Latest update: September 15th, 2013
We hear it all the time: “This is a peanut-free facility, you can’t eat that peanut butter sandwich here!” A person may say, “So what? I am allergic to broccoli, it’s disgusting, keep it far from me.”
We all should realize that food and medication allergies are no laughing matter. Reactions can be so severe that they could lead to death.
Allergic reactions commonly manifest as runny nose, hives, itching, tingling, rashes, vomiting, stomach pain, swollen lips eyes or face, or sneezing and coughing. The most severe reaction is something called anaphylactic shock.
Anaphylaxis is a rapidly progressive allergic reaction that is potentially life threatening. Although there has been an increase in the number of children diagnosed as being at risk of anaphylaxis, deaths are rare. But deaths have occurred, and anaphylaxis is therefore regarded as a medical emergency.
The symptoms of anaphylactic shock could include difficult or noisy breathing, swelling of the tongue, swelling or tightness in the throat, difficulty talking, wheezing, persistent coughing, low blood pressure, loss of consciousness, and collapse. Young children who are going through anaphylactic shock may appear pale and floppy,
Food allergies are the most common triggers to an anaphylactic reaction. Nine foods cause 90 percent of food allergic reactions and can be common causes of anaphylaxis. These are:
tree nuts (such as hazelnuts, cashews, almonds)
People all over the world live with allergies that trigger anaphylaxis. Some less common food triggers are citrus fruits and vegetables. But any food can cause anaphylaxis. Children frequently outgrow allergies to milk, soy, and eggs, but peanut, tree nut, and fish allergies tend to last a lifetime.
Food allergens account for 30 percent of deaths caused by anaphylaxis. In extreme cases, anaphylaxis can occur from kissing someone who has eaten the offending allergen, or from the food vapor in the case of cooking shellfish.
Medications can also cause anaphylaxis. Penicillins, cephalosporins, aspirin, NSAIDs, antimalarials, anaesthetics, sedatives, antipsychotics, antihypertensives, intravenous contrast dye and the flu vaccine are among the substances that carry risk of severe allergic reaction. Penicillin is the most common medication to cause anaphylaxis. Serious reactions to penicillin occur about twice as frequently following intramuscular or IV administration than taking it by mouth.
In contrast to food anaphylaxis, drug anaphylaxis is characterized by a high frequency of heart failure and rapid onset (within minutes), especially in older people.
Latex products, especially natural latex, commonly found in gloves, balloons, baby bath toys, belts, elastic bands, erasers, gloves, and some shoes can trigger anaphylaxis in those who are sensitive. Synthetic latex appears to be less allergenic than natural latex. Some people with latex allergy will also have an allergy to certain foods such as avocados, bananas, chestnuts, and kiwi because of cross reactivity to latex.
Insect venom from bees, hornets, wasps, and fire ants can also cause anaphylactic shock. Stings are more likely to cause anaphylaxis than bites. Anaphylaxis to insect stings has occurred in three percent of adults and one percent of children who have been stung. These stings can be fatal even on the first reaction.
Exercise is a rare trigger, but is likely to happen in people sensitive to certain foods (e.g. wheat, celery, and cheese) or medications. If the allergen is taken before being physically active, it can cause anaphylaxis. Typical symptoms include extreme fatigue, warmth, red face, rashes or hives, occasionally progressing to swelling of the face, wheezing, upper airway obstruction and collapse.
Extremely uncommon triggers include exposure to airborne allergens (such as animal dander) and cold temperatures. Sometimes a specific cause cannot be identified and this condition is called idiopathic anaphylaxis.
How does Anaphylaxis Happen?
Allergies occur when the immune system (immunoglobulin cell type “E”) produces antibodies against substances in the environment (allergens). These immune system cells set off an inflammatory reaction. The inflammatory response is the cause for most allergic symptoms, especially the closing of the throat, redness and swelling of the skin.
Anaphylaxis can occur within minutes to hours after being exposed to the trigger.
How Anaphylaxis is Treated
Anaphylaxis is a medical emergency and anyone experiencing symptoms should call EMS (Hatzoloh or 911) right away to get medical treatment. Adults may be able to express a feeling of “something not being right.” But children may not be able to communicate that something is wrong. Parents, teachers and caregivers should be accustomed to keeping a wary eye on children who have severe allergies. An “allergy emergency plan” should be made a practiced to benefit a member of the family who might G-d forbid have an anaphylactic episode.
As soon as anaphylactic symptoms begin, a shot of epinephrine or adrenaline, referred to pharmaceutically as an “epi-pen,” should be intramuscularly injected into the patient as quickly as possible.
Individuals who live with ongoing risk of anaphylactic shock keep epi-pens on their person at all times. Many rabbanim permit such a person to carry an epipen on Shabbat in areas without an eruv.
In addition to an epipen, patients might require resuscitation measures such as airway opening, supplemental oxygen and large volumes of IV fluids. Some cases even need a second shot of epinephrine five to 15 minutes after the first if the initial dose has not been effective.
Five to 20 percent of patients may experience a recurrence of anaphylaxis 8-12 hours after the initial incident. Therefore, once brought to the hospital, these patients are monitored for several hours. Steroids are administered to reduce the risk of a secondary episode of anaphylaxis. Furthermore, anaphylaxis may result in respiratory failure, shock, multiorgan system failure, and prolonged symptoms can last up to 32 hours despite treatment. Once the patient is released from the hospital, the swelling and rashes may persist for days or weeks until the body recovers.
Allergy Vs. Sensitivity/ Intolerance
Food allergies can be triggered by even a small amount of the food and occur every time the food is consumed. People with food allergies are advised to avoid the offending foods completely. On the other hand, food intolerances often are dose related. Someone with lactose intolerance may be able to have some milk in their coffee with no reaction, but not be able to handle an entire glass of milk.
Many factors contribute to food intolerance. In some cases, as with lactose intolerance, the person lacks the enzymes necessary to properly digest certain proteins found in food. Also common are intolerances to some chemical ingredients added to food to provide color, enhance taste, and protect against the growth of bacteria. These ingredients include various dyes and monosodium glutamate (MSG), a flavor enhancer.
Substances called sulfites are also a source of intolerance for some people. They may occur naturally, as in red wines or may be added to prevent the growth of mold.
Salicylates are a group of plant chemicals found naturally in many fruits, vegetables, nuts, coffee, juices, beer, and wine. Aspirin also is a compound of the salicylate family. Foods containing salicylates may trigger allergy symptoms in people who are sensitive to aspirin. Of course, any food consumed in excessive quantities can cause digestive symptoms.
Intolerance to wheat has been a growing issue. In addition to celiac disease, which requires a gluten and thereby wheat free diet, non – celiacs have found incredible intolerance to wheat. Many speculate that new intolerance to wheat and other genetically modified foods is due to tampering with the agricultural model which makes our food. Today’s wheat is not the wheat that was eaten 50 years ago. Mark Hyman, MD describes how today’s wheat is becoming a really popular allergen because It contains a “Super Starch,” amylopectin A, that is allows fat to form in the body. Today’s “gmo” (genetically modified) wheat contains a form of “super gluten” that is highly inflammatory. Finally, “gmo” wheat is designed to be extremely addictive, making us crave and eat more of it.
Symptoms of food intolerance include:
Gas, cramps, or bloating
Irritability or nervousness
Identifying a Food Sensitivity
Identifying a food sensitivity is very important. Symptoms caused by food sensitivities can be more debilitating than environmental allergies and include migraine, joint pain, and GI distress.
Allergies and sensitivities can be tested for by use of skin tests and blood tests. These tests are not always accurate, however. Patients are urged to keep a food diary and make a daily accounting of what they ate (or perhaps what they came in contact with chemically) and to note any symptoms on that day. This would theoretically narrow down the offending trigger.
Another way to identify problem foods is to go on an elimination diet. This involves completely eliminating any suspect foods from the diet until symptoms completely go away. Then, the patient would begin to reintroduce the foods, one at a time. This helps pinpoint, which foods cause symptoms. For ideas of what these offending foods may be, try adhering to a diet based on your blood type.
Treatment of Food Sensitivities
Avoidance and elimination of the offending food as much as possible is the best treatment for food sensitivities.
When a food sensitivity has been identified and eliminated from the diet, the result can be the eradication of syndromes such as digestive disorders, migraines, obesity, chronic fatigue, ADD, aching joints, skin disorders, arthritis and perhaps more.
Alternative therapies such as acupuncture have also been proven to minimize the adverse reaction to sensitive foods. Alternative treatments are also useful for those who have non-food allergies which are triggered by the environment (hay fever, spring blossoming). By reducing the inflammatory response with acupuncture or other interventions, patients can breathe better and be itch-free.
Esther Hornstein is a New York State licensed acupuncturist. In her Brooklyn private practice she treats both children and adults for allergies as well as for other conditions. For more information on Acupuncture and Oriental Medicine, please visit: www.2ndNatureAcu.com
About the Author: Esther Hornstein is a New York State licensed acupuncturist. In her Brooklyn private practice she treats both children and adults for allergies as well as for other conditions. For more information on Acupuncture and Oriental Medicine, please visit: www.2ndNatureAcu.com
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