Food allergies: The stakes are too high for myths and pseudoscience

Epi-pen

The price of life is eternal vigilance. If you have severe food allergies, that is your reality. Every day, every meal, every bite. Eating is an intrinsic and essential part of what we do and who we are, so the idea that our bodies can rebel violently to everyday foods can be difficult to believe. But it’s real, and the numbers of the severely food allergic are growing. Frustratingly, we don’t know why. While recognized over 100 years ago, the social acknowledgment had lagged. That’s improved in the past decade. Food allergy prevention approaches are now a routine part of travel, school, sports, and the workplace. Peanuts on planes seem to have completely disappeared. The days of lunchbox peanut butter sandwiches are over, with many schools completely banning all peanut-containing products. It is the education system that seems to have become a ground zero for allergy programs and policies, where educators are challenged to ensure that schools are safe environments for all children, some of whom have long lists of food allergies.

While 30% of the population believes that they have a food allergy, the actual prevalence is about 5%. Allergies are a product of our immune systems, with multiple biochemical pathways triggered in response to a specific antigen. “Allergy” can describe mild skin reactions and respiratory distress, right through to life-threatening reactions. The majority of food-related allergic reactions are not life-threatening. Anaphylaxis is the term that describes the most rapid and severe immune response, which can occur in response to a drug (the most common cause of anaphylaxis), an insect, or food. Food-allergy anaphylaxis is rare, occurring in one to 70 per 100,000 of the population. Eight food cause over 90% of anaphylactic reactions: milk, eggs, peanuts, tree nuts, fish, shellfish, soy, and wheat. Reactions may involve multiple body systems (gastrointestinal, skin, respiratory) including breathing difficulties and swelling of the throat. Anaphylaxis is estimate to have fatality rates of 0.7-2%. Death occurs due to upper airway obstruction, vascular fluid shifts, and depressed heart function. The risk of anaphylaxis, and how quickly it can appear in any individual with a history of allergy, is difficult to predict, and can be influenced by age, the type of allergen, the extent of exposure, and underlying illness like asthma.

Evaluation of anaphylactic food allergies involves a number of diagnostic tools including skin testing, in-vitro tests, and food challenges. There is no single diagnostic test. Different tests may be used depending on the patient’s history of reactions. All of these tests have different risks and benefits and must be performed under the supervision of an allergist, where immediate access to resuscitation equipment is available. Food allergies in children can resolve over time, like milk and egg. Tree nut and peanut allergies, however, are more likely be life-long conditions.

Given the life-threatening nature of some food allergies, you’d think there would be no room for myths or pseudoscience. You’d be wrong. Confusion and misinformation abounds. There is the unfortunate tendency to label any sort of negative reaction to any substance as being an “allergy”. I see this frequently when speaking with patients about their medical history, who rhyme off a long list of drug “allergies”, which more frequently describe intolerance, like diarrhea to antibiotics, or nausea and drowsiness from narcotics. Then there are “allergies” pulled out of thin air. The current fad food “allergy” is gluten, a self-diagnosed condition in which gluten is believed to be some sort of dietary toxin – which must be distinguished from (1) the person with the documented anaphylactic wheat allergy and (2) those with celiac disease, an auto-immune response to gluten that requires absolute avoidance (but does not cause anaphylaxis if ingested). Capitalizing on the confusion about allergies and intolerances are alternative medicine providers, who offer their own definitions of allergies, and (conveniently) their own cures. The result is widespread confusion about allergies, and worries that we’re seeing too many nonexistent allergies while raising the risk we’ll miss the truly life-threatening ones. As a parent of young children, I sympathize with the staff at my local school, where each year means a new group of parents who grumble about the school’s policies in place to minimize the risk of allergic reactions. Eggs, peanuts and milk are the most common allergies, but peanuts and tree nuts cause more fatal anaphylactic reactions, so restrictions on those food products are more common. Tragic deaths have driven systems to implement new policies. What’s worse, severe reactions are more common in children and children and young adults are at greater risk of a fatal reaction.

With food allergies, the consequences of a single wrong decision can be fatal. I was reminded of this when I heard about Natalie Giorgi, a 13-year-old girl who died of anaphylaxis this past July after accidentally biting a peanut butter-contaminated Rice Krispie square. Here parents were present and they immediately gave her an antihistamine, diphenhydramine (Benadryl). She initially showed no signs of a reaction. Suddenly she started vomiting, which quickly progressed to a massive anaphylactic reaction. Her father, a physician, administered the two epinephrine injections (Epi-pens) they had on hand, with no effect. A third Epi-pen was found, and given. No effect. Sadly, she could not be resuscitated, even after EMS arrived. Her last words were “I’m sorry, Mom,” and she died in front of her parents. From dancing to dead, in minutes, simply because of a bite of food.

This type of scenario is terrifying to those with allergies, parents, and health professionals. Was this tragedy preventable? Based on the limited information in the story, the only possible error may have been the administration of Benadryl, which may have delayed the first dose of epinephrine. With food-related anaphylaxis fatalities, the median time to death is 30 minutes. Seconds count. Delays in using epinephrine may be based on fears of the inappropriate administration of epinephrine. Given there is essentially no risk to epinephrine when administered via Epi-pen, nothing should delay prompt administration when anaphylaxis is suspected, even if the reaction is initially mild. Immediate referral to emergency services is also essential.

There is currently no cure for food allergies. Research into desensitization looks promising, but it’s not ready for use outside of clinical trials yet.

With Natalie’s tragedy in mind, here are some of the more common myths and facts about food allergies.

1. Myth: Allergies are a fad, and they’re not dangerous

Fact: While 50-90% of self-reported food allergies are not allergies, severe food allergies do exist. They can have a sudden onset, and be fatal in minutes. Prior reactions don’t predict future reactions. The only way to prevent reactions in those with a history of anaphylactic allergies is strict and complete avoidance of the allergen. Other types of reactions, such as celiac disease (an immune disorder triggered by gluten), require allergen avoidance, but are not immediately life-threatening like allergies can be.

2. Myth: Benadryl can be helpful for anaphylaxis

Fact: The only treatment useful for the management of anaphylaxis is intramuscular epinephrine (e.g., Epi-pen). All other treatments, such as antihistamines like Benadryl, inhalers, and steroids are secondary treatments and do not replace the need for the immediate administration of epinephrine. There is no established role for the administration of Benadryl during what is known to be an anaphylactic reactions.

3. Myth: I was exposed to an allergen, but I’m fine. Maybe I’m not going to have a reaction.

Fact: Maybe, but maybe not. Anaphylactic reactions do not always appear immediately, and can be delayed by minutes or even hours. Reactions can manifest in different ways.

4. Myth: Food allergy is the same as food intolerance.

Fact: A food intolerance is non-allergic by definition. Lactose intolerance is an example, where the reaction to lactose does not involve the immune system. Intolerances may be unpleasant but they are not fatal.

5. Myth: My naturopath/chiropractor/acupuncturist/homeopath diagnosed my allergy:

Fact: Naturopaths and other alternative medicine providers do not diagnose allergies in evidence-based ways. Yet many offer purported different diagnostic tests as part of their practice. Treatments have either been shown to be unreliable or have been demonstrated to be useless. Unproven or disproven tests for food allergy that alternative practitioners may offer include:
IgG blood tests
IgG blood tests (e.g., Hemocode and Yorktest) cannot identify food sensitivities or allergies, only recent exposure to different food ingredients. It has no established value as a diagnostic test for food allergies.
Applied kinesiology
AK is a well-known scam that is purported to diagnose allergies by holding a suspected allergen and then pressing down on that limb. Muscle weakness is said to signify an allergy. Careful evaluations show that AK tests can be completely manipulated by the tester, and they have no relationship to actual allergic responses.
Electrodermal test or “Vega Testing”
The Vega test is claimed to measure body electric currents (to acupuncture points) with an allergen in the electrical circuit. There is no correlation between Vega test results and reality, in that it cannot identify allergies at all.
Cytotoxic testing (Bryan’s test)
These fake allergy tests were last generation’s IgG blood tests, sold in storefronts, and involves mixing a patient’s white blood cells with suspected allergens. There is no correlation between the results, and allergic responses. The FDA and other regulators have taken action to clamp down on cytotoxic assay sales, but providers can still be found.
Hair analysis
While useful for testing for exposure to drugs and some chemicals, there’s no basis for examining the hair to determine allergies
Pulse test
Used more for diagnosing food “intolerance”, this involves measuring the pulse before and after eating a suspected allergen. It should be self-evident why this sort of testing isn’t advisable for suspected allergies.

6. Myth: My naturopath/chiropractor/acupuncturist/homeopath can eliminate my allergy
Fact: Despite claims that are made with regularity, there are no “cures” for allergies that exist within alternative medicine. Perhaps because of the limited treatment options, alternative purveyors offer a variety of “allergy elimination” treatments that are claimed to be effective for a variety of allergens. NAET, or Nambudripad’s Allergy Elimination Techniques is claimed to eliminate “energy blockages” through some combination of chiropractic and acupuncture treatments. Testing includes some elements of applied kinesiology (see above) and electronic devices that measure skin resistance, akin to the Vega test (see above). Not surprisingly, there is no credible evidence that “NAET” can eliminate allergies of any kind but this does not prevent its proponents from making wildly dangerous claims:

NAET can kill

Peanut anaphlyaxis is real. NAET is pseudoscience

Perhaps not surprising, NAET techniques can kill.

7. Myth: “May contain” warning labels just provide legal protection for companies. Those foods are fine for those with anaphylactic allergies.
Fact: May contain labels should be taken literally. A recent study of products labelled “may contain peanuts” contained detectable levels of peanuts 8.6% of the time.

8. Myth: I diagnosed my child’s allergy so they don’t eat “X” anymore.
Fact: Many more people believe they have food allergies than actually have them. Unnecessary dietary restrictions can have nutritional consequences, so professional evaluation is warranted if food allergy is suspected.

Did I miss any? Add yours in the comments.

Photo from flickr user intropin used under a CC licence.

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7 thoughts on “Food allergies: The stakes are too high for myths and pseudoscience

  1. I am allergic to strawberries. It’s not life-threatening but it is serious enough that if I am served a dessert garnished with strawberries, I have to carve out an exclusion margin around it, otherwise the juice that has soaked in will cause a reaction. I sometimes get rashy, and on bad days my airway will narrow, but normally I just swell up and itch. My upper lip swells (like I’ve been punched), my eye swells (ditto) and other body parts that are not socially acceptable to scratch in public swell. :(

    But I agree, lots of people claim to have allergies to food that don’t. It’s okay if you just don’t like something, or it doesn’t agree with your tummy. It’s not a character flaw to dislike eating something, but it doesn’t mean you have an allergy.

  2. While you’re right that there is a difference between allergy and intolerance, often it’s easier to use “allergy” as a shorthand for all sorts of stuff. Hey, my GP and my dentist both have a box that reads Allergies in my files and it lists, among others, tetracyclin, which “only” makes me violently sick. I’m sure both of them know what’s the difference between various responses of immune system but from a practical view, they need to know that I can’t use tetracyclin, penicillin or macrolid antibiotics because they do nasty things to me, regardless of the exact etiology of said nastiness. For that matter, I’d probably prefer the allergenic ones to “just” badly tolerated tetracyclin because rash, itch and swellings feel somewhat better than my guts trying to turn inside out.

    Similarly, while most lay people understand that my allergy to apples means that I shouldn’t eat them, the concept of intolerance may be lost to them, especially if one starts tossing words like gluten or lactose around. Part of my family is dumber than a box of rocks and explaining that I’m not allergic to milk, that I only have lowered levels of the lactase enzyme which makes me digest milk badly, resulting in diarrhoea…. If I explain this, I’ll be considered a snob for using complicated words. Milk allergy, while not the right explanation, is fine enough for given public.

    I have a somewhat related question. I’m allergic to cats. I own one and my symptoms are minor compared to my reaction to other cats. I’ve heard from many other cat owners that they react less to their cats than to others. Is there a plausible explanation or possibly a bit of research?

  3. Ok, I’ll try but it looks like links will be lost… So please see blog for that.

    What causes food allergies?

    There is growing evidence that food proteins introduced into the blood stream result in the development of food allergies.
    Charles Richet discovered more than a hundred years ago that food proteins present in vaccines or injections will cause food allergies.
    He was awarded the Nobel Prize for this work.
    How are food proteins introduced into the blood stream?

    Vaccines, injections, tick bites and poor digestion due to acid reducing medications such as proton pump inhibitors (PPI).

    Food (plant and animal) proteins such as egg, milk (casein), yeast, gelatin, red seaweed (agar) are present in various vaccines (CDC’s vaccine ingredients list).

    Vitamin K1 injections contain vegetable oil (legume and nut oils) and/or animal fats. So allergies to peanuts and tree nuts could be traced to such injections.
    Tick bites result in the injection of a protein called alpha-gal (which is present in red meat) into the blood stream.[3]
    When acidity in the stomach is reduced by acid reducing medications, food proteins are not broken down. They travel to the intestine intact and get absorbed into the blood stream.[4]
    In all cases, the food proteins thus introduced into the blood stream can result in developing allergies to those food items.
    Direct evidence from the CDC that vaccines cause food allergies

    The Centers for Disease Control (CDC) has a document called “Recommendations of the Advisory Committee on Immunization Practices (ACIP)”.

    You can find it here.
    Reference 168 in the document is the following paper:
    Sakaguchi M, Nakayama T, Inouye S. Food allergy to gelatin in children with systemic immediate-type reactions, including anaphylaxis, to vaccines. J Allergy Clin Immunol 1996;98:1058–61.
    Link to the paper.

    The paper concludes:
    “Twenty-four of the 26 children with allergic reactions to vaccines had anti-gelatin IgE ranging from 1.2 to 250 Ua/ml. Seven had allergic reactions on ingestion of gelatin-containing foods. Of these, two had reactions before vaccination, and five had reactions after vaccination. All the control children without allergic reactions to vaccines had no anti-gelatin IgE.

    CONCLUSION:We reconfirmed a strong relationship between systemic immediate-type allergic reactions, including anaphylaxis, to vaccines and the presence of specific IgE to gelatin. Moreover, some of the children also had allergic reactions to food gelatin before or after vaccination.”

    Reference 79 in the document is the following paper:

    Nakayama T, Aizawa C, Kuno-Sakai H. A clinical analysis of gelatin allergy and determination of its causal relationship to the previous administration of gelatin-containing acellular pertussis vaccine combined with diphtheria and tetanus toxoids. J Allergy Clin Immunol 1999;103:321–5.

    Link to the paper.

    The paper concludes:
    “Most anaphylactic reactions and some urticarial reactions to gelatin-containing measles, mumps, and rubella monovalent vaccines are associated with IgE-mediated gelatin allergy. DTaP immunization histories suggest that the gelatin-containing DTaP vaccine may have a causal relationship to the development of this gelatin allergy.”
    After removing gelatin from vaccines, they were able to confirm that was indeed the problem.
    Kuno-Sakai H, Kimura M. Removal of gelatin from live vaccines and DTaP-an ultimate solution for vaccine-related gelatin allergy.Biologicals 2003;31:245-9. [PubMed]
    C-section – A contributing factor

    “In the gastrointestinal tract of babies born by c-section, there is a pattern of “at risk” microorganisms that may cause them to be more vulnerable to developing the antibody Immunoglobulin E, or IgE, when in contact with allergens” – Christine Cole Johnson, Ph.D., MPH, chair of Henry Ford Department of Health Sciences.[5]

    Mechanism of food allergy development

    When food proteins are injected in to the blood stream, a type I hypersensitivity reaction against an allergen, encountered for the first time, causes a response in a type of immune cell called a TH2 lymphocyte, which belongs to a subset of T cells that produce a cytokine called interleukin-4 (IL-4). These TH2 cells interact with other lymphocytes called B cells, whose role is the production of antibodies. Coupled with signals provided by IL-4, this interaction stimulates the B cell to begin production of a large amount of a particular type of antibody known as IgE that are specific to the food proteins. Secreted IgE circulates in the blood and binds to an IgE-specific receptor (a kind of Fc receptor called FcεRI) on the surface of other kinds of immune cells called mast cells and basophils, which are both involved in the acute inflammatory response. The IgE-coated cells, at this stage are sensitized to the allergen (food proteins). [1] [2]

    Mast cells and basophils are found in large numbers in and around the mouth. These locations are prone to injury and thus need more protection against infection. These mast cells and basophils are now IgE-coated and primed to react to the food proteins.
    If the vaccinated person now eats these foods, the food proteins bind to the IgE molecules held on the surface of the mast cells or basophils in the mouth. Cross-linking of the IgE and Fc receptors occurs when more than one IgE-receptor complex interacts with the same food allergenic molecule, and activates the sensitized cell. Activated mast cells and basophils undergo a process calleddegranulation, during which they release histamine and other inflammatory chemical mediators (cytokines, interleukins, leukotrienes, and prostaglandins) from their granules into the surrounding tissue causing several systemic effects, such as vasodilation, mucous secretion, nerve stimulation and smooth muscle contraction. This results in rhinorrhea, itchiness, dyspnea, and anaphylaxis. Depending on the individual, the allergen, and the mode of introduction, the symptoms can be system-wide (classical anaphylaxis), or localized to particular body systems; asthma is localized to the respiratory system and eczema is localized to the dermis.[2]
    In other words, an allergic reaction occurs to the foods that contain the food proteins which were present in the vaccine. Red seaweed is a food source for shellfish. Vaccines can induce an allergy to red seaweed proteins. Consuming shellfish (or any seafood that is contaminated with red seaweed proteins) will result in an allergic reaction that may be blamed on shellfish but may actually be caused by the red seaweed present in the shellfish.

    Expert opinion

    “ …. i have often heard people dismiss the widespread experimental model of allergy, in which BALB/c mice are injected IP with ovalbumin in alum (the most common adjuvant in vaccines for humans) and then later challenged orally or nasally with OVA. the dismissal is usually based on a statement that goes something like “but this isn’t the way that humans are sensitized to allergens”.

    well……perhaps, at least in some cases, it IS how humans are sensitized to allergens? perhaps not by intraperitoneal injections, but nevertheless by injections? sometimes by needles (containing alum); sometimes by insects; perhaps sometimes by injuries (thorns? nails? cuts?)….” – Dr. Matzinger at the National Institute of Allergy and Infectious Diseases.

    You can see Dr.Matzinger’s full response here.
    Example of inducing food allergy in mice:
    ^ Birmingham N., Thanesvorakul S., Gangur V. Relative immunogenicity of commonly allergenic food versus rarely allergenic and non-allergenic foods in mice. J. Food Prot. 2002;65:1988–1991.
    Same mechanism, different disease ?

    Pancreatic digest (of unknown mammalian origin?) and human diploid lung fibroblasts are also used in the manufacture of vaccines. The same sensitization mechanism could result in auto immune disorders such as diabetes and asthma? In other words, your body becomes allergic to some of its own tissues and begins attacking them.
    Perfect storm ?

    Increasing C-section deliveries.
    Standard practice of administering Vitamin K1 injections to newborns to prevent Vitamin K Deficiency Bleeding (VKDB).
    Vaccine schedule with increasing number of vaccines.
    Over prescription of acid reducing medications.
    Result, an epidemic of food allergies in children and adults.
    Prevention or mitigation

    Since avoiding vaccines/injections is difficult, the following steps can help:
    If possible choose vaccines that do not have food proteins.
    Administer only one vaccine or injection at a time. Wait a few weeks before the next one. Vaccines/injections have multiple food proteins and multiple adjuvants. Adjuvants improve the efficacy of the immune response. However, they can also increase the probability of developing allergies to the food proteins in the vaccine. Today, kids get five shots in one sitting. Multiple food proteins and adjuvants being simultaneously administered can significantly increase the probability of developing food allergies.
    Obviously, C-sections and acid reducing medications should also be avoided when possible.

  4. Your argument appears to have been lifted wholesale from this discussion at Sciencesforms.net, or perhaps you are the same poster. As others pointed out there, the articles cited as evidence don’t say that vaccines cause allergies. As commenter Arete writes in the discussion:

    “Second, your title is plain fallacy – the article you cite does not provide direct evidence that vaccines cause food allergies. It demonstrates that vaccines can cause reactions in people susceptible to food allergies and speculates that vaccines may have a causal relationship in the development of allergies.”

    An article “Addressing Parents’ Concerns: Do Vaccines Cause Allergic or Autoimmune Diseases?” (Offit, Paul A and Hackett, Charles A PEDIATRICS Vol. 111 No. 3 March 1, 2003 pp. 653 -659 doi: 10.1542/peds.111.3.653; Pubmed citation here) summarizing the evidence about vaccines causing allergic diseases says:

    “Taken together, these studies fail to support the hypothesis that vaccines cause allergic diseases.”

    • I am the scienceforums poster.

      Nakayama et al, found evidence and suggested causal relationship between DTaP and gelatin allergy.

      Following above findings, Kuno-Sakai et al, below used gelatin-free vaccine to conclusively prove that vaccines were indeed the cause.
      Kuno-Sakai H, Kimura M. Removal of gelatin from live vaccines and DTaP-an ultimate solution for vaccine-related gelatin allergy.Biologicals 2003;31:245-9

      Offit et al, vaccinated all children including the control group.
      So they can make no conclusions about vaccines not causing food allergy.
      The only conclusion they can draw is that 2-component diphtheria-tetanus-acellular pertussis vaccine; 5-component diphtheria-tetanus-acellular pertussis, diphtheria-tetanus-whole-cell pertussis; or diphtheria-tetanus
      cause the same level of food allergies.

      “Infants were randomized to receive 2-component diphtheria-tetanus-acellular pertussis vaccine; 5-component diphtheria-tetanus-acellular pertussis, diphtheria-tetanus-whole-cell pertussis; or diphtheria-tetanus (control group) beginning at 2 months of age. Children were followed for ∼2.5 years and the risk of allergies was determined by parent questionnaires and examination of medical records. Allergic disorders studied included asthma, atopic dermatitis, allergic rhinoconjunctivitis, urticaria, and food allergies. No differences in the incidence of allergic diseases were observed in children who did or did not receive pertussis vaccine.”

      They performed a very narrow study and drew a broad conclusion.

      As I have pointed out, injecting food proteins into the bloodstream has been shown to cause food allergies repeatedly starting with Charles Richet more than a hundred years ago. Now it is common to induce food allergy in mice by injecting them with food proteins. Tick bites cause red meat allergy. Acid reducing medication cause food allergies. The same mechanism has been demonstrated/proven over and over again.
      There is way more evidence to draw a conclusion that vaccines cause food allergies than Offit et al., have used to conclude the opposite.

      Thanks.

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