Controlling Food Allergies

A Pound of Prevention
by
Charles R. Attwood, M.D., F.A.A.P.

was a severe asthmatic throughout my childhood, often missing several days of school each month. On many occasions this was complicated by pneumonia or bronchitis and I would be hospitalized and placed in an oxygen tent. My parents felt helpless, and I'm sure our doctor shared their concern. The only known treatment was an injection (sometimes several) of adrenaline when the gasping and wheezing got severe, and antibiotics, usually penicillin, for secondary infections. We were usually offered the encouraging words, "At least it won't kill you." In retrospect, I now understand that this was the doctor's attempt to compensate for his inadequate management of this miserable disease. I'm certain that it never occurred to him, or to my parents, that it may have been caused by something that I was eating; that it may have been preventable.

Even today, I can still remember the sensation of being unable to get enough air into and out of my lungs, though I haven't had asthma since leaving home for college at age 17. Many years later, while I was in a pediatric training program, I made the connection: Milk and dairy products, which I never really liked, had been discontinued when I left home for college. As a practicing pediatrician, I would see this relationship of asthma and several other allergic disorders to dairy products, repeatedly in the years to come. And now, after 35 years of general pediatric practice, I've come to the conclusion -- which is shared by many allergists -- that 6 out of 10 children are allergic to milk protein. Not all are asthmatics; many have recurrent middle ear infections, allergic rhinitis, and, especially in infants, chronic skin rashes, such as eczema. Older children and adults often manifest their food-related allergies as chronic bronchitis and sinusitis. But asthma itself may persist for a lifetime.

Milk and dairy products aren't the only foods capable of causing severe allergies in children and adults. Others are eggs, seafood, soybeans, peanuts, corn, tomatoes, and wheat, to name a few. Allergic disorders are caused by proteins known as allergens, and are therefore commonly associated with foods of high protein content, especially of animal origin. Remembering my experience as a child, I've always discontinued dairy products as a first step for my severely allergic patients, before subjecting them to a full allergic workup, which may include a serum IgE level and skin-testing. This simple approach often surprises the whole family, who have been used to the constant and disappointing use of aerosol inhalations, shots, drugs, and sleepless nights. Why hasn't this been done before, they ask? Good question; I've had dozens of severe asthmatics who've been treated by physicians unsuccessfully for years. Many physicians are, unfortunately, trained only to treat illnesses; they're not as inclined to approach allergies as a preventable disorder.

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More protein may mean more allergy

FOOD Protein . . . . . . . . . . . . . . . . . g\serving
Corn, (3 1/2 oz).......................................3
Milk, skim (8 oz)..................................... 8
Eggs (2).................................................12
Soybeans (1/2 cup cooked)....................17
Brazil nuts (3 1/2 oz)...............................14
Shrimp (3 1/2 oz)....................................21
Peanuts (3 1/2 oz)...................................26
Pork (3 1/2 oz).......................................30

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This attitude may necessarily change in the near future, because the number of asthma deaths have risen sharply during the last decade, both in this country and in Europe. The increasing use of repeated doses, sometimes daily, of such drugs as albuterol, a bronchial dilator has corresponded to this increase in fatalities, especially in the inner cities of America.

Since asthma is an allergic disease in most cases, along with a secondary inflammatory change in the bronchioles, the use of inhaled corticosteroids regularly, as a prevention of the severe attacks of wheezing, is becoming a standard medical procedure for severe asthmatics. This has been more effective than waiting for the shortness of breath to begin, but obviously does nothing to eliminate the underlying cause.

Food is not the only allergen-containing material that precipitates asthma and the other allergic diseases. Inhalants, such as house dust mites, moulds, and pollens often play an important role. Many individuals are allergic to several foods as well as several inhalants. Unlike food, many of these inhalants cannot easily be avoided, so there may be a need for weekly desensitizing injections of an extract which contain gradually increasing doses of these offending substances. Food allergies are simpler to prevent; after they're identified, they're just avoided. Sounds simple? It was until March of this year, when stories about genetically engineered foods began appearing on the front pages of newspapers throughout the country.

Genetic engineering of foods, another trick against Mother Nature, is almost certain to bring with it mass confusion about food allergies. The first attempts to introduce the genes of Brazil Nuts, with its over 1,000 proteins, into soybeans, were successful in creating a more protein-dense soybean. But the thousands of people who were allergic to Brazil nuts would now, according to early clinical testing, be allergic to this new variety of "super soybean." A likely moratorium may halt this new product until the allergy consequences are fully known. But we can be assured that this is only the beginning; food manufacturers are planning to introduce these new superfoods by the hundreds, each containing the genes of many other plant species. Preventing food allergies would then be possible, only when consumers make their choices from natural foods.

So the key to food allergy management still remains the same. We must follow nature's rules and prevent, rather than treat them. Why go on living with these disorders, allowing them to reappear regularly, then trying to treat them, always with questionable results. On the other hand, it's a bit hasty to go immediately through a comprehensive allergic workup involving skin testing. Save this for later. First, pick the top food allergens, dairy products, eggs, meat, seafood, soybeans, corn, and wheat. Remove them from the diet, one at a time, for 4 to 6 weeks, beginning first with dairy products. This can be done with the help of a food dairy, a daily log of food eaten and the frequency of symptoms.

Now, back to that villain which causes the majority of allergic disorders: milk and other dairy products. Here again, always take the simplest step first. It's usually unnecessary to avoid every conceivable food that contains the slightest amount of dairy products. Fortunately, small amounts cooked with other foods, and in commercial products, are often tolerated. Just remove from the diet the obvious sources of milk, cheese, and yogurt. If you are rewarded with noticeable improvement, then you can refine the procedure by carefully reading labels. Talk with your pediatrician or family physician. Tell him you're ready for a pound of prevention.

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