Food sensitivity and intolerance may be mistaken for allergic reaction in children
Staff Writer |
Many people misunderstand what food allergies are, and even doctors can be confused about how to best diagnose them, suggests a new report from the American Academy of Pediatrics.
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It's common for people to think they have a food allergy, but the reality may be different, said Dr. Scott Sicherer, the lead author of the AAP report.
"If you ask someone on the street if they have a food allergy, there's a good chance they'll say 'yes,'" said Sicherer, who heads pediatric allergy and immunology at Mount Sinai Hospital in New York City.
"But a true food allergy involves an immune system reaction against a particular food, he explained.
"Just because you think a food upsets you, that doesn't mean it's an allergy, Sicherer said.
And it's critical to distinguish an allergy from other "adverse reactions" to food, he stressed.
"Some people may have an intolerance, such as lactose intolerance," Sicherer said. "Sometimes it's a reaction due to food poisoning. Some people may just have a hard time eating a big meal."
Food allergy symptoms range from mild (hives and stomach cramps, for instance) to a life-threatening reaction called anaphylaxis -- which can impair breathing and send the body into shock.
People with true allergy need to avoid the problem food, and possibly carry an auto-injector of epinephrine (EpiPen) in case they suffer a severe reaction.
That's a burden, and an expense, Sicherer pointed out. So having an accurate diagnosis is key.
However, even some doctors don't know how to best diagnose food allergies, according to the AAP report. In one study of primary care doctors, 38 percent mistakenly said that skin-prick tests or blood tests are enough to definitively diagnose a food allergy.
The problem is that people can test "positive" for certain allergy triggers on those tests, Sicherer said, but not really have symptoms when exposed to the substances.
The "gold standard" test is a food challenge, which is done by an allergy specialist. There, a patient ingests small amounts of a suspect food over a period of time to see if an allergic reaction occurs.
But, Sicherer said, a food challenge is not always needed: Context matters.
If a child (or adult) has a history of symptoms that clearly point to a culprit food -- and a skin or blood test is positive for that allergen -- then that's enough for a diagnosis, Sicherer noted.
Besides the need for better diagnosis, the report calls for more education on prevention.
At one time, allergy experts believed that young children could be protected from food allergies by delaying the introduction of peanuts, eggs and dairy into the diet. ■