The Many Meanings of Food Allergy
Introduction
Like most drivers, I prefer to drive with a pleasant distraction. But I’m not rocking out to The Biebs; my vice is audiobooks. Still, I’ll mouth the words to Jim Dale’s rendition of Harry Potter and the Order of the Phoenix just as passionately as any teenager rocking out to their favorite heart throb du jour. I recently picked up a new read: Darwin’s Doubt by Stephen C. Meyer, narrated by Derek Shetterly. In this unabridged reading, the author chronicles some of his experience with other people’s understanding of Darwin’s own theories. Stephen Meyer spends inordinate amounts of time trying to ascertain what other people believe about Darwin’s theories. As you can imagine, few have it right, many have it nearly right, and some have it just plain wrong.
When it comes to something esoteric like a theory on evolution, the stakes aren’t exactly high stakes. Nearly correct interpretations of Darwin’s theory have been taught and perpetuated, but their impact on real life seems, perhaps unfairly, academic. However, nearly correct interpretations can be quite dangerous when it comes to something medical… like food allergies. Food allergy can quite literally represent a life-or-death situation and I hope that you can see the value in only working with solid information if you have/suspect food allergy in either yourself or a loved one. I think it’s important to address the false aspects of the kind of interpretation that is nearly-correct. This is where the efforts of specialists need to be concentrated. And, yes, this is a HUGE motivating principle reason of my blog.
Stephen Meyer’s experience in educating his audience about Darwin’s theories first started with stories about all of the many interpretations of Darwin’s thoughts. Evolution means many things to many people. Food allergy means many things to many people too. It’s helpful to find where your understanding is, because that is where my efforts ought to concentrate… And so I blog. I blog because there is a crisis of opinion right now. I blog because anyone with a keyboard is flooding social media on digital platforms with their thoughts on allergy and immunology. And just like Darwin’s theories, few have it right, many have it nearly right, and some have it just plain wrong. And so I’ll weigh in once every-other-week on things that I’ve seen and heard and read.
Let me know where you are from the information standpoint. I hope to meet you collectively. I hope to meet you where you are and take you to where we are going which is a better and less-allergic tomorrow. And I thought a nice place to start would be food allergy.
Terms
-Food allergy: “An adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food.” [1] Food allergy has come to represent several different things within the medical community:
IgE-mediated immune responses:
IgE-mediated food allergy
Oral allergy syndrome
Non-IgE-mediated immune responses:
Food protein-induced enterocolitis syndrome (FPIES)
Allergic proctocolitis (AP)
Food protein-induced enteropathy
Celiac disease
Mixed IgE- and non-IgE-mediated immune responses:
Eosinophilic esophagitis (EoE) and other eosinophilic gastrointestinal diseases
-Food intolerance: Any reproducible or non-reproducible reaction to foods that isn’t a food allergy.
Adverse Food Reactions: Food Allergy or Food Intolerance?
My experience in managing false perceptions initially encouraged me to start a blog about allergies, but it hasn’t been the only influence to guide my passions. Ultimately, I felt compelled to write because there is an unmet need in the digital / social community for a more hearty discourse. And I can’t think of a better subject-of-interest than that of adverse food reactions, a term which encompasses both food allergy and food intolerance.
Adverse food reaction is a catch-all term and implies a certain lack of detail. It essentially acknowledges that a swallowed substance is associated with an abnormal event. “When I swallowed X, then Y happened.” For some, adverse food reaction doesn’t happen every time for a presumed triggering food. For others, it does and this is called a reproducible adverse food reaction. Let’s use cow’s milk as an example.
Cow’s milk can cause a host of adverse food reactions like lactose intolerance and food allergy. And lactose intolerance is very, very different than food allergy. Milk can either make for a gassy evening on the one hand, or cause the tongue to swell and prevent airflow to the lungs on the other. This milk comes from the same cow or carton or even glass, but it has a very different results. Some people can joke about their “food allergy.” They can be convinced to eat a few bites Ben and Jerry’s and not end up in the emergency department. They can tell a chef that their sauce should have only less cream “because of my food allergy,” rather than no cream at all. As you can see, food allergy has the potential to carry entirely different meanings. Food allergy has come to represent many things among many different people. As it would seem, it has slowly become synonymous with adverse food reaction within the context of public discourse.
One need only look at the wide prevalence data of food allergy to appreciate this particular point. Cow’s milk protein allergy (CMPA) is the most common food allergy. According to several good studies, both new and old, CMPA is estimated to affect somewhere between 2% - 6% of children, with a higher values affecting children under 1-years-old. [2] Most children outgrow this allergy:
50% demonstrate the ability to tolerate cow’s milk by 1 years-old. [3]
80%-90% demonstrate the ability to tolerate cow’s milk by 5-years-old. [4]
Curiously, parent-reported CMPA is much higher, with reports from a study of studies (a meta-analysis) that rates the presence as high as 17%. [5] There is a wide discrepancy between parent’s perception of CMPA and an allergist’s diagnosis of CMPA, but when it comes to food avoidance, perception is reality. It isn’t difficult to see that parents are quite likely to be unnecessarily avoiding foods on the basis of what they think is a legitimate diagnosis. And where does this perception come from? Parent perception is, in some cases, educated by incorrect test results from either blood tests or skin prick tests. In other cases, in comes from incorrect physician advice. And in still other cases, it is educated by the public-at-large via social media. Again, few have it right, many have it nearly right, and some have it just plain wrong.
I am concerned about the nearly unopposed efforts in the blogosphere and Instagram / Facebook realms. This is something I am hoping to change, but it will take a community to do it. I hope that you find such a place here. I welcome comments. I welcome feedback. For those of you who either have food allergy or have a loved one with food allergy, I hope that you find useful information here. If you have concerns about food allergy, please go to your local doctor and/or allergist to help set you up with correct information and services.
My upcoming posts will focus on IgE-mediated food allergy and will, in particular, focus on peanut allergy. I can expand the topics covered in response to community feedback, but find that there is an abundance of studies about peanut allergy; consequently, it’s an easy place to start.
References
[1] Boyce JA, Assa’ad A, Burks AW, Jones SM, Sampson HA, Wood RA, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol 2010;126(suppl):S1-58. (IV).
[2] Host A. Frequency of cow's milk allergy in childhood. Ann Allergy Asthma Immunol. 2002;89(6 Suppl 1):33–7.
[3] Wood RA. The natural history of food allergy. Pediatrics. 2003;111:1631–1637.
[4] Host A, Halken S, Jacobsen HP, Christensen AE, Herskind AM, Plesner K. Clinical course of cow's milk protein allergy/intolerance and atopic diseases in childhood. Pediatr Allergy Immunol. 2002;13(Suppl 15):23–28.
[5] Rona RJ, Keil T, Summers C, Gislason D, Zuidmeer L, Sodergren E, Sigurdardottir T, Lindner T, Goldhahn K, Dahlstrom J. The prevalence of food allergy: a meta-analysis. J Allergy Clin Immunol 2007;120:638-46.
