Be Scared: Gluten is a Real Allergen, and it can be Lethal

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Editor’s Note: This video is part of the ongoing allergy series in partnership with Columbia Allergy. To learn more about allergies, eczema, and related topics, please refer to our Allergy Guide!


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Have you ever read the fine prints under the ingredients list of packaged foods that say “Made in a facility that also processes…” or “May contain traces of…”? If so, chances are you or a loved one has severe food allergies. When we talk about severe food allergies – the kind where the person cannot even touch or breathe particulates of the food, most people automatically assume it’s a peanut allergy. If not peanut, then maybe a tree nut. That is a deadly misconception because people can have just as severe of an allergy to something other than nuts. If I had a dollar for every time I hear, “you can just pick it out of the dish” or “it’s just a little bit – no harm, no foul” or “just a taste won’t hurt” or “just give them Benadryl” over the past 4 years – my pockets would be pretty dang full.

If there’s anything you will take away from reading this article, it’s that people can be SEVERELY allergic to any type of food – and they can be just as severely allergic to MULTIPLE foods as well. We all know gluten and gluten-containing grains such as wheat, barley, rye, oat, etc. – it’s everywhere and in almost everything, even in McDonald’s sweet and sour sauce.

Gluten, for those who are allergic to it, can be lethal.

You may have heard of many people with gluten sensitivities and disorders such as Celiac disease, where damages to small intestines are triggered by gluten. People who have a true allergy to gluten will react much more severely to even a tiny bit of exposure (e.g. touching a piece of playdough), and the reaction can escalate extremely quickly! We learned about it the hard way, as did many anaphylaxes (ANA) allergy parents have, just how quickly you can go from a tiny hive the size of a third of a sesame seed to blood pressure plummeting and going into anaphylactic shock. We’re talking seconds.

If your children have severe food allergies, know that you are not alone. Together, we need to spread awareness of the real dangers of allergies and take active steps to mitigate risks and prevent exposure – not just within our homes and control, but at school, at practice, at parties, at restaurants, on an airplane, and under any other circumstances. Our little ones deserve a safe environment to grow up in, and our society can handle small adjustments to help ensure that allergy kids won’t die.

We turned to our friend, the renowned allergist and immunologist Dr. Sanjeev Jain, from Columbia Allergy, with some of the most commonly asked questions about living with severe food allergies.

I have a wheat allergy. Does this mean I’m allergic to gluten? Can I have gluten-free oats?

A wheat allergy and a gluten allergy are not one and the same, although they are often seen coupled together. To find out if you have a wheat allergy, a gluten allergy, or both, make an appointment with an allergist to have IgE testing for both performed. If you have a wheat or a gluten allergy, and you do not have an oat allergy, then gluten-free oats would be a safe food option for you.

Should we avoid eating something that says it has been processed in a facility with allergens?

Patients with anaphylactic allergies should avoid eating foods that could be cross-contaminated with the known allergen to avoid a potential exposure that could cause a severe allergic reaction. Patients who have undergone OIT for an anaphylactic allergy, and who have been cleared for cross-contamination do not need to avoid foods that have been processed in the same facility as their allergenic food.

Revolution Foods

What is a delayed allergic reaction and what triggers it?

Delayed allergic reactions are typically type IV hypersensitivities. These hypersensitivities are cell-mediated and are not IgE mediated like typically food allergies or hayfever. Delayed allergic reactions are typically triggered by poison ivy, and chemicals or metals that come in contact with the skin. These can occur 24-72 hours after exposure to the substance and can result in a significant rash on the skin.

What is considered an anaphylactic reaction? What kind of red flags can parents look for in their children to determine whether it’s a “Zyrtec” or “epi” situation?

An anaphylactic reaction occurs when there is an allergic reaction that involves 2 or more body systems, and/or severe systemic involvement like a change in the level of consciousness, a drop in blood pressure, and/or respiratory distress. A mild reaction like hives or mild mouth itching can typically be managed with an antihistamine such as Zyrtec or Benadryl. Red flags for a potential “epi” situation include hives that worsen or do not improve with an antihistamine, repeated vomiting or dry heaving, swelling of the face or lips, wheezing or change in voice, change in behavior, drowsiness, or a combo of symptoms from 2 systems such as wheezing and hives or vomiting and cough. The FARE Food Allergy Anaphylaxis plan can be filled out by your allergist and used as a guide for which medications to administer during an allergic reaction and when to administer them.

Should we avoid eating something that says it has been processed in a facility with allergens?

Patients with anaphylactic allergies should avoid eating foods that could be cross-contaminated with the known allergen to avoid a potential exposure that could cause a severe allergic reaction. Patients who have undergone OIT for an anaphylactic allergy, and who have been cleared for cross-contamination do not need to avoid foods that have been processed in the same facility as their allergenic food.

Can we trust food labels and ingredients lists entirely? Are there official certifications for food labeling that ensures the ingredients are, for example, in fact, free from the top 9 allergens?

At this point in time, the FDA requires labeling for the top major allergens which are milk, egg, fish, shellfish, tree nuts, peanuts, wheat, and soybeans. Starting January 1st, 2023, the FDA will also require special labeling for products containing or processed with sesame. You will typically find warnings on these labels that will notify the consumer that the product contains, may contain, or was processed with one of these top allergens. According to the FDA, the labeling requirement is met if the name of the allergen is part of the name of an ingredient like milk in “buttermilk” if the allergen name is in parentheses next to an ingredient like “lecithin (soy)” or if there is a statement that says “contains” and then the allergens are listed. Labeling is not required for foods that are placed in a wrapper or container like a sandwich as in a deli, so extra caution should be taken around these types of products. For persons with anaphylactic allergies to foods outside of the top 8 allergens may not be able to fully rely on food labels to find safe foods to eat.

Is there a limit to how many epinephrine injections can be given following a severe allergic reaction?

Epinephrine auto-injector prescriptions come in packs of 2 to allow for the second administration of epinephrine in 5-15 minutes should anaphylaxis symptoms not significantly improve after the first injection of epinephrine. Ideally, a person should not be administering more than 2 epinephrine injections outside of a healthcare facility. After the first injection of epinephrine is administered, the patient or onlooker should call 911 and be transported to the nearest hospital to receive more comprehensive and continued medical attention. Once in the hands of health care professionals, additional medications may be administered to help prevent continued reactions and to manage the current reaction. If you live in a remote area with limited access to emergency or hospital services, we recommend that you consult with your allergist to discuss a customized plan should you or your child have an allergic reaction with limited resources.

What happens after you achieve “bite-size protection”?

In most circumstances, “bite-size protection” would mean that a child would be protected against an anaphylactic allergic reaction should they accidentally eat a bite of an allergenic food. The exact definition can vary between food allergy treatment programs so please clarify what this means for your specific program. “Bite-size protection” would typically occur after a child has been desensitized to a larger amount of the allergenic food and can tolerate accidental exposure without their immune system reacting.

 

 

 

 

 

 


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