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Health // Doctor in the House
Rasa Fournier

Dealing With Food Allergies

Dr. Jeffrey Kam & Robin Guiffreda
Straub Clinic and Hospital

Where did you receive your schooling and training?

Kam: I did my pediatric training at Kapiolani Medical Center for Women and Children and my allergy training at the National Jewish Hospital in Denver. I have been an allergist for almost 20 years. I am currently chief of the Department of Allergy and Immunology at Straub and treat children and adults.

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Guiffreda: My son was referred to Straub when he was 3 for possible peanut allergy. We have a family history. The problem was his school said he needed to get tested for peanut allergy. He tested positive, and they said, “This isn’t the school for you.” None of them was trained, and they weren’t prepared to handle an emergency allergy situation. I found another school that did make accommodations for us. This was a private school, but the DOE also was saying no Benadryl on campus. Other parents and their children were in the same situation, so we partnered up, like other states, to have a team with a doc and a layperson to out-reach to the community and create awareness about anaphylaxis and how to prevent it. I have partnered with Dr. Kam for outreach.

What is anaphylaxis? What’s the goal of the Anaphylaxis Community Experts program?

Kam: Anaphylaxis is a severe food allergy reaction. The old school of thinking is, give Benadryl first and if the reaction gets worse, only then administer an EpiPen (or epinephrine autoinjector, which delivers a dose of epinephrine, also called adrenaline). Benadryl, even though it’s oral and easily administered, should not be first-line therapy. There have been cases of allergy reactions that were treated with Benadryl initially but the reaction worsened; when the EpiPen was finally administered the reaction had progressed too far and the individual died. You can die from anaphylaxis within minutes. Benadryl takes 30-60 minutes to start working. An EpiPen starts working within minutes.

The new treatment guidelines also recommend administering an EpiPen if the food that the person is allergic to has been ingested even if no allergic symptoms are present. If an EpiPen is used, the individual still needs to be evaluated at an ER or physician’s office, even if the allergic reaction has totally resolved.

Guiffreda: We need to retrain the thinking even for emergency technicians and doctors to go ahead and give the shot.

Have schools accepted it at this point?

Kam: Yes, they’ve accepted the use of the EpiPen as first-line therapy. EpiPens are manufactured only in double packs now. Some schools presently allow only a single EpiPen per child. But if the first injector malfunctions or is injected incorrectly, you have a second one. For severe reactions, the EpiPen can be repeated.

Are people born with allergies or do they develop later?

Kam: You’re born with an allergic tendency. Generally if one parent has an allergy, the child has a 25 percent chance of developing an allergy. If both parents have allergies, your chances increase to 75 percent. About one in 20 children and one in 100 adults have food allergies.

At what age do allergies manifest?

Kam: Usually food allergies will occur before age 2. Children begin with food allergies and rashes, those progress on to nasal allergies, then asthma. It’s called the “allergic march.” It is thought by avoiding allergenic triggers in early life you can prevent sensitization to more allergens and possibly avoid the march to asthma.

What are the most common food allergens?

Kam: Cow’s milk, eggs, peanuts, tree nuts, fish, shellfish, soybeans and wheat account for 90 percent of all food allergy reactions. Generally peanut, tree nut and seafood allergies are considered to be lifelong. In some children, with strict avoidance of peanut protein, about 20 percent can eventually eat peanuts. For many foods like milk and soy and wheat, the allergies will be outgrown. We used to think this would happen by age 3 or 4, but now we’re thinking tolerance will occur during the teenage years.

The problem with peanuts is that they are hidden in lots of foods. Parents and people with food allergies need to read all food ingredient labels very carefully.

Guiffreda: Peanut gets into processed foods at factories that share equipment. So even if you’re buying something that isn’t made with nuts, you still have to consider cross contamination.

Kam:The only time you’re going to have a life-threatening reaction to a food like peanuts is if you actually eat it. If you touch it, smell it, you may feel sick, but it’s not going to kill you.

Is kissing a danger?

Kam: Yes, that’s like ingesting it. The “kiss of death” can happen.

What are symptoms of anaphylaxis?

Kam: The most common symptoms are rash/hives, difficulty breathing and a feeling of doom.

How do you test for food allergies?

Testing for food allergies can be done by skin or blood test. Skin testing is done by lightly pricking the skin with a small amount of a purified food protein. If the area becomes itchy and bumpy like a mosquito bite, you are allergic. Unfortunately, food testing by either method has a high false positive rate. Testing should only be done for foods that are highly suspected as causing an allergy. It is not recommended to do numerous food tests to see if you have any food allergies. I have had many patients who’ve had a blood test done and were avoiding numerous foods because they tested positive. After further evaluation and oral challenges, it was found that they could eat these foods without difficulty.

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