Food allergies and skin manifestations

It is the normal human psyche to connect any ailment we suffer to something that we ate !People often misinterpret food intolerance or any toxic effect caused by a food as food allergy.

Food allergy is an abnormal response to food that is triggered by a specific reaction in the immune system and expressed by certain, often characteristic, symptoms by various body systems like skin, gastrointestinal tract respiratory tract, eyes etc.
Food articles acting as allergens are responsible for multiple skin allergies.
Some of these allergies are mild and pass away with time as the body outgrows them while others can worsen, persist , trouble and may pose a challenge to treat. Often some food allergies even evoke devastating reactions which can be fatal.

An immunological reaction is responsible for food allergy which can occur in some patients only after a small amount of substance is ingested is distinctly different food intolerance that happens due to different non immune mechanisms. Food intolerance occurs due to a variety of other illnesses or food poisoning, which occurs when contaminated food is ingested. If a patient says to the doctor, "I think I have a food allergy," the doctor has to consider a number of diagnoses. The possibilities include not only food allergy but also any other diseases that have symptoms brought on by food.

The food allergens are external proteins which when introduced into the system evoke an antibody formation- largely the IgE antibodies which bind to the mast cells and cause release of a chemical called as histamine. Release of histamine then causes the skin to become swollen, red and extremely itchy and also affect other systems.
The food protein fragments responsible for an allergic reaction are not broken down by cooking or by stomach acids or enzymes that digest food. These proteins can cross the gastrointestinal lining, travel through the bloodstream and cause allergic reactions throughout the body.

Generally, people with allergies come from families in which allergies are common -- not necessarily to food but perhaps allergies to pollen, fur, feathers, or drugs. The prevalence of these allergies is greatest in the first few years of life and declines over first decade of life.

Although an individual could be allergic to any food, such as fruits, vegetables, and meats, there are eight foods that account for 90% of all food-allergic reactions. These are: milk, eggs, peanut, tree nuts (walnuts and cashew) fish shell fish, soy and wheat. Mushrooms can also cause explosive allergies with minimal consumption

Food additives such as artificial colors ,flavors esp. yellow dye 5, monosodium glutamate largely used while preparing Chinese foods to enhance flavor and some preservatives are also notorious food allergens
A person may exhibit allergy to multiple food items at the same time and often certain foods further trigger preexisting allergies e.g. coffee, caffeine in coffee can cause food intolerance as well as aggravate a preexisting food allergy.

Most allergies to foods begin in the first or second year of life. While some of these reactions may resolve over time (such as allergies to cows milk or eggs), other food allergies acquired in infancy (such as allergies to nuts or shellfish) typically persist throughout life. Allergies to milk or soy milk (a milk substitute made from soybeans) sometimes occur in infants and young children

A spurt in these allergies is on rise in the recent times due to frequent eating out of house habits, increased usage of packaged tinned and canned foods which are high on flavors, additives and preservatives.

Urticaria - reflects red blotches of itchy swollen skin called as wheals or hives may occur in a focal area or be widespread in nature and sometimes associated with swelling of lips, eyelids and even tongue and respiratory passage leading to a medical emergency and a potential choking to death effect or sometimes dizziness, vomiting drop in blood pressure and collapse.

Anaphylaxis- food allergy is a leading cause for anaphylaxis in children, also commonly seen in adults and known to recur often... they happen as rapid onset of symptoms within minutes to hours of food ingestion causing itching, redness, Swellings of lips, tongue & throat, choking sensation, vomiting ,stomach cramps , unconsciousness and can be life threatening

Atopic dermatitis Approximately 1/3 of infants and children with moderate to severe atopic dermatitis, an eczematous skin disorder have food allergies .Age of onset is usually infancy to early childhood and usually reflect as a red dry irritated itchy skin on face, limbs, and folds of the body. These allergies evoke a vague skin response and correlation of ingestion of a food allergen with clinical symptoms of itching and flare is often difficult to pinpoint, also other environmental trigger factors like dust, pollutants ,clothes etc often add to the allergic manifestations in atopics and mask the effect dietary factors have on the skin,

Elimination of suspected foods is indicated, this helps the skin to heal and repair. Once the skin repairs, on re exposure to the suspected trigger foods will provoke a markedly itchy rash making the diagnosis clear. Once suspected food is picked up treatment is total elimination from the diet .commonly implicated foods include milk, eggs, peanut, soy and wheat.

Oral allergy syndrome Heat labile fresh fruits and vegetables e.g. apple, brinjal, raw potatoes, bananas, melons etc.can cause oral allergy syndrome( also called as contact urticaria ) experienced as burning, swelling itching and erythema of lips tongue palate and throat .They can also cause swelling and choking in throat and anaphylaxis. This allergy is of rapid onset and allergen component in the fruits and vegetables is the pollen grains.

Several points of information help to determine a food allergy

• Noting the suspected food
• Quantity of food ingested
• Description of the symptoms that occur
• Type of symptoms in the past after ingestion of the same food
• Length of time since the last reaction

A diet diary, a chronological record of all ingested foods anything placed in the mouth (including toothpaste, chewing gum etc) over specific period of time and note any symptoms experienced in this time. This helps to establish a relation between the ingested food and symptoms of allergy.

Elimination diets Eliminating basically notorious foods or specific known trigger foods and monitor for symptoms of allergy closely and act as a therapeutic trial. On elimination of the diet symptoms disappear and recur on reintroduction after a few days. On reintroducing various foods over a period of time the list of allergic foods is obtained

Elimination of offending food if identified correctly helps to prevent further episodes of allergy
This is very difficult in practical life as a patient may be allergic to multiple food items at the same time and in chronic allergies like atopic dermatitis and asthma environmental factors play a role in keeping the allergic phase active and also masquerade the actual food allergies

Oral food challenge tests is considered as a gold standard for diagnosing food allergies the challenge consist of administering increasingly large amount of suspected food over 1-2 hrs starts with 100mg of suspected food and not more than 10gm of suspected food.

Allergy skin prick tests help to determine immunologic IgE mediated allergies and are only suggestive and not conclusive, these are not entirely reliable in very young children 1yr of age, and may also provoke a aggravation of the allergy.

An intradermal skin test is more sensitive but can provoke aggravation of allergy

These tests are conducted by qualified personal and under medical guidance as reactivation of symptoms can occur while testing.

Non medical therapies-
Strict avoidance of identified food allergens. Especially in those people who manifest allergies with severe and life threatening symptoms. And is the only proven therapy for food allergies
Providing a list of foods allowed is not beneficial as ingredients change frequently instead a patient must be encouraged to read labels

Medical Therapy during the active episodes of allergy in the form of molecules called as antihistamines which work by blocking the release of histamine from the mast cells.
In widespread allergies cortisone may help to relieve the most severe forms and epinephrine may be required in emergency situations

In emergency situations patient needs hospitalization and acute critical care.
Patients with severe allergies are taught to wear medical alert identification, keep antihistamines readily available, taught self administration of medications like epinephrine

Immunotherapy involves desensitization of the patient with the food allergen and helps in children especially with milk, eggs, wheat and soy and possibility of outgrowing the allergy for several years. Allergies to peanuts and sea foods are difficult to outgrow as individuals retain their food sensitivity for life time.

A child with food allergy must not accept eatables from classmates and friends, school authorities must be informed on the same and included in patient education . Parents and school personnel should be taught to recognize emergency symptoms as immediate treatment is sometimes required. Stay in regular contact with a qualified doctor on the same front and appropriate specialty referral sought when necessary.

Eat safe and live healthy seems to be the new age motto for millions of food allergy sufferers all over the world , for left unheeded food can become your fatal enemy and that’s a reality!

THE INFORMATION IN THIS ARTICLE REFLECTS THE VIEWS OF THE AUTHOR ONLY. A QUALIFIED HEALTH CARE PROFESSIONAL SHOULD BE CONSULTED BEFORE USING ANY THERAPEUTIC PRODUCT DISCUSSED. ALL READERS SHOULD VERIFY ALL INFORMATION AND DATA BEFORE TREATING PATIENTS OR UTILIZING ANY THERAPIES NOTED IN THIS PROGRAMME.