Food Allergies

Coping with Food Allergies

Guido R. Zanni, PhD

Published Online: Monday, April 14, 2014

This information can help food allergy patients find ways to cope.

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What Is a Food Allergy?
A food allergy can negatively affect your health. It occurs when an individual is exposed to a particular food (see insert). The first time you eat the offending food, your immune system creates disease-fighting antibodies. When you eat the food again, your body treats it as a foreign invader and attempts to get rid of it. It does this by releasing a substance called histamine. Histamine is a powerful chemical, affecting the skin, the gastrointestinal tract, and the respiratory and cardiovascular systems.⁵ Symptoms may appear immediately or up to 2 hours later (Online Table 1). The severity of the reaction depends on your sensitivity to the food and how much you ate. An individual does not necessarily have to eat the food to have a reaction. Inhaling particles of the food or having the food contact the skin generally cause mild reactions.⁶

Table 1: Food Allergy Symptoms

Hives Flushed skin or a rash Tingling or itchy sensation in the mouth Swelling of the face, tongue, or lips Vomiting and/or diarrhea Stomach cramps

Coughing Wheezing Dizziness Swelling of the throat Difficulty breathing Loss of consciousness

Adapted from reference 4.

When a food allergy is severe, it may lead to a life-threatening allergic reaction called anaphylaxis. Symptoms include itching; swelling of the lips or tongue, difficulty swallowing, hoarseness, shortness of breath, coughing, wheezing, chest pain, a weak pulse, dizziness, vomiting, diarrhea, and cramps.⁷ People generally experience 2 or more symptoms. Ninety percent of deaths from food allergies are caused by allergic reactions to peanuts or tree nuts.^1,8 While most allergic reactions occur within 2 hours of eating the food, anaphylaxis can occur within 4 to 8 hours.¹ Call 911 if you or others experience severe symptoms, such as difficulty breathing. Death may occur within 30 minutes. Just because the initial symptoms may be mild, there is no way of knowing if the symptoms will progress to anaphylaxis.¹ If in doubt, call 911. An attempt to “wait it out” can be a fatal mistake.

The number of individuals with food allergies has steadily increased in the past 20 years (an 18% increase). Approximately 6% of children have food allergies. One-third of children with food allergies also have asthma, which increases their risk for anaphylaxis.^9,10

If you suspect that you or your child has a food allergy, see an allergy specialist, who can identify the food(s) causing an allergic reaction. Allergy specialists often administer a skin prick test. Needles with tiny amounts of food extract pierce the skin’s surface. Swelling or redness around one of the needle sites confirms that you are allergic to that particular food.

Can a Child Outgrow Allergies?
Many children outgrow allergies to milk, eggs, wheat, and soy by the time they reach adolescence. Allergies to peanuts, tree nuts, and shellfish tend to last a lifetime. When adults develop a food allergy, it tends to last for the rest of their lifetime.^6,7

Treating Food Allergies
There is no cure for food allergies. Treatment focuses on managing symptoms and avoiding the food. For mild reactions, OTC antihistamines can help ease the discomfort. Your local pharmacist can help you select the right product and explain its use and side effects. For serious reactions, your doctor will prescribe agents that counter anaphylaxis. One example is a self-administered epinephrine injection (often called an EpiPen). Epinephrine immediately reverses anaphylaxis.⁵

Coping Strategies
Reading labels is critical. The law requires manufacturers to list all ingredients in a product. If the product contains a known food allergen, it must be listed on the label. Manufacturers must also list the unintentional presence of food allergens that may result from cross-contact during food processing. For example, if a machine processes peanut butter and is later used to process another food, the second food may contain trace amounts of peanut butter. In these cases, the label notes “may contain peanuts.” If a label is confusing, do not buy the product. Online Table 2 lists other coping strategies.

Table 2: Coping with Allergies

Be cautious when buying foods without labels, such as a cake from a pastry shop. Avoid all foods for which you are unsure of the ingredients. Avoid foods that may have cross-contact with other foods. Keep a food diary that tracks the foods you eat, your symptoms, and how long after eating the symptoms appear. This helps identify the food allergy. Avoid high-risk food situations where accidental food ingestion can occur (eg, buffets). Ask your doctor for a written emergency management plan. Share this plan with your child’s teachers. Inform others that your child is carrying an EpiPen. Always wear a medical band noting food allergies. Carry the name and telephone number of an emergency contact. If you are prescribed an injectable epinephrine pen, always carry it with you. If you are not sure how to use the pen, ask your doctor to demonstrate how it is used. Routinely check the expiration date on the pen. Carry 2 pens in case 1 malfunctions. When eating out, inform your server of your food allergy. Do this even if you had the same meal in a different restaurant. Different chefs may use different ingredients. After you use an EpiPen, dial 911 immediately.

Adapted from references 1, 11-13.

More Information
The FDA website (www.fda.gov) has helpful information.

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Dr. Zanni is a psychologist and health-system consultant based in Alexandria, Virginia.

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References: 

1. Food allergies: what you need to know. FDA website. www.fda.gov/food/ingredientspackaginglabeling/foodallergens/ucm079311.htm. Accessed February 24, 2014.
2. Chung EH. Vaccine allergies. Clin Exp Vaccine Res. 2014;3:50-57.
3. Sicherer S. Food allergies. Medscape website. http://emedicine.medscape.com/article/135959-overview. Accessed February 24, 2014.
4. American Academy of Allergy, Asthma & Immunology. Food allergy: tips to remember. www.aaaai.org/conditions-and-treatments/library/at-a-glance/food-allergy.aspx. Accessed February 24, 2014.
5. Food allergies. WebMD website. www.webmd.com/allergies/food-allergies. Accessed February 24, 2014.
6. Food allergy. US National Library of Medicine. www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001820. Accessed February 24, 2014.
7. Food allergy. National Institute of Allergy and Infectious Diseases website.  www.niaid.nih.gov/topics/foodAllergy/understanding/Pages/allergicRxn.aspx. Accessed February 24, 2014.
8. McWilliams LM, Mousallem T, Burks AW. Future therapies for food allergy. Hum Vaccin Immunother. 2012;8:1479-1484.
9. Voluntary guidelines for managing food allergies in schools and early care and education programs. Centers for Disease Control and Prevention website. www.cdc.gov/healthyyouth/foodallergies/pdf/13_243135_A_Food_Allergy_Web_508.pdf. Accessed March 5, 2014.
10. What is an allergic reaction to food? National Institute of Allergy and Infectious Diseases website. www.niaid.nih.gov/topics/foodAllergy/understanding/Pages/allergicRxn.aspx. Accessed February 24, 2014.
11. Berin MC, Mayer L. Can we produce true tolerance in patients with food allergy? J Allergy Clin Immunol. 2013;131:14-22.
12. Coping with allergies. http://allaboutfoodallergies.com/coping-with-allergies. FoodDiet website. Accessed February 24, 2014.
13. Emotional and social issues. Food Allergy Research & Education website. www.foodallergy.org/emotional-and-social-issues. Accessed February 27, 2014.

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Diabetes Drugs

Diabetes drugs can take up to a decade before they're released

There are a number of different types of diabetes drugs - with some having similar ways of acting. Drugs which act similarly to each other are put into the same class of drugs.
Below is a list of the most common drug classes, how they work, who they are for and which medications fall into these drug classes.

Jump to the treatment you’re interested in:

• Insulin
• Biguanides / Metformin
• Sulphonylureas
• Meglitinides / Prandial glucose regulator / Glinides
• Alpha-glucosidase inhibitors
• Thiazolidinedione / Glitazones
• DPP-4 inhibitors / Gliptins
• Incretin mimetics / GLP-1 analogues
• Amylin analogues

 

 

Insulin

Insulin is a hormone which helps to regulate blood sugar. A number of different types of insulin are available as medication, with some insulins acting for as long as a day and others acting for only a few hours.
However, insulin is prescribed for people with type 1 diabetes and for people with type 2 diabetes who have not responded so well on oral medication (tablets).

• Read more on insulin

Biguanides / Metformin

The only available diabetes medication in the biguanides class of drugs is metformin.
Biguanides prevent the liver from producing glucose and helps to improve the body’s sensitivity towards insulin. Metformin is commonly used as a first line treatment for type 2 diabetes and may occasionally be prescribed, in combination with insulin, for people with type 1 diabetes.

• Read more on metformin

Sulphonylureas

Sulphonylureas are the class of antidiabetic drug for type 2 diabetes that tends to include those drugs which end in ‘ide’.
The following drugs are all in the sulphonylureas class (branded names in brackets):

• Glibenclamide –also known as Glyburide (Daonil)
• Glipizide (Glucotrol)
• Gliquidone (Glurenorm)
• Glyclopyramide (Deamelin-S)
• Glimepiride (Amaryl)
• Gliclazide (Diamicron)

Sulphonylureas work by increasing the amount of insulin the pancreas produces and increasing the working effectiveness of insulin. The mode of action of sulphonylureas means that hypoglycemia and weight gain can be relatively common side effects.

Meglitinides / Prandial glucose regulator / Glinides

The glinides are a class of drug which have a similar response as sulphonylureas but act for a shorter time. Meglitinides are prescribed to be taken by people with type 2 diabetes within half an hour before eating. As the drugs act for a shorter period than sulphonylureas, the side effects of hypoglycemia and weight gain have a smaller likelihood.

Examples of prandial glucose regulators are (brand names in brackets):

• Repaglinide (Prandin)
• Nateglinide (Starlix)

Alpha-glucosidase inhibitors

Alpha-glucosidase inhibitors, such as acarbose (marketed as Precose or Glucobay) or miglitol (branded as Glyset) are drugs for type 2 diabetes which slow down the digestion of carbohydrates in the small intestine and therefore can help to reduce after meal blood sugar levels.

Thiazolidinedione / Glitazones

Thiazolidinediones, also known as glitazones, are a medication for type 2 diabetes which help to improve insulin sensitivity and have been found to help decrease triglyceride levels.
However, these have recently been in public spotlight as questions over their long term safety.
In September 2010, the most popularly prescribed drug in this class rosiglitazone (Avandia) was banned for use by the European medicines Agency over heart attack concerns.
Pioglitazone (Actos) has also made the news in connection with instances of bladder cancer, however, the danger has not been deemed sufficient to need to ban the drug in the UK.

DPP-4 inhibitors / Gliptins

DPP-4 inhibitors, also known as gliptins, are a class of drug which help to stimulate the production of insulin and reduce the production of glucagon, particularly during digestion.
DPP-4 inhibitors are usually prescribed for people with type 2 diabetes who have not responded well to drugs such as metformin and sulphonylureas.
This drug class includes following medications (trade names in brackets):

• Sitagliptin (Januvia)
• Vildagliptin (Galvus)
• Saxagliptin (Onglyza)
• Linagliptin (Tradjenta) –approved for use in the USA

Incretin mimetics / GLP-1 analogues

Incretin mimetics, also known as GLP-1 analogues, are an injectable treatment for type 2 diabetes.
Incretin mimetics look to mimic the effect of a group of hormones called incretins which increase the production of insulin and decrease the release of glucagon in a relatively similar way DPP-4 inhibitors.
This is not a coincidence as the way DPP-4 inhibitors work is to prevent the protein dipeptidyl peptidase-4 from destroying the incretin hormones.
GLP-1 analogues have been found to be particularly effective in helping to improve blood glucose levels and helping with weight loss.
The following GLP-1 analogues are prescribed in the UK (branded names in brackets):

• Exenatide (Byetta)
• Liraglutide (Victoza)

Amylin analogues

Amylin is a hormone produced by the pancreas and released at the same time as insulin, but in much smaller quantities (about 1% compared with insulin). Amylin helps to suppress glucagon release and therefore reduce post meal blood glucose levels.
Pramlintide acetate (marketed as Symlin) is available in the US as an injectable drug for the treatment of both type 1 and type 2 diabetes.
The use of amylin with insulin can carry an increased chance of hypoglycemia.

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The Pharmacist

Nature of the Work

Pharmacists distribute prescription drugs to individuals. They also advise their patients, physicians, and other health practitioners on the selection, dosages, interactions, and side effects of medications, as well as monitor the health and progress of those patients to ensure that they are using their medications safely and effectively. Compounding—the actual mixing of ingredients to form medications—is a small part of a pharmacist's practice, because most medicines are produced by pharmaceutical companies in standard dosages and drug delivery forms. Most pharmacists work in a community setting, such as a retail drugstore, or in a healthcare facility, such as a hospital.
Pharmacists in community pharmacies dispense medications, counsel patients on the use of prescription and over-the-counter medications, and advise physicians about medication therapy. They also advise patients about general health topics, such as diet, exercise, and stress management, and provide information on products, such as durable medical equipment or home healthcare supplies. In addition, they often complete third-party insurance forms and other paperwork. Those who own or manage community pharmacies may sell non-health-related merchandise, hire and supervise personnel, and oversee the general operation of the pharmacy. Some community pharmacists provide specialized services to help patients with conditions such as diabetes, asthma, smoking cessation, or high blood pressure. Some pharmacists are trained to administer vaccinations.
Pharmacists in healthcare facilities dispense medications and advise the medical staff on the selection and effects of drugs. They may make sterile solutions to be administered intravenously. They also plan, monitor, and evaluate drug programs or regimens. They may counsel hospitalized patients on the use of drugs before the patients are discharged.
Some pharmacists specialize in specific drug therapy areas, such as intravenous nutrition support, oncology (cancer), nuclear pharmacy (used for chemotherapy), geriatric pharmacy, and psychiatric pharmacy (the use of drugs to treat mental disorders).
Most pharmacists keep confidential computerized records of patients' drug therapies to prevent harmful drug interactions. Pharmacists are responsible for the accuracy of every prescription that is filled, but they often rely upon pharmacy technicians to assist them in the dispensing medications. (Pharmacy technicians are covered elsewhere in the Handbook.) Thus, the pharmacist may delegate prescription-filling and administrative tasks and supervise their completion. Pharmacists also frequently oversee pharmacy students serving as interns.
Some pharmacists are involved in research for pharmaceutical manufacturers, developing new drugs and testing their effects. Others work in marketing or sales, providing clients with expertise on the use, effectiveness, and possible side effects of drugs. Some pharmacists work for health insurance companies, developing pharmacy benefit packages and carrying out cost-benefit analyses on certain drugs. Other pharmacists work for the government, managed care organizations, public healthcare services, or the armed services. Finally, some pharmacists are employed full time or part time as college faculty, teaching classes and performing research in a wide range of areas.
Work environment. Pharmacists work in clean, well-lighted, and well-ventilated areas. Many pharmacists spend most of their workday on their feet. When working with sterile or dangerous pharmaceutical products, pharmacists wear gloves, masks, and other protective equipment.
Most pharmacists work about 40 hours a week, but about 12 percent worked more than 50 hours per week in 2008. In addition, about 19 percent of pharmacists worked part-time. Many community and hospital pharmacies are open for extended hours, so pharmacists may be required to work nights, weekends, and holidays. Consultant pharmacists may travel to healthcare facilities to monitor patients' drug therapies.