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Treating Food Allergies

 Once you have been diagnosed with a food allergy, it is important to review treatment options with your doctor and to create an Emergency Medical Plan so that you—and your family and friends—will know what to do in the event of a reaction.  Researchers are working hard to develop therapies that would prevent an allergic reaction, but for now, strict avoidance of problem foods remains the primary treatment for food allergies.  Fortunately, epinephrine is a highly effective therapy that stops severe allergic reactions (anaphylaxis), while several other medications help control mild-to-moderate reactions and relieve symptoms.   

Elimination and Avoidance
In treating food allergies, the line of first defense is eliminating problem foods from your diet and learning how to avoid any food that might contain ingredients that could trigger a reaction.  This requires alertness and, sometimes, a little detective work.  While it’s easy to avoid the obvious, such as a bag of peanuts or a glass of  milk, you’ll also need also become an expert on identifying hidden allergens at home, at school, in restaurants, and while traveling.  Work with your family to store, prepare, and cook food safely.  Read the ingredient labels on all packaged foods to make sure that they don’t contain problem ingredients.  (If you’re not sure, call the manufacturer to find out.)  When dining out, know which cuisines and dishes are most likely to contain problem ingredients.  Carry a restaurant card to help the staff ensure that your order is allergen-free.  If you‘re in doubt about any food, don’t eat it.  Luckily, helpful strategies and resources are available to help you decode labels and menus and manage your diet, wherever you may be.

Finally, always be prepared to handle a reaction—it will give you peace of mind in case you accidentally eat the wrong food.  Follow your Emergency Medical Plan at the slightest sign of a reaction.  Always carry your medication and wear emergency identification jewelry.

Severe Reactions/Anaphylaxis
Epinephrine (adrenaline) is the first-line treatment for anaphylaxis—a sudden, severe, and potentially dangerous allergic reaction. It is a life-saving medication that reverses all the symptoms of anaphylaxis.  People who are at risk for anaphylactic reactions should always carry epinephrine auto-injectors (EpiPen® or Twinject®), which allow them (or someone with them) to administer the drug as soon as a reaction begins.   DO NOT WAIT to see if the reaction will subside.   Administer epinephrine immediately and then call 911.  This will calm the reaction until you can get to the emergency room for further treatment.  

Once epinephrine is administered, other medications also may be helpful. 

Steroids (e.g., cortisone) may be given, typically in the emergency room, to help reduce inflammation after an anaphylactic attack.  Although steroids do not work fast enough for emergency treatment, they may help prevent a recurrence after the initial reaction has been treated. 

Antihistamines, known as H1 blockers, are prescribed to relieve mild allergy symptoms, although they cannot control a severe reaction.  Medications in this class include diphendydramine (Benadryl®) and cetirizine (Zyrtec®).  An antihistamine can help symptoms subside during anaphylaxis, but it should never be given as a substitute for epinephrine.  

If you suspect that you have ingested a problem food—even if you’re not absolutely sure—you should take Benadryl immediately to help suppress symptoms.  But if serious symptoms do appear, epinephrine should be administered without delay. 

Asthma Medications. Short–acting bronchodilators (known as “rescue” inhalers), such as albuterol (Alupent®, Proventil®, Ventolin®), may be used to help relieve breathing problems once epinephrine has been given, particularly if you are experiencing asthma symptoms. They should not be depended upon to treat the breathing problems that can occur during anaphylaxis—use the epinephrine.

Treatments for Mild Allergy Symptoms
Antihistamines and oral or topical steroids can be used to manage mild symptoms such as itching, sneezing, hives and rashes.

Both eczema and hives may cause itching.  If you have eczema, developing a good skin care routine, such as using a moisturizing cream several times a day, can help.  Also available are medicated creams such as hydrocortisone, a steroid cream.  For both hives and eczema, antihistamines can provide relief from the itch and make the hives go away.

Be Prepared…Be Safe
To sum up, an effective food allergy treatment plan includes all of the following:

• Strict avoidance of problem foods
• Working with your doctor to develop an Emergency Medical Plan
• Wearing emergency identification jewelry at all times
• Carrying your medication wherever you go
• Taking your medication at the first sign of a reaction
• Getting to an emergency room for follow-up treatment if you have a severe reaction

Finally, if you experience side effects after taking any medication prescribed for your allergy, or if a particular therapy isn’t helping to control your symptoms, be sure to speak with your allergist.  To avoid drug interactions, you should also let your allergist know  before you take any medication for another condition.  Communicating with your healthcare team is essential to living safely with food allergies.