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Food allergies can cause misery and death



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If you haven't had a meal of shrimp and then awakened with your skin on fire, or had a glass of milk and an hour later found yourself with a horrible stomachache, count yourself lucky. Millions of Americans aren't so fortunate. They suffer from food allergies.

The reaction can range from minor skin rashes to life-threatening anaphylactic shock.

For allergy sufferers, know that your misery has a lot of company. Federal agencies report that:

-Approximately 2 percent of adults and 5 percent of infants and young children in the United States suffer from food allergies.

-Each year, about 30,000 people require emergency treatment and 150 to 200 people die because of allergic reactions to food.

-Eight major foods or food groups - milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat and soybeans - account for 90 percent of food allergies.

What is a food allergy?

The mechanism for food allergies is the same as for environmental allergies: The immune system mistakes something you eat for a dangerous invader and attacks. In the confusion, the antibodies attack the body, too.

Unlike environmental allergies - pollen, dust and so forth - there's no cure or even relief for food allergies.

Once you identify something that makes you sick, the remedy is simple: Don't eat it. "You can't take a pill and then go out and have a shrimp dinner," said Dr. H. James Wedner, professor of medicine at Washington University School of Medicine.

But often, you don't know that the food culprit is in what you are eating. For instance, an ice cream parlor may mix your strawberry ice cream next to where they mixed pistachio ice cream. If you are allergic to nuts, that could cause a reaction.

All it takes is coming in contact with a protein from the food that your body sees as an invader. Highly allergic people can get reactions even from smelling certain foods, doctors say.

The incidence of food allergies has grown exponentially in the past 30 years, and experts don't really know why.

What they fear is that while the number of people with food allergies continues to grow, so do the sources of places to get allergens - foods that will cause a reaction.

And with the prevalence of prepared foods, allergens can lurk in some unlikely places. In 1999, a study in Minnesota and Wisconsin found that 25 percent of foods failed to list peanuts or eggs as ingredients. The Food and Drug Administration says the number of recalls caused by unlabeled allergens rose to 121 in the 2000 from about 35 a decade earlier.

You can develop new allergies at any age. As your body changes, so will its idiosyncrasies. A doctor's diagnosis, a skin-prick test, a personal history and a family history can help you pinpoint your allergies.

Food allergies often get the blame when food intolerance is the problem. Intolerance refers to when the body doesn't properly process food. That's why doctors stress getting tested by an allergist.

One common condition is lactose intolerance - when the body doesn't make enough of the enzyme needed to digest milk products. The result is about the same as food poisoning.

"People have milk allergies, but by far the biggest problem adults have is lactose intolerance," said Wedner of Washington University.

Some foods, such as certain sorts of fish and cheese, have enough histamine to make the body believe it's having an allergic reaction when it's not. The way to tell, says Dr. Mark Dykewicz, assistant professor of medicine at St. Louis University, is by getting tested or observing the obvious.

"What most people think is food allergy is not," Dykewicz said. "Unless there's a consistent experience, you may find it difficult without getting an allergy assessment to learn what you're allergic to.

"Obviously, in the case of someone who every time they eat shrimp they have problems, it's enough to stay away from shrimp."

Doctors might have people keep journals of their eating and illnesses. Sometimes that's enough. Otherwise, doctors say, the only way to determine an allergy is to be tested.

Skin testing involves using an extract of common or suspected allergens that is pricked into the skin to see if a reaction occurs.

The next method is to check suspect foods one by one in the doctor's office. Patients get either a small portion of the food or a placebo and then wait for 30 minutes or so. If there's no reaction the portion is increased. Eventually, doctors will know whether the food causes the allergic reaction.

Dr. Rosa Kincaid, a medical doctor who runs a holistic practice, routinely takes an eating history from patients. Sometimes she finds the food itself is the problem, sometimes she finds the additives are a problem. Often, she has success telling patients to avoid foods with artificial flavors and preservatives, she said.

She also has some patients use an "elimination diet."

"Make a list of the food you crave, that you must have, and then for three weeks totally eliminate those things from your diet," she said.

"Then, reintroduce the foods. (If) you haven't had symptoms in 14 days and you eat some chips and the symptoms come back," it's a sign that the food is causing the problem, she added.

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HIDDEN ALLERGENS

Even conventional practitioners are wary of food additives and labels, because they don't adequately describe the presence of some allergens, the experts said.

With the proliferation of prepared foods, food labels were supposed to provide information to help people be aware of what they're eating.

However, food manufacturers use some cryptic labeling. For example, "potassium caseinate" is a milk product. Most words that start with "lac" are from milk. Albumin is from eggs. Gluten is from wheat. Fructose is from corn.

"And then we find natural flavors' andnatural colors' on food labels," said Dykewicz.

When trying to diagnose an allergy or food intolerance, Dykewicz says, he often must go through the corporate legal office and then sign a nondisclosure agreement to identify food additives that might be harming his patients.

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CHANGES IN THE LABELING LAW

The old federal labeling law allowed a lot of loopholes in the disclosure of what was in a product. In 2001, Anne Munoz-Furlong, founder and CEO of the Food Allergy & Anaphylaxis Network, wrote a scathing article about food labeling. The Food and Drug Administration posted it on its Web site:

"These days, food ingredient labels are written for food scientists, not consumers. Words such as potassium caseinate, albumin and semolina all appear on labels.

"Good for scientists, but for consumers it takes detective work - or the experience of a reaction - before we learn that these words indicate the presence of milk, eggs and wheat, respectively," Munoz-Furlong wrote.

The new law, the Food Allergen Labeling and Consumer Protection Act of 2004, enacted on Aug. 2 of last year, corrects a gap in the old law. The gap was that some dangerous food Additives Could Be Listed By Their Chemical Names, Even Though They Originated From Potentially dangerous foods. For example, potassium caseinate is extracted from milk and could cause an allergic reaction. Albumin is from eggs and could cause an allergic reaction. The updated law allows the government to require that allergens be listed more clearly on food labels.

The bad news is that the food industry can phase in required changes, so the full effect of the law may not be felt for up to four years.

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HOW TO HELP YOURSELF

At home

-Don't even bring allergens into the house. Children, especially, eat food that tastes good, despite the parents' wishes.

-Know the allergy restrictions of your children's friends and even your own friends and neighbors.

-Know what is in your foods when you have a party. If someone asks for the content of the food on your snack tray, don't get insulted. For example, even some imitation crab can have up to 10 percent real crab for flavoring.

-If you're suspicious of foods, don't eat them.

At the grocery store

-Learn the language of food labels. For example, anything with "lac" on it will have milk products. "My patients become excellent food-label readers," said Dr. H. James Wedner of Washington University.

-Beware "natural flavors" if you have a fruit allergy.

-Tell the grocer when meat or fish counters have allergens too close to one another. For example, fish that's in direct contact with shrimp or shrimp juice can carry the shrimp allergen protein once they're separated.

At restaurants

-Beware of creative cooking; chefs sometimes mix foods. A chef may make fish stew with shrimp stock, or a cook may make french fries in the same oil used to fry shrimp.

-Wedner's patients carry a bright red card that reads: "I AM DANGEROUSLY ALLERGIC TO-"; patients fill in the blank space. "Give that to a waiter to give to the chef," Wedner says. "Then the chef knows what shouldn't be served to you."

-If you eat out often, carry an EpiPen. It's a self-injecting dose of epinephrine, a form of adrenaline that will suppress an allergic reaction until a person can get to a hospital. "Some people think it's OK to carry around over-the-counter Benedryl, but that won't do it with a severe reaction," Wedner said.

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(c) 2005, St. Louis Post-Dispatch. Distributed by Knight Ridder/Tribune News Service.

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