The Peanut Problem

peanuts

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We hear so much about food allergies, but how common are they, how are they diagnosed—and is there any cure? 

Dr. Shaila Gogate loves talking about food allergies—and for more than professional reasons. Gogate, who is certified by the American Board of Allergy and Immunology and sees patients at the Colorado Allergy and Asthma Center, has two children, both of whom are allergic to common foods (her son to peanuts, her daughter to eggs). So she sees food allergies through two lenses—as a doctor and as a mom. Only 1 to 5 percent of the population actually has a food allergy, Gogate says, and most of those allergies are to peanuts, cow’s milk, hen’s eggs, wheat, shellfish, fish, soy and tree nuts, all of which must by law be listed on food labels. We sat down with Gogate at her Lowry office to get the lowdown.

What’s the difference between a food allergy and a food intolerance?
“There’s a big difference. With an allergy, it is an allergic, immunological process occurring. For example, if a child with a peanut allergy ingests a peanut, her body creates an allergic antibody, and within five minutes to a half hour she will flush, break out in hives, maybe vomit or have diarrhea and sometimes even have respiratory issues like sneezing or wheezing. It’s like this volcano explodes inside a person. A food intolerance, in contrast, is a digestive response, not an immunological one. It’s not a life-threatening issue.”

If someone accidentally has an allergic reaction, what can they do?
“No matter what a person is allergic to, he or she needs to carry an epinephrine auto injector, which basically blocks the release of the substances that cause reactions from allergic cells. Our philosophy in this office is that you’ll never go wrong using epinephrine and then taking antihistamines after that.”

Are food allergies becoming more common?
“We seem to think that allergies are increasing in prevalence. There could be several reasons. It might be because there is a reporting bias today because we are all more aware of food allergies. It might be because we are introducing allergenic foods too late in a child’s life. Or there’s something called ‘the hygiene hypothesis,’ which suggests that there is less micro-bacterial flora out there—in other words, our world is too clean—so your body looks for something else to fight against. That might explain why food allergies are more common in this country and why sometimes people develop allergies when they move to the States.” 

Can food allergies actually develop at any time in a person’s life?
“There are always exceptions, but most food allergies start in childhood and are eventually outgrown. Wheat, milk, egg and soy are outgrown the most often—80 percent of the time. Fish and shell sh allergies can start a little later. Peanut and tree-nut allergies are only outgrown 15 to 20 percent of the time. If you think you might have outgrown an allergy, it’s best not to test it yourself—that’s walking a dangerous line. It’s better to see an allergist and get a quick scratch test, where doctors apply an extract of the substance to a skin scratch and see if there’s a reaction at the site.”

Can a young child sense a food allergy?
“It’s funny because allergic kids often know what foods to avoid. I see this a lot— you put a piece of egg in an infant’s mouth and it either tastes metallic or makes their mouth itch so they spit it out. Kids will instinctively eat around foods that might be allergic.”

If someone is allergic to food, is he more likely allergic to other things? 
“Yes. These ‘atopic diseases,’ or allergic diseases, tend to run in a gang. It will often start with eczema, and sometimes move on to a food allergy, and then as the immune system matures, the person may develop a runny nose, sneezing (hay fever) or asthma. Those are things we keep an eye on in food-allergic children.”

Are there ways to prevent food allergies?
“For a long time, we have thought that avoidance was the way to go. But in 2014 there was an interesting study; it was noticed that in Israel, where many babies at a young age are fed Bamba, a snack like a peanut Cheeto, there is a much lower incidence of peanut allergy. After this observation was made, kids were fed Bamba early in life, and it decreased the incidence of peanut allergy by 70 percent. It was just one study, but there are followups going on right now. There are also more and more studies being done to see if taking a small dose of an allergic substance, like a peanut protein, and then slowly increasing that dose, can induce a tolerance in a patient. It might be possible to use a patch or take a pill to slowly increase someone’s tolerance. I think that in my practicing lifetime, we’ll have different treatments for food allergies beyond what we have now: simple avoidance. The question will be: Can you tolerize a patient to something, so if there is an accidental exposure, nothing happens? I’m hopeful.” 

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