Learn about Food Allergies & Anaphylaxis
Food allergies affect as many as 32 million Americans, including 6 million children.
A food allergy is an immune system response to a food the body mistakenly believes is harmful. When a person with food allergy eats the food, his or her immune system releases massive amounts of chemicals, including histamine, that trigger a cascade of symptoms that can affect the respiratory system, the gastrointestinal tract, the skin, and/or the cardiovascular system. There is no cure for food allergies. The prevalence of food allergies appears to be increasing among children under the age of 18, that is 2 students in every classroom. Although food allergy desensitizations are being studied, these are not yet proven treatments, so strict avoidance is the only way to prevent an allergic reaction. Managing a food allergy on a daily basis involves constant vigilance. Trace amounts of an allergen can trigger an allergic reaction in some individuals. Unfortunately, food allergy deaths do occur, even among persons with a history of mild reactions in the past.9-1-1 must ALWAYS be called with every anaphylactic reaction.
Here are 10 FAACTs about Food Allergies
Anaphylaxis Is a serious allergic reaction that comes on quickly and has the potential to become life-threatening.Symptoms can develop rapidly after exposure to an allergen, often within minutes and usually within 30 minutes. However, it can take up to 2 hours for symptoms to occur after exposure to a food allergen.Sometimes a second round (or “phase”) of allergic reactions can occur after the initial anaphylactic reaction. This is called “biphasic anaphylaxis”. A second reaction may happen as early as an hour after the first reaction or as long as 72 hours later (the average is 10 hours later) and can be less severe, as severe, or even more severe than the initial reaction.Must be treated immediately with epinephrine (adrenaline).
Prompt administration of epinephrine is crucial to surviving a potentially life-threatening reaction. Epinephrine has very few side effects. It is prescribed as an auto-injector device (Auvi-Q®, EpiPen®).
A food allergy is NOT:
A food intolerance (lactose intolerance, gluten intolerance, etc.). - An intolerance does not involve the immune system – it involves the digestive system because the body lacks an enzyme needed to digest and process a particular food. - Symptoms of an intolerance include gas, bloating, and abdominal pain.A food preference (vegetarian, kosher, etc.).Celiac Disease (is a NON-IgE mediated food allergy).
Eight foods account for 90 percent of all food allergy reactions:
Tree nuts (cashews, pecans, walnuts, etc.)
Fish (halibut, salmon, etc.)
Shellfish (crab, lobster, shrimp, etc.)
However, almost any food can cause a reaction.
To learn more about food allergy, we recommend the video “Understanding Food Allergy” by the National Institute of Allergy and Infectious Diseases.
Avoid high-risk types of restaurants
Persons with food allergies should generally avoid high-risk types of restaurants, including:
Buffets and deli stations (risk of cross-contact).Asian cuisine (peanuts, tree nuts used in many dishes).Bakeries (risk of cross-contact).Ethnic (language barrier).
There are ways to minimize risk of accidental exposures and feel more secure about eating out.
Look for allergy information from the restaurant. Some chains are food-allergy aware and may post allergen information on their Web site. Establish good relationship with manager, staff, etc.Consider using a “chef card” to alert the staff about your food allergy.
Leave the restaurant or bring your own food if you feel uncomfortable about the restaurant’s food preparation.
Treatment of Anaphylaxis
Allergy & Anaphylaxis Emergency Plans are designed to provide clear, concise instructions on how to quickly assess and manage symptoms of a developing allergic reaction. Symptoms may be mild at the beginning, but if left untreated may progress to more severe symptoms. This is why prompt treatment is essential, and is the main reason for why your doctor urges you to be very familiar with your allergy action care plan.
Treatment of anaphylaxis is relatively simple. Any of the following symptoms requires prompt injection of epinephrine:
Any throat, lung, circulatory, or heart symptomsTwo or more organ systems become affected (e.g., skin and gastrointestinal symptoms)Vomiting (recommended because it may be difficult to absorb oral antihistamines)
Once epinephrine is administered, an antihistamine should also be administered. If there are respiratory symptoms, albuterol can be administered as well.
If the allergic reaction is limited to isolated skin symptoms, oral symptoms or throat itching, or gastrointestinal symptoms not including vomiting, you can use an oral antihistamine first and observe the person very closely, with a source of epinephrine ready to be used if symptoms progress.
There is some debate about what to do for someone with a past history of a severe reaction who has eaten the food allergen or was suspected to have eaten the allergen but has not yet developed any symptoms of an allergic reaction. Some care plans strongly urge that epinephrine be immediately given or that an antihistamine should immediately be given. Some experts have advocated that this is the best strategy. Others have advocated treatment according to the symptoms that develop. It is difficult to say what the best strategy is. There is minimal downside to using epinephrine – it will “work” for mild symptoms and should not result in adverse reactions beyond some temporary local pain, bruising, and short-term jitteriness. It is unknown whether presumptive use of epinephrine contributes to reduced quality of life. Sit down with your doctor to discuss the pros and cons of what to do in these situations.
It is important to be deliberate and not hesitate when you have to use epinephrine. The device is potentially life-saving and has far more benefit than risk.
Should your child receive a dose of epinephrine, he or she requires 4-6 hours of medical observation in case the reaction escalates or a second (biphasic) reaction occurs. Additional medications may be needed (steroids, antihistamine, or additional doses of epinephrine).
When a person is experiencing symptoms of anaphylaxis, additional steps should include:
Eliminate all risks of additional allergen exposure.Call 9-1-1 and/or seek medical attention immediately. Monitoring or additional medications may be required.Repeated doses of epinephrine may be necessary every 10 minutes if the symptoms are not going away.After epinephrine has been administered, have the person lay down with his or her legs raised, if possible, to help restore blood flow to vital organs (heart, lungs, brain).Administer secondary medications to help the patient breathe, such as an asthma inhaler; antihistamines to relieve itching and hives; and other medications as directed in the Allergy and Anaphylaxis Emergency Care Plan or as instructed by emergency medical personnel.
Delays in giving epinephrine can result in rapid decline and death within a short amount of time.
When treating anaphylaxis, epinephrine is the first-line of treatment! Antihistamines, inhalers, and other treatments all have a delayed onset of action and should only be used as secondary treatment. These medications cannot be depended on to reverse anaphylaxis because they will not restore low blood pressure or poor circulation. Antihistamines in this case become secondary agents, to be used only after epinephrine has been given. They are still important to give, but not instead of epinephrine.
Allergists recommend that all individuals at risk for anaphylaxis carry TWO epinephrine auto-injectable devices with them at all times AND an Allergy & Anaphylaxis Emergency Plan (AAP) signed by a board-certified allergist.
** You should take your epinephrine auto‑injectors everywhere you go, but they should be kept at room temperature (25°C, 77°F) until the marked expiration date, when they should be replaced. Your epinephrine auto-injector should not be refrigerated or exposed to extreme heat or light. Keep these temperature requirements in mind if you’re thinking of putting your auto‑injectors in your car’s glove compartment, for example.
Download FAACT's Poster for Epinephrine Auto-Injector Options - 2020.
About Eleanor Garrow-Holding President & Chief Executive Officer
Eleanor Garrow-Holding has worked, educated, and advocated in the food allergy community since 2004. She was inspired to start this work after her son, Thomas, was diagnosed with life-threatening food allergies to tree nuts, peanuts, wheat, and sesame; eosinophilic esophagitis (EoE) triggered by milk and wheat; asthma; and environmental allergies. In December 2015, Thomas had a food challenge with wheat and passed. He is no longer IgE-allergic to wheat. After a 3-month trial with wheat and another 3-month trial with milk (post wheat) in his diet and upper endoscopies, he has also outgrown the wheat and milk triggers for EoE and is in remission from EoE as of July 2016. As of October 2019, Thomas has now outgrown peanut, almond, sesame, and brazil nut and continues to avoid walnut, cashew, pecan, hazelnut, and pistachio.
As CEO of the Food Allergy & Anaphylaxis Connection Team (FAACT), Eleanor provides leadership, development, and implementation for all of FAACT’s initiatives and programs, including Camp TAG (The Allergy Gang) – a summer camp for children with food allergies and their siblings that Eleanor founded in 2009. Eleanor has a Bachelor of Healthcare Administration degree from Lewis University in Romeoville, IL, and worked in hospital management for 16 years in Chicago and suburban Chicago prior to working in the nonprofit sector.
After Thomas was diagnosed in 2004, Eleanor established a food allergy support group in a southwest Chicago suburb, Parents of Children Having Allergies (POCHA) of Will County, focusing on education and advocacy; chaired the FAAN Walk for Food Allergy in Chicago in 2007 and 2008; was awarded the FAAN Muriel C. Furlong Award for Community Service in 2008; and advocated in the Illinois state legislature on food allergy and Eosinophilic Disorders (EGID, EoE) issues. Thanks to the efforts of Eleanor and other patient advocates, legislation to ensure insurance coverage for elemental formulas was signed into law in 2007 and legislation establishing food allergy management guidelines for Illinois schools was signed into law in 2009.
Eleanor joined the Food Allergy & Anaphylaxis Network™ (FAAN) in 2009 as Vice President of Education and Outreach, where she oversaw educational initiatives, all food allergy conferences, the Teen Summit, Camp TAG (The Allergy Gang) now under FAACT’s umbrella, a Teen Advisory Group, support group development, and more. She advocated for the Food Allergy & Anaphylaxis Management Act (FAAMA) in Washington, DC, with her son Thomas as part of FAAN’s Kids Congress on Capitol Hill and also advocated on Capitol Hill for the School Access to Emergency Epinephrine Act. Eleanor served on the expert panel for the CDC’s Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs and was a reviewer for the National Association of Education (NEA) Food Allergy Book: What School Employees Need to Know. Eleanor conducted numerous radio, television, and print interviews on food allergy issues and wrote articles for Allergic Living and Living Without magazines. She presented at national and regional conferences about food allergy management in school and restaurant settings and educated personnel in schools and school districts across the country on food allergy management in schools and continues to do so with FAACT.
In 2013, Eleanor joined the Cincinnati Center for Eosinophilic Disorders (CCED) as Senior Specialist of Program Management at Cincinnati Children’s Hospital and Medical Center. There she led day-to-day clinical operations, clinical research projects, program development, marketing, and development.
Eleanor has and continues to educate employees from numerous food industry companies and entertainment venues about food allergies, such as McDonald’s Corporation, The Hain Celestial Group, Mars Chocolate North America, all SeaWorld Parks, and more.
Leading the charge at FAACT, Eleanor and the FAACT Leadership Team provides the education, advocacy, awareness, and grassroots outreach needed for the food allergy community. Eleanor serves on the DBV Technologies Peanut Allergy Patient Advisory Board, the National Peanut Board's Allergy Education Advisory Council, Sea World's Allergy Resource Team, St. Louis Children’s Food Allergy Management & Education (FAME) National Advisory Board, Association of Food and Drug Officials (AFDO) Food Allergen Control Committee, and The EDGE Teen Center Board of Directors. In August 2015, Eleanor was inducted into The National Association of Professional Women's (NAPW) VIP Professional of the Year Circle for her commitment to healthcare and nonprofit industries. FAACT is The Voice of Food Allergy Awareness.
You may reach Eleanor at Eleanor.Garrow@FoodAllergyAwareness.org.
Susan Kelly, BSN, RN Vice President of Education
Susan Kelly is a passionate food allergy advocate and educator from Lynbrook, New York (a village in Long Island). She has four daughters and is a food allergy and Eosinophilic Esophagitis parent. She co-leads the FAACT-recognized Friends Helping Friends Food Allergy Support Group, focused on providing food allergy education, support, and empowerment.
Susan is a graduate of the University of Scranton and was the recipient of the University’s 1996 Excellence in Nursing Award. She currently works for a board-certified allergist and immunologist and is a member of Sigma Theta Tau International Honor Society of Nursing. Her clinical background includes general medicine, cardiology, intensive care and emergency room nursing. She has worked at NYU Medical Center, Beth Israel Deaconess Medical Center, and St. Francis Hospital.
Today, Susan’s work includes writing, public speaking, and educating communities on the seriousness of food allergies as well as anaphylaxis recognition and response. She held Food Allergy Public Awareness Forums for her local assemblyman and has helped schools create and implement inclusive food allergy management and anaphylaxis policies, as recommended by the CDC’s voluntary guidelines for food allergy management in the school setting. In 2017, Susan was named the Lynbrook Community “Citizen of the Year” for her efforts. She blogs about food allergy life at www.MomNurseFoodAllergies.wordpress.com.
Susan successfully advocated for Lynbrook’s police officers to be trained in anaphylaxis recognition and response and to carry stock epinephrine auto-injectors. Susan was also instrumental in passing food allergy training legislation for restaurants in Nassau County. She was recently appointed as the Health and Wellness Chairperson for the Village of Lynbrook.
As FAACT’s Vice President of Education, Susan will oversee food allergy education in schools, support group development, and other education initiatives and will represent FAACT at medical conferences. Susan looks forward to continuing her mission of community health and wellness and maintaining her strong commitment to bringing more education and awareness on the issues that accompany food allergies to our families, communities, and schools with FAACT.
You may contact Susan at Susan.Kelly@FoodAllergyAwareness.org.