Food allergy

In the cases of a food allergy , the immunes system reacts to proteins in a certain food - by forming antibodies (usually so-called IgE antibodies). It is therefore not directed against pathogenic germs, but against foods that are actually completely harmless to the body such as milk, seafood or nuts. From now on, the immune system is on the alert: If it detects the supposedly dangerous foreign body the next time, it can turn against it (but it doesn't have to be).

In the case of an allergy, symptoms such as skin rashes, gastrointestinal problems and anaphylactic reactions such as shortness of breath and circulatory problems appear.

In principle, any foods can trigger an allergy. The reactions also vary in strength depending on the trigger. With fruits and vegetables, those affected tend to show milder symptoms such as rashes. If someone is allergic to nuts or shellfish and seafood, reactions can range from severe to life-threatening.

Is there a food allergy list?

Yes, the 14 most important foods (ingredients) that can trigger allergies are subject to mandatory labeling . This means that they must be shown on products in the trade and on menus or suppliers must be able to name them on request.

This food allergy list includes:

1. Eggs
2. peanuts
3. fish
4. cereals containing gluten (e.g. wheat, rye, barley, oats)
5. Crustaceans
6. Lupins
7. milk
8. Nuts such as almonds, hazelnuts and walnuts
9. Shellfish and mollusks such as mussels, oysters or squids
10. sulphurous preservatives (sulphites)
11. celery
12. mustard
13. Sesame seeds
14. Soybeans

The causes of a food allergy are not yet entirely clear. Some people have a familial higher risk of developing a food allergy. There is debate as to whether smoking, excessive hygiene, a caesarean section, or not breastfeeding an infant all contribute to developing an allergy.

In principle, experts differentiate between two forms of food allergy :

primary food allergy (affects mainly children) and secondary food allergy (affects more adults).

• In the case of primary food allergies , the defense reaction is directed directly against a food: the immune system recognizes it as a foreign body and begins to fight it.
• In the case of secondary food allergy, there is first an allergy to pollen (mostly birch pollen), latex or even house dust mites. Only later do cross-reactions with certain foods such as apples, celery, nuts or carrots occur. This is because the proteins in these food are very similar to those in pollen.

The most common food allergy triggers in adults are:

• Nuts (especially peanuts, hazelnuts)
• celery
• Soybean
• Fish, seafood / shellfish
• kiwi

The most common food allergy triggers in children include:

• Cow's milk
• Chicken egg
• Nuts (especially peanut, hazelnut)
• Soybean
• wheat flour
• fish

Food allergy or intolerance?

Most food intolerances are not allergies . Although their symptoms may be similar, they do not trigger an anaphylactic reaction with shortness of breath, a drop in blood pressure, or cardiovascular failure.

• While in the case of an allergy, the immune system develops antibodies against a certain food and usually reacts violently to it immediately after consumption,
• People with a food intolerance do not tolerate certain substances as well. For example, the body cannot digest large amounts of lactose (milk sugar) or fructose (fruit sugar) optimally, which in turn causes those affected to experience abdominal pain , gas , stomach cramps or diarrhea a few hours after eating . Additives and flavorings such as glutamate can also cause allergy-like symptoms.

It is therefore important that a doctor clarifies the symptoms, arranges tests if necessary, and makes a diagnosis. What is important for the doctor is which symptoms appear and when.

Food allergy: symptoms

The symptoms of a food allergy can be many:

• Most commonly, a food allergy causes discomfort in the mouth and throat, puffy eyes, or a rash on the face - the skin itches, swells, reddens, and wheals are formed.
• Sneezing attacks or runny nose can occur.
• Also under gastrointestinal symptoms such as nausea, vomiting , abdominal pain or diarrhea with people suffering from a food allergy often. As a rule, the symptoms appear half an hour to an hour after eating.
• Sometimes there are breathing problems , those affected suddenly have to cough, become hoarse and get wheezing.
• If the face and airways swell , this can lead to acute shortness of breath . In the worst case, life-threatening anaphylactic shock (allergic shock) occurs after consuming certain foods with a drop in blood pressure and loss of consciousness. Immediate treatment is now required. Either by an (emergency) doctor or with the help of an emergency kit that contains an adrenaline injection to be injected into the thigh muscle. People with an already diagnosed, life-threatening allergy (for example a pronounced nut allergy ) must always have such an emergency kit with them.
• Important to know: Around one in five allergy sufferers have food allergy symptoms again after a few hours.

If a food allergy first becomes noticeable in adulthood, it usually lasts for life. In children with a diagnosed allergy to milk protein, wheat or soy, the symptoms can subside after a few years. That is why experts recommend regular tests.

Food Allergy Test: Which Doctor?

You are asking yourself: Which doctor should I go to if I suspect a food allergy - and how does he diagnose it? Anyone who suspects they are suffering from a food allergy should contact their general practitioner or medical practitioner with an additional qualification in allergology.

In an interview, the allergist will clarify which symptoms have occurred and what you have eaten and drunk and when . It is therefore helpful if you have already kept a nutrition symptom diary and know whether there are frequent allergies in your family. Write down important questions and, if necessary, what medications you are taking.

The doctor will rule out other gastrointestinal disorders. In addition, doctors have various food allergy tests available that they can use to examine whether the immune system is overreacting to a certain trigger.

1. The skin test (prick test)

The doctor applies the suspected allergens in the form of a solution with food protein to the forearm with a pipette. In the next step, he slightly scratches the areas so that they get into the skin. If the body reacts, red, itchy wheals form. However, if the person being tested takes antihistamines or corticosteroids, this can lead to incorrect results.

2. Blood test for antibodies

For the food allergy blood test , the allergist will take some blood so that it can be tested in the laboratory for certain antibodies (IgE antibodies) that the body may have produced against certain foods. An increased value indicates an allergy.

3. Oral provocation test

If the skin test and blood test indicate a food allergy, an oral provocation test under medical supervision can confirm the suspicion. For this, the person concerned is given the suspicious food under medical supervision to see whether a reaction is triggered. It is important that doctors can treat him immediately in an emergency.

4. More options

Sometimes a two-week elimination diet can also provide information. If the symptoms improve during the diet, this indicates an allergy. If the person concerned eats the food again and food allergy symptoms reappear, this confirms the suspicion.

In some practices, those affected can be tested for other antibodies in the blood at private expense - the IgG / IgG4 antibodies . However, experts do not currently recommend these tests because they are hardly meaningful.

Treat food allergy

Therapy step number 1 is to avoid the allergen and thus the trigger - and to learn to deal with acute complaints and strong immediate reactions. This is not always easy, especially with children. It is all the more important to inform the environment well and to look carefully at the list of ingredients when shopping or in a restaurant . In Germany, the most common allergens must be specified. When in doubt, the only thing that helps is asking.

In order to rule out nutrient deficiencies in the so-called elimination diet (for example, if you are allergic to milk), those affected and parents of children with a food allergy should be well informed about substitute foods . Qualified nutritional advice and special patient traininghelp to cope more easily in everyday life and to reduce fears. Here, those affected and / or their parents learn how to avoid the allergy triggers and the smallest traces of them and how to replace them if the elimination diet threatens nutrient deficiencies. They also learn how to recognize problematic foods for them when buying, preparing or visiting a restaurant and receive emergency training. The health insurance companies usually bear or subsidize the costs.

Heating some foods makes them easier to tolerate. So it happens that apple allergy sufferers can sometimes tolerate apple pie. But be careful: this does not work with nuts, celery and many animal allergy triggers. They are more heat stable.

There is still no permanent drug therapy for food allergies . Experts recommend an antihistamine for non-life-threatening reactions. In the long-term treatment of food allergies, mast cell stabilizers such as cromoglicic acid and ketotifen, which inhibit the release of inflammatory messenger substances such as histamine from mast cells (certain immune cells), have not shown a consistent effect in previous studies. The medical guideline recommends that doctors only use them in individual cases and under observation as a therapy option for gastrointestinal symptoms.

Cure a food allergy - that has not yet worked. In children, however, food allergies can subside or go away over time. In particular, allergies to milk “grow together” more often. The pediatrician therefore keeps an eye on whether something has changed. After all, the best diet is a balanced one.

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