By Karri Emly

More than 12 million Americans, or one in 25 people, have food allergies, according to The Food Allergy & Anaphylaxis Network (FAAN). This figure continues to grow each year, and represents a two-fold increase in food allergies over the last decade. Although an individual can be allergic to any food, eight foods account for 90% of all food-allergic responses: milk, eggs, peanuts, tree nuts (almonds, pecans, walnuts, cashews, and pistachios), fish (tuna, salmon, catfish, etc.), shellfish (shrimp, crab, lobster, etc.), soy, and wheat. Around 6.9 million Americans are allergic to seafood, and about 3.3 million are allergic to peanuts or tree nuts. Around 2.2 million school-aged children have food allergies, with the incidence in those under the age of 3 being one in 17, according to FAAN. Many of these children will outgrow their food allergies.

Just a trace amount of an allergen that is ingested, inhaled, or in contact with the skin can produce an allergic reaction. A food allergy occurs when the immune system incorrectly identifies a food protein as being a threat to the body. The immune system releases histamine into the blood which, in turn, results in an allergic reaction.

These reactions vary from person to person and in level of severity. The allergic response may begin with a tingling sensation or itching or it may produce hives, a warm sensation in the skin, wheezing or difficulty breathing, coughing, swelling of the tongue or throat, vomiting, diarrhea, cramping, a drop in blood pressure, or the loss of consciousness. These symptoms may begin anywhere from several minutes to two hours after exposure to the allergen. Life-threatening reactions can worsen over a period of several hours.

Anaphylaxis, the most severe allergic reaction, is rapid in onset and can cause death. It can be caused by allergies to food, latex, bee stings, and pharmaceuticals. In the United States, food allergy is the leading cause of anaphylaxis outside the hospital setting and is responsible for an estimated 150 to 200 deaths and 30,000 emergency visits a year, according to FAAN. Studies have shown that early administration of epinephrine is vital to the successful treatment of anaphylactic reactions. Epinephrine is available by prescription in a self-injectable device (EpiPen® or Twinject®) for those with known severe allergic responses to allergens.

Food allergies need to be taken seriously because a mild allergic reaction to a food in the past can become a more severe reaction in the future. An FAAN review of food fatalities showed that most of the deceased did not have a severe allergic reaction until the one that caused death. The best approach to a food allergy is to avoid the food that causes the allergic reaction. Here are some tips to help limit exposure to food allergens.

Read the food ingredient list on all manufactured products. Peanuts, peanut butter, tree nuts, tree nut flours, soy, milk, and wheat ingredients are lurking in foods. For example, some brands of prepared cookie dough contain tree nut flours and some brands of chocolate ice cream contain peanuts, neither of which is obvious until one reads the ingredient list on the packaging.

Ask what ingredients are in buffet or homemade items before consuming anything. When in doubt, do not eat any food, no matter how delicious it looks. If you are preparing a holiday meal this year, avoid using ingredients that are known to cause food allergies in your guests. For those with wheat allergies, make pumpkin pie without a crust by baking the pie filling in a ramekin. Serve barbecued bacon-wrapped water chestnuts in place of bacon-wrapped scallops for those with seafood allergies and eggnog made from soy milk for those with a milk allergy. Simply picking the allergen, such as tree nuts or peanuts, off of or out of a prepared food will not make the food any safer for someone who has a food allergy because even trace amounts of an allergen can cause a reaction.

When eating out or ordering in, ask if the allergen can be left out of the preparation of the food item you wish to order. For example, request that tree nuts be omitted from salads and for dressings or condiments made with peanut butter or soy be omitted entirely. When in doubt, ask for dressings and condiments served on the side to avoid contamination of the entire entrée. Remember to ask if desserts contain tree nuts as these are not always disclosed in menu descriptions.

If you have a food allergy and will be celebrating the holidays outside of your own home, take the opportunity to introduce your family, friends, and coworkers to your favorite holiday foods that are allergen-free. Take your own entrée, side dish, or dessert and explain to the host and to the other guests that you want to share in the holiday cheer without the stress of dealing with a food allergy and the possible medical consequences of an allergic reaction. Be prepared: if you have an EpiPen®, take it with you at all times and make sure someone else at the celebration knows how to use it.

Avoiding food allergens can sometimes be a challenging ordeal, but well worth the effort if it means you will be able to enjoy another holiday celebration with your loved ones.

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Karri Emly is marketing consultant and pharmacy educator for Pharmacy Care Solutions, a compounding pharmacy located in Columbus. To learn more about compounding, visit www.pharmacycaresolutions.com.