“A peanut was like a weapon, like you have a gun to your head and you could have the trigger pulled any time”, high school student, Carter Grodi, said when describing his fear associated to his peanut allergy. (1)
The cause of adverse food reactions (see definition below) is not fully understood, and research is just beginning to uncover some of the underlying reasons for the occurrences such as illness, genetic, infancy nutrition, pregnancy nutrition and more. For some, treatment and management of any adverse food reaction can be easy, but often times, it can be a stressful, tedious, and daunting task.
"Adverse reactions to food (ARF) encompass food allergies and food intolerances, both of which can result in distressing symptoms and adversely affect health." (2)
This blog discusses what research currently knows about prevention, and what new research has recently discovered about treatment and management.
****ALWAYS talk with your health care team before starting any health, diet, or exercise plan.****
PREVENTION:
While we do not know the cause of food allergies, intolerances, and sensitivities, there is growing research on the prevention of these adverse food reactions, however, most of the research how found that steps for prevention need to occur in the early stages of life to be effective. Many studies find that infancy and childhood dietary habits may have a significant impact on allergy prevalence in children. Researchers are beginning to study allergy prevalence based on the mothers diet and health during pregnancy.
During Pregnancy:
There has been much research on pregnancy and allergy prevention, but there is little data to show there is a correlation. (3) mentions multiple studies on the topic. Three studies found that dietary patterns had no effect on the outcome of allergies in children up to age 3. One study found that the Mediterranean diet might even increase the risk of allergies, however, another found that the Mediterranean diet has been linked to asthma/wheezing symptoms, but there is no association with food allergies and this style of eating. (3,4)
During Infancy:
Previously in the 1990s and early 2000s, researchers believed that preventing peanut allergies began with the delayed introduction of the food until about age 3, however, over a period of time of this, there was not a decreased occurrence of peanut allergies, but instead, an increase (5). A study performed on infants between 4months and 11months found some very interesting results when it comes to the prevention of food allergies. The study separated over 500 infants into two groups: group 1 completely avoid peanuts the first couple years of life while group 2 was introduced early on. The study followed these infants over about 2 1/2 years and found that those who avoided the allergen had a higher prevalence of an allergy by age 5. The group who was introduced early on had a prevalence of 1.9%, while the group 1 had a prevalence of 13.7%. (6)
Katie Marks-Cogan, MD (7) released a review of allergy prevention for mothers (linked here).
Her review discusses the following steps as a guide in hopes to help prevent food allergies. The steps are as follows:
1. Introduce allergen early. Four to six months is ideal because this is the window of time where our immune systems is working its hardest. During this time period our immune systems will learn to develop a positive or negative response to different types of foods.
2. Only introduce when it is best for the baby. A parent should only introduce certain foods when the baby is ready. If a baby is sick, unhealthy, or the parent is unable to monitor the baby’s reaction for at least the following 2 hours or more, then the introduction should wait.
3. Sustaining frequent exposure is necessary. A parent needs to reintroduce the food several times before assuming the infant does or does not have an allergy. Since the immune system is consistently developing at this stage in life, if may take multiple exposures to result in a positive reaction.
4. Be persistent. It is important to keep in mind that even at such a young age, the infant can be very picky. During the time period in the child’s life, feeding can be very difficult, but it is important to stay consistent and persistent when introducing new foods in order to decrease prevalence of food allergies.
5. Breastfeeding and early introduction. Breastfeeding has not been proven to decrease food allergy prevalence. Simply eating allergenic foods and exposing them to the infant through breast milk may not be an effective method. Infants need exposure through other methods as well.
Genetics
Research on human genetics and adverse food reactions are also being developed. It is believed that there may be a genetic component related to food allergies, intolerances, and sensitivities. Children that have one parent with allergies are twice as likely to develop a food allergy as well. (2) There is even a skin prick test performed on infants at birth to test to see if the child is an atopic individual. “Atopy is a condition of genetic predisposition to produce IgE antibodies in repose to an allergen” (2) The increase of antibodies is what will often lead to the allergic reactions and responses within the body. Knowing if a child is atopic, could allow the parents to start prevention measures early, in hope to prevent the expression of the gene, thus the development of the allergy. Genetic tests similar to the skin prick test can also revel if an individual has a specific gene mutation, thus a higher risk for developing a specific intolerance or allergy. (8)
TREATMENT
Allergen Specific Treatments
General Traditional Methods
When it comes to adverse food reactions, the approach is normally centered around preventing reactions, rather than treating or preventing the allergy, intolerance, or sensitivity itself. Approaches taken to mange allergies and prevent reaction often consist of avoiding those foods and carrying an epinephrine auto-injector (pictured a top) incase a reaction occurs. Sometimes individuals are often advised to avoid foods often associated with their allergy, even if they have not experienced or been positively tested for that specific food. An example of this is when individuals are allergic to latex, they are often advised to avoid foods such as avocados, bananas, kiwis, mangos, tomatoes, and others, because of the latex proteins in these foods and an increased chance of developing an allergy. (9) One study discussed seven strategies for managing food allergies, including elimination diets, immunotherapy, food substitutions or alterations, diets in breastfeeding women, medical or pharmacologic therapies, probiotics, and education. Each method did lead to improvements, but not every method produced significant results. One study found that pharmacologic therapies, specifically thymomodulin and cromolyn, did help, but produced better results when combined with an elimination diet. Overall, the main method studied and used to manage allergies is simply the avoidance of the allergen in order to prevent reactions and manage their allergy, but there are growing studies using Oral Immunotherapy (OIT). OIT is becoming more common and the approach of avoiding the allergen is now highly being reconsidered.
Oral Immunotherapy (OIT)
OIT is the process of feeding an individual small amounts of the allergen overtime to allow the immune system to adapt and fight the allergen easily without a significant reaction. OIT consists of using oral food challenges (OFCs) throughout 6 months or more to gradually increase an individual’s tolerance to the allergen. The first phase begins with a small dose, normally only a few milligrams, of the allergen, while increasing the dosage every 1-2 weeks over the period of six months. The next phase consists of a maintenance period where the individual does not increase dosage and continues the same dose for one year. This phase could last 3-5 years, but normally individuals continue with another food challenge to evaluate tolerance. OIT as a whole could last about 2 years, then if maintained after therapy, could help improve individuals tolerance to the allergen. The most common foods used with OIT are milk, peanuts, and eggs, all of which have provided great results when the patient continues daily dosage after treatment, however, many other foods have been used with this type of therapy as well. For some, the allergen can be tolerated in large doses enough to consume it at a meal, but for others, they just consume a small dosage daily to keep up tolerance in order to minimize reactions and side effects of accidental exposure. Carter Grodi, who interviewed with The New York Times (1) consumes two peanut M&Ms daily to maintain tolerance. This allows him to eat lunch at school without fear of what his friends packed that day, or eat a birthday cake without fear of cross contamination while it was being prepared. OIT has improved the lives of many, allowing them to proceed with life without the small inconveniences the fear of a reaction can bring.
Sublingual and Epicutaneous Immunotherapy
Two other common therapies used for allergies with the same basis as OIT are sublingual immunotherapy and epicutaneous immunotherapy. Sublingual immunotherapy (SLIT) is administered through small droplets of the allergen underneath the tongue. SLIT tends to be a safer and easier method than OIT because allergic reactions are more common with OIT than SLIT, but SLIT is usually less effective. Epicutaneous immunotherapy (EPIT) is carried out through the diffusion of the allergen into the epidermis. There is currently research being produced to use this method of therapy as a patch you place on the skin, similar to a nicotine patch. Overall, the OIT method seems to produce the best results and significantly increases tolerance of allergens, but it does come with more risks than other therapies.
Alternative dietary approaches-Non-Allergen Specific Treatments
Probiotics
Probiotics have also been discussed and researched as a method of treatment for food allergies. Probiotics are highly involved with the immune system because they target and activate many different types of immune cells. Probiotics promote a healthy digestive tract which is important in the body for tolerating food proteins. Because high concentrations of antibodies can indicate a food allergy, probiotics are used in treatment due to probiotics being highly involved in the production of antibodies. Probiotics are responsible for helping to maintain a homeostatic environment in the gut by balancing good and bad bacteria. The microbiota help regulate the tolerance of food proteins, leading to the question if probiotics can help improve tolerance of foods in those with allergies.
When food is digested, food proteins are broken down into smaller peptides, but some of the proteins stay in tact, and are then passed into gut-associated lymphoid tissue (GALT). These tissues will then distinguish allergenic proteins from non-allergenic proteins. Probiotics are able to interact with this tissue and aid to increasing tolerance of allergenic foods. Some studies have found that dysbiosis, the imbalance of good and bad bacteria, in the gut could even lead to the development of the GALT being unable to tolerate certain food proteins, thus leading to the development of food allergies, intolerances, or sensitivities. Some studies have shown that lower amounts of healthy gut bacteria make infants and children more susceptible to food allergies. (9, 11, 12)
Marine Algae
Marine algae has also been considered as an option for treatment of allergies as well. Marine algae has anti-inflammatory, anti-allergic, anti-coagulant, and anti-oxidant components and properties. The algae can work to increase tolerance of foods by suppressing allergen specific antibodies, allowing the body to intake an allergen without a major allergic response. Studies have found many types of algae contain polysaccharides and oligosaccharides that specifically target certain antibodies and slow their production. Polysaccharides have also been largely studied and related to food allergies by suppressing inflammatory responses in the gut. (11, 12)
Chinese Medicine
Traditional Chinese medicine is also being studied in the treatment of food allergies. Like marine algae, some studies have found that different Chinese herbal medicine formulas have suppressed antibodies as well. One formula mix named food allergy herbal formula-1 (FAHF-1) has been associated with decreasing histamine levels in mice with peanut-induced anaphylaxis, while increasing and activating immune cells. Although this study seems promising, the preparation of FAHF-1 could be toxic if not prepared correctly. Many Chinese medicines and medicinal plants have been studied in food allergies and a variety of other diseases, however, the herbal medicinal system lacks the proper regulations and studies to back up this method of treatment. It can be effective, but should be done in caution and with a qualified professional’s supervision. (11, 12)
Humanized Monoclonal Mouse Anti-IgE IgG1 Antibodies
Another therapy method for food allergies is humanized monoclonal mouse anti-IgE IgG1 antibodies that are made to bind to IgE and IgG antibodies to prevent them from producing a reaction when exposed to the allergen. One clinical trial tested this method in adults with peanut allergies. After receiving a dosage of the anti-IgE, participants completed multiple oral food challenges within one month. Some individuals found that their tolerance improved, others had no change, and even a couple had severe allergic reactions. This method needs to be further evaluated and studied due to sporadic results. (11, 12)
Recommendations for specific foods and Role of specific nutrients
Probiotics and Prebiotics
The gut microbiome is highly involved with immune function, and homeostasis in the gut is crucial for overall immune function, but particularly with food allergies since the gut is often the first place an allergic response begins due to food proteins absorbing into gut-associated lymphoid tissue (GALT). Because of this a diet higher in probiotics and prebiotics could help manage food allergies, but other nutrients, such as fats, Zinc, and Vitamin D, should be adequate or high in the diet as well due to their effect on the gut microbiome. Although there has been a good amount of research on the relationship between styles of eating and food allergy prevention, there is limited research on eating patterns and the management of food allergies. It can be assumed that a basic healthy diet could help manage allergies, while including many probiotics and prebiotics to help balance the microbiome in the gut. Probiotics are found in fermented foods such as yogurt, kefir, kombucha, and some cheeses, such as gouda. Prebiotics are found in fiber rich foods such as fruits, vegetables, and whole grains. Though probiotics are highly influential to food allergy management, research has shown that fat, Zinc, and Vitamin D may also play an important role as well. (9)
Fats
Many Westernized diets lack adequate amounts of unsaturated fats. Western diets are typically high in saturated fats and protein, which then put the gut microbiome at risk for dysbiosis. Adequate intake of fat is necessary for overall gut health and microbiome balance, while essential fatty acids are crucial for immune function and regulation. An individual with food allergies should regularly consume unsaturated fats in their diet while limiting saturated fats. Unsaturated fats are mostly sourced from plants such as seeds, vegetable oils, and nuts. Some examples of foods high in unsaturated fats include the following: avocados, nut oils, olive oil, pumpkin seeds, walnuts, peanuts, flax seeds, and fish. (3)
Zinc
Zinc is essential for many cellular functions, but specially as an enzyme cofactor for superoxide dismutase (SOD), which is important for oxidative-antioxidative balance. A study found that children with food allergies and lower concentrations of Zinc, which created an imbalance and weaken anti oxidative barrier. This weakened barrier, puts individuals at a higher risk for reactions. Individuals with food allergies should either increase intake of foods high in Zinc, or include a Zinc supplement in their diet to improve overall immune function by protecting that anti-oxidative barrier in the gut. Foods high in Zinc include legumes, seeds, and whole grains, such as hemp, flax, and pumpkin seeds, chickpeas, lentils, whole grain breads, quinoa, rice and oats. (3)
Vitamin D
Vitamin D is normally associated with bone health and calcium homeostasis, however, recently it been researched and studied in relation to the immune system. Vitamin D's active form, Calcitriol, has an effect on epithelial cells, T cells, B cells, macrophages, and dendritic cells. Vitamin D is best absorbed through sunlight, about 30 mins daily, however, some foods with a great source of this vitamin are fortified juices and milks, fatty fish, cheeses, and egg yolks. (3)
Overall Diet
Though this is not to be taken as medical advice, a diet for someone with food allergies could consist of adequate protein, carbohydrates, and fats, limiting saturated fat, focusing on whole foods, foods that contain probiotics and prebiotics, and foods that contain high amounts of key vitamins and minerals such as Vitamin D, Zinc, and unsaturated fats to help support gut health, immune function, and overall health.
Management and treatment can differ for every individual, and research is constantly being conducted on the best methods for this, as well as methods to prevent these adverse food reactions. You should ALWAYS consult with a health care professional when diagnosing, treating, managing, and trying to prevent food allergies.
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