Food allergies

People who have been diagnosed with IgE-mediated immediate food allergy and have experienced severe allergic reactions such as laryngeal edema/anaphylactic shock must strictly avoid allergenic foods for life. There is no universal safe method of "eating a small amount and adapting slowly"； The eating plan for people with mild to moderate non-severe allergies and special age groups must be formulated under the full supervision of an allergist. Do not try it on your own.

Not long ago, I met a 12-year-old boy in the clinic. He had a history of cashew nut allergy for 3 years. He had urticaria after eating cashew nuts when he was a child. His grandma always thought that "it will be better if the child grows up and his immunity is strong." So she stuffed the child with half a salt-baked cashew nut while his parents were not at home. , but in less than 10 minutes, the child complained that his throat was tight and he couldn't breathe. When he was delivered, his lips were purple, and he was rescued by emergency injection of epinephrine. The grandma cried at the door of the emergency room and slapped her mouth, saying that she thought it was just a rash and nothing was wrong.

At this point, someone may ask, isn’t it said that there is desensitization treatment now? Indeed, there are now two completely different intervention ideas in the academic community. One is the "complete avoidance principle" that has been used for decades. As long as the allergen is found, it is 100% not to touch it, especially for people with a history of severe allergies. The core logic of this school is that there is no absolute relationship between the severity of allergic reactions and the intake. For some people, even just the residue of allergenic food may induce shock. Complete avoidance is the only 100% safe solution. The other school is the oral immune tolerance treatment that has become popular in recent years. To put it bluntly, in medical institutions with emergency conditions, allergens are gradually ingested starting from a dose of a few micrograms, slowly allowing the overactive immune system to "familiar" with the substance and no longer launch an attack. There are indeed many successful cases of this program. Many children who were allergic to eggs and milk when they were young can eat normally after half a year to a year of treatment, but the controversy is not small: Firstly, the overall success rate is only about 60%. Secondly, if the treatment is interrupted midway, the allergic reaction is likely to be more severe than before. The most important thing is that this program has strict applicable groups. People with severe allergies and immune deficiencies cannot touch it at all. It is definitely not the "just increase the dosage slowly at home" as mentioned on the Internet. Not long ago, there was a food blogger who desensitized himself to peaches at home. After eating less than half a pill, he was admitted to the ICU, just to gain traffic.

Oh, by the way, there’s another point that people tend to get confused about: Don’t mistake food intolerances for allergies. Many people say they are allergic to these things when they drink milk and have diarrhea or eat seafood and get acne. In fact, more than 80% of them are food intolerances - the two are completely different in nature. Allergy is when the immune system treats normal food as a foreign invader and attacks it, which can range from a rash to a rash. In severe cases, shock may occur. Intolerance is a lack of corresponding digestive enzymes in the body. For example, lactose intolerance means a lack of lactase. If you drink milk and cannot digest it, you will have diarrhea. This has nothing to do with the immune system. If you drink Shuhua milk, take lactase, and then drink milk, nothing will happen. You cannot completely quit milk. I am lactose intolerant, and I will have diarrhea after drinking half a cup of iced milk, but I can drink a whole box of warm Shuhua milk without any problem. My friends used to laugh at me as having a "selective milk allergy."

Another pitfall that everyone easily steps into is invisible allergens. Many times you are allergic even though you haven't eaten anything that is allergic to you. When you look through the ingredient list, you find that the merchant didn't label all the ingredients. There was a patient who was allergic to peanuts. He ate tomato hot pot at home and got wheezes all over his body after just two bites. After much searching, he discovered that peanut butter was added to the hot pot soup base to enhance the flavor. The ingredient list only said "compound seasoning" and did not mention peanuts at all. There is also the milk tea that everyone loves to drink in the summer. Many milk tea tops and fruit tea bases are added with soy protein and chopped nuts to improve the taste. If you are allergic to soybeans or nuts, be sure to ask if these ingredients are present when ordering. Don’t be too troublesome. We encounter two or three cases every week in the summer of people who are allergic to milk tea.

As for "probiotics improve allergies" and "Chinese medicine regulates allergies" that are very popular on the Internet, there is currently no unified conclusion in the academic community. Some small-sample studies have shown that specific strains, such as Lactobacillus rhamnosus GG, can alleviate mild to moderate milk allergy in some children, but larger clinical trials have shown that there is no difference between the effect and the placebo. Don’t just buy “allergy-specific probiotics” that cost hundreds of dollars and pay IQ tax. If you really want to try it, you have to ask your attending doctor first. Others say that "allergy means low immunity, just take more protein and exercise more" is even more nonsense. Allergy is essentially an over-activation of the immune system, which has nothing to do with low immunity. Indiscriminate consumption of health care products that improve immunity may make the immune system more active and allergic attacks more frequent.

Anyway, every time I teach allergy patients to the end, I always add: Everyone’s immune system is unique. Don’t listen to relatives and friends who say, “My child is also allergic and nothing will happen to him.” Eating is a small matter, but life is a big matter. There is no point in taking risks just for one bite.