Allergy food hierarchy list

The "Allergic Food Hierarchy Table" is a food allergy risk stratification tool commonly used by allergy departments and clinical nutrition departments. The core logic is to sort from high to low the probability and severity of triggering allergic reactions in the general population. Currently, mainstream domestic practice is divided into four levels: extremely high risk, high risk, medium risk, and low risk. The core function is to serve as a reference for parents and allergic people in the risk assessment period during the supplementary feeding period, so as to avoid blindly touching allergens and not daring to eat anything to cause nutritional deficiencies.

I met a mother a while ago. Her baby just turned 6 months old. She came to the outpatient clinic with a thick old parenting book and asked. She said on the Internet that eggs and shrimp are highly allergic. Can she wait until the baby is 2 years old to add more? In fact, the most practical thing about this table is that it saves you the trouble of searching for miscellaneous information. You can first have a rough risk profile and then adjust it based on your own situation. There is no need to adhere to it as an imperial edict.

Let’s first talk about the extremely high-risk category that everyone is most concerned about, which is the category that clinically triggers the highest proportion of severe allergies such as laryngeal edema and anaphylactic shock. It should be mentioned here that the statistical data in different regions are really quite different: in the version of the European and American Allergy Association, peanuts and tree nuts are firmly ranked in the first echelon. Looking at the domestic clinical data in the past five years, the top three are fresh milk and egg white. , shelled seafood (shrimps, crabs, shrimps, etc.), I was an intern at the outpatient clinic last week, and I picked up three children in the morning whose faces were swollen and breathless after eating steamed egg whites. Basically, they were force-fed by the elders who thought that "eggs are a good supplement, so they should be eaten early and more." There is another special thing on this level: wheat. Ordinary people will most likely be fine if they eat it. However, if a small number of people exercise within 6 hours after eating wheat, it will induce "wheat-dependent exercise-induced allergy", and severe cases may also lead to shock. For these people, wheat is directly at an extremely high risk level, so this watch is never fatal and must be adjusted based on personal circumstances.

Speaking of this, some people must ask, should we wait until the baby is older to eat extremely high-risk foods? Nowadays, the academic circles are quite quarrelsome about this matter: old-school clinicians will recommend that high-risk babies with a family history of allergies try to avoid this layer of food before the age of 3 to avoid triggering acute allergies. ； However, the updated guidelines of the European Academy of Allergy and Clinical Immunology (EAACI) in 2022 instead recommend that high-risk babies can try diluted egg whites and peanut butter in small amounts after adding complementary foods for 6 months. As long as there are no abnormalities after the first try, regular small amounts of exposure can reduce the probability of subsequent sensitization by 70%. My advice from my tutor when I go out to the clinic is not to blindly follow the trend of adding early or late. First, do a serum-specific IgE test for your baby. If the IgE value of the corresponding food is lower than 0.35IU/ml, try a small amount. There is no harm in being more stable.

The level one level below the extremely high risk level is the high-risk level. This level is basically the one that everyone encounters the most every day, such as fuzzy tropical fruits: mango, pineapple, kiwi, fresh nuts (fresh walnuts, fresh cashews, etc.), and insect proteins such as silkworm pupae and bee pupae. Last year, a high school classmate of mine came to me and said that after eating half a mango, his whole mouth was swollen like a sausage, and he could not even speak. This is typical mango contact dermatitis. Most of the food allergens in this layer are plant proteases or skin irritants. Many people are not really allergic, but just have poor mucosal tolerance. For example, if the mango is heated and then eaten, many people will not have a reaction.

Next down is the medium-risk layer. These foods have a lower probability of allergy. Even if they trigger reactions, they are basically mild symptoms such as rash and mild diarrhea. Common fruits with small fluff such as peaches, apricots, and strawberries, miscellaneous beans such as soybeans and green beans, and freshwater fish such as bass and crucian carp are all on this layer. A patient once told me that he gets hives when eating fresh strawberries, but eating dried strawberries and strawberry jam is completely fine. This is because the salicylic acid and active protease in fresh strawberries are allergens and are inactivated after processing, so they will not trigger reactions.

Everyone is familiar with the low-risk tier with the lowest risk, which is the category that most people will not be allergic to throughout their lives, such as staple foods such as rice and millet, common light vegetables such as cabbage, radish, and winter melon, as well as common temperate fruits such as apples and pears, and common poultry and livestock meat such as pork and chicken. But it is not 100% safe. I met a patient who was allergic to rice two years ago. He had diarrhea after eating a mouthful of rice and could only eat millet and quinoa as staple food all year round. The probability of this rare situation is about one in a million. If it really happens, you can only adjust the level according to your own situation.

Many people ask how to use this watch? Let me give you the most practical method: If you have suddenly developed urticaria or unexplained diarrhea recently, and you suspect it is a food allergy, first classify all the foods you have eaten in the past month according to this level, and first stop all foods in the extremely high-risk and high-risk levels. After 1-2 weeks, if the symptoms subside, then add them one by one starting from the low-risk level, each time Add one type of observation for 3 days. If there is no reaction, add the next one. It is much more reliable than the food IgG intolerance test you go to the market for, which costs hundreds of dollars. Oh, by the way, the food IgG test is not recognized by the international allergy community at all. If you find out a lot of "intolerances" that make you taboo, it is basically an IQ tax.

To be honest, this table is essentially a reference tool, just like the sweetness grading in a milk tea shop. Most people choose 30% sugar and don’t go overboard. But if you are addicted to sweetness or are afraid of sugar, you can adjust it yourself. There is no standard that must be followed. After all, everyone’s immune system is weird. Some people go to the hospital after touching a peach, while others eat silkworm chrysalises and bee pupae with no problem. If you really suspect an allergy, keep a food diary for 3 consecutive days and then see an allergist at a regular hospital. It is much more reliable than blindly trying to avoid dietary restrictions based on the table.