Nothing To Sneeze At: Dealing with Food Allergies

Maybe you’ve never ended up in the hospital, short of breath and covered with hives; even so, you could have a food allergy or sensitivity. More subtle manifestations of food allergies can be nearly as devastating as full-blown attacks. Worse, food allergies may have complex mental and emotional components, in addition to physical manifestations.

The most common signs of a true allergic response to food are coughing, difficulty breathing, rashes, hives, itchy and watery eyes, runny nose, congestion, diarrhea, vomiting and rapid heart rate; a sensitivity to food can manifest in more subtle ways, including headache, bloating or gastrointestinal problems, and may appear as chronic symptoms, like aching joints, eczema, mood swings or fatigue. Because symptoms are so broad, and can be caused by other illnesses, allergies and intolerances are hard to diagnose. Further complicating diagnosis is the fact that pretty much any food can be allergenic. There are some more common offenders, such as wheat, milk, eggs, corn and soy, but no food is exempt from scrutiny.

The causes of allergies are many and varied. It's thought that dietary habits in the first year of life will influence allergy potential more than any other factor--another argument for breast feeding for as long as possible. In adults, poor digestion is an underlying cause of food allergies and intolerances. Incompletely digested protein molecules can enter the bloodstream, where the body mistakes them for harmful proteins like viruses. Other components:

• Food additives including antibiotics, food colors, sulfites, MSG and sodium benzoate can stimulate allergic responses and decrease immunity.

• Stress plays a major role in allergies by upsetting digestion, suppressing immunity and weakening adrenal response.

• Hormonal changes, even those associated with monthly periods, appear to increase allergic reactions.

• Eating processed, refined foods can cause or aggravate allergies by increasing stress, lowering immunity, and causing nutritional deficiencies.

• A restricted diet can cause food allergies. If the same foods are eaten day after day, the body is likely to develop sensitivity to those foods.

• Nutritional deficiencies, caused by eating a restricted or processed diet, can contribute to food allergies.

Allergies, intolerances and sensitivities: what’s the difference?

A true food allergy is an autoimmune response that includes a sudden and severe reaction to a certain food and may be life-threatening. A food intolerance, on the other hand, is an abnormal physical response to food. Lactose intolerance is a perfect example. People who lack the enzyme to break down lactose can probably tolerate lactose-free milk and can usually eat dairy infrequently and in small amounts. People who are truly allergic to milk will have a reaction to milk proteins, not sugars. A food sensitivity is a little different--the reactions are usually delayed and often chronic, symptoms may appear several hours or even a day later, and they're mediated by a different biochemical response in the body.

Allergic reactions can range from irritating to life-threatening. Certain foods are more likely to provoke reactions. Headaches, for example, are more commonly associated with wheat and chocolate, while wheat and eggs are more likely to trigger asthma. Other examples:

• Hives: shellfish, nuts, citrus fruits, tomatoes, strawberries, eggs, chocolate, beef, pork, mangoes, sulfites, food colorings.

• Eczema (dermatitis): eggs, citrus, tomatoes.

• Migraines: cheese, chocolate, nuts, wheat, citrus, tomatoes, eggs, milk, MSG, nitrates, alcoholic beverages.

• Hay fever: milk, wheat, nuts, chocolate, food colorings, sulfites.

There are a several of ways to test for food allergies. Some clinical tests for food allergies, such as the ELISA-ACT, can also reveal sensitivities to food additives and environmental toxins. Some clinical evaluations use sublingual drops or capsules of foods to test for allergens, but the procedure is subjective and time consuming. Probably the most practical test is the elimination diet, which avoids those foods that are known to be reactive, suspect, or regularly consumed.

With the elimination diet, one focuses on foods that are unlikely to provoke an allergy or sensitivity, while cutting out any potentially allergenic food for two to three weeks to clear the body of allergens. (A brief juice fast can clear the body even faster-- check with your health care professional before beginning any fast.) After two to three weeks on the elimination diet, suspect foods are reintroduced one at a time, with a four-day pause after each new addition. If the body responds with an allergic reaction, add it to your list of confirmed suspects. It’s best to use only whole, unprocessed, organic foods on the elimination diet, since reactions to additive, preservatives and chemicals are possible. The foods included on the elimination diet are:

• All fruits, except citrus and tomatoes

• All vegetables, except corn

• Rice

• Turkey

• White fish (no salmon or shellfish)

• Almonds, walnuts or sunflower seeds

The elimination diet gives the body a chance to recover and allows the immune system to rebuild. After you’ve isolated and removed foods to which you’re allergic or sensitive, a rotation diet can be a lifelong eating plan. With the rotation diet, you’ll eat a wide variety of whole, unprocessed foods, rotating the days when different foods and food families are consumed. Because a variety of foods are incorporated, the body is less likely to become allergic to any one food. And because foods are rotated, the body has four to seven days to recover from a potentially allergenic food. Some foods have to be completely avoided, but most foods can be tolerated if they're eaten infrequently or periodically.

Staying satisfied with allergy-free alternatives.

Food allergies don't mean you have to go hungry--there are tasty alternatives to traditionally allergenic foods. Some to try:

Milk. Up to 25 percent of Americans are lactose intolerant, meaning they lack the necessary enzyme to digest lactose, or milk sugar. Milk, cheese and other dairy substitutes made from soy, rice, oats, grains or nuts are good alternatives to milk products for lactose intolerance. One note: because some dairy-free cheeses contain casein (milk protein), they're not appropriate for people with true milk allergies; check labels, and stick to casein-free products.

Wheat. The staff of life is one of the most common food allergens, and it's pretty sneaky stuff, turning up in everything from salad dressing to soy sauce. People who are allergic to wheat but not gluten are able to eat wheat-free grain products like rye, oats and barley that contain some gluten. People with gluten sensitivities have fewer options and must avoid wheat as well as any grain that contains gluten (see sidebar).

Corn. Corn is so commonly refined and used in processed foods as a sweetener and thickening agent that it has become a common allergen. It may be disguised in foods as cornstarch, fructose, dextrose and caramel coloring. Check labels on any foods you buy.

Peanut butter. Many people with peanut allergies can tolerate tree nuts like almonds and walnuts, and most seeds. Almond butter, tahini and other nut and seed butters can usually replace peanut butter. If you have a severe peanut allergy, check with your health professional first.

Chocolate. Carob, ground from the pod of a leguminous evergreen tree that grows in the Mediterranean area, is the only reliable substitute for chocolate. (Chocolate purists might argue that complete abstinence is a better alternative.) [SIDEBAR]

Against The Grain: Gluten Intolerance Maybe wheat is the staff of life, but for people with wheat allergies, gluten intolerance and celiac disease, it’s nothing but trouble. The culprit: gluten, a combination of complex proteins found in wheat, kamut, spelt, barley, rye, oats and triticale.

Normally, gluten is digested without an issue. But in people with true gluten intolerance or celiac disease, the body perceives responds to gluten with a full-blown immune response. Immediate symptoms include bloating, diarrhea, abdominal swelling and pain. Longer-term symptoms include gastrointestinal disturbances, skin disorders, weight loss, anemia, muscle pain, fatigue and behavior changes.

The only treatment is strict adherence to a completely gluten-free diet, avoiding wheat, rye, barley, and anything that contains gluten—a tricky proposition, since many processed foods including canned soups, salad dressings, processed cheese, even ice cream, may contain wheat-based thickeners, fillers and stabilizers. Some gluten-free grains are also suspect, since they may be milled in a plant that also processes wheat, and thus contaminated.

If you're avoiding gluten because of gluten intolerance or celiac disease, there are many alternatives to wheat. Gluten-free starch substitutes include rice, amaranth, quinoa, teff, corn and millet; you’ll also find lots of gluten-free products in natural food stores and many larger mainstream groceries, including pasta, cakes, cookies, crackers, and chips.