Nut and Peanut Allergy

Tuesday, December 25, 2007

Oh, nuts! They sure can cause you trouble if you're allergic to them — and a growing number of kids are these days. So what kind of nuts are we talking about? Peanuts, for one, though they aren't truly a nut. (They're a legume [say: leh-gyoom] like peas or lentils.) A person could also be allergic to nuts that grow on trees, such as almonds, walnuts, pecans, and cashews.


When you think of allergies, you might picture lots of sneezing and loads of runny noses. But unlike a mild allergy to spring flowers, a nut or peanut allergy can cause difficulty breathing and other very serious health problems. That's why it's very important for someone with a nut or peanut allergy to avoid eating nuts and peanuts, which can be tough because they're in lots of foods.

Why Does the Body Go Nuts Over Nuts?
When someone has a food allergy, his or her body sort of misfires. Instead of treating a nut or peanut like any old food, the body reacts as if the nut or peanut is harmful. In an attempt to protect the body, the immune system produces antibodies (special chemicals designed to fight infections) against that food.

The antibodies then cause mast cells (which are a type of immune system cell in the body) to release chemicals into the bloodstream, one of which is histamine (say: his-tuh-meen). The histamine then causes symptoms in a person's eyes, nose, throat, lungs, skin, or gastrointestinal tract.

A person with nut or peanut allergies could have a mild reaction — or it could be more severe. An allergic reaction could happen right away or a few hours after the person eats it. Some of the first signs that a person may be having an allergic reaction could be a runny nose, an itchy skin rash such as hives, or a tingling in the tongue or lips. Other signs include:

tightness in the throat
hoarse voice
wheezing
cough
nausea
vomiting
stomach pain
diarrhea
In the most serious cases, a nut or peanut allergy can cause anaphylaxis (say: ah-nuh-fuh-lak-sis). This is a sudden, severe allergic reaction in which several problems occur all at once and can involve the skin, breathing, digestion, the heart, and blood vessels. A person's blood pressure can drop, breathing tubes can narrow, and the tongue can swell. People at risk for this kind of a reaction have to be very careful and need a plan for handling emergencies, when they might need to get special medicine to stop these symptoms from getting worse.

How Is a Nut or Peanut Allergy Diagnosed?
If your doctor thinks you might have a nut or peanut allergy, he or she will probably send you to see a doctor who specializes in allergies. The allergy specialist will ask you about past reactions and how long it takes between eating the nut and getting the symptom, such as hives. The allergist also may ask about whether anyone else in your family has allergies or other allergy-related conditions, such as eczema or asthma. Researchers aren't sure why some people have food allergies and others don't, but they often run in families.

The allergist may also want to do a skin test. This is a way of seeing how your body reacts to a very small amount of the nut that is giving you trouble. The allergist will use a liquid extract of the nut that seems to be causing you trouble. (A liquid extract is a liquid version of something that usually isn't liquid.) He or she also may use liquid extracts of other common allergy-causing foods or substances.

The doctor will make a little scratch on your skin (it will be a quick pinch!) and drop a little of the liquid extract on the scratched spot or spots. Different extracts will go on the different scratch spots, so the doctor can see how your skin reacts to each substance. If you get a reddish, raised spot, it shows that you are allergic to that food or substance.

Some doctors may also take a blood sample and send it to a lab. That's where it will be mixed with some of the food or substance you may be allergic to and checked for certain antibodies.

It's important to remember that even though the doctor tests for food allergies by exposing you to a very small amount of the food, you should not try this at home! The best place for an allergy test is at the doctor's office, where they are specially trained and could give you medicine right away if you had a serious reaction.

How Is It Treated?
There is no special medicine for nut or peanut allergies and most people don't outgrow them. The best treatment is simply to avoid the nut. That obviously means not eating that nut, but it also means avoiding the nut when it's mixed in foods. (Sometimes these foods don't even taste nutty! Would you believe chili sometimes contains nuts to help make it thicker?)

Some people who are very sensitive may need to avoid foods just because they are made in the same factory that also makes nut products. And a kid may have to sit at a special table in the school cafeteria because just smelling or touching someone else's peanut-butter sandwich could cause a reaction. But most kids with peanut allergy just need to avoid eating nuts or foods containing nuts.

Have an Emergency Plan
If you have a serious nut or peanut allergy, you and a parent should create a plan for how to handle a reaction, just in case one occurs. That way your teachers, the school nurse, your basketball coach, your friends — everyone will know what a serious reaction (anaphylaxis) looks like and how to respond.

To immediately treat anaphylaxis, doctors recommend that people with a nut or peanut allergy keep a shot of epinephrine (pronounced: eh-puh-neh-frin) with them. This kind of epinephrine injection comes in an easy-to-carry container that looks like a pen. You and your parent can work out whether you carry this or someone at school keeps it on hand for you. You'll also need to identify a person who will give you the shot.

You might want to have antihistamine medication on hand as well, though if anaphylaxis is occurring, this medicine is not a substitute for epinephrine. After receiving an epinephrine shot, you would need to go to the hospital or a medical facility, where they would keep an eye on you and make sure the reaction is under control.

Handling Your Nut or Peanut Allergy
If you find out you have a nut or peanut allergy, don't be shy about it. It's important to tell your friends, family, coaches, and teachers at school. The more people who know, the better off you are because they can help you stay away from the nut that causes you problems. Telling the server in a restaurant is a good idea because he or she can steer you away from dishes that contain nuts. Likewise, a coach or teacher would be able to choose snacks for the group that don't contain nuts.

Here are some to avoid:

peanut butter, peanuts, and peanut oil
mixed nuts, candied peanuts, beer nuts, and peanut brittle
crushed nuts in sauces
Asian foods (for example, satay and pad thai)
pesto (an Italian sauce made with nuts)
marzipan (a paste made from ground almonds and sugar)
health food bars, energy bars, and sports bars
all cakes and pastries with unknown ingredients, particularly carrot cake, pumpkin cake or pie, and fruit and nut rolls
bouillon and Worcestershire sauce
praline and nougat
muesli and fruited breakfast cereals
vegetarian casseroles prepared with nuts and some veggie burgers or soy burgers
prepared salads and salad dressings
gravy mixes
candy with nuts (M&Ms, Snickers, Hershey bars with nuts, Hershey almond kisses, salted nut rolls, and others)
It's great to have people, like your parents, who can help you avoid nuts, but you'll also want to start learning how to avoid them on your own.

It will help you when reading food labels because there are some ingredients that contain nuts, but have names that sound nothing like nuts — hydrolyzed vegetable protein, for instance. The good news is that many food companies are starting to note on their labels when the product could contain even a trace of peanuts or other nuts.

Here are some other tips that might make life a little easier when you have an allergy to peanuts or nuts:

If you're staying at a friend's house, bring some of your own "safe" food.
Make your own lunches. Try veggie wraps, meat sandwiches, or fruit and cream cheese sandwiches.
Use — and encourage others to use — an antiseptic hand-wash after meals.
Avoid fried foods (especially in restaurants and fast-food places) that may be made with peanut oil.
Consult with a dietitian to come up with safe but delicious meals and snacks.
Carry a list of foods to watch out for in your backpack or bag.
Put some safe foods in your backpack for a quick snack that does not need to be checked.
Become an avid label reader. Check the ingredient list and any processing description such as "this product was manufactured alongside a product that contains peanuts."
Use the manufacturer's toll-free phone number if you have questions about the ingredients contained in your favorite foods.
Having a nut allergy can be a little frustrating, but it doesn't need to keep you from the activities you like to do. In time, you'll probably get very good at avoiding your problem nut. As long as your "problem nut" isn't your brother or sister!

Food Allergies

Sunday, December 23, 2007

"Hey, do you want some?" your friend asks as he offers you a mouthwatering homemade brownie. You're tempted by the delicious dessert, but then you see the crushed peanuts on top. Darn! You're allergic to peanuts. Maybe just one little bite?

Nope. If you have a food allergy, even a very tiny bit of that food can make you sick. It's better to say no thanks to the brownie and have a nut-free dessert. Lots of kids have food allergies - 2 million in the United States alone.

These foods cause the most food allergies:

peanuts and other nuts
seafood, such as shrimp
milk, particularly cow's milk
eggs
soy
wheat
What Is a Food Allergy?
Food allergies occur when your immune system makes a mistake. Normally, your immune (say: ih-myoon) system protects you from germs and disease. It does this by making antibodies that help you fight off bacteria, viruses, and other tiny organisms that can make you sick. But if you have a food allergy, your immune system mistakenly treats something in a certain food as if it's really dangerous to you.

The same sort of thing happens with any allergy, whether it's a medicine (like penicillin), pollen in the air (from flowers and trees), or a food, like peanuts. So the thing itself isn't harmful, but the way your body reacts to it is.

If a kid with peanut allergy would have eaten that peanut-topped brownie, here's what would happen. Antibodies to something in the food would cause mast cells (a type of immune system cell in the body) to release chemicals into the bloodstream. One of these chemicals is histamine (say: his-tuh-meen).

What's a Reaction Like?
The histamine then causes symptoms that affect a person's eyes, nose, throat, respiratory system, skin, and digestive system. A person with a food allergy could have a mild reaction - or it could be more severe. An allergic reaction could happen right away or a few hours after the person eats it. Some of the first signs that a person may be having an allergic reaction could be a runny nose, an itchy skin rash such as hives, or a tingling in the tongue or lips. Other signs include:

tightness in the throat
hoarse voice
wheezing
cough
nausea
vomiting
stomach pain
diarrhea
In the most serious cases, a food allergy can cause anaphylaxis (say: ah-nuh-fuh-lak-sis). This is a sudden, severe allergic reaction in which several problems occur all at once and can involve the skin, breathing, digestion, the heart, and blood vessels. A person's blood pressure can drop, breathing tubes can narrow, and the tongue can swell.

People at risk for this kind of a reaction have to be very careful and need a plan for handling emergencies, when they might need to get special medicine to stop these symptoms from getting worse.

Many kids outgrow allergies to milk and eggs as they grow older. But severe allergies to foods like peanuts, certain kinds of fish, and shrimp often last a lifetime.

How Do You Know if You Have One?
Sometimes it's easy to figure out that a kid has a food allergy. He or she might get hives or have other problems after eating it. But other times, it's more of a mystery what's causing the problem. Most foods have more than one ingredient, so if a kid has shrimp with peanut sauce, what's causing the allergy - the peanut sauce or the shrimp?

Doctors believe that allergies could be hereditary, which means if your parent or other close relative has certain allergies like hay fever, you're more likely to develop the allergies. Some kids are born allergic to certain foods, whereas others develop food allergies over time. This may be due to someone's surroundings or changes in the body as they grow older.

Many people react to a certain food but are not actually allergic. For example, people with lactose intolerance (say: lak-tose in-tah-luh-runtz) get belly pain and diarrhea from milk and other dairy products. That doesn't mean they're allergic to milk. They don't feel good after drinking milk because their bodies can't properly break down the sugars found in milk.

What Will the Doctor Do?
If you think you may be allergic to a certain food, let your parents know. They will take you to the doctor to get it checked out.

If your doctor thinks you might have a food allergy, he or she will probably send you to see a doctor who specializes in allergies. The allergy specialist will ask you about past reactions and how long it takes between eating the food and getting the symptom, such as hives. The allergist also may ask about whether anyone else in your family has allergies or other allergy-related conditions, such as eczema or asthma.

The allergist may also want to do a skin test. This is a way of seeing how your body reacts to a very small amount of the food that is giving you trouble. The allergist will use a liquid extract of the food and, possibly, other common allergy-causing foods to see if you react to any of them. (A liquid extract is a liquid version of something that usually isn't liquid.)

The doctor will make a little scratch on your skin (it will be a quick pinch!) and drop a little of the liquid extract on the scratched spot or spots. Different extracts will go on the different scratch spots, so the doctor can see how your skin reacts to each substance. If you get a reddish, raised spot, it shows that you are allergic to that food or substance.

Some doctors may also take a blood sample and send it to a lab. That's where it will be mixed with some of the food or substance you may be allergic to and checked for certain antibodies.

It's important to remember that even though the doctor tests for food allergies by exposing you to a very small amount of the food, you should not try this at home! The best place for an allergy test is at the doctor's office, where they are specially trained and could give you medicine right away if you had a serious reaction.

How Are Food Allergies Treated?
There is no special medicine for food allergies. Some can be outgrown, and others a kid will have his or her whole life. The best treatment is simply to avoid the food itself and any foods or drinks that contain the food.

One way to figure that out is to read food labels. Any foods that might cause an allergic reaction will be listed near or in the ingredient list. Doctors and allergy organizations also can help by providing lists of safe foods and unsafe foods. Some people who are very sensitive may need to avoid foods just because they are made in the same factory that also makes their problem food. You may have seen some candy wrappers that say the candy was made in a factory that processes nuts, too.

Have a Plan
No matter how hard you try, you may eat the wrong thing by accident. Stay calm and follow your emergency plan. What's an emergency plan? Before a slipup happens, it's a good idea to create a plan with your doctor and parents. The plan should spell out what to do, who to tell, and which medicines to take, if you have a reaction.

This is especially important if you have a food allergy that can cause a serious reaction (anaphylaxis). For serious reactions, people may need a shot of epinephrine (say: eh-pih-neh-frin) with them. This kind of epinephrine injection comes in an easy-to-carry container that looks like a pen. You and your parent can work out whether you carry this or someone at school keeps it on hand for you. You'll also need to identify a person who will give you the shot.

You might want to have antihistamine medication on hand as well, though if anaphylaxis is occurring, this medicine is not a substitute for epinephrine. After receiving an epinephrine shot, you would need to go to the hospital or a medical facility, where they would keep an eye on you and make sure the reaction is under control.

Living With Food Allergies
Having a food allergy is a drag, but it doesn't need to slow a kid down. If you have nut, milk, or egg allergies, we've created cut-and-carry cards that can help you spot problem ingredients in foods. Your mom, dad, and other adults also can help you steer clear of reactions.

But what if something you really like turns out to be on your "do not eat" list? Today, so many people have food allergies that companies have created lots of good substitutes for favorite foods - everything from dairy-free mashed potatoes to wheat-free chocolate chunk cookies!

Egg Allergy

Eggs are everywhere. Not only are they served for breakfast, but they're also in all sorts of foods - from muffins to meatloaf. But what if you were allergic to eggs?

Babies sometimes will have an allergic reaction to eggs. If that happens, they can't eat eggs for a while. But the good news is that most kids outgrow this allergy by age 5 and can eat eggs with no problem after that.


What Is an Egg Allergy?
You probably know that some people are allergic to certain foods, like peanuts or shrimp. When a person has a food allergy, his or her body responds as if the food is a dangerous substance. This can happen to a little kid who eats eggs because his or her immune system isn't fully developed and can't handle the protein in eggs. (Most children are allergic to the protein that's in the egg whites, but some react to the protein in the yolk.)

The immune system, which normally protects against germs and other problems, uses antibodies to fight the egg protein like it's a harmful invader. A baby who is allergic to eggs might feel sick or get a rash after eating eggs or any food containing eggs. The reaction could happen fast or it might take a few hours.

Signs and Symptoms
Here are some symptoms a person might experience due to an egg allergy:

skin: hives, eczema, flushing, or swelling
digestive system: belly pain, diarrhea, nausea, vomiting, or itching around the mouth
respiratory system: runny nose, wheezing, or difficulty breathing
cardiovascular system: rapid heartbeat, low blood pressure, or heart problems
In rare cases, a person could have a very serious allergic reaction, which can cause anaphylaxis (say: ah-nuh-fih-lak-sis). Immediate medical attention is needed because the person may have breathing problems and a drop in blood pressure.

Anaphylaxis is treated with a medicine called epinephrine (say: eh-puh-neh-frun), which is given by injection (a shot). Kids who have a severe egg allergy will usually carry - or have a grown-up carry - an epinephrine injection, just in case.

Do Allergies Cause Asthma?

People who have certain kinds of allergies are more likely to have asthma. Do you have allergies that affect your nose and eyes, causing stuff like a runny nose or red, itchy eyes? If so, you're more likely to have asthma, too. Whatever causes the allergic reaction, such as pollen or dust, can also trigger asthma symptoms.


But not everyone who has allergies gets asthma, and not all asthma happens because of allergies. Huh? Allergies and asthma can be a little confusing, so let's find out more.

About 9 million kids in the United States have been diagnosed with asthma. Of these, about three out of four have asthma symptoms that are triggered by an allergy to something (called an allergen). In these people, the symptoms of asthma like wheezing, coughing, or trouble breathing are often brought on by being around allergens.

Allergies have a lot to do with your immune (say: ih-myoon) system. Most of the time your immune system fights germs and bacteria to help you stay healthy. But in a kid with allergies, the immune system treats allergens (such as pollen) as if they're invading the body, like a bad germ.

When the immune system reacts to an invading allergen, the body releases substances that cause allergy symptoms, such as a runny nose or red, itchy eyes. Some kids can also get asthma symptoms, like coughing, wheezing, or a tight feeling in the chest.

If you have asthma, it is a good idea to find out whether allergies may be causing your asthma symptoms. To figure out what they're allergic to, sometimes kids will visit a special doctor called an allergist (say: ah-lur-jist).

If the allergist finds out that you are allergic to certain things, the best way to prevent allergic reactions (and to help stop asthma symptoms from bugging you) is to avoid being around the allergens. The doctor may also prescribe medicine for your allergies, if you can't completely avoid what's causing them.

Celiac Disease

Have you ever eaten gluten? No, not glue - gluten! If you've ever eaten a piece of bread, a slice of pizza, or a bowl of cereal, chances are you have. Gluten (say: gloo-tin) is a protein found in wheat, rye, and barley - grains that are in many everyday foods.

Most people can eat food containing gluten with no trouble. But for some people, eating gluten can cause a reaction in their bodies. Someone who has this problem has celiac (say: see-lee-ak) disease.

After you eat food, it goes to your stomach, which is part of a group of organs that make up your digestive system. An important part of the digestive system is the small intestine, which is lined with villi (say: vih-lie). Villi are usually described as microscopic, finger-like projections. Weird, huh? Fingers in your intestines! But don't forget that they're microscopic, meaning they are extremely small - so small you can't see them without a microscope. The villi are important because they absorb nutrients into the body.

For someone with celiac disease, eating gluten - in a piece of bread, for instance - causes an immune system reaction. Your immune system ordinarily keeps you from getting sick, but in someone with celiac disease, the body starts damaging and destroying the villi. Without villi, a person's body can't absorb vitamins and nutrients from food. Without enough nutrients, a kid's body has a tough time staying healthy and growing properly. Even if the person is eating a lot, he or she might still lose weight and might develop anemia (say: uh-nee-me-uh) from not absorbing enough iron.

Why Do Kids Get Celiac Disease?
No one is sure why celiac disease happens, but it appears to run in families. You have a 5-10% chance of getting celiac disease if someone in your family has it. It's common in people from the northern European countries and the United States. How common? We think that about one in every 133 people has celiac disease in the United States. Obviously, many people who have celiac disease do not know it. If all these people were diagnosed, celiac disease would be more common than Type 1 diabetes. Fortunately, awareness is growing about the problem, and there are better ways of testing people for it.

Signs and Symptoms
Some common symptoms of celiac disease are diarrhea, decreased appetite, stomachache and bloating, poor growth, and weight loss. Many kids are diagnosed with the problem between 6 months and 2 years of age. It makes sense because, at this time, kids are getting their first taste of gluten in foods. For some people, the problems occur gradually and the symptoms may be terrible one week and not as bad the next. Because of this, some people aren't diagnosed with the celiac disease until they are older. The problem is chronic, which means that the symptoms may go away and come back over and over again.

A person with celiac disease may feel tired, and he or she could be irritable. Some people with the disease also have skin rashes and mouth sores. The problem is sometimes mistaken for other digestive problems called inflammatory bowel disease or lactose intolerance. And in some cases, a kid won't have any symptoms and then will all of a sudden start having problems during a time of stress, such as after an injury.

How Do People Know If They Have It?
Someone who has a lot of stomachaches, diarrhea, weight loss, or any of the other symptoms mentioned above should talk to the doctor. It may or may not be celiac disease, but a doctor can help sort this out. The doctor will usually order a screening blood test.

If the screening tests show a person might have celiac disease, the next stop is usually a gastroenterologist, a doctor who specializes in digestive problems. This specialist may decide to take a sample of the person's small intestine to look at under the microscope. This small sample is called a biopsy. If a biopsy is done, the doctor will give the person some special medicine to keep him or her comfortable during the procedure.

How Is It Treated?
Celiac disease is treated by not eating gluten. This can be difficult because gluten is in many foods, but a dietitian can help adjust a person's diet to cut out gluten. It is important not to start a gluten-free diet unless you are truly diagnosed with celiac disease. Following a gluten-free diet allows the small intestine to heal. But that doesn't mean the person can start eating gluten again. For someone with celiac disease, gluten will always irritate their intestines and, if this happens, the diarrhea, stomachaches, and other problems will return.

If you're diagnosed with celiac disease, it can be a challenge to learn which foods contain gluten. You may not be able to remember them all, but you can keep a list with you, and ask about menu items at restaurants before digging in. Before you know it, you'll be a pro at knowing which foods are safe and which are not. Here's a quick quiz:

Which of these foods contain gluten?

pizza
fried chicken
pasta
If you said all three, you're right! Pizza was the easiest choice because you know the crust is bread. But did you know that battered foods like fried chicken and even some French fries contain gluten? Pasta also contains gluten because it is made from wheat. Luckily, you can make or buy gluten-free pizza crust, make fried chicken with a gluten-free batter, and find gluten-free pasta and French fries. In fact, nearly all of the foods we eat can be made gluten-free.

In addition to foods that contain gluten, you'll need to watch out for foods that may have been contaminated with gluten. That means a food that doesn't contain gluten as an ingredient, but came into contact with gluten-containing foods. This is most likely to occur at home in your own kitchen. For instance, wheat bread crumbs in the toaster, the butter, or peanut butter.

If you have celiac disease you will need your own toaster and you should also have separate spreads and condiments to avoid this cross-contamination. Some foods are contaminated during processing, so your mom or dad can help you by finding foods that are certified as gluten-free. For instance, gluten-free oats are now available for people with celiac disease.

The best approach is to read labels, but here are a few foods to steer clear of until you can verify that they are gluten-free:

packaged rice mixes
lunch meats
sausages
instant cocoa
canned soups
A diagnosis of celiac disease does not mean giving up all your favorite foods. It just means adapting them to be gluten-free. There are many different gluten-free products, baking mixes and recipes available to help. A support group is a great resource for finding out which recipes and products are best.

A support group can help keep you up to date as well. For instance, a few years ago it was recommended that distilled vinegar be completely avoided on a gluten-free diet. Now we know that the gluten molecules do not appear in the distillate. Huh? What it means is that distilled vinegar is now an OK ingredient. That made a big change in the allowed foods someone with celiac disease could eat.

If you're part of a support group, you hear of these kinds of changes right away. A support group is also a great place to get to know other kids who have celiac disease and to learn that you're not alone.