Allergies & Intolerances
Some people react badly to certain foods and these reactions are broadly divided into allergies and intolerances.
For allergy sufferers their body will react aggressively and potentially fatally to exposure to the allergen and the reaction will often become more acute the more often the sufferer is exposed. Mild allergy symptoms range from some digestive discomfort, watery eyes, itching and hives to light-headedness. A more severe form of allergic reaction known as anaphylaxis is a medical emergency and is characterised by more severe rash and swelling as well as a sudden drop in blood pressure which can cause light-headedness, increased heart-rate, wheezing or difficulty swallowing, an impending sense of doom, and possibly more severe digestive symptoms such as vomiting.
If you are in doubt of the severity of a reaction do not hesitate to call 999 as symptoms can develop very quickly and are potentially fatal!
Usually allergy testing with a specialist is not available on the NHS unless you have had an anaphylactic incident however you may be able to get testing directly through your GP.
Food intolerances cause less acute symptoms which can have long term effects. Sufferers can experience symptoms including joint pains, bloating and fatigue. These symptoms do not always appear immediately and most cannot be diagnosed though medical tests.
What’s the Difference
In a food allergy the body produces Immunoglobulin E antibodies when foods are consumed. This is because the body believes that the foods are damaging and produces IgE as a response. It is the IgE, histamine and other enzymes and chemicals produced by the body that cause the symptoms of the attack. In an allergy test where blood samples are taken it is the IgE that is measured. A skin prick test is the most commonly used method of allergy testing and this measures the histamine response to various proteins.
In a a food intolerance / sensitivity it is not an antibody reponse that occurs and therefore it is more difficult to determine if someone has an intolerance. Ways to overcome this include an exclusion diet (cutting out the foods for 2 weeks to check if the symptoms disappear and them reintroducing the foods and checking if the symptoms reappear) or a food sensitivity test
Common Allergies and Sensitivities
In theory, any food can cause a food allergy. But in fact just a handful of foods are to blame for 90% of allergic reactions to food. These foods are known as the ‘big eight’. They are:
- peanuts (groundnuts)
- nuts from trees (including Brazil nuts, hazelnuts, almonds and walnuts)
- shellfish (including mussels, crab and shrimps)
In children, most allergic reactions to food are to milk, peanuts, nuts from trees, eggs, soya and wheat. Most children grow out of most allergic reactions to food in early childhood. In adults, most allergic reactions are to peanuts, nuts, fish, shellfish, citrus fruit and wheat.
Here are some more common and some unusual allergies.
A number of cereals have been reported to cause allergic reactions in sensitive children and adults. These include wheat, rye, barley, oats, maize (corn) and rice. Sometimes people can react to more than one type of cereal.
Allergy to coconut is rare in the UK, but coconut can cause allergic reactions (including anaphylaxis) in people who are sensitive. A small number of people who are allergic to nuts have reacted to coconut. It might also cause reactions in people who are allergic to latex.
Gluten is the mixture of proteins found in some cereals, including wheat, rye and barley. Gluten intolerance, or coeliac disease, is a lifelong disease, which is caused by sensitivity to gluten. It can damage the lining of the small intestine, which stops the body from absorbing nutrients, causing diarrhoea and eventually malnutrition. Coeliac disease can sometimes run in families.
Until recently, coeliac disease was only thought to affect about one in 1500 people in the UK. Now we think it’s more common, and better tests for the condition have shown that it might affect as many as one in 300 people in the UK. In some areas of the world it seems to be more common, for example in parts of Ireland as many as one in 100 people may be affected.
Coeliac disease is often diagnosed after weaning, when cereals are introduced into the diet, but it can also be diagnosed at a later age. Research suggests that waiting until a baby is about four to six months old before starting to give them wheat makes it less likely that they will develop coeliac disease.
If it isn’t treated, coeliac disease can lead to anaemia, bone disease and, on rare occasions, certain forms of cancer. It can also cause growth problems in children. People with some medical conditions might be more likely to develop coeliac disease, for example Type 1 diabetes, thyroid problems, ulcerative colitis and certain neurological disorders, such as epilepsy. There is no cure for coeliac disease. The only way to avoid the symptoms is not to eat foods containing gluten, such as wheat, rye, barley, malt, malt extract, malt flavouring, beer and lager. Processed food can often contain hidden gluten, but a large number of gluten-free products, such as bread, cakes and pasta are now available.
Like most food allergies, egg allergy is more common in childhood and about half the children who have it will grow out of it by the age of three. In a few cases, egg allergy can cause anaphylaxis. Egg allergy is mainly caused by three proteins in the egg white called ovomucoid, ovalbumin and conalbumin. Cooking can destroy some of these allergens, but not others. So some people might react to cooked eggs, as well as raw eggs. Occasionally someone might react to egg because they have an allergy to chicken, quail or turkey meat, or to bird feathers. This is called bird-egg syndrome.
Fish allergy can often cause severe reactions, including anaphylaxis. Adults are more likely to have an allergic reaction to fish and shellfish than children, which is probably because adults will have eaten these foods more often. People who are allergic to one type of fish, such as cod, often react to other types of fish such as hake, haddock, mackerel and whiting as well. This is because the allergens in these fish are quite similar. Cooking doesn’t destroy fish allergens. In fact, some people with fish allergy can be allergic to cooked but not raw fish.
Fruit and vegetable allergy (Oral Allergy Syndrome)
Allergic reactions to fruits and vegetables are usually mild and often they just affect the mouth, causing itching or a rash where the food touches the lips and mouth. A number of people who react in this way to fruit or vegetables will also react to tree and weed pollens. So, for example, people who are allergic to birch pollen are also likely to be allergic to apples and possibly peaches. Cooking can destroy a number of the allergens in fruits and vegetables, so cooked fruit often won’t cause a reaction in people with an allergy to fruit. Pasteurised fruit juice might not cause an allergic reaction either, for the same reason. However, the allergens in some vegetables, such as celery, aren’t affected by cooking. Some fruits and vegetables, such as tomatoes, are more likely to cause a reaction as they get riper.
Lactose is a sugar found naturally in milk. It’s important to distinguish between lactose intolerance and milk allergy, because milk allergy can cause severe reactions. Lactose intolerance is caused by a shortage of the enzyme lactase, which is needed to break down lactose so it can be absorbed into the bloodstream. When someone doesn’t have enough of this enzyme, lactose isn’t absorbed properly from the gut, which can cause symptoms such as bloating and diarrhoea.
Lactose intolerance can be caused by a number of things. In humans, the body produces less lactase after the age of two. However, in white Western Europeans, lactase can be produced into adult life, which allows lactose to be broken down properly. Because of this, lactose intolerance is more common in certain ethnic and racial populations than in others. In the UK, about 5% of the general population have lactose intolerance. In communities where milk is not traditionally part of the typical adult diet, a much bigger proportion of people are affected. For example, up to 75% of the black African community and more than 90% of the Asian community are intolerant to lactose. Digestive diseases, or injuries to the small intestine can sometimes cause lactose intolerance, because they reduce the amount of lactase produced. In rare cases, the condition can be inherited.
Milk from mammals including cows, goats, sheep and humans contain lactose. This means that goats’ milk and sheep milk aren’t suitable alternatives to cows’ milk for people who are intolerant to lactose. There is no medical treatment for lactose intolerance, but symptoms can be avoided by controlling the amount of lactose in the diet. Adults with lactose intolerance can often have a small amount of milk without getting any symptoms.
Latex allergy is caused by a reaction to a number of allergens found in natural rubber or latex. In recent years, the number of people with latex allergy has increased, particularly among healthcare workers and people with spina bifida, because they come into contact with lots of latex products. Latex contains lots of allergens that are similar to the allergens in some foods. So people who are allergic to latex might also find they react to foods such as banana, mango, kiwi, chestnut, paprika, celery, apple, carrot, cherry, coconut, strawberry and avocado. This is called latex-food syndrome.
Lupins are common garden plants, which are related to legumes such as peas, lentils and beans. Many types of lupin seed are poisonous, because they contain bitter-tasting toxins. But sweet lupins don’t contain these toxins and they can be eaten by humans or livestock. Sweet lupin seeds are being used more and more to replace cereal grain in many food products, for example flour and pasta. Allergy to lupin has been recognised for some time in mainland Europe, where lupin flour is used widely in food products. This type of allergy only seems to have started emerging in the UK quite recently. Lupin allergy can cause severe reactions, including anaphylaxis, but there have been very few confirmed reports of lupin allergy in the UK so far. The Anaphylaxis Campaign in the UK has advised people with peanut allergy to avoid lupin. It’s mainly used in flour-based products such as pastry.
Maize (or corn) allergy isn’t common in the UK, although there have been reported cases. For people who are sensitive to maize, avoiding it can be very difficult, because maize is commonly used in a wide variety of food products.
People with a meat allergy might react to beef, mutton, pork or chicken. Sometimes people who are allergic to one type of meat or poultry might also react to other types. Cooking destroys some of the allergens in meat, but some people will still react to cooked meat. Processed meats, such as frankfurters, luncheon meats and pâtés, sometimes contain other ingredients, particularly milk products, as emulsifiers or flavour enhancers. So it’s possible for someone who is allergic to milk to react to a meat product because it contains milk. For example, milk is sometimes used in chicken nuggets to stick the breadcrumbs to the chicken pieces.
Allergy to cows’ milk is the most common food allergy in childhood, and affects 2-7% of babies under one year old. It’s more common in babies with atopic dermatitis. A reaction can be triggered by small amounts of milk, either passed to the baby through the mother’s breast milk from dairy products she has eaten, or from feeding cows’ milk to the baby. Children usually grow out of milk allergy by the age of three, but about a fifth of children who have an allergy to cows’ milk will still be allergic to it as adults. The symptoms of milk allergy are often mild and can affect any part of the body. They can include rashes, diarrhoea, vomiting, stomach cramps and difficulty in breathing. In a very few cases, milk allergy can cause anaphylaxis. Cows’ milk allergy is caused by a reaction to a number of allergens in cows’ milk, such as casein and whey.
Milk from other mammals (such as goats and sheep), and hydrolysed milk and soya formulas, are sometimes used as a substitute for babies who are at risk of developing cows’ milk allergy. However, the allergens in milk from goats and sheep are very similar to those in cows’ milk. This means that someone with a cows’ milk allergy might react to these other types of milk as well, so goat’s and sheep milk aren’t suitable alternatives for people who are sensitive to cows’ milk.
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Milk protein intolerance
Intolerance to cows’ milk protein is a type of intolerance that is common in babies and children, and symptoms start from the time when cows’ milk is first introduced into the diet. There is no cure for it and the only way to stop the symptoms is to avoid cows’ milk products. Cows’ milk protein intolerance is different to lactose intolerance and milk allergy.
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Tree Nut allergy
Allergy to nuts from trees is usually lifelong. The nuts that are most likely to cause allergic reactions are walnuts, hazelnuts, almonds, pecans, Brazil nuts, macadamia nuts and cashew nuts. On rare occasions, all these nuts can cause anaphylaxis in people who are sensitive. Sometimes people with an allergy to one type of nut will also react to other nuts. So if you have a nut allergy, you need to be very careful to avoid nuts and unrefined (crude) nut oil. Strictly speaking, peanuts are legumes, not nuts, and they grow underground rather than on trees.
Allergy to peanuts (also known as groundnuts and monkey nuts) is often lifelong, but research suggests that, in a very few cases, young children diagnosed with peanut allergy may grow out of it. Peanuts are one of the most common causes of food allergy and can cause severe reactions, including anaphylaxis. They contain a number of allergens that are not destroyed by cooking or roasting. Peanut allergy can be so severe that very tiny amounts can cause a reaction. Because of this, coming into contact with traces of peanut can be enough to cause a reaction in people who are sensitive. For example, someone might come into contact with traces of peanuts from unrefined oils, or when food is served using utensils that have been used with food containing peanuts, or even being close to someone eating peanuts. Refined peanut oil is thought to be safe for people with peanut allergy, because the proteins that cause allergic reactions are removed during the manufacturing process. However, cold-pressed, or unrefined/unprocessed (crude) peanut oil can contain small amounts of peanut allergens, which can cause a reaction in people who are sensitive.
Pine nut allergy
Pine nuts can cause severe allergic reactions, including anaphylaxis, in people who are sensitive. People who are allergic to pine nuts might also react to peanuts and nuts such as almonds.
Quorn is a type of protein, which is made from a fungus. It has been available in the UK since 1985, and is often used as a meat substitute. There have been some reports of intolerance to Quorn, but this is not surprising, because it has a high protein content (allergens are usually proteins). Intolerance to Quorn is much less frequent than to other foods such as soya and dairy products. As Quorn is made from a fungus, some people who react to other fungi or moulds (including by inhalation) may also react to Quorn.
Rice allergy is common in countries in Eastern Asia, such as Japan, where rice is commonly eaten, but it isn’t common in the UK. People who are allergic to rice can react when they eat it or when they inhale its pollen. Rice can cause hayfever symptoms in areas where it’s grown commercially. People who are allergic to rice can sometimes react to a number of other foods from the same botanical family, such as barley, maize, wheat, oats and rye, as well as other foods such as peach and apple.
It is not known how many people in the UK suffer from sesame allergy, but it’s quite common in countries such as Australia and Israel. Sesame seeds, sesame oil and other sesame products such as tahini, are used in cooking, for example in Turkish or oriental dishes, and in manufactured products such as bread, biscuits, salads, sauces and houmous. Sesame allergy can be severe, and can cause anaphylaxis. People with sesame allergy might also react to poppy seeds, kiwi fruit, hazelnuts and rye grain.
Allergy to shellfish is quite common, and a number of different types of shellfish can cause reactions in people who are sensitive, for example shrimps, prawns, lobster, crab, crayfish, oysters, scallops, mussels and clams. People who are allergic to one type of shellfish often find that they react to other types. Shellfish allergy can often cause severe reactions, and some people can react to the vapours from cooking shellfish.
Soya allergy is a common childhood allergy. Most people grow out of it by the age of two, but occasionally adults are allergic to soya. The symptoms of soya allergy are similar to milk allergy, and they include rashes, diarrhoea, vomiting, stomach cramps and breathing difficulties. Some people with soya allergy might also react to milk. Very rarely, soya can cause anaphylaxis.Soya is used as an ingredient in about two-thirds of all manufactured food products, including bakery goods, sweets, drinks, breakfast cereals, ice cream, margarine, pasta, processed meats and seasoned foods. Soya can be described in a number of different ways on food labels, for example as hydrolysed vegetable protein, vegetable oil and lecithin. Soya flour is used to increase the shelf life of many products and to improve the colour of pastry crusts. Textured soya protein, which is sometimes called textured vegetable protein, is made from compressed soya flour. It’s used as a meat substitute and to improve the consistency of meat products. Refined soya oil (the main component of vegetable oil) should be safe for people with soya allergy, because the proteins that cause allergic reactions are removed during the refining process.
Children who are allergic to cows’ milk are sometimes given soya-based formulas as a substitute. But people with a cows’ milk allergy can sometimes be allergic to soya too. So soya-based formulas might not be suitable for children with cows’ milk allergy.
Allergic reactions to spices are rare and usually mild, but severe reactions can happen occasionally. Some people react to mustard, coriander, caraway, fennel, paprika or saffron and, less frequently, to onions, garlic or chives. Reactions to mustard have been reported to cause anaphylaxis, particularly in mainland Europe, where mustard is used more. The allergens in spices are similar to those in pollens and vegetables, and people who are allergic to mugwort and birch are more likely to be sensitive to spices for this reason.
Vegetable oil allergy
Vegetable oil is usually a blend of oils. In the UK, the oils used the most to make up vegetable oil are soya, rapeseed, sunflower, maize, palm, coconut and palm kernel oils. Where they appear in pre-packed food, these oils will have been refined. The refining process removes proteins from the oil. Since it’s the proteins in oils that can cause allergic reactions, sensitive people probably won’t react to refined oils. Some speciality oils, such as sesame and walnut, aren’t refined, so they are best avoided by people who are sensitive to the nuts or seeds they are made from.
Wheat allergy is common, particularly among babies. One of the main allergens in wheat is a protein called gliadin, which is found in gluten. Because of this, people with a wheat allergy are sometimes recommended to eat a gluten-free diet. As with all food allergies, if you think you’re allergic to wheat you should talk to your GP before changing your diet.