Food Allergy and Anaphylaxis: Promoting Awareness and Understanding

As May 9-15, 2021 is Food Allergy Awareness Week, there is an opportunity to raise awareness for food allergies and anaphylaxis. Fortunately, the incidence of fatal food anaphylaxis for an individual is low and adds little mortality risk.^1,2 However, as food allergy anaphylaxis can nevertheless be fatal, it is important to highlight food allergy awareness to provide appropriate treatment and counseling for patients.

Food allergy is an allergic reaction that involves the immune system. For food allergies—specifically immunoglobulin E (IgE)-mediated food allergic reactions—there are specific food proteins against which the body mounts an immune response. In the most common type of food allergy, IgE antibodies target certain proteins in food that they mistakenly see as a threat. Food-specific IgE antibodies are formed that bind to receptors on mast cells, basophils, macrophages, and dendritic cells, and when allergens reach cell-bound IgE antibodies in susceptible individuals, mediators are released that induce allergy symptoms. There are non-IgE-mediated or mixed IgE-mediated reactions, as well, but the IgE-mediated immunologic basis is key to understanding how food allergies work.

Research from 2019 suggests that at least 10.7% (>26 million) of US adults are food allergic, whereas 19% of US adults believe they have a food allergy.³ Having confirmatory testing with a strong clinical history is important to avoid undue quality of life burden and to provide appropriate counseling, treatment, and dietary management, if necessary.

Anaphylaxis is a multisystemic, severe, and potentially life-threatening allergic reaction. Symptoms can vary from confusion and agitation to lip and mouth swelling, difficulty breathing, wheezing, hypotension/weak pulse, and/or hives or redness all over the body. Epinephrine is the treatment of choice for this reaction. Many patients with food allergies have epinephrine autoinjectors. Epinephrine is generally not needed for mild hives—but if there is any concern for respiratory symptoms or persistent vomiting or abdominal pain, epinephrine is typically necessary. Delayed epinephrine administration has been cited as the most common cause of death from food allergies.^4,5 In addition, as we enter the summer months, patients and providers need to be aware that epinephrine autoinjectors may lose potency within hours if stored in a heated car.⁶

Any food can cause an allergic reaction. However, there are 8 types of food that account for about 90% of all reactions: milk, wheat, egg, peanuts, tree nuts, fish, crustacean shellfish, and soy.⁷ For those affected, education in treatment and prevention of food allergy reactions is crucial—which is why patients should be provided help in reading and understanding food labels.⁸ This is especially true for children with food allergies, who should be encouraged to start reading food labels as soon as they can read with practice at home from caregivers.

There are multiple organizations that can provide assistance for food allergy education, diagnosis, treatment, and advocacy. These include, but are not limited to:

1. The American Academy of Allergy, Asthma & Immunology (AAAAI)
2. The American College of Allergy, Asthma & Immunology (ACAAI)
3. The World Allergy Organization (WAO)
4. The Food Allergy Research & Education Organization (FARE)
5. Kids With Food Allergies (KFA), a division of the Asthma and Allergy Foundation of America

These organizations have various online resources also available for patients and providers.^{9,10, 11,12,13}

Eevar Benjamin Rossavik, DO, is a chief pediatrics resident who will soon join his program’s faculty to be a pediatrics attending. He has a specific interest in allergy, asthma, and immunology.

Clinicians and experts interested in responding to this piece, or submitting their own articles to HCPLive, can contact the editorial team here.

References

1. ^{Turner PJ, Jerschow E, Umasunthar T, Lin R, Campbell DE, Boyle RJ. Fatal Anaphylaxis: Mortality Rate and Risk Factors. J Allergy Clin Immunol Pract. 2017;5(5):1169-1178. doi:10.1016/j.jaip.2017.06.031}
2. ^{Umasunthar T, Leonardi-Bee J, Hodes M, et al. Incidence of fatal food anaphylaxis in people with food allergy: a systematic review and meta-analysis. Clin Exp Allergy. 2013;43(12):1333-1341. doi:10.1111/cea.12211}
3. ^{Gupta RS, Warren CM, Smith BM, et al. Prevalence and Severity of Food Allergies Among US Adults. JAMA Netw Open. 2019;2(1):e185630. Published 2019 Jan 4. doi:10.1001/jamanetworkopen.2018.5630}
4. ^{Chooniedass R, Temple B, Becker A. Epinephrine use for anaphylaxis: Too seldom, too late: Current practices and guidelines in health care. Ann Allergy Asthma Immunol. 2017;119(2):108-110. doi:10.1016/j.anai.2017.06.004}
5. ^{Lieberman P. Biphasic anaphylactic reactions. Ann Allergy Asthma Immunol. 2005;95(3):217-258. doi:10.1016/S1081-1206(10)61217-3}
6. ^{https://www.aaaai.org/about-aaaai/newsroom/news-releases/epipens-heat#:~:text=Epinephrine%20autoinjectors%20(EAIs)%20have%20recommended,59%20%E2%80%93%2086%20degrees%20Fahrenheit%20permitted}
7. ^{https://www.fda.gov/food/buy-store-serve-safe-food/food-allergies-what-you-need-know}
8. ^{https://www.foodallergy.org/resources/how-read-food-label}
9. ^{https://www.aaaai.org/conditions-and-treatments/library/allergy-library/food-allergy}
10. ^{https://acaai.org/allergies/types/food-allergy}
11. ^{https://www.worldallergy.org/education-and-programs/education/allergic-disease-resource-center/professionals/food-allergy}
12. ^{https://www.foodallergy.org}
13. ^{https://www.kidswithfoodallergies.org}