Food Allergies: When Eating Is Risky : Part 2

by Food and Drug Administration (FDA)

(Page 2 of 3)

Injectable epinephrine is a synthetic version of a naturally occurring hormone also known as adrenaline. For treatment of an anaphylactic reaction, it is injected directly into a thigh muscle or vein. It works directly on the cardiovascular and respiratory systems, causing rapid constriction of blood vessels, reversing throat swelling, relaxing lung muscles to improve breathing, and stimulating the heartbeat.

Epinephrine designed for emergency home use comes in two forms: a traditional needle and syringe kit known as Ana-Kit, or an automatic injector system known as Epi-Pen. Epi-Pen's automatic injector design, originally developed for use by military personnel to deliver antidotes for nerve gas, is described by some as "a fat pen." The patient removes the safety cap and pushes the automatic injector tip against the outer thigh until the unit activates. The patient holds the "pen" in place for several seconds, then throws it away.

While Epi-Pen delivers one premeasured dosage, the Ana-Kit provides two doses. Which system a patient uses is a decision to be made by the doctor and patient, taking into account the doctor's assessment of the patient's individual needs.

Advice from Study

Hugh A. Sampson, M.D., and colleagues at Johns Hopkins University School of Medicine in Baltimore, Md., published a study of anaphylactic reactions in children in the Aug. 6, 1992, issue of The New England Journal of Medicine. The study involved 13 children who had severe allergic reactions to food: Six died, and seven nearly died. Among the study's conclusions:

Asthma, a disease with allergic underpinnings, was common to all children in the study.

Epinephrine should be prescribed and kept available for those with severe food allergies.

Children who have an allergic reaction should be observed for three to four hours after a reaction in a medical center capable of dealing with anaphylaxis.

Anne Munoz-Furlong, who founded The Food Allergy Network for people with food allergies in 1991 after struggling to deal with her own child's allergies, comments: "My youngest daughter was diagnosed with milk and egg allergies when she was 9 months old, nine years ago. We tried to lead a life around her restricted diet. For example, we had Jell-O mold for her first birthday because I didn't know it was possible to create a cake without milk or eggs. I knew there must be other families struggling with the same issues."

Finding the Forbidden

Because there is no "cure" for food allergies other than strict avoidance of an offending food, one of the biggest problems those with food allergies face is verifying whether a forbidden product is contained in a particular food. For example, in Sampson's study, all six deaths occurred because either the child or the parent was unaware the food contained a substance to which the child was allergic. Munoz-Furlong says the Nutrition Labeling and Education Act, which requires more complete food labeling, should greatly help people with food allergies to avoid dangerous foods. "The new labeling changes will make it easier for the consumer to readily identify things they could be allergic to," says Linda Tollefson, D.V.M., chief of the epidemiology branch at FDA's Center for Food Safety and Applied Nutrition. "Before this law was passed, true allergens were required to be on the label, but the exceptions were standardized foods, which will now have to list all ingredients."

According to Elizabeth J. Campbell, director of the center division of programs and enforcement policy, the principle underlying standardized foods originally was that people basically knew what was in various foods.

"Originally food standards were adopted to ensure uniformity. If you saw a product labeled mayonnaise, food standardization meant it had to be mayonnaise. People used to know what was in mayonnaise; nowadays they have to be told that mayonnaise contains both eggs and oil," Campbell says. "Years ago when the law was first written to provide for standards of identity for certain foods, it only required that optional ingredients be declared. The new law stipulates that all ingredients in standardized foods must be declared."

Campbell believes that once the labeling is in place, consumers will have the information they need to make correct food choices. "In most cases, ingredients have to be labeled simply because they are ingredients, not because they are unsafe," she stresses. "For those with food allergies, I think it is more of a patient education problem."

Food additives, such as sulfites and certain colors, can also cause problems for people sensitive to them.

"If you have a food allergy, you really have to alter your life," Tollefson says. "You have to really read labels, and really be careful about what you eat."

Steve Taylor, Ph.D., a professor and head of the Department of Food Science and Technology at the University of Nebraska in Lincoln, says the biggest problem for people with food allergies is restaurant food. Historically, restaurants have been regulated by local health departments and have not had to label foods. "For many restaurants, labeling of food products they serve would cause horrendous problems ... what about chalkboard menus? How would you include all the ingredients? Enforcement would be a nightmare," he admits.

But steps are being taken to better educate restaurant employees. The Food Allergy Network and The American Academy of Allergy and Immunology, along with The National Restaurant Association, recently produced a pamphlet on food allergies, which has been distributed to 30,000 members of the association. The brochure explains what restaurants can do to help customers who need to avoid certain foods, defines anaphylaxis, and advises employees on what to do if food allergy incidents occur. John A. Anderson, M.D., director of the Allergy and Immunology Training Program at Henry Ford Hospital in Detroit, says changes in food habits may be responsible for the feeling some physicians have that food allergies may be on the rise.

About the Author

www.fda.gov
FDA is A United States government body that oversees medical devices, including contact lenses, intraocular lenses, excimer lasers and eyedrops. In the US, these products must be approved by the FDA before they can be marketed.