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Taking a bite out of food allergies

Training wheels. Soccer cleats. Food allergies.

Unfortunately, you’re guaranteed to outgrow only the first two items on that list.  A significant portion of food allergies extend into adulthood, and some adults develop an allergy to a food they once consumed without a problem a.  Today, an estimated 9 million – or 4 percent – of U.S. adults have food allergies, and the incidence is on the rise.

“In spite of intense research into the cause of food allergies, we don’t know why food allergies are so common, and the incidence seems to be increasing,” says John Leung, MD, director of the Food Allergy Center at Tufts Medical Center and co-director of the Food Allergy Center at Floating Hospital for Children.

Some scientists speculate that it’s related to changes in how food is processed. Others hypothesize that modern-day hygiene limits childhood exposure to infectious agents, compromising immune system development – triggering immune responses to substances our bodies would normally ignore.

Regardless, food allergies are real, can be life-threatening and sometimes require lifelong management. They also can be challenging to accurately diagnose. Fortunately, Tufts Medical Center’s Food Allergy Center provides a comprehensive, expert resource for the region’s physicians and their adult patients. A collaborative effort between the departments of Allergy and Gastroenterology, the Center provides state-of-the-science diagnostic and treatment services as well as educational resources.

Dr. Leung himself has a rare skillset that distinguishes the Center. Board-certified in Allergy and Immunology and Gastroentrology (as well as Internal Medicine), he has a broader problem-solving perspective than most single-discipline subspecialists.

“Training in two subspecialties gives me the ability to view a problem from multiple angles,” he explains. “This is particularly helpful in cases when symptoms are non-specific and a diagnosis is not straightforward.”

The Center’s advanced diagnostic testing options include supervised oral challenge – the gold standard for confirming or ruling out food allergies – during which the patient consumes the problem food in slightly increasing amounts under close physician monitoring. Skin-prick testing and blood tests may also be used to support a diagnosis.

Diagnostic testing can help identify whether an issue is a food allergy or food sensitivity. “Contrary to the common belief that most adverse food reactions are allergic/immunological in nature, less than a fifth actually are,” he points out. “It is of paramount importance to distinguish food allergy from food sensitivity because their nutritional management is quite different.”

For example, patients with cow’s milk allergy must avoid all dairy products because they can cause potentially life-threatening anaphylaxis, while patients with lactose intolerance are often encouraged to consume a tolerable amount of dairy products to achieve their nutritional goals, Dr. Leung explains.

Notably, an estimated 40 percent of patients with true food allergies also have other allergies, such as asthma, eczema and allergic rhinitis. As a result, the Center works closely with other Tufts Medical Center subspecialties, including pulmonology, dermatology and ENT, ensuring the most comprehensive management of each patient’s care – a level of multidisciplinary collaboration that sets the Tufts Medical Center program apart.

Because there is no cure for food allergies, strict avoidance of the offending food is the cornerstone of treatment. The Center’s staff can advise not only how to avoid the problem food (soy, for example, is ‘hidden’ in many foods) but also avoid nutritional deficiencies. Other topics include dining out, alcohol and food allergies, and intimate contact (people who have eaten peanuts or peanut products should brush their teeth and wait a few hours before kissing someone with a peanut allergy, for example).

In case of accidental exposure, antihistamine, corticosteroids, asthma medication or an epinephrine autoinjector are used to prevent dangerous reactions. This further underscores why education and nutritional guidance are so imperative – and why they are an integral part of the Center’s services.

“We use teaching videos and as much face-to-face time as necessary to make sure all concerns and questions are addressed,” Dr. Leung says.

In addition, all Center patients receive a food allergy action plan – written instructions for what to do in different scenarios. This plan not only guides the patient but also family, friends and co-workers to recognize food allergy symptoms early and administer epinephrine if the patient cannot.

Dr. Leung wants referring physicians to know that he and his colleagues at Tufts Medical Center’s Food Allergy Center are here to help when patients present with suspected or established food allergies – and they do so in a timely fashion. “I pride myself on getting back to referring physicians within less than a week of seeing their patients, and we respond to emails and phone calls from patients within 24 hours – faster if it is urgent.” 

To refer a patient, or to learn more, please call 617-636-3266.

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