The Food allergies Are produced when the body's immune system generates an altered response, which is detrimental, creating specific antibodies called IgE , Against harmless substances but which are detected as foreign (allergens).
When the allergen enters the body it binds to the available IgE and causes a degranulation and release of Histamine Which is responsible for the symptoms. That is to say, when you come into contact with food by skin contact, inhalation or ingestion, reactions that may be more or less serious and which affect one or more organs such as the skin, digestive system, respiratory system and cardiovascular system.
It is an increasingly common problem affecting children and young adults. According to WHO data in June 2006, the estimated prevalence of food allergies is 1 to 3% in adults and 4 to 6% in children.
However, this varies according to the age and dietary habits of the population and according to the countries and stages of life. Half of those affected are allergic to more than one food. Foods to which you are most allergic They are The milk , Egg, soybeans, wheat, nuts such as peanuts and walnuts, fish and shellfish.
Some allergies such as milk or egg disappear, starting the first in the first year of life, and disappearing in 75% of cases at 5 years; And the second disappearing in 75% of cases at 7 years. As for nuts, fish and shellfish, awareness tends to persist throughout life.
Diagnosis of food allergies
To diagnose a food allergy you have to take into account several aspects and make use of different techniques. The diagnosis is very important because it can cause problems both if we overdiagnose, as it can lead to eating disorders and malnutrition, as well as psychosocial and family problems. If we underdiagnose we can put the patient's life at risk.
To begin with, it will be necessary to base a clinical history where different aspects will be explored in relation to the clinical picture as symptoms, time interval between ingestion and allergic reaction, as well as the elapsed between one reaction and another.
It will also be convenient to carry out a diary of food or symptoms to be able to relate chronologically the ingestion of certain foods. 2 weeks of registration and 2 weeks of removal of suspect foods are recommended.
As complementary tests to the previous we find the in vitro tests and the tests in vivo. Among the first, we find the specific IgE determination that is useful in the follow-up of patients and allows us to confirm the diagnosis suspected by the clinical history and skin tests; And the activation test of basophils (peripheral blood leukocytes) that release their contents when activated by the allergen.
In As for the live tests, we refer to the skin tests. Among them we find the prick test, which consists of placing drops of the extracts to study in the forearm and puncture through it. Or the prick-prick test, which consists of making a sting in the suspect food and subsequently on the patient's skin.
Finally, oral exposure tests or provocation tests, which consist in putting the patient in contact with a small amount of suspect food in a controlled manner and usually in a hospital environment, which is subsequently progressively increased according to the evolution of the response.
Symptoms of food allergies
The symptoms usually appear between the first minutes and the few hours after having come in contact with the food. Late reactions rarely occur (except for atopic dermatitis). Keep in mind that the same food allergen in a person does not produce the same symptoms, with the same speed and intensity always.
- Skin symptoms: S On the most frequent, the most striking and the least serious. Urticaria and local or generalized skin redness, edema (swelling of the lips and eyelids or place of contact) may occur and atopic dermatitis (AD) that is difficult to evaluate as it is not immediate.
- Gastrointestinal symptoms We meet with him Oral allergy syndrome (SAO), which is a contact lens in the oral area: itching and angioedema of the lips, tongue, palate and throat. As well as digestive manifestations such as nausea, abdominal pain, vomiting and / or diarrhea.
- Respiratory symptoms : Sneezing in series, clear and abundant mucus and nasal congestion accompanied by tearing and ocular itching (this is the most frequent symptom). He asthma and the Glottis edema (Inflammation of the throat that hinders the entry of air and causes alterations in the voice) are more serious.
- Anaphylaxis : Multisystemic involvement (2 or more of the above symptoms). This picture requires immediate urgent attention and carries the risk of death. It appears in minutes after ingestion of the food or even traces of it. Progress very quickly. Patients may develop generalized pruritus, urticaria, angioedema, laryngeal edema, bronchospasm, abdominal pain, vomiting, diarrhea, cardiac arrhythmias, hypotension and shock. The foods most frequently involved in anaphylaxis are peanuts, nuts, shellfish, seeds, fresh fruits, celery, egg And milk.
Treatment
First of all, the allergist must inform with complete accuracy of the treatment, prognosis and risks that can lead to an inadvertent ingestion of the food, as well as to provide instructions on how to proceed.
The basic treatment is dietary and consists of the strict elimination of the food involved in the allergic reactions. In case the person is allergic to several foods, substitute foods should be sought in order to make a diet that meets the nutritional requirements.
As for the pharmacological treatment, the allergist will be in charge of guiding the doses and medications suitable for the patient. For mild reactions, the recommended drugs are:
- The Antihistamines Which inhibit the action of histamine, and which are administered in syrup, lozenge, eye drops or injectables.
- Corticosteroids, which have an anti-inflammatory action and bronchodilators for respiratory-like reactions.
For the Serious reactions or Anaphylaxis An autoinjectable adrenaline is used, which is the only drug capable of reversing the symptoms of a systemic reaction with cardiovascular compromise.
Psychological consequences
Food allergy is a burden for patients and their families, affecting mental health in general and the quality of life . He stress , Anxiety levels and impacts significantly influence the family and daily life, even reaching excessive levels that can lead to psychopathological disorders. Patients often describe allergy as a way of life and tend to be frustrated by the disease.
Adolescents are a group of great interest because they are often involved in innumerable risk behaviors in the management of their food allergies, are often frustrated about the continuous surveillance and decision-making that they must take, and feelings of feeling ignored And misunderstood by others.
Inadequate knowledge of their problem, excessive confidence and risk minimization encourage them not to check food labels, do not worry when they eat outside and do not know how to decide whether or not to take the adrenaline autoinjector if they have a Anaphylactic reaction.
Numerous studies have been carried out regarding the psychological consequences in allergic patients. Specifically in a reference food allergy center in the Veneto region of northwest Italy, one was performed to evaluate the effectiveness of the psychological treatments that were applied to the patients.
They emphasize the following reasons for which they requested psychological support:
- 40% reported emotional, social, anxiety disorders, stress and mood problems, as well as excessive worry, fear, loneliness, social isolation and poor self-esteem.
- The 18 % Reported eating problems such as the monotonous or overly restricted diet to follow, difficulties in introducing food, excessive shyness and fear of reintroducing food.
- 2% sought treatment for behavioral problems, including oppositional behavior, and 25% of treatments were sought as a result of an anaphylactic reaction.
Therefore, the objectives pursued are to ensure the health of the patient as well as a quality of life that allows for personal, family, social and work development adequate, and a normalization of the situation of the latter.
Recommendations and prevention
The work of the psychologist is fundamental in helping the patient, providing strategies for the proper management of their situation, and the new change in the lifestyle provided. For example, by the restrictive diet you should follow depending on the food you are allergic to, managing your allergy in social situations and correctly identifying the symptoms to apply the corresponding medication.
Psychoeducation will be needed to facilitate more adaptive (emotional, behavioral, cognitive and social) approaches to allergy management, allowing patients to express their feelings in a safe environment, relieve feelings of anguish, and avoid psychopathological risk.
The patient will be advised by providing information to improve their difficulties and strengths in dealing with food allergy, lecturing them on the change in their eating habits, as well as extreme precautions in handling and cooking food.
On the other hand, the patient should take special care in reviewing food labels, bearing in mind that many of these foods may appear in numerous products in a masked or unknown manner.
With regard to situations in which patients should eat outside the home, for example, in the school dining room, in a restaurant, on a birthday... the psychologist will work with them social skills like saying no to those foods that can cause allergy , As well as train them in asking and reviewing the ingredients of what they eat out, without it being a stress to have to do it, and normalizing the situation.
With regard to prevention, this has been the subject of much debate, and meta-analyzes have shown that prolonged breastfeeding during the first 3 to 6 months of life protects high-risk children. The American Academy of Pediatrics It also recommends avoiding ingestion of nuts by the mother of the infant, delaying the introduction of solids at 6 months and introducing nuts and shellfish after 3 years of age.
Final reflection
It is necessary to make society aware of the consequences of allergies. In some supermarkets there is a growing variety of products free of any food component, such as lactose or gluten, however, it is necessary to continue increasing the supply of products and lower costs.
Allergies and their relatives complain about how expensive it is to be allergic, both personally, because they spend a lot of time reading product labels in supermarkets, and financially.
On the other hand, there are few restaurants that offer food for allergy sufferers, limiting the leisure of these people, who stop going to certain social sites because of their allergic problem. Even so, it is true that there has been a breakthrough lately, without going any further the other day in an advertisement on a public transport was reported on taking precautions during Christmas meals, where anaphylactic reactions were often given.
It is true that there has been a breakthrough lately and are increasingly present in the media, where it is reported taking precautions on special occasions, for example in times like Christmas, where the number of anaphylaxis is triggered.
However, there is still a way to go and there are numerous investigations that are being carried out, especially in the field of intervention, to try to improve the quality of life of these people.
References
- Mary E. Bollinger, DO *; Lynnda M. Dahlquist, PhD; Kim Mudd, RN, MSN *; Claire Sonntag, BA, Lindsay Dillinger, BA; And Kristine McKenna, MS. The impact of food allergy on the daily activities of children and their families. Ann Allergy Asthma Immunol . 2006; 96: 415-421.
- A. J. Cummings1, R.C. Knibb2, R.M. King3 & J. S. Lucas. The psychosocial impact of food allergy and food hypersensitivity in children, adolescents and their families: a review. Allergy 2010; 65: 933-945.
- Jennifer S. LeBovidge, PhD *; Karol Timmons, RN, MS, CPNP *; Christine Rich, MS, RN; Addie Rosenstock, MS, CCLS; Kirsten Fowler, MS, CCLS; Heather Strauch, BA * Leslie A. Kalish, ScD; And Lynda C. Schneider, MD *. Evaluation of a group intervention for children with food allergy and their parents. Ann Allergy Asthma Immunol . 2008; 101: 160-165.
- Acosta, A., Bellido, N., Bello, L., Benito, E., Cortes, E., Durán, E., García E., Grande, M., Hernández, P., León, C., López , P., Madrona, E., Manzano, A., Miguel, N., Mouriz, D., Múñoz, P., Rodríguez, C., Sánchez, A. (2011). Food Allergies, Now What? (2nd ed.). International Marketing and Communication.