Check Your Work: Understanding Food Allergies

Before you read further, take the quiz: Quiz: Understanding Food Allergies

Each week during Allergy and Asthma Awareness Month, Drug Topics will be publishing a weekly quiz focused on a different aspect of allergy and asthma management. Our second weekly quiz, published on Thursday, May 16, focused on food allergy management. Below, we break down the answers.

Question 1

Which of the following is not a typical symptom of a food allergy reaction?

Answer: Fever

Like seasonal allergies, food allergy symptoms do not include fever. They may, however, include symptoms such as hives, flushed skin, tingling or itching in the mouth, swelling of the face, tongue, or lips, coughing or wheezing, throat and vocal cord swelling, difficulty breathing, or loss of consciousness. In some, these allergies are life threatening, leading to anaphylaxis.¹

The Food Allergen Labeling and Consumer Protection Act of 2004 identified 8 foods as major food allergens: milk, eggs, fish, Crustacean shellfish, tree nuts, peanuts, wheat, and soybeans. In 2021, the Food Allergy Safety, Treatment, Education, and Research (FASTER) Act added sesame as the ninth major food allergen on that list.^1,2

Question 2

What is the current recommended approach for diagnosing food allergies in most patients?

Answer: All of the above (Skin prick testing with a panel of common allergens; blood tests for specific allergens; and oral food challenge)

According to the National Institute of Allergy and Infectious Diseases, the gold standard for diagnosing food allergy is an oral food challenge.³ During this test, a patient slowly eats a food, in increasing amounts, while under medical supervision. However, these tests can be time consuming and can cause an acute allergy reaction, leading to cautious use by physicians. Instead, the most frequently used diagnostics are allergy skin-prick tests and allergy blood tests. Like tests for environmental allergies, skin-prick tests depost an allergen extract under the skin, causing a red bump if an allergy is present. An allergy blood test measures the level of immunoglobulin E specific to a certain food or food protein in the blood.³

Question 3

Early peanut introduction is recommended for which group of infants?

Answer: Infants with severe eczema and/or egg allergy

A 2017 guideline addendum from the American Academy of Pediatrics recoomends the early introduction of peanut protein in infants who are at an increased risk of developing a peanut allergy.⁴ Based on the results of the landmark LEAP Trial (NCT00329784), the addendum includes 3 new guidelines: Guideline 1 recommends that infants at the highest risk—infants with severe eczema and/or an egg allergy—should be introduced to peanuts as early as 4 to 6 months of age. Guideline 2 recommends that infants with mild to moderate eczema, who are also at an increased risk for peanut allergy, should be introduced to peanuts around 6 months of age. And Guideline 3 recommends that infants without eczema or food allergy who are not at an increased risk of peanut allergy, have peanut “freely” introduced into their diet.

Question 4

What is the most effective way to manage severe food allergy anaphylaxis?

Answer: Epinephrine injection

Anaphylaxis is a serious and life-threatening allergic reaction. Unlike other allergic reactions, which typically occur in one part of the body, anaphylactic reactions typically affect multiple parts of the body at the same time.⁵ According to the American Academy of Allergy, Asthma, and Immunology, anaphylaxis requires immediate medical treatment, “including a prompt injection of epinephrine and a trip to a hospital emergency room.”

The risk of anaphylaxis is higher in patients with allergies or asthma and a family history of anaphylaxis, as well as in patients who have previously experienced an anaphylactic reaction.

Question 5

Unlike food allergies, food intolerance involves the digestive system and do not cause which of the following?

Answer: Anaphylaxis

Food allergies involve the immune system, where an individual’s immune system produces immunoglobulin E antibodies. Food intolerance takes place in the digestive system, and occurs when an individual cannot properly break down a food—due to an enzyme deficiency, a sensitivity to food additives, or a reaction to a naturally occurring chemical in the food.⁶ Crucially, individuals with a food intolerance, rather than a food allergy, can often eat small amounts of the food without a problem. Because of the risk of anaphylaxis, the treatment plan of an individual with a food allergy includes avoiding all contact with the allergy-causing food.

How did you do? Check back next Thursday and Friday for the next quiz in our Allergy and Asthma Awareness Month series.

References

1. Food allergies: What you need to know. FDA. Reviewed April 12, 2023. Accessed May 15, 2024. https://www.fda.gov/food/buy-store-serve-safe-food/food-allergies-what-you-need-know

2. Allergic to sesame? Food labels now must list sesame as an allergen. FDA. January 10, 2023. Accessed May 15, 2024. https://www.fda.gov/consumers/consumer-updates/allergic-sesame-food-labels-now-must-list-sesame-allergen

3. Diagnosing food allergy. National Institute of Allergy and Infectious Disease. Reviewed September 14, 2022. Accessed May 15, 2024. https://www.niaid.nih.gov/diseases-conditions/diagnosing-food-allergy

4. Sicherer SH. New guidelines detail use of “infant-safe” peanut to prevent allergy. AAP News. January 5, 2017. Accessed May 15, 2024. https://publications.aap.org/aapnews/news/12250/New-guidelines-detail-use-of-infant-safe-peanut-to?autologincheck=redirected

5. Anaphylaxis. American Academy of Allergy, Asthma, and Immunology. Accessed May 15, 2024. https://www.aaaai.org/conditions-treatments/allergies/anaphylaxis

6. Food intolerance versus food allergy. American Academy of Allergy, Asthma, and Immunology. Accessed May 15, 2024. https://www.aaaai.org/tools-for-the-public/conditions-library/allergies/food-intolerance