Allergy Capital

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Management of Food Allergy

People who suffer from food allergy need to identify and avoid the cause, recognize symptoms of an allergic reaction and start treatment early.

How is food allergy managed?
People who are known to suffer from food allergy need to:

• Identify and avoid the cause (if possible)
• Recognize the early symptoms of an allergic reaction
• Know what to do if it happens again

Identifying the cause
Your doctor will normally ask a series of questions that may help to narrow down the list of likely causes such as foods or medicines consumed that day, or exposure to stinging insects. This approach will also help to exclude conditions that can sometimes be confused with food allergy. Skin prick testing or blood (RAST) allergy testing can help confirm or exclude potential triggers.

Avoidance strategies
These include carefully reading the labels of foods in supermarkets for terms indicating the presence of allergen.
Eating away from home poses some risks. It is often wise to inform your host or restaurant chef about your allergy and the importance of avoiding contamination of your meal with allergen.

Care of food allergic children raises some particular issues

• Children's parties may involve sending the allergic child with their own special party food. Swapping of food needs to be discouraged.
• Those in child care or at school might only be allowed to eat home-prepared food and treats rather than communal food or that purchased at the school canteen. This has to balanced with the difficulty involved in getting very young infants to eat only food supplied from home.
• Relatives, baby-sitters and other care givers need to be warned about the problem.
• Getting other care-givers (such as school teachers) to administer adrenalin for the treatment of severe allergic reactions is a difficult issue. Currently, only South Australia has a formal training program to educate teachers about the nature of severe allergic reactions and the use of injected adrenalin for its treatment.

A support group for parents of children suffering from food-induced anaphylaxis has been established called FACTS (Food Anaphylactic Children Training & Support Association). This is a voluntary non-profit organization that provides information, support and a regular newsletter to families with food -anaphylactic children.

Recognizing the symptoms
Early symptoms of an allergic reactions often include an itchy mouth, hands or feet, followed sometimes by more devastating symptoms. These should be considered as warning signals to get emergency medical help and to start treatment immediately until help arrives.

Develop an Emergency Action Plan
A well thought-out "Action Plan" is an essential part of management and should be practiced. It requires you to recognize early warning symptoms, to carry the medication you need and to know how to use it. Your doctor will advise you how to best manage your allergic reaction.

• Remove the trigger & minimize the effect of co-factors (e.g. spit out the offending food to minimize further absorption of allergen, stop exercising).
• Seek urgent medical assistance (e.g. call an ambulance)
• Inject adrenaline. Injected adrenaline (epinephrine) works rapidly to reverse the effects of severe allergic reactions (anaphylaxis) and should be considered "First Aid" for its treatment.
• Other medication. Some patients will be advised to take other medicines like antihistamines or cortisone tablets. It is important to realize that these will not prevent a life-threatening allergic reaction, as they take the best part of an hour to be absorbed.
• Observe for relapse under medical supervision. This is because severe symptoms ("rebound") sometimes recur after apparent recovery.

Who should carry adrenaline (epinephrine)?
Food allergy in infancy is common (around 1 in 20 have at least a transient food allergy). While it is natural to be anxious about having another allergic reaction, serious allergic reactions fortunately occur much less often. Patients are usually advised to carry adrenaline (epinephrine) when they are considered to be at significant risk of having further dangerous allergic reactions. Factors that may be considered when reaching this decision may include:

• Dangerous allergic reactions in the past
• Frequent asthma requiring regular medication
• Living remote from medical care (eg. on a farm a long way from hospital)
• Other factors (eg. frequent travel)

Other management issues

• Patients who have had anaphylaxis should wear a Medic Alert bracelet. This increases the likelihood that adrenalin will be administered in an emergency.
• Some types of heart and blood pressure medicines (such as Beta-blockers or ACE inhibitors) can make severe allergic reactions worse, or interfere with the drugs used in treatment. These are best avoided.
• Immunotherapy (desensitization) injections are only useful for anaphylaxis caused by bee or wasp stings, but not for treating severe food allergy.