Food Allergies - Know it. Treat It.

May 11, 2021

By Barret Procyshyn, Pharmacist at Dauphin Clinic Pharmacy

May is Food Allergy Awareness month in Canada. Food allergy occurs when your immune system incorrectly attempts to treat something in a particular food as if it is a dangerous a substance or allergen in your body, and an allergic reaction is the result.

Anaphylaxis is a medical term used to describe a severe allergic reaction. While it is acute it is also potentially fatal. The most common causes of anaphylaxis are food allergens. Food induced reactions account for 30-50% of anaphylaxis cases in North America. It is most common in young children with up to 7% of the population being overly sensitive to a food allergen. Peanut allergies are the most significant. About 20% of those with a peanut allergy will outgrow it. According to the CDC allergies in children increased by 50% from 1997 to 2011 and hospitalization rates also continue to rise.

Do not confuse "food allergy" and "food intolerance". Food intolerances do not involve the immune system; they are the inability to digest or absorb certain foods. A food allergy can be life threatening. The good news is fatalities from food allergies are decreasing, likely attributed to better education and preparedness. Awareness is key!

Risk factors for food allergy include age, its more common in younger age groups. Family history of allergies means children and siblings are more likely to have the same allergies. If you are allergic to one food, you are more likely to be allergic to others. Also, other medical conditions like asthma and eczema increase the likelihood of food allergies. The prevalence of allergies is increasing, and we do not have the exact reason for this. Many theories exist and more studies are needed to determine the causes.

Anaphylaxis usually presents in minutes, but some reactions can occur a few hours later. Symptoms of anaphylaxis generally involve 2 or more of the body systems; skin, respiratory system (breathing), heart, digestive system and others. Note that an anaphylactic reaction may not include trouble breathing. In children we commonly see respiratory symptoms and then a skin reaction. In adults we most commonly see hives, swelling in the face and tongue, flushing, and significant "reddening" on the skin. Food Allergy Canada (www.foodallergycanada.ca) asks you to think of the acronym FAST to be able to recognize symptoms quickly.

FACE: hives, itching, redness, swelling of face, lips, or tongue

AIRWAY: trouble breathing, swallowing, or speaking, nasal congestion; sneezing

STOMACH: stomach pain, vomiting, diarrhea

TOTAL BODY: hives, itching, swelling, weakness, dizziness, sense of doom, loss of consciousness

Epinephrine is the first line choice for treating anaphylaxis. Epinephrine acts quickly to improve breathing, stimulate the heart, raise a dropping blood pressure, reverse hives, and reduce swelling of the face, lips, and throat. It can also prevent hypotension and shock. Most importantly, it can save a life. Epinephrine in the auto-injector format is available in an adult dose and a youth dose for those under 30kg. You should always confirm the dose for a child with advice from a doctor or pharmacist. If required, an Epi-Pen is to be injected intramuscularly into the thigh. It can be given straight through thin clothing if required. Additional doses can be used every 5 to 15 minutes depending on the symptoms. A majority of those living in the parkland are more than 10 to 15 minutes away from their nearest emergency room; therefore, they should have more than one dose on hand. You still need to get medical attention as soon as possible, as the epinephrine can wear off. Please take note that oral or topical anti histamines are not effective in the treatment of anaphylaxis and are not lifesaving. Asthma medications should never be used in place of epinephrine either.

Epinephrine is quite safe. Side effects are mild and are important to see because you know the epinephrine is working properly. They include tremor, feelings of anxiety, palpitations, headache, and dizziness. A person experiencing anaphylaxis should not be expected to self- administer the EpiPen. So, if you are a friend or a family member of someone who has an EpiPen you need to learn how to use it properly. For more information on EpiPens and for some great resources, be sure to visit www.epipen.ca. Your clinic pharmacist will also track the EpiPens expiry date to give you a reminder to replace it before it expires. EpiPens do not require a prescription, however, speak to your clinic pharmacist so you can effectively use one if needed. With camping and cottage season just warming up, make sure you are properly prepared for a safe summer.

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