Archive for Food Allergies

Food Allergy, Anaphylaxis and Epinephrine

Over the recent decades, food-related anaphylaxis is continually increasing, particularly in young children.

Data shows that food allergies and related anaphylaxis are on the rise, especially in young children, and the resulting deaths prove to be an ever-growing problem in the United States. Common triggers for food allergies are milk, eggs and peanuts. Symptoms of anaphylaxis may general present with coughing, wheezing, and/or vomiting. Children too young to verbalize a reaction may show signs such as crying, drooling or regurgitation.

One of the most commonly used therapies for food-related anaphylaxis is epinephrine.

In the event of an allergic emergency, treatment with epinephrine by injection should be given quickly. Clinical guidelines recommend that corticosteroids and antihistamines, other available therapies, should only be used as supplementary to epinephrine – not in replacement of. Corticosteroids given after epinephrine can help reduce the chances of recurrent reactions. Antihistamines given after epinephrine can help control symptoms such as itching and flushing. However, research shows that nearly half of all patients experiencing anaphylaxis are inappropriately administered other treatments before receiving epinephrine.

It is important to note that, although rare, deaths from anaphylaxis do happen. The average time to cardiac or respiratory arrest from ingestion of reaction-inducing food is around 30 minutes. Fatal reactions are most likely to happen to those who have previously had mild reactions. Recognizing the symptoms and being quick to act are necessary for anyone with (or around) children with food-related allergies. It is a community-wide effort: parents, teachers, nurses, babysitters. Everyone must be at the ready to recognize symptoms and deliver treatment. Staying educated and alert are ways that everyone can help prevent future anaphylaxis fatalities.

Food Allergy, Anaphylaxis and Epinephrine

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Tips for Managing Food Allergies

Managing food allergies may seem overwhelming at first, but it does get easier over time.

Start with these basic measures to safeguard yourself from adverse reactions and prepare yourself for the challenges you will face.

  • Emergency medication – Due to the nature of food allergies, it is important to be prepared against anaphylaxis, always carry your Epi-pen.
  • Outline an emergency care plan and inform family and friends of the plan. This will alert those around you to recognize signs and symptoms of your allergies so that they know when and how to use your emergency medication.
  • Wear medical identification at all times to make responders aware of your allergy.
  • Plan in advance how to handle certain situations; prepare yourself for variety of environments you may find yourself in. Keep a food diary to assist in learning what foods to avoid and get tested if symptoms persist.

To successfully manage food allergies, you have to monitor your diet and lifestyle.

Accidents can happen and you should always be prepared. If you have any questions, you can read more about Food Allergies on my website at Or if you feel the need to be tested for allergies and live in the NYC area, please call our office to arrange for a consultation, 212-247-7447.

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Is it a Food Allergy?

Food allergy awareness has boomed over the past decades, and rightfully so. Many people suffer from some sort of food allergy, whether a minor irritation or life-threatening situation. Let’s talk about the symptoms, the causes, and what you can do if you suffer from food allergies.

Some common allergies include nuts, shellfish, gluten, egg and dairy. Allergic reactions to foods typically begin with minutes to a few hours after eating the food. How often and how severe one experiences symptoms varies widely from one person to another. Mildly allergic persons may only suffer from a runny nose or sneezing, while highly allergic persons may experience severe and potentially life-threatening rations.

The most common symptoms of a food allergy involve the intestines or the skin. Symptoms presenting on the skin can include rashes or hives. Intestinal symptoms often include nausea, vomiting, stomach cramps, indigestion, and diarrhea. Other symptoms can include swelling of the tongue, lips, or throat; asthma, with coughing or wheezing; itchy or runny nose and sneezing; loss of blood pressure; and, in rare cases, anaphylaxis, a very severe allergic reaction.

While it’s possible that a patient experiencing these symptoms is having an allergic reaction to food, there may be other causes in the works. We can run a skin test to be sure that these symptoms are caused by a food allergy before a treatment plan can be discussed. In the skin test, we look for particular allergies by scratching the patient’s skin with a toothpick like tool containing a tiny sample of the potential allergen. The skin’s reaction to the test will help us to determine if you are in fact allergic to the food in question or if their symptoms may be caused by something else.

If you do have a food allergy, it is the result of their body’s immune system over-reacting to food proteins. Normally the immune system protects the body against allergic reactions; however, in the individual with a food allergy, the immune system produces increased amounts of the allergic antibody called immunoglobulin E (IgE). When these antibodies combine with food proteins, histamine and other chemicals are released as part of the body’s immune reaction. The release of these chemicals can result in the symptoms mentioned earlier.

Avoidance is key in the treatment of food allergies. However, avoiding trigger foods isn’t always a guarantee. Accidents happen and it’s always smart to have a backup plan. For those with mild allergies, oral antihistamines can be quite helpful. For those with severe reactions, keep an EpiPen handy at all times. If you have any questions or want to be tested for allergies, please give our office a call!

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About LEAP and Its Consequences in Medical Practice & Prevention and Lifestyles

The study I touched on in my previous post, Learning About Peanut Early, confirmed that early exposure to the product, in controlled doses, can actually significantly reduce the risk of an allergic onset later on in life. The test was carried out on children who were considered at-risk of developing peanut allergies later in life, based on skin-prick tests and their allergies to things like milk and eggs.

Experts quickly jumped onboard and started debating the ways through which not only medical professionals should approach the findings, but also about how they should be implemented worldwide. The same experts continuously warn parents that the study is not a base for giving their children peanuts or products containing them, unless they were instructed to do so by their physicians or pediatricians and the practice is done in a controlled environment that disposes of the necessary equipment to deal with emergencies.

The problem arising from the study is that medical professionals from around the world would need to be instructed in finding new approaches in dealing with peanut allergies. Skin-prick tests are crucial, and without them, the study wouldn’t have been possible in the first place. So getting those tests in areas where there are none is a huge priority.

Another issue is that this whole idea is based on a very strict timeline, so timing, in this case, is the most important factor. Skin-prick tests and other signs like egg allergies can quickly determine whether an infant is prone to developing a peanut allergy immediately. A course of action can only be followed once this has been confirmed, and, once again, only under the strict supervision of a professional healthcare provider.

As these debates unfold and solutions are being brought to the forefront, new studies are called for. Can the practice be applied to children over 1 year of age, and will the results confirm the practice in that case as well? Many more questions remain unanswered, but now that a red flag has been raised, there’s little doubt that steps will be taken in the right direction in due time.

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Breakthrough in Understanding Peanut Allergies

For quite a while now, physicians and healthcare providers have emphasized the fact that people prone to developing a peanut allergy should steer clear of them and products containing peanuts. But a new randomized clinical trial, presented in Houston at this years AAAAI Convention, comes to dispute that concept, clearly showing that children who were served products containing trace amounts of peanuts, even though they were prone to developing an allergy later on, had considerably avoided it.

The study focused on whether adding products which contained peanuts in the first year of life to children prone to developing the allergy would have any effect, positive or negative. Out of the control group who were instructed to give their kids products with peanuts in them at least 2 or 3 times a week, only 3% developed an allergy. In the other group, which completely avoided peanuts and products containing them, a staggering 17% developed allergies.
For everybody else, this is both good and bad news. For starters, medical professionals may have been wrong all this time, advising people to steer clear of products they were prone to develop an allergy to. Inadvertently, they may even have contributed to the spike of people suffering from various allergies. The study clearly shows that introducing these foods early on in life, particularly in the first 11 months of a child’s life, can help them develop the normal immune response and not the allergy outbreak.

A word of caution though – this does not warrant you or your kids eating things you know you’re allergic to, or introducing trace amounts of them into your weekly diets. Research still needs to be made and an appropriate portion determined for your own safety.

If you have question and live in the NYC area, give me a call for a consultation, DO NOT introduce a known allergen into your body without consulting a reputable healthcare provider. Already developed allergies can be managed through avoidance and special medication successfully.

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The Dangers Of Raw Milk

As a doctor, I am interesting in preventing disease as well as treating it. So I try to encourage my patients that having a healthy lifestyle is key is lessening their frequency of having allergies and asthma.

What concerns me is that in the public’s quest to eat healthy, some may have gone overboard. Many people who promote organic food–because it has less additives and pesticides, which is a good thing– are now promoting a food that has potential dangers in its so-call pure state: that is raw milk.

Under the mistaken belief that raw milk is better for your health, the American Academy of Pediatrics issued a statement that “substantial data suggest that pasteurized milk confers equivalent health benefits compared with raw milk, without the additional risk of bacterial infections.”

Pasteurization is the term in which heating milk to a high enough temperature for a long time period to kill disease-causing bacteria has been used safely for over 100 years. And states the New York State Department of health that “pasteurization is the only way to ensure that milk products do not contain harmful bacteria such as salmonella, E. coli, Campylobacter, Staphylococcus aureus, Yersinia, Brucella, Coxiella and Listeria.”

In an interesting article by the FDA, it stated that CDC reported between 1993 and 2006 more than 1500 people in the US became ill due to drinking raw milk or eating cheese made from raw milk. Also the CDC stated that “unpasteurized milk is 150 times more likely to cause food borne illness and results in 13 times more hospitalizations. It is especially dangerous to people with weakened immune systems, children, older adults and pregnant women.”

Symptoms of people becoming ill from raw milk include: vomiting, diarrhea (sometimes bloody), abdominal pain, fever headaches and body aches. More serious reactions such as blood-stream inflections, kidney failure and inflammation of the nervous system can occur. Consult a physician in you or your children exhibit these systems.

When shopping for milk or milk products, make sure to check the package to see it its states pasteurized.

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Oral Allergy Syndrome

Some of my patients have been recently complaining about watery and swollen eyes, sneezing and itchy throat, symptoms that are commonly associated to ragweed.

Many people might think that ragweed is a spring or summer allergy, but really the ragweed season becomes intense in the fall, beginning, nowadays in August and going strong through October.

Ragweed can also be an oral allergy syndrome (OAS). This means that the pollen which comes from ragweed, a weed that bears a similarity to the proteins in vegetables and fruits. So the immune systems reacts by an allergic response to fight off what the body perceives as a danger.

Certain foods exacerbate ragweed allergies. These are bananas, chamomile tea, dandelion, Echinacea, melon ( honeydew, cantaloupe and watermelon), sunflower seeds and zucchini.

According to an interesting article by the Allergy and Asthma Foundation of America (AAFA), other pollen allergies that may cross-react to certain foods are:

Birch pollen allergy–may react to kiwi, apples, pears, peaches plums, coriander, fennel, parsley, celery, cherries, carrots, hazelnuts and almonds.

Grass Pollen Allergy–people may react to peaches, celery, tomatoes, melons and oranges.

Natural Rubber Latex (NRL) Allergy. Even people handling food with latex may induce an allergic response if one is eating bananas, avocados, kiwi, chestnut and papaya.

The symptoms of oral allergy syndrome can be complex and may constitute a diagnosis of other medical conditions such as food intolerance, other types of food-borne illnesses or food poisoning.

Contact an allergist to determine whether you have OAS or another food illness.

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Food Allergies And The International Traveler

All lot of my patients love to travel. Experiencing another culture is great way to broaden your horizons. But beyond the sights and sounds of distant locales, a primary component of any traveler’s experience is dining out in those countries.

For the food allergy traveler, this can be daunting. But there are four ways for you to dip into cuisine of these countries, safely.

Carry allergy cards. In 2004, a couple’s daughter returned from her trip through Europe, complaining that she couldn’t or was wary of eating most foods there due to her nut allergies. She only ate vanilla ice cream, shishkaboobs and bread throughout her trip.

So her parents started It is company that produces allergy alert cards that are laminated and the size of a business card. The card states the allergy the traveler is susceptible to in English and one of 60 foreign languages and shows a picture of the allergy itself.

Allergy FT: Allergy Food Translator App Screens. This mobile app for iOS only ( lists 62 food allergies and translates them into French, German and Spanish– which claim its developer–will help you navigate cuisine in 57 countries around the world that speak these languages. All you do is select the language, then select the allergy and the allergy warning in those languages pops up on the screen. Allergy FT said is updating its app to include more languages.

IAMAT Directory. If an allergic reaction to food does occur while your traveling abroad, an indispensable resource to have is International Association for Medical Assistance To Travelers (IAMAT) directory. It lists the local hospitals of a particular country that assistant travelers and that speak English. Contact them at (

Ep-iPen. The IAMAT states travelers with food allergies should carry at least two vials of epinephrine in case of a anaphylactic reaction.

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An Allergy Can Turn You Into A Reluctant Vegeterian

I have a friend, a retired doctor, who is a vegetarian. He is strict and won’t eat any red meat, chicken or fish. I know that eating vegetarian is healthy, but once and a while I like a pastrami sandwich, you know what I mean.

But for some people, being vegetarian is not a matter of choice.

Doctors across the country are seeing a phenomenon in which people are suddenly allergic to meat because they were bitten by a certain type of tick.

Most people associate tick bites with other diseases, such as Lyme disease. But this tick is different. Called the Lone Star tick, named for the state of Texas–it has caused severe allergic reactions in people who have eaten a burger or a steak and has landed them in the hospital. The allergy has spread from the Southwest and the East and is spreading to other parts of the US.

An interesting article in Science Daily quotes Vanderbilt University Medical Center’s Dr. Robert Valet who says, “it is not completely understood exactly how the allergy starts. The thought is that the tick has an alpha-gal sugar in its gut and introduces it as part of the allergic bite and that causes the production of the allergy antibody threat then cross-reacts to the meat.”

Vanderbilt reports seeing one or more new cases each week.

In the Wall Street Journal, Dr. Erin McGintee, an allergist on Long Island has reported to have seen as many as 200 Lone Star tick cases in the last three years. She says “the symptoms can occur as long as eight hours afte eating meat rather than immediately.

Allergic symptoms, said Dr. Valet, can range from the hives and swelling, to broader ones such as vomiting, diarrhea, trouble breathing, and a drop in lood pressure. Other symptoms such as itching can be treated with antihistamines, but severe or broader ones can only be treated with epinephrine.

People who have suffered an allergic attack are encouraged to carry an EpiPen in case of a reoccurance of symptoms from cross-contimination of any food associated with red meat.


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Fish Allergies

In recent years, the conventional wisdom is that the Americans consume too much meat in their diet. Public health officials have said that we should diversify our diet with dairy, vegetables and fish. Yet some Americans are allergic to fish and may be allergic to products that contain fish.

WebMD states that food products containing fish ingredients are: “Worcestershire sauce, barbecue sauces made with Worcestershire; Caesar salad and Caesar dressing, caponata (Sicilian eggplant relish), caviar and fish roe; artificial fish like imitation crabmeat, and fish sauce, oils, and gelatin.”

I tell my patients that those who are allergic to fish, may only be allergic to only a certain type of fish. Some allergists feel that a fish allergic person should avoid fish altogether, but that person may feel that he or she should be allowed to eat other types of fish in their diet. They can ask their allergist to test them for their specific fish allergy.

The American College of Allergy, Asthma and Immunology (ACAAI) website states that after your allergist tests you for your particular fish allergy “take extra precautions to avoid cross-contact (when two foods come into contact with each other and their proteins mix) when purchasing fish from a market or when dining out.”

Typical symptoms of fish allergies, like other food allergies, may include: nausea, stomach cramps, indigestion, vomiting, diarrhea, stuffy/runny nose, sneezing, headaches, and asthma. Yet some people are so sensitive to fish allergies, that merely touching fish or being in an area where it is being cooked can provoke a severe anaphylactic response. People that are so allergic adverse are advised to carry an epien (epinephrine injector) with them and to avoid fish contaminated areas.

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