake and review of diagnostic results
    • Provide safe testing for food allergy (blood, skin, patch, etc.)
    • Confirm food immunotherapy success rates in all patients over time to ensure food allergy “remission”

  • Design and publish national guidelines on food allergy diagnosis, safety and desensitization treatment applicable to the most common allergic foods

 

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