[People] should be hopeful, but they should not be in denial.
As a child, Allison Constantino of Winter Springs, Florida, experienced a shellfish allergy so significant it sent her to the emergency room. The artist and nature lover described her childhood shellfish allergy as “HUGE.” As an adult, however, her allergy went away and never returned. She figures that as she aged, her immune system got stronger and kept the shellfish allergy at bay. Sandra Hinchliffe, a writer and webmaster from northern California, tells a similar story. As a toddler, she endured her first anaphylaxis event—a severe, life-threatening allergic reaction—with eggs. As a child, she took allergy shots, but as she grew up, her allergies simply disappeared. But unlike Constantino, when Hinchliffe reached middle age, the allergies came roaring back, and she now follows her doctor’s strict orders to avoid egg and yeast. She carries EpiPens with her wherever she goes. “[People] should be hopeful, but they should not be in denial. These allergies can and do return in some of us as our immune system ages,” she says. Both of these women’s experiences are not unique, but they showcase the uniqueness of individual allergy patients. Some children eventually grow out of their allergies, others never do, whereas others grow out of them and have them return. The overall likelihood of outgrowing an allergy depends on a range of factors, such as the type of allergy and how severe it is in each child.
What is a food allergy?
A food allergy is a medical condition in which exposure to a specific food triggers an allergic reaction. In short, the body identifies a food as dangerous, and when it gets exposed to it, the body reacts. Symptoms of food allergies range from mild, such as a skin rash, hives, wheezing, and repetitive cough, to life-threatening, such as an inability to breathe, swallowing difficulties, and weak pulse. The Centers for Disease Control and Prevention (CDC) reports that food allergy prevalence has become a public health issue. The U.S. saw a 50 percent increase in food allergies between 1997 and 2011, and between 1997 and 2008, the prevalence of a peanut or tree allergy more than tripled in U.S. children. Overall, an estimated 15 million Americans have food allergies, according to the CDC, which includes 5.9 million children. This is approximately two children per classroom.
The Odds of Outgrowing a Food Allergy
According to Mayo Clinic, food allergies affect six to eight percent of children under the age of 5, but approximately 60 to 80 percent of youths with a type of dairy allergy (milk or egg) can eat these foods without any reaction by the time they reach age 16. Young children who can eat these foods in baked form, like in a cake, are extremely likely to be able to eat plain eggs or milk at an older age. They also might outgrow other food allergies, like nut and shellfish allergies, though this isn’t as likely. For example, only about 20 percent of young children outgrow peanut allergies, and 14 percent lose a tree nut allergy. The number is even lower with shellfish allergies, as only four to five percent of children with any fish or crustacean allergy go on to adulthood and experience no reaction—Constantino got lucky and bucked the odds.
Types of Food Allergies
There is really only one type of food allergy: “true allergy.” These are IgE-mediated food allergies in which a severe allergic reaction can occur. Stacey Galowitz, DO, a board-certified allergist with ENT and Allergy Associates in Somerset, New Jersey, says, “IgE-mediated food allergies are the reactions to food everyone is familiar with: you eat a peanut and break out in hives, have swelling, experience shortness of breath and vomiting, etcetera. The more severe form of this is called anaphylaxis.” She says anaphylactics are those who need to carry epinephrine devices. According to The American College of Allergy, Asthma & Immunology, eight types of food account for about 90 percent of all reactions: eggs, milk, peanuts, tree nuts, fish, shellfish, wheat, and soy. People who are not diagnosed with a food allergy, but still experience some form of pain when eating certain foods, usually have a food sensitivity. Such sensitivities are IgG mediated, and “IgG-mediated food allergies are not actually allergies in the true sense,” says Dr. Galowitz. She says the difference between intolerance/sensitivity and IgE-mediated food allergies is that one might be uncomfortable (IgG) and the other might be fatal (IgE).
Gluten allergy—which is also called celiac disease, and is the allergy to the proteins in wheat, barley, and rye—is a bit different. According to the Food Allergy Research and Resource Program and the University of Nebraska–Lincoln, celiac disease differs from IgE-mediated food allergies, in part, because its symptoms take 48–72 hours to show up, whereas IgE-mediated allergy symptoms appear rather quickly. Celiac disease, though, affects about one percent of the world’s population, according to the Celiac Disease Foundation. “Gluten sensitive” is a way to describe those who cannot tolerate gluten and experience symptoms similar to those with celiac disease, but do not experience the same intestinal damage. This sensitivity type is a widespread condition. According to Beyond Celiac, an organization that helps people with celiac disease live healthy lives, researchers estimate that 18 million Americans have gluten sensitivity. However, for those of you with gluten sensitivities, you might be okay eating gluten. A recent study published in the journal Digestion found that 86 percent of those who believed they were gluten sensitive could tolerate gluten with no issue.
Tests for Food Allergies
To determine if you have outgrown your food allergy, you can take a couple of tests:
- A blood or skin test. For IgE-mediated food allergies, “You need a skin test or a blood [test] plus a clinical history of reaction,” says Dr. Galowitz. If a test reveals a high level of IgE, you are more likely to experience an allergic reaction; if the level is low, you might tolerate the food. The American College of Allergy, Asthma & Immunology says the test is not very invasive and produces quick results.
- A food challenge. According to Food Allergy Research and Education, in a food challenge test, someone with (or with a previous) food allergy digests a small amount of the food they are allergic to in a controlled setting. The tester starts by giving a person a minimal amount of the food and then gradually raises the dosage. The tester will stop the food challenge immediately if the person experiences any reactions, and anyone taking the test gets closely monitored by a medical professional throughout the entire test.
The food challenge takes a number of hours. Most tests last from four to six hours, but it can go longer if someone experiences a reaction. Feeling a little nervous to try a food challenge? You shouldn’t. Researchers conducted the largest national survey of allergic reactions in a U.S. non-research setting and published their results in the Annuals of Allergy Asthma & Immunology. The results showed that the food challenge is a safe method, as it resulted in very few allergic reactions—86 percent of the challenges had no reactions and 98 percent had no anaphylaxis. This means that adults can take the test to determine if they are still have their childhood food allergies, and they shouldn’t feel worried about doing so.
Getting Ready for the Food Challenge
If you feel the food challenge might help you determine if you can eat the foods you couldn’t as a child, you should speak to your doctor. If a medical professional decides this test could benefit you, here are some test tips to follow (provided by National Jewish Health):
- Do not eat any other food during the challenge. Only eat what the medical professional says you can eat.
- If you feel sick, you should cancel the test. This includes feeling any type of illness, such as a headache, stomachache, allergic reaction of any type, or fever. Your results could present false positives, or worse, the test could make you sicker. If you have any concerns, you should always speak with your doctor ahead of time.
- If you do experience any type of reaction during the test, you might be given medication that makes you drowsy. Because of this, you should arrive to the food challenge with another individual who can drive you home, if necessary.
- You should notify your doctor if you take any antihistamines, as they could affect the results. Most of the time, the doctor will instruct you to stop taking any oral antihistamines anywhere from three to five days before the test, depending on what brand of medication you take.
It is also best practice to tell your doctor of any medications you are currently taking prior to the test. Oh, and you might get asked to bring specific food to the test. The doctor might even ask you to bring your favorite food with you “in which to place the food to be challenged,” per National Jewish Health.
If you had a food allergy in the past, it is possible you have outgrown it.
In fact, the odds are in your favor if you experienced a milk or egg allergy as a child, though less so with other food allergies. With the safety of the food challenge and skin or blood tests, they’re likely worth it—afterwards, you’ll know if you can begin adding shrimp back to your barbeques or peanut butter to your sandwiches. As always, consult with a doctor and tell him or her your own personal history and family history with food allergies. From there, they can make an educated decision on if a blood test or food challenge is right for you.