Debunking 11 food allergy myths

Key takeaways:

• Misconceptions about food allergies abound, including those that conflate allergy with intolerance, misunderstand the role of IgE and concern food allergy diagnosis.
• Correct diagnosis is critical for patients.

Editor’s Note: In Healio Allergy/Asthma’s column, “Food Allergy: Fact vs. Fiction,” Douglas H. Jones, MD, breaks down what’s true and what’s myth for a variety of topics related to food allergies. If you have a question you would like answered in this column, email Jones at rmaaimd@gmail.com or Sasha Todak at stodak@healio.com.

Food allergies affect millions of people around the world, and yet there are still many misconceptions and myths surrounding them.

I want to tackle some of the most common food allergy myths and provide accurate information to help you better understand these conditions.

Myth 1: Food allergies and intolerances are the same.

Fact: Food allergies and food intolerances are distinct. Food allergies involve the immune system’s response to specific proteins in food, triggering symptoms that can range from mild to severe and can be potentially life-threatening. Food intolerances, on the other hand, typically involve digestive issues without an immune response and are not going to cause immediate life-threatening reactions. They primarily cause gas, bloating, diarrhea and, in some cases, joint pains, headache and brain fog.

Myth 2: Food allergies are always IgE-mediated.

Fact: Although most food allergies are mediated via the immune system and a protein called immunoglobulin E (IgE), there are non-IgE-mediated food allergies that can also be potentially life-threatening. An example of this is food protein-induced enterocolitis syndrome, or FPIES. This can manifest as severe vomiting and diarrhea and can be dangerous when there is rapid volume depletion in the person.

Myth 3: Food allergy test alone yields the diagnosis.

Fact: Skin prick tests and blood tests are just one part of making a food allergy diagnosis. The tests need to be interpreted alongside a person’s medical history and other tests, such as oral food challenges, to provide an accurate diagnosis.

Along these lines, tests should be targeted and ordered according to the patient’s history. The tests need to be interpreted in the context of the food being tested and the history of the patient. Broad food allergy panels are not appropriate and discouraged as they have a high false-positive rate.

Further, nonvalidated tests such as IgG testing have not been shown to correlate clinically with food allergy or food intolerances. In fact, IgG food testing is more a measure of exposure and tolerance.

Myth 4: Food allergies are always outgrown.

Fact: Although some children may outgrow allergies to milk, eggs, soy and wheat, allergies to peanuts, tree nuts, fish and shellfish tend to persist into adulthood. Interestingly, the percentage of children outgrowing food allergies by age 5 years is decreasing even for milk, eggs, soy and wheat. Consulting an allergist and undergoing proper testing is essential to determine whether an allergy has been outgrown and how to potentially reintroduce this food into the person’s diet.

Myth 5: Small amounts of allergenic foods are safe.

Fact: For individuals with severe allergies, even trace amounts of allergenic foods can trigger life-threatening reactions. Strict avoidance is crucial to prevent such reactions.

Myth 6: Natural or organic foods don’t cause food allergies.

Fact: Natural or organic foods can still cause allergic reactions. The presence of allergenic proteins in certain foods is not related to their cultivation methods. People will still react to farm-fresh eggs as much as commercial eggs.

Myth 7: Cooking the foods can eliminate the food allergies.

Fact: Cooking may reduce the allergenic potential of some foods, but it doesn’t eliminate allergens entirely. Some people with allergies react to even well-cooked forms of allergenic foods. Some patients may tolerate milk or eggs in baked goods, but not in straight forms. However, some may not tolerate any version of milk or eggs.

Further, there is a form of food allergy called oral-allergy syndrome or food-pollen syndrome where people may experience oral or gastrointestinal symptoms from certain fresh/raw fruits and vegetables but tolerate them cooked or processed. To determine what foods or version of the foods need to be avoided, a careful history is needed along with appropriate testing and a knowledge of the nuances of the foods and potential cross-reactivities. An allergist has specialized training in this area and patients should be referred so they know what they can and can’t eat safely.

Myth 8: It is fine to recommend diphenhydramine as first-line treatment for food allergic reactions.

Fact: Diphenhydramine, sold by the brand name Benadryl (Johnson & Johnson) among others, plays no role in treating food allergic reactions. It should never replace injectable epinephrine as first-line treatment. Advising patients to start with diphenhydramine and then waiting to see if a reaction worsens is a recipe for catastrophe. Injectable epinephrine is the first-line treatment. Diphenhydramine also has side effects, such as somnolence, that can be detrimental in an acute allergic reaction. When someone is reacting, we need them alert and awake, not falling asleep.

Myth 9: Food allergies only develop in childhood.

Fact: Although many allergies do develop during childhood, adults can also develop new allergies. It’s important to recognize the possibility of developing allergies at any age. Current United States data would suggest one in 13 children have food allergies and one in 10 adults have food allergies. Interestingly, almost one in 20 people think they have food allergies.

Myth 10: Previous reactions predict future ones.

Fact: Severity of reactions are unpredictable. A history of mild reactions does not predict that future ones will be mild. Further, reactions do not necessarily worsen with each exposure. The immune system may be more primed, but many factors go into reaction severity such as hormones, infections, underlying conditions such as asthma and eczema and how well they are controlled, medication use, last consumption of food, etc. As of now, there is no cure for food allergies. Strict avoidance and having an emergency action plan in place are crucial for managing allergies effectively.

Myth 11: Higher numbers on a food allergy test indicate more severe allergy.

Fact: Food-specific IgE numbers do not indicate severity. Rather, they indicate likelihood of reacting on exposure. It does not make a diagnosis (see previous myth) and it does not predict the severity of a reaction.

Understanding the truth behind these common food allergy myths is essential for the well-being of individuals living with allergies and those around them. Accurate information can help create a safer environment and foster empathy and support for those managing food allergies.

Correct diagnosis is critical for patients. A food allergy diagnosis is a life-altering event for not only the patient, but the family. It changes every second of every day in a person. It is important to make an accurate diagnosis so that proper education and preparation can be given along with an emergency plan and medications. It is important that patients also not unnecessarily avoid foods to which they are not allergic. This can have several detrimental effects on the patient and family and potentially put them at more risk of developing an allergy to that food.

Lastly, there are treatment options available now such as oral and sublingual immunotherapy. These treatment measures address the underlying problem and change the immune system in a beneficial way so that reaction thresholds are increased.

For more information:

Douglas H. Jones, MD, FAAAAI, FACAAI, is cofounder of Global Food Therapy, Food Allergy Support Team and OITConnect, the director at Rocky Mountain Allergy at Tanner Clinic, and a Healio Allergy/Asthma Peer Perspective Board Member. He can be reached at rmaaimd@gmail.com or on Instagram @drdouglasjones.