Written by Carley Higgins on behalf of Supriya Lal, RD, MPH
Food Allergies defined:
A food allergy is defined as “an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food” (Valenta.) The top 9 food allergens are milk, eggs, peanuts, tree nuts, fish, shellfish, soy, wheat and sesame (“Food Allergy & Anaphylaxis: Prevention). Food allergens elicit an immune reaction in our body. IgE’s are antibodies that are produced by our immune system, in the case of an allergy, your immune system overreacts, producing these IgE antibodies causing an allergic reaction (Valenta). Food allergies can produce a severe and life threatening response called anaphylaxis, which usually begins as soon as a person eats the food they are allergic to. Anaphylaxis can cause difficulty breathing, swollen lips and throat, reduced blood pressure, vomiting and fainting (“Food Allergy & Anaphylaxis: Prevention).
So does getting a stomach ache when you have milk, preferring gluten/wheat free products or having celiac disease counts as a food allergy? No! In fact there is still a large confusion to this day on what actually constitutes a food allergy, vs an autoimmune disease or a food sensitivity/intolerance or preference. While these other issues can cause unwanted symptoms, they do not affect the immune system in the way a food allergy does, and cannot lead to anaphylaxis or death. Food intolerances or sensitivities affect your digestive tract. Usually your body is unable to break down specific foods, like in the case of lactose intolerance, where the body lacks the enzyme lactase. Food intolerances often cause GI distress like diarrhea, vomiting, cramps or constipation (Schaefer). In order for something to be defined as a food allergy, the immune response must be present, and more than just GI distress will usually occur. Some allergies can be so severe that even touching the food can cause unwanted reactions (Schaefer).
The Rise of Food Allergies
On top of how dangerous food allergies are, the number of people with food allergies has been increasing greatly in Westernized countries, making them a major public health problem. In the last two decades, food allergies have doubled, with 32 million Americans having at least one food allergy and six million children, or two children in every classroom having a food allergy (“Food Allergy & Anaphylaxis: Prevention). Peanuts specifically have been identified as the most common allergy in children, affecting 1.6 million children in the US. On top of the rise, there is no way to “cure” food allergies. Those suffering must simply avoid the food, which can be challenging and lead to dangerous mistakes (“Food Allergy & Anaphylaxis: Prevention).
What has changed to cause such an increase in these food allergy numbers? It is important to remember that food allergies are not genetic, as ⅔ of children with food allergens do not have parents with allergies, meaning anyone can develop a food allergy (“Food Allergy & Anaphylaxis: Prevention). There are a few hypotheses that explain the rise in food allergies. The first is the late introduction of common allergen foods. Between 1997 and 2011 the American Academy of Pediatrics made a recommendation to parents to wait till children were older to feed them the top allergen foods, particularly those at high risk of a food allergy. It was then at this time that we saw a large spike in food allergies, suggesting this recommendation may not have been the best (“Preventing Food Allergies: Early Interventions: Fare). Newer studies contradict that recommendation. In 2015, a study done by Learning Early About Peanut Allergies (LEAP) was conducted to figure out if giving a child peanuts earlier on in life actually protected them from developing a peanut allergy. The study followed 600 plus children ages 4 to 10 months. The children were split into two groups. The first group had the infants completely avoid any peanut or peanut products, while the second group were fed peanut foods a few times a week. The study followed the children until they reached age five. It concluded that children in group two, who ate peanuts from a young age regularly, were 80% less likely to develop a peanut allergy than those who completely avoided peanuts (“Preventing Food Allergies: Early Interventions: Fare).
While this study showed us a lot about peanuts, it did not confirm any hope for early introduction for any of the other top allergens. Another study done in 2016 by Enquiring About Tolerance (EAT) wanted to test the early exposure theory on the other top allergens. In this study 1,300 breastfed infants were split into two groups. When the infants were three months, half of them continued to exclusively breastfeed while the other half tried peanuts, milk, egg, sesame, fish and wheat, in an age appropriate way. The study did not find a difference in the development of allergies between the groups. Because of this, they concluded that introducing top allergen foods early on to infants does not increase their chance of developing the food allergy (“Preventing Food Allergies: Early Interventions: Fare). These similar studies point to fairly different outcomes, but both suggest that early introduction of top allergen foods to infants is not dangerous, and with peanuts, can have a positive effect of decreasing a child’s likelihood to develop a peanut allergy.
The idea of feeding an infant one of the top allergen foods can seem daunting, as it is unknown whether or not they will react to it, but avoidance is not the answer. Guidelines for early introduction suggest consulting with a pediatrician first to find out your baby’s allergen risk. In the case of peanuts, baby’s with severe eczema or an already identified egg allergy are at high risk for developing a peanut allergy, and doctors recommendations should be taken in this case (“Preventing Food Allergies: Early Interventions: Fare). If your baby is not at high risk for developing a food allergy, it is recommended to give your baby a very tiny taste of the food, and wait 10 minutes to see if any reaction occurs. If not, you can continue to feed them the food. This should be done at home or in a doctor's office, where at least two hours of time can be devoted to feeding them and monitoring the infant afterwards (“Preventing Food Allergies: Early Interventions: Fare). Whether early introduction helps you find out that your child does or does not have an allergy, or helps prevent them from developing a food allergy, it may be an important step in slowing down the rate of food allergens developing today.
The lack of early introduction is not the only hypothesis explaining why food allergies are on the rise. The Hygiene Hypothesis suggests that food allergens have risen because our environment is “cleaner” so children’s immune systems have been programmed to overreact to new food proteins, creating food allergies (Gupta). A 2016 study measured hygiene factors associated with food allergies. The study consisted of 1,359 children aged 0 to 21, 61% with a food allergy and 30% with asthma. They tested a few main hygiene factors, such as antibiotic use, infections, siblings, pets, maternal health and child care (Gupta). The study found that skin infection and eczema in the first year of life increased children’s risk of food allergies, while having siblings and attending a child care center decreased the likelihood of developing a food allergy. Children attending a child care center may have been exposed to greater bacteria early on in life, protecting them from food allergies. Having a pet, antibiotic use and maternal health had no impact on the development of food allergies (Gupta). The dual allergen exposure theory also suggests that early eczema is a predictor of food allergies. Broken skin from scratching eczema can allow food proteins into the body through the skin (Lack). If the food proteins consistently go through the skin rather than the mouth and GI tract, sensitization can occur, leading to a food allergy. This explains why we have a lot of peanut allergies in our country. We avoid feeding them to our infants, yet they are consumed so often in infant’s environments (Lack).
Why should we care about the rise?
These studies show some of the various hypotheses on why the increase in food allergies is occurring. It is clear a lot more research needs to be done on this topic. But for someone without an allergy, or not currently worrying whether or not feeding their infant top allergen foods is safe, why should we care about the rise of food allergies? Do other people’s food allergies have any effect on us? One place food allergies are affecting others without allergies are in schools. Schools have voluntary guidelines regarding managing food allergens in schools, but some schools have chosen to be completely “nut free” not allowing any students to bring outside food into school. If this trend were to continue, many families who rely on simple peanut butter and jelly sandwiches for lunches would be negatively impacted. Schools who do not go “nut free” may offer more education to students and teachers on the seriousness of allergies. In NYC, schools cannot guarantee they are “allergy free” but rather state they are “allergy aware” making sure children and staff know exactly who is allergic to what foods. Overall education in schools in the future should be expected to children and staff with and without food allergies (“Allergies”).
The rise in food allergies may also force people not allergic to food to learn to navigate allergy warnings and food labels. Say you are grocery shopping for a dinner party, work event or child’s birthday party and someone coming has a peanut allergy. You must learn what allergy labels like “contain” “may contain” and “processed in a facility that” mean, and where to find this on packaging. Simple mistakes of not reading the label, or missing a label warning sign could be a hospital trip for someone with food allergies. Increasing food allergy numbers can also affect the restaurant and food industry. In the UK, a restaurant owner was put on trial for “unknowingly” serving a peanut sauce to a customer who specified he was allergic to peanuts, and the customer ended up dying (Claar). Restaurants need to make sure staff are trained on food allergies, know the severity of them and that they are knowledgeable on which products in the restaurant may contain or be contaminated by specific food allergens. A peanut farmer in Georgia also feels the effects of peanut allergies. She worries about the future of her farm as peanut allergies rise and more and more people fear the food she is producing (Claar).
Food allergies are also often portrayed negatively in the media, as comedic or as a weakness. A 2015 study followed two groups, one watched tv and movie clips of food allergies shown in a comedic way, and the other showed food allergies in a serious light. Those who watched the comedic food allergy clips, had more negative feelings towards people with allergies, and found they would be less likely to take food allergies seriously, and less likely to take action in a food allergy emergency. Additionally if characters in shows with food allergies are seen as weak, children with food allergies are more likely to be bullied for their allergy (“How the Media Portrays Food Allergies.”). An example of this is shown in the old popular tv show, That’s So Raven. Raven had a serious allergic reaction, and the scene is supposed to be comical, brushing off the severity of it. By shedding a more positive or educational light on food allergies in the media, we may be able to teach young children how serious they really are.
The Future of Food Allergies:
Whether we will see a decrease in top allergen food products in the future, or a reduction in purchase of them is something to think about. As food allergies rise, the education on them must also rise. It does not seem fair to force people not allergic to these foods to avoid them, but is it safe to have these foods everywhere with no restrictions? It will be interesting to see where food allergies are heading and their effects on the food industry, our personal food decisions and how they are portrayed in the media.
Works Cited
“Allergies.” Web, https://www.schools.nyc.gov/school-life/health-and-wellness/staying-healthy/allergies.
Claar, Richard, et al. “How Food Allergies Impact Food & Beverage Suppliers " Martec.” Martec, 1 Oct. 2021, https://martecgroup.com/food-allergies/.
“Food Allergy & Anaphylaxis: Prevention: Why Are Food Allergies on the Rise.” Food Allergy & Anaphylaxis | Prevention | Why Are Food Allergies On the Rise, https://www.foodallergyawareness.org/food-allergy-and-anaphylaxis/prevention/why-are-food-allergies-on-the-rise/.
Gupta, Ruchi S., et al. “Hygiene Factors Associated with Childhood Food Allergy and Asthma.” Allergy and Asthma Proceedings, vol. 37, no. 6, 2016, pp. 140–146., https://doi.org/10.2500/aap.2016.37.3988.
“How the Media Portrays Food Allergies.” Food Allergy Research & Education, https://www.foodallergy.org/resources/how-media-portrays-food-allergies.
Lack, Gideon. “Epidemiologic Risks for Food Allergy.” Journal of Allergy and Clinical Immunology, vol. 121, no. 6, 2008, pp. 1331–1336., https://doi.org/10.1016/j.jaci.2008.04.032.
“Preventing Food Allergies: Early Interventions: Fare.” Food Allergy Research & Education, https://www.foodallergy.org/research-innovation/accelerating-innovation/early-introduction-and-food-allergy-prevention.
Schaefer, Anna. “Food Allergy vs. Sensitivity: What's the Difference?” Healthline, Healthline Media, 4 Oct. 2018, https://www.healthline.com/health/allergies/food-allergy-sensitivity-difference#food-allergies.
Valenta, Rudolf, et al. “Food Allergies: The Basics.” Gastroenterology, vol. 148, no. 6, 2015, https://doi.org/10.1053/j.gastro.2015.02.006.
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