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"Food allergies are rough - my friend has a gluten allergy!”
“I have a mild food allergy to sesame”
"Oh sorry, can you just pick off the pecans from the salad?"
"Hold on - I need some hand sanitizer since my hands are sticky with peanut butter"
"He should outgrow his food allergies, right?"
"Isn't there a cure for peanut allergy now?"
"It's only a little bite - she should be fine!"
These statements may sound calm and reassuring, however each one contains dangerous myths that we need to bust.
Food allergies are often misunderstood and confusing, with each person navigating their own unique symptoms and reactions. The daily fear of having an allergic reaction can turn conversations dire quickly.
Fear takes over our logical thinking and we go into protective mode. Rumors spread fast through word of mouth and lead to more confusion. With so much noise offline and online, separating fact from fiction requires more work.
This guide will lay out facts on food allergies, sourced from clinical research and leading institutions. Since we all eat multiple times a day, you can learn these facts to protect people living with food allergies.
Let’s tackle the myths, one by one.
Myth 1: Anaphylaxis looks like puffy lips or blotchy hives on your face or across your body.
Fact: Anaphylactic symptoms are not always visible and may present differently in each person. Popular culture from shows or movies leads us to believe these visual cues are always noticeable. In real life, the first symptoms may not be visible to others. Studying the symptoms closely will help you protect a life in case you witness someone accidentally exposed to their allergen.
Let's back up - what exactly is happening during anaphylaxis?
Anaphylaxis triggers the immune system to flood the body with chemicals after interacting with a food allergen. This abundance of chemicals can shock your system, constricting airways and dilating blood vessels which prevents oxygen from being carried throughout the body to the major organs.
This systemic response can present itself differently as many of these systems and organs are affected as a chain reaction throughout the body. Symptoms may show up in the nose, lungs, throat, sinuses, stomach and/or on the skin.
Myth #2: “I only have a mild allergy to sesame.”
Fact: Our bodies are full of dynamic systems, including our immune systems. Food allergy reactions can be mild or severe but a food allergy cannot be mild or severe. Do not let your past experiences predict the future expectations of how your body will react.
The path of a food-allergic reaction can be unpredictable, appearing mild at first but perhaps escalating in time. Reaction symptoms can occur between a few minutes to a few hours after exposure.
It is important to know the differences between mild and severe symptoms and the variety of ways they can present themselves.
Mild symptoms (antihistamine appropriate if experiencing one of these; two or more symptoms needs epinephrine):
Itchy or runny nose
Itchy mouth
Mild itching or a few hives on skin
Nausea or gut discomfort
Severe symptoms are unique to each person. If any of these occur, give epinephrine immediately:
Lung: shortness of breath, wheezing, repetitive coughing
Heart: pale or bluish skin, faintness, unusual sleepiness, weak pulse, dizziness
Throat: tight or hoarse throat, trouble breathing or swallowing
Mouth: significant swelling of tongue or lips
Skin: many hives over body, widespread redness
Gut: repetitive vomiting
Myth 3: Antihistamines will stop an allergic reaction before it turns severe if taken quickly.
Fact: Epinephrine is the only medicine that can reverse anaphylaxis. Epinephrine is the medication form of adrenaline, a hormone your body makes in response to a stressor or threat.
Adrenaline makes the fight or flight reaction occur, constricting blood vessels and increasing blood pressure to ensure circulatory support and deliver oxygen to the most vital organs. Epinephrine expands the tubes that bring air to the lungs and the heart beats faster.
Think of epinephrine as an ambulance for your body - your body’s emergency responder.
When in doubt, use epinephrine. It is very safe and acts as adrenaline. Antihistamines will not save lives in a severe reaction.
Myth #4: “I’ve heard there is a cure for peanut allergy.”
Fact: No, a cure for food allergies does not exist. There are therapeutic treatments available for some food allergies, with more clinical trials underway, but these do not cure food allergies.
Treatment options are still costly, requiring a high investment of time and money. They also carry unique considerations and potential risks for overall health and quality of life.
For peanut specifically, the United States Food & Drug Administration (FDA) approved Palforzia, the first oral immunotherapy pill for peanut allergy. The goal of Palforzia is not to gain tolerance of eating peanut butter and jelly sandwiches, but rather to minimize the risk of severe allergic reaction from accidental peanut exposure.
Myth #5: “The restaurant added pecans to my salad and I said no nuts. I’ll just pick them off and eat it anyways.”
Fact: Cross-contact occurs when even the smallest amount of food protein comes in contact with food. Unfortunately we don’t always see the food proteins because the amounts can be miniscule but still dangerous.
Tip: If you’re at a restaurant, be sure to ask about their processes for preparing food in an allergy-safe environment. Listen for cues such as using clean utensils, cutting boards, surfaces and fresh gloves for food prep and if you’re not comfortable with what you are hearing, politely ask for a manager to clarify and align on your medical needs.
Myth #6: “I’ll just use hand sanitizer real quick.” (after eating peanut butter)
Fact: Hand sanitizer may kill 99% of germs, but it will not remove and destroy allergenic food proteins.
Scrubbing hands with soap and warm water for 20 seconds is the best way to break down and remove food proteins.
If you do not have access to soap and water, disinfectant hand wipes (example brand: Wet Ones wipes) are another option that will work.
Myth #7: “People with an egg allergy should avoid the flu shot”.
Fact: Not true anymore! The United States Center for Disease Control (CDC) has confirmed that people with a history of egg allergy of any severity should still receive any licensed, recommended, and age-appropriate influenza vaccine. If eggs cause only hives (raised, red, itchy skin bumps), you can safely get the flu vaccine appropriate for your age and health status anywhere.
In the past, this guidance was well accepted by physicians and often included on screening forms, asking if a person had an egg allergy. Now, the good news is that doctors’ offices do not need to ask about egg allergy prior to the shot, nor do they observe for 30 minutes post-vaccine in their clinic to watch for reactions.
Studies have examined both the nasal spray flu vaccine and flu shots in egg-allergic and non-egg-allergic patients, finding that severe allergic reactions in people with egg allergies are unlikely.
A recent CDC study found the rate of anaphylaxis after all vaccines is 1.31 per 1,000,000 vaccine doses given!
Myth #8: “It’s a good thing you’ll outgrow your food allergy over time”.
Fact: This statement is well-meaning but not always true. Researchers have found that the type of food allergy plays a role in whether someone will outgrow it, not the person itself.
Each food is very different and the likelihood of outgrowing a food greatly differs as well.
Milk, egg, wheat and soy are thought to resolve more than other allergens in childhood, but this is not always the case. Peanut, tree nut, sesame, fish and shellfish allergies unfortunately are less likely to be outgrown. Here are some data points from studies to consider.
It’s been reported that between 75-80% of children are likely to outgrow their milk and egg allergy before age 16.
Wheat allergy is typically resolved by adulthood, with 65% of kids outgrowing it by age 12.
Approximately 20% of people outgrow their peanut allergy.
About 9 percent with a tree nut allergy eventually outgrow their allergy.
Outgrowing a food allergy really does depend on the food and waiting it out over time. Luckily there are options such as oral immunotherapy that make it safe to tolerate smaller amounts but these do not cure a person of their food allergies.
Myth #9 “Every time I eat dairy, it upsets my stomach. I think I have a food allergy.”
Fact: An upset stomach triggers panic at times, leaving you to wonder if it's a food intolerance or a food allergy. Gastrointestinal symptoms may show up similarly for both, but there are clear distinctions to help you know the difference.
Food allergies involve the immune system and can escalate to life-threatening if not managed properly. With food allergies, the body produces IgE antibodies that can create an over-exaggerated histamine and chemical response throughout the body. If histamine is released in the gastrointestinal tract, a person develops stomach pains, cramps, diarrhea, vomiting or a combination of these symptoms. Histamine may also be released throughout other systems of the body leading to additional symptoms. The only way to stop this reaction is with epinephrine.
Food intolerances occur when a person cannot properly break down food in their stomach due to enzyme deficiencies, sensitivities, or reactions to chemical additives. Symptoms from food intolerances remain in the digestive system. Luckily intolerances are not life-threatening but can certainly feel life-disrupting.
The three ways to confirm a food allergy diagnosis involve scheduling an appointment with a board-certified food allergist for a skin prick test, blood work and/or food challenge. Food challenges are determined only after the allergist carefully reviews skin and blood work tests to determine if this is necessary.
Myth #10 “Is celiac disease or avoiding gluten the same as having a food allergy?”
Fact: No, these are different conditions. Many people with a gluten intolerance call it an allergy incorrectly, but in fact it's an intolerance where the proteins found in many grains, including wheat, barley and rye are not digested properly.
For some people who have Celiac disease, this is still not a food allergy. Celiac disease is a genetic, auto-immune condition. Eating gluten triggers an immune response that attacks the small intestine. These attacks lead to damage on the lining of the small intestine, which means that nutrients cannot be absorbed properly into the body. Eating crumbs with gluten can even cause damage to the small intestine, resulting in serious gastrointestinal symptoms.
Wheat food allergy, gluten intolerance and celiac disease are three different conditions but often get confused since symptoms might show up in the digestive system. If you are questioning the diagnosis, make sure to consult with your doctor. A blood test can rule out Celiac disease and blood or skin tests can determine if wheat food allergy is a concern.
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Sources about
Myth 1: About anaphylaxis
Myth 2: Mild and Severe Reactions
Myth 3: Antihistamines vs Epinephrine
Myth 5: Cross-Contact
Myth 6: Hand Sanitizer & Food Allergens
Myth 7: Egg & Flu Shot
Myth 9: Food Intolerance vs Food Allergy
Myth 10: Celiac Disease
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