Food allergies are a growing concern and affect millions of people worldwide. They occur when the body’s immune system, normally tasked with fighting off infection, mistakenly identifies certain proteins in food as harmful. This triggers an abnormal immune response, leading to a range of allergic reactions. 

These reactions can be mild, causing discomfort, or severe, leading to a life-threatening condition called anaphylaxis. In India, more than 25% of adults and around 20% of children have food sensitivities. Food allergies can develop at any age. 

Identifying food allergies and effectively managing them is crucial for a person’s well-being and can be done with the help of an allergy test package. 

Basics of Food Allergies 

Food allergies involve a complex interplay between the immune system and certain proteins found in food. In the case of food allergies, the immune system mistakenly identifies certain proteins in food as a threat. This triggers an allergic reaction in the body and chemicals like histamine are released, which leads to the symptoms we associate with allergies. 

The incidence of food allergies is on the rise globally. One possible reason behind this increase is the reduced exposure to germs and infections in early life, leading to the immune system becoming overly sensitive. 

Food allergies can significantly impact a person’s quality of life as constant vigilance is required to avoid trigger foods and the fear of accidental exposure and the potential for severe reactions can cause anxiety. 

Food Allergies vs. Food Intolerances 

Food intolerance is more of a digestive issue rather than an immune system issue as in the case of food allergies. In individuals with food intolerance, the body may lack the necessary enzymes to break down certain food components, leading to discomfort and symptoms like gas, bloating, or diarrhoea. 

Recognising the difference between the two is crucial for proper diagnosis and appropriate management. 

Symptoms of Food Allergies 

Food allergy symptoms range from mild and manageable to severe and life-threatening. Here’s a breakdown of some common symptoms: 

• Hives (itchy, raised welts) 
• Redness 

• Eczema (inflamed, itchy skin) 
• Tingling or itching in the mouth and throat 
• Metallic taste in the mouth 
• Nausea 
• Vomiting 
• Abdominal cramps 
• Diarrhoea 
• Difficulty breathing 
• Wheezing 
• Coughing 
• Hoarseness 
• Angioedema (swelling of the face, lips, tongue, throat) 
• Anaphylaxis: This is a life-threatening reaction characterised by a combination of symptoms, including difficulty breathing, dizziness, rapid pulse, and potentially loss of consciousness. 

Early recognition of food allergy symptoms is critical. 

Types of Food Allergies 

Food allergies, although triggered by the immune system, have two distinct forms: Immunoglobulin E (IgE)-mediated and non-IgE-mediated allergies. 

The IgE Response: A Speedy Onslaught 

IgE-mediated allergies are the most common type of allergies, responsible for around 90% of all food allergies. They involve a rapid and dramatic immune system response. Here’s how it unfolds: 

• Upon initial exposure to a particular food protein, the immune system identifies it as a threat and produces specific IgE antibodies against it. 
• When the individual encounters the food again, the IgE antibodies recognise the protein and trigger an immune response against it by releasing a cascade of chemicals, including histamine, into the bloodstream, which leads to symptoms that we recognise as allergic reaction. 

The Non-IgE Response: A Slower, More Subtle Attack 

Non-IgE-mediated allergies involve a different immune system pathway and often present a more complex picture. In non-IgE allergies, different immune system cells, such as T cells, are involved in the reaction. The exact mechanisms are still being unravelled, but these reactions typically do not involve histamine release.  

Table 1: IgE-mediated vs Non-IgE–mediated Allergic Reactions 

	IgE-mediated Allergic Reactions	Non- IgE-mediated Allergic Reactions
Time to appearance of symptoms	Minutes to 2 hours	Hours to days
Typical triggers	Milk Eggs Peanuts Tree nuts (almonds, walnuts, cashews, etc.) Shellfish (shrimp, crab, lobster) Fish Soy Wheat Sesame (recently recognised as the 9th major food allergen)	Milk (protein intolerance) Soy (protein intolerance) Gluten (in celiac disease) Fruits and vegetables (oral allergy syndrome)
Severity	More severe (anaphylaxis)	Less severe
Commonly seen in	Children	Adults

The Eight Most Common Food Allergies 

Food allergies can be triggered by a wide range of foods, but the following eight culprits stand out as the most common allergens, affecting millions worldwide.  

1. Cow’s Milk Allergy: 

• Prevalence: Affects about 6% of infants and toddlers, but most outgrow it by 3 years of age. 
• Age of Onset: Typically, in infancy or early childhood. 
• Symptoms: Can range from mild (hives and eczema) to severe (anaphylaxis). Gastrointestinal issues like vomiting and diarrhoea are also common. 
• Diagnosis: Blood test, skin prick test, and elimination diet. 
• Treatment: Strict avoidance of cow’s milk and milk products. Alternatives like soy, almond, or rice milk can be explored. 
• Complications: Growth problems, and nutritional deficiencies if not managed properly. 

2. Egg Allergy: 

• Prevalence: Affects about 1-2% of children and adults. 
• Age of Onset: This can occur at any age but is more common in children. 
• Symptoms: Similar to milk allergy, ranging from mild skin reaction to anaphylaxis. 
• Diagnosis: Blood test, skin prick test, and elimination diet. 
• Treatment: Strict avoidance of eggs and egg products. Careful reading of food labels is crucial. 
• Complications: Anaphylaxis is a possibility, and accidental exposure can be serious. 

3. Tree Nut Allergy: 

• Prevalence: Affects about 1% of children and adults. 
• Age of Onset: Typically in childhood, but can develop at any age. 
• Symptoms: Can range from mild (mouth tingling, hives) to severe (anaphylaxis). 
• Diagnosis: Skin prick test and blood test. 
• Treatment: Strict avoidance of all tree nuts the individual is allergic to (e.g., almonds, walnuts, and cashews). 
• Complications: Accidental exposure can be serious, and some individuals may experience severe reactions even from inhaling nut dust. 

4. Peanut Allergy: 

• Prevalence: One of the most common food allergies, affecting about 1% of children and adults. 
• Age of Onset: Typically in childhood and often lifelong. 
• Symptoms: Similar to tree nut allergy, ranging from mild to severe. 
• Diagnosis: Skin prick test and blood test. 
• Treatment: Strict avoidance of peanuts and peanut products. Many individuals with peanut allergies carry epinephrine auto-injectors for emergency use. 
• Complications: Peanut allergy carries a high risk of anaphylaxis, and even small amounts can trigger a severe reaction. 

5. Shellfish Allergy: 

• Prevalence: Affects about 2% of all adults in the US. 
• Age of Onset: This can occur at any age. 
• Symptoms: Similar to other allergies, ranging from mild to severe. 

• Diagnosis: Skin prick test and blood test. 
• Treatment: Strict avoidance of all shellfish (shrimp, crab, lobster, etc.). 
• Complications: Shellfish allergies are lifelong, and accidental exposure can be serious. 

6. Fish Allergy: 

• Prevalence: Affects about 2% of all adults in the US. 
• Age of Onset: This can occur at any age. 
• Symptoms: Similar to other allergies, ranging from mild to severe. 
• Diagnosis: Skin prick test and blood test. 
• Treatment: Strict avoidance of all fish or specific types of fish the individual is allergic to. 
• Complications: Fish allergies are lifelong, and accidental exposure can be serious. 

7. Soy Allergy: 

• Prevalence: More common in infants and young children, but most outgrow it by age 3 years. It can also occur in adults. 
• Age of Onset: Typically, during infancy or early childhood. 
• Symptoms: Similar to other allergies, ranging from mild to severe. 
• Diagnosis: Blood test, skin prick test, and elimination diet. 
• Treatment: Strict avoidance of soy and soy products. Careful reading of food labels is essential. 
• Complications: Growth problems and nutritional deficiencies if not managed properly. 

8. Wheat Allergy: 

• Prevalence: Affects about 1% of children and adults. Celiac disease, gluten intolerance with a different immune response, is more common. 
• Age of Onset: This can occur at any age. 
• Symptoms: Similar to other allergies, ranging from mild to severe. 
• Diagnosis: Blood test, skin prick test, and elimination diet. 
• Treatment: Avoiding wheat and products containing wheat. 
• Complications: Growth problems, and nutritional deficiencies if not managed properly. 

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Other Common Food Allergies 

Let’s explore some other food allergies that can significantly impact individuals. 

Fruits and Vegetables: 

• Oral Allergy Syndrome (OAS): This is a reaction to certain fruits, vegetables, or tree nuts that are structurally like pollen. Symptoms like itching, tingling, and swelling in the mouth and throat typically occur within minutes of ingestion and are usually mild. Examples of triggers include: 

• Fruits: Apples, peaches, cherries, and kiwi 
• Vegetables: Celery, carrots, and birch pollen 

Seeds: 

• Sesame Allergy: Recently classified as the ninth major food allergen, sesame allergy is becoming more recognised. Symptoms can range from mild to severe and resemble other food allergies. 
• Other Seed Allergies: Allergies to other seeds like poppy seeds, sunflower seeds, and chia seeds are less common but can still occur. 

Spices: 

• Spice Allergies: While less frequent than other food allergies, some individuals may experience reactions to spices like cinnamon, mustard, or monosodium glutamate (MSG). Symptoms can include skin reactions, nasal congestion, or headaches. 

Diagnosis of Food Allergies 

Food allergies can significantly impact your life, but fortunately, certain diagnostic tools can help you pinpoint the specific trigger. While many food allergy packages are available in laboratories, a healthcare professional will choose the most appropriate tests based on your situation. Here’s a breakdown of some common diagnostic methods: 

1. Dietary Review: 

This initial step involves discussing your medical history and symptoms with a doctor or allergist. They will ask detailed questions about your reactions, including the suspected food triggers, timing, and severity of symptoms. 

2. Skin Prick Testing: 

This is a quick and relatively painless test often used to screen for allergies to common food allergens. 

3. Oral Food Challenges: 

This test involves consuming gradually increasing amounts of the suspected trigger food under medical supervision. It’s the most accurate way to confirm a food allergy. 

4. Blood Tests: 

Blood tests can measure the level of specific antibodies (IgE) against various food allergens. 

It is not recommended for you to self-diagnose your food allergies. Instead, you should consult a healthcare professional who can: 

• Recommend appropriate management strategies based on the severity of your allergy. 

• Discuss the risk of anaphylaxis and the importance of carrying an epinephrine auto-injector (if prescribed). 
• Guide you in navigating social situations and reading food labels effectively. 
• Refer you to an allergist for more specialised care if needed. 

A proper diagnosis is crucial for developing a personalised plan to manage your food allergies and live a healthy life. 

Conclusion 

Food allergies can be a complex and disruptive issue, but with knowledge and proper management, you can take control of your health.  

• Food allergies occur when the immune system mistakenly identifies proteins in food as harmful, triggering a range of reactions. 
• Symptoms can range from mild to severe. 
• Diagnosis involves a combination of medical history, skin prick tests, blood tests, and potentially, an elimination diet. 
• Effective management requires avoiding trigger foods, careful label reading, and open communication with others. 

By understanding food allergies and taking proactive steps to manage them, you can live a full and healthy life.