1. What is an allergic reaction?

An allergic reaction is when a person’s immune system overreacts to an otherwise harmless substance (ex. Dust mite and peanut). In an allergic person, these substances are referred to as allergens. When a person is exposed to an allergen, his body produces antibodies that trigger the release of chemicals in the body like histamine, that causes the symptoms of allergies.

2. How do allergic reactions look like and what are the signs and symptoms?

Allergic reactions vary, depending on several factors such as the allergen, the area of the body it affects, and the response of the person’s immune system. Symptoms can range from mild to severe. For example, food allergens can cause localized itching of the mouth, but they may also cause dangerous swelling of the tongue and the throat. Inhaled allergens like dust and pollen may cause itching of the eyes, sneezing, and wheezing. Some persons may be allergic to medications what can manifest as itchy rashes, hives, flushing of the skin, appearance of blisters, and swelling of the eyelids and the lips. Difficulty of breathing can occur in severe allergic reactions and can cause a potentially fatal condition called anaphylaxis.

3. What are the causes of allergies?

Allergy can affect anyone. Some people are more prone to allergic problems when it runs in their family, while others may have no family history at all. People with other medical conditions such as asthma, eczema, chronic lung infections, and those with diseases that require intake of multiple drugs are more prone to developing allergies. Anything can be an allergen, Things that people are commonly allergic to include food (peanut, egg, soy, and shellfish), dust mite, tree and grass pollens, insect venom, medications, animal dander, and chemicals (hair dye, detergents).

4. How are allergic reactions diagnosed?

Doctors can diagnose your allergies based on your symptoms. Your doctor may also perform tests (skin prick test, blood allergy test, and patch test) to find out what you are allergic to and how severe your allergies are.

5. How are allergic reactions treated?

Treatment depends on what your allergens are and how severe your reactions are to them. In general, you can avoid having allergic reactions by avoiding the allergens that cause them. Your doctor may recommend having an “allergy diary” and medications to relieve your symptoms. Allergists may recommend shots to certain allergens like dust and pollen.

6. How can allergic reactions be prevented?

A person with allergies should make a list indicating what he or she is allergic to and the type of allergy that he or she has. It is also helpful to inform their families, caregivers, schools, employees, and friends of what they are allergic to. Your doctor may also provide you with medications that you should carry with you at all times in case of an emergency. Early recognition of an impending allergic reaction will also prevent fatal complications.

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Diet is frequently associated in various skin disorders. One way in which diet affects skin disorders is the concept of food allergy. Food allergy is defined by the US National Institute of Allergy and Infectious Diseases as: “an adverse health effect arising from an immune response that occurs reproducibly on exposure to a given food”. Simply put, this occurs when there is a breakdown of the body’s tolerance to food ingested^1,2. Typical manifestations of a food allergy are skin reactions such as hives and itchiness, respiratory tract symptoms such as difficulty of breathing, and gastrointestinal tract symptoms such as vomiting and diarrhea. A severe and potentially fatal reaction called anaphylaxis, can also be experienced. While many advances have been made in understanding the mechanism, treatment and prevention of food allergy, the mainstay of treatment remains to be avoidance of the food allergen/s^1-5.

Allergenic foods comprising more than 85% of food allergy are egg, milk, peanut, tree nuts (walnut, cashew, pistachio), fish, shellfish, sesame seed, soy, and wheat. Several studies identify egg allergy as the most prevalent^4,5. In adults, allergies to certain fruits and vegetables are common³. Usually, many people outgrow their food allergies over time, such as hen egg and cow milk allergies. In contrast, peanut and tree nut allergies, along with shellfish allergy, are known to persist throughout life^1-3. In addition, nickel is also a very common allergen and this could be found in certain foods such as oatmeal, beans, peas, soybeans, shellfish, and chocolate^2,4,6.

A hypoallergenic diet is a diet composed of foods low in allergenicity. Specifically, it is free from soy, nuts, egg, dairy, corn, beef, gluten, shellfish, and citrus fruits. That said, patients on a strict hypoallergenic diet should be carefully monitored and properly managed so as to avoid nutritional deficiencies. In children, food allergies to milk, egg, soy, and wheat tend to disappear during late childhood and these specific foods may eventually be tolerated after 1 to 2 years. As mentioned, allergies to peanut, tree nuts, and shellfish typically persist and may be lifelong^1-4.

There are certain skin diseases that can benefit from a hypoallergenic diet. Several studies have shown that certain food allergens can lead to an exacerbation of a patient’s dermatitis. Specifically, food allergy has been shown to be present in 20 to 80 percent of patients with atopic dermatitis (AD). Thus, a hypoallergenic diet may be helpful in patients with AD. Other skin diseases that may benefit from a hypoallergenic diet are systemic contact dermatitis (SCD) and allergic contact dermatitis (ACD). Furthermore, acute vesicular hand dermatitis may benefit from a diet low in nickel-rich foods^2,4,6. 

In order to find out if one has a food allergy and identify the specific food/s one is allergic to, one may consult with an allergologist. A detailed history and thorough physical examination are important, then skin prick testing (SPT) or radioallergosorbent test (RAST) can be done to identify potential food allergens. Once potential allergens have been identified, one must always be vigilant in checking food labels and ingredients in order to prevent the unfortunate manifestations of food allergy. In the event of an allergic reaction, rescue medication should always be available^1-6.

References:

1. Renz, Harald, et al. “Food Allergy.” Nature Reviews, vol. 4, no. 17098, 4 Jan. 2018, pp. 1–20., doi:doi:10.1038/nrdp.2017.98. 
2. Katta, Rajani, and Megan Schlichte. “Diet and Dermatitis: Food Triggers.” The Journal of Clinical and Aesthetic Dermatology, vol. 7, no. 3, 2014, pp. 30–36. 
3. Chapman, Jean, et al., editors. “Food Allergy: A Practice Parameter.” Annals of Allergy, Asthma & Immunology, vol. 96, Mar. 2006, pp. 1–68. 
4. Dhar, Sandipan, and Sahana Srinivas. “Food Allergy in Atopic Dermatitis.” Indian J Dermatol, vol. 61, 2016, pp. 645–648. 
5. Waserman, Susan, and Wade Watson. “Food Allergy.” Allergy, Asthma & Clinical Immunology, vol. 7, no. Suppl 1, 2011, pp. 1–7. 

Kaimal, Sowmya, and Devinder Thappa. “Diet in Dermatology: Revisited.” Indian J Dermatol Venereol Leprol, vol. 76, no. 2, 2010, pp. 103–116.

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