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Allergy Today: Food Allergy FAQs

An important part of managing food allergies is having access to the right knowledge and trusted information. Increased awareness helps people living with a food allergy, as well as their family and whānau, to better navigate their condition.Screen Shot 2022-03-24 at 12

The information in this FAQ is adapted from the Australasian Society of Clinical Immunology and Allergy (ASCIA) and Food Allergy Canada’s “Food Allergy Myths vs Facts” (2019) webinar, presented by Canadian allergist Dr. Susan Waserman.

What is a food allergy?
A food allergy occurs when a person ingests a food (allergen), which is usually harmless, and the person’s immune system reacts by releasing antibodies called Immunoglobulin E (IgE) – which results to allergic symptoms.

Is food allergy serious?
Even a small amount of food allergen can cause an allergic reaction. Mild or moderate food allergic reactions are common in Australia and New Zealand. Allergic reactions can also be severe and life-threatening.

Are there specific foods that cause an allergic reaction?
Some foods are more associated with allergic reactions, including egg, cow’s milk (dairy), peanuts, tree nuts (almond, brazil nut, cashew, hazelnut, macadamia, pecan, pine nut, pistachio and walnut), fish, sesame seed, shellfish (crustacea and molluscs), soy, wheat and lupin. However, almost any food can cause an allergic reaction.

Are food allergy and food intolerance the same?
Food allergy and food intolerance are not the same. Food intolerances involve the digestive system, while food allergies involve the immune system.

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Is food allergy a lifelong condition?
Some types of food allergies tend to be lifelong, such as peanut, tree nuts, and shellfish (crustaceans and molluscs) allergies.
Some children outgrow milk and egg allergies by the time they reach school age.

Do adults develop food allergy?
Food allergy often begins in childhood but can develop at any point in life. When a person develops food allergy in adulthood, it usually persists.

Is it better to delay introduction of allergenic foods to babies?
Recent recommendations (including from ASCIA) for introduction of foods to infants encourage offering allergen-containing food (e.g. peanut and egg) to infants around six months of age (when ready) but not before four months.

Is it okay for someone diagnosed with food allergy to eat a little bit of their food allergen?
Even a small amount of food allergen can cause an allergic reaction to someone who has food allergy. However, there is an experimental treatment called oral immunotherapy where, under medical supervision, patients progressively eat increasing amounts of the food to which they are allergic, in order to try to reduce chances of allergic reaction to the food allergen.

Do people with peanut allergy need to avoid all legumes?
Peanut is a part of the legume family which includes peas, beans and lentils. The majority of people with a peanut allergy are able to eat other legumes. However, lupin – also a legume, is an emerging food allergen, especially for people with a peanut allergy. Individuals with a peanut allergy are advised to talk to their doctor about lupin allergy.

Is tree nut allergy the same as peanut allergy?
Having a tree nut allergy is not equivalent to having a peanut allergy. Allergy to one tree nut does not mean an allergy to all tree nuts. People with a specific tree nut allergy are advised to talk to their doctor about planning to eat types of tree nuts that are not part of their normal diet.

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Can avoiding allergenic foods during pregnancy and breastfeeding prevent food allergy in the baby?
Currently, there is no evidence that avoidance of allergenic foods during pregnancy and breastfeeding prevents food allergy in the infant.

ASCIA states that “exclusion of any particular foods (including common food allergens) from the maternal diet during pregnancy or breastfeeding is not recommended”.

If someone has a food allergy, can they eat a product that has a “may contain” statement?
“May contain” food label statement (precautionary allergen statement) is not required by law. Products with this statement should be avoided by people with allergy as the risk is unknown. Some products with “may contain” statements can have enough allergen to cause a reaction.

ASCIA recommends that people who have a food allergy discuss foods that have precautionary allergen statements with their doctor.

Does anaphylaxis always involve skin symptoms like hives?
Hives may not be always present in anaphylaxis. Anaphylaxis includes symptoms in two or more of the body systems: skin, respiratory, gastrointestinal (in relation to bee or wasp sting allergic reaction), cardiovascular and neurological.

According to current definitions, low blood pressure (a cardiovascular symptom) alone, in the absence of other symptoms, can also represent anaphylaxis. Anaphylaxis can be a myriad of symptoms and you have to keep an open mind to the presence of anaphylaxis.

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Can the smell of peanut butter cause anaphylaxis in people with peanut allergy?
Allergic reactions can occur when protein particles from the allergenic food rise into the air and are then inhaled, for example, steam produced by cooking fish or powdered milk particles being released in the air.

The odour or smell of peanut of peanut butter alone does not contain the protein that causes an allergic reaction, but smelling the odour can cause anxiety in people with peanut allergy.

Smelling is different from inhaling airborne proteins.

Do airborne food reactions happen?
Someone can have a reaction due to particles of protein that arise into the air and are then inhaled. This rarely happens but can occur. In some instances, difficulty in breathing may occur from inhaling fumes when someone is cooking seafood and in factories that process seafood. By far, the major food reactions are after the ingestion of an allergenic food.


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Does an allergic reaction only happen minutes after ingesting the allergenic food?

Most allergic reactions occur within minutes of ingesting the allergen, however the time frame can vary. Some can be up to several hours later.

There can also be a second or “biphasic” reaction which can happen after the initial allergy symptoms from the first allergic reaction have subsided, even when the person is not exposed to any further allergen. The second or “biphasic” reaction can be less serious, the same, or more severe than the first reaction.

In case of anaphylaxis, a second or “biphasic” reaction is more likely when the first dose of epinephrine injection or treatment was delayed.

Do allergic reactions get worse with each exposure to an allergen?
Allergic reactions range from being mild to severe, can vary among individuals, and are unpredictable. Various cofactors, such as asthma, general health, alcohol consumption, medications and exercise,  influence the threshold at which a person reacts to an allergen.

Can antihistamines be used to treat anaphylaxis?
Antihistamines cannot be used to treat anaphylaxis.

Adrenaline (Epinephrine in EpiPen®) is the first line treatment for anaphylaxis. It is the only recognised medication for the immediate treatment of anaphylaxis. It reverses symptoms of allergic reactions and is more effective when given early.

Adrenaline (epinephrine) reverses “bronchoconstriction” which causes lung/respiratory symptoms and “vasodilatation” which opens up blood vessels and leads to low blood pressure.

Antihistamine is recommended in treating mild and moderate allergic reactions only. Oral sedating antihistamines should not be used in people with anaphylaxis.

For more information, talk to a GP or an allergy specialist and access credible resources.

Disclaimer: This article is for information purposes only and does not constitute specific medical advice. Please consult with your GP or healthcare provider for specific health concerns.

Australasian Society of Clinical Immunology and Allergy (ASCIA). 2021. Food Allergy - Frequently Asked Questions (FAQ).

Australasian Society of Clinical Immunology and Allergy (ASCIA). 2021. Food Intolerance.

Food Allergy Canada. (2019). Food allergy myths webinar [Video]. YouTube.

Allergy Today, March 2022