In 2013, then US president Barack Obama won praise for an out-of-the-box proposal. He introduced a law offering incentives to schools for maintaining an emergency supply of epinephrine auto-injectors (a medical device used to treat severe allergic reactions) and coming up with a plan to bring on board trained personnel to administer the life-saving medication to children in schools.
Parents with children who suffered from food allergies, one of the most common types of allergies in the country, lauded the initiative.
The reason: every year, over 2,00,000 people in the US require urgent medical care due to allergic reactions to food.
While bringing the law into effect, Obama revealed that his eldest daughter Malia Obama suffered from a peanut allergy.
Peanut allergy and tree nuts allergies (allergy to tree nuts like almonds, walnuts and cashews) are among the most common food allergies in the US, especially among children.
Signs and symptoms
“In one case, an eight-year-old boy from Bengaluru, to begin with, used to have rashes all over the body,” says Dr Nagendra Prasad, a Bengaluru-based allergy specialist. “He would also vomit after consuming peanuts. Subsequently, he had an episode of anaphylaxis after which he was admitted to the hospital. He was treated for the reaction and recovered. The parents of the boy had already noticed the symptoms and had come here just to confirm the diagnosis. In this case, the boy was initially allergic to peanuts and subsequently we found that he was allergic to pistachios and walnuts as well.”
Dr AB Singh, secretary, Indian College of Allergy, Asthma and Clinical Immunology (ICAAI) and former scientist emeritus, Institute of Genomics and Integrative Biology (CSIR-IGIB), Delhi, says nut allergy or peanut or tree nut allergies causes nasal or bronchial allergies and can eventually lead to anaphylactic shock — a serious condition which when left untreated even for 10 to 15 minutes can turn out to be life-threatening.
“Anaphylaxis is most commonly associated with allergic reactions to food allergens,” Dr Singh told Happiest Health.
Dr Prasad says there are eight to ten nuts that commonly cause sensitivity in various forms. “It may be manifesting in the form of reactions on the skin, or in the form of respiratory complications such as wheezing, sneezing and a runny nose. Any of these symptoms may manifest in these children if they are allergic to any type of food,” says Dr Prasad.
According to the American College of Allergy Asthma and Immunology (ACAAI) immunoglobulin E (IgE) are antibodies produced by the body’s immune system when one is exposed to an allergen. These antibodies then travel to the body’s cells that release chemicals, causing all the symptoms of an allergic reaction.
According to ACAAI, the symptoms of a peanut allergy include:
- Stomach cramps
- Shortness of breath, difficulty breathing
- Repetitive cough
- Tightness in throat, hoarse voice
- Weak pulse
- Pale or blue coloring of the skin
- Swelling of the tongue and/or lips
As for tree nut allergy, ACAAI says the nut allergies symptoms include:
- Abdominal pain, cramps, and vomiting
- Difficulty swallowing
- Itching of the mouth, throat, eyes, skin or any other area
- Nasal congestion or a runny nose
- Shortness of breath
Dr Singh, who is also the author of ‘Allergy and Allergen Immunotherapy: New Mechanisms and Strategies’ says that although there isn’t a particular age at which one develops a nut allergy, peanut and tree nut allergies are more common among children than among adults. “By the time they become adolescents, the peanut or tree nut allergy usually goes away. In some cases, it can continue into adulthood,” he says.
Diagnosis of nut allergy
Dr Singh says that a common misconception is that a food allergy can be diagnosed only using a blood test taken from a laboratory and without an allergist ‘actually examining the patient’.
“The most commonly used test to diagnose food allergies is the simple skin prick test which gives you a result within 10 to 15 minutes,” says Dr Singh.
He says another reliable type of test is the oral food challenge (OFC) test, where the person who suspects a food allergy is asked to take small amounts of the peanut or tree nut (suspected allergy-causing food) and find out at what point they begin to show symptoms of an allergic reaction. “That helps us determine the minimum amount of that allergen that the patient can tolerate. This test has to be done in a hospital environment so that any allergic reactions can be treated quickly. There is another type of test, called the in-vitro test, where the blood of the patient produces antibodies (like immunoglobulin IgE) against that particular food.”
“In cases where the suspected allergen is juicy in nature, such as an apple or a banana, we dip the needle into that substance and then prick the skin — this is called the prick-prick test,” says Dr Prasad.
Nut allergies treatment
Dr Singh says the best way to prevent an allergic reaction is to avoid consumption of the allergen. Dr Singh says that people who have been diagnosed with food allergies are also advised to always carry a vial of epinephrine with them.
“Epipens (epinephrine auto-injectors) are not widely available in India. The alternative that is available is the same drug, but in a vial. The patient and caregivers must know how to load it into the syringe and administer it,” says Dr Prasad.
Dr Singh says, “Unfortunately, even as per global standards, immunotherapy, as of today, is not advised in the case of food allergies. In immunotherapy, small quantities of the same allergen you are found to be allergic to is given in increasing doses and concentrations gradually, over the years. The process can last three to four years. There are chances of the person going into anaphylactic shock or developing other severe allergic reactions which may be difficult to recover from,” says Dr Singh.
Dr Singh says that although immunotherapy can reduce the symptoms and severity of the allergy in the case of allergic rhinitis, it is not recommended in case of food allergies.
Dr Prasad says that while earlier it was believed that children, especially infants, should not be given hard foods such as nuts at such an early age, as per the latest published data, nuts, especially peanuts and groundnuts, should be given at an early age, so children don’t develop sensitivity to the food later.
“There is no standard protocol for desensitizing patients to food types except in the case of milk, egg and peanuts. Desensitization is the process through which we take extracts of the allergen and administer it orally or in the form of drops or solids daily so that the body will develop a tolerance to the allergen,” says Dr Prasad.