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Spring 2008

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Food Triggers for Asthma and Allergies

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The Official Publication of AAN - MA

Food Triggers for Asthma and Allergies

Recently, my wife was preparing dinner and, to her surprise, had a significant allergic reaction to a kiwi fruit concoction that she was preparing. As dinner went on, her symptoms grew progressively worse from an odd tingling sensation on her tongue to an inability to speak clearly and some associated minor respiratory distress. She found out the hard way that she was allergic to kiwi, which is not an uncommon thing. Everything turned out for the best, and the condition quickly reversed itself. She now knows that she cannot eat this forbidden fruit. This scenario is even more concerning for an asthma patient for whom an allergic reaction could lead to an asthma exacerbation requiring swift medical attention.

What are the sources?
According to the American Academy of Allergy, Asthma and Immunology, this is a common experience, and approximately 35% of children with atopic disease (i.e., eczema, asthma and rhinoconjunctivitis) will have some degree of food allergy. Food allergies and asthma are on the increase, with approximately 8% of children age three and under having food allergies.1 There are six food groups that account for nearly all food allergies in children: milk, wheat, egg, peanuts, soy, and tree nuts. In the adult population that number is decreased to four: peanuts, tree nuts, fish, and shellfish. The adult allergies are generally not outgrown.

Typical symptoms of a food allergy reaction are:2

  • Itching or tingling of the lips, palate, tongue, or throat
  • Swelling of the lips or tongue
  • Hoarseness and sensation of tightness in throat
  • Abdominal cramps
  • Skin itching
  • Skin flushing
  • Hives
  • Diarrhea
  • Low blood pressure
  • Vomiting
  • Respiratory distress.

The incidence of food allergy as a cause of anaphylaxis — a severe, whole-body allergic reaction — is rising. Death is usually caused by respiratory failure, and patients with asthma are at the greatest risk.3 Patients with asthma tend to experience more severe and life-threatening allergic food reactions; and when it is a reaction that is in the respiratory tract, there is always a more severe reaction.4 Unfortunately, most fatal anaphylactic reactions are unpredictable.5

Restaurants and fast food establishments may also pose a level of danger to the sensitive patient, especially someone who has peanut or tree nut allergies. Frequently this is seen in ice cream shops, bakeries, and restaurants that serve Asian food. The best defense for an allergic person is communication with the establishment in an attempt to understand what the ingredients of the meal may be and if there are any hidden ingredients that may reside in food served with the main courses (salad dressings, sauces, or egg rolls).6 Also, people with allergies should ask the restaurant chef how the food is prepared. If you are allergic to shrimp and it is cooked in the same skillet as the french fries, then eating the fries may trigger a reaction. A safe course would be to avoid eating at restaurants whenever possible.

What treatments are available?
When you have a life-threatening reaction (e.g., respiratory distress, swelling of the throat and tongue) to a food allergy, your medical caregivers will use epinephrine, the treatment of choice.7 If you have food allergies, a smart thing to do would be to keep an injectors with you so that you (or your loved one) can deliver fast relief for a life-threatening reaction. Beyond that, less severe responses that usually go along with a food allergy include skin or gastrointestinal symptoms, which may be treated with oral antihistamines.

It is vitally important that you know what foods you are allergic to and then avoid them at all costs. Generally, diagnostic testing that includes elimination diets, skin testing, and in vitro testing accomplishes this. Elimination diets must be done under the advice and direction of a physician. An elimination diet is essentially what it sounds like — the systematic removal of potential or suspected food allergens. They usually are taken over a period of 10 to 14 days. You can ask your health care provider for more information about this.

Skin testing and in vitro testing are useful ways to determine whether you are allergic to a food. However, this may not be all-inclusive because some people who do present with a very strong positive history of food allergy may have a negative skin and in vitro test.8 Because of these variables, the American Academy of Allergy, Asthma and Immunology recommends that anyone being evaluated for possible allergies be referred to an allergy/immunology specialist. This is especially important for the patient who has had past reactions, severe or persistent disease, a hospital admission for exacerbation, coexisting asthma, allergic rhinitis, atopic dermatitis, or allergic conjunctivitis (may also be known as “pink eye”).

As with asthma, you should work with your doctor and respiratory therapist to develop an action plan. The allergic components of asthma and the causative agents must be listed. The action plan should be made available to schools and day care centers as well as with any caregivers. The school nurse or nurse office should also have a copy of the action plan. The child should be told not to trade foods or sample anyone else’s food at school, as this may involve food that will cause a severe or life-threatening reaction. Rescue steps must also be detailed on the action plan. It is also important that the person with allergies/asthma and caregiver understand what rescue action must be taken to counteract a severe reaction.

About the Author
Thomas J. Kallstrom, BS, RRT, AE-C, FAARC, is associate executive director and chief operating officer of the American Association for Respiratory Care. He is also a member of the National Asthma Education and Prevention Program Coordinating Committee and is a certified asthma educator.

References
1. Beausoleil JL, Fiedler J, Spergel JM. Food intolerance and childhood asthma: what is the link? Paediatr Drugs 2007; 9(3):157-163.
2. Wang J, Sampson HA. Food anaphylaxis. Clin Exp Allergy 2007; 37(5):651-660.
3. Keet CA, Wood RA. Food allergy and anaphylaxis. Immunol Allergy Clin North Am 2007; 27(2):193-212.
4. Spergel JM, Fiedler J. Food allergy and additives: triggers in asthma. Immunol Allergy Clin North Am 2005; 25(1):149-167.
5. Pumphrey R. Anaphylaxis: can we tell who is at risk of a fatal reaction? Curr Opin Allergy Clin Immunol 2004; 4(4):285-290.
6. Furlong TJ, DeSimone J, Sicherer SH. Peanut and tree nut allergic reactions in restaurants and other food establishments. J Allergy Clin Immunol 2001; 108(5):867-870.
7. Roberts G. Anaphylaxis to foods. Pediatr Allergy Immunol 2007; 18(6):543-548.
8. American Academy of Allergy Asthma and Immunology. Conditions that may have an allergic component. Vol. 3, 2000.

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