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airborne allergies

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Airborne Food Allergens—What’s the Risk?

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When we hear stories of serious allergic reactions to food, they often involve someone unknowingly ingesting a food that contains their allergen. Gut-wrenching stories like the grilled cheese that killed a NYC preschooler, the Indian takeout food fatality in England, the woman left paralyzed after ingesting peanuts while traveling in Budapest, and the sesame-related death of a teenage girl after eating a Prèt A Manger baguette at an airport. 

For many of us, these stories hit a bit too close to home.

In these cases, the food was ingested—but what happens when the allergen goes airborne?  

In January, a story about an 11-year-old New Jersey boy rocked headlines after he died from what authorities believe was an allergic reaction from breathing in the steam from fish cooking in the kitchen. 

While rare, allergic reactions to aerosolized allergens do occur. 

According to Dr. John Lee, Clinical Director of the Boston Children’s Food Allergy Program, most airborne reactions probably occur due to particles of protein that rise into the air when food is actively cooked, and then they’re inhaled. “I’ve had patients describe their throat itching while around peanuts, or reported mild reactions on airplanes, but most airborne reactions typically result from particles of protein rising off heated foods.” For example, he offers someone with a shellfish allergy walking into a seafood restaurant, or a wheat-allergic patient standing near boiling pasta.

According to the American Academy of Allergy, Asthma and Immunology, exposure to airborne food allergens does not typically result in anaphylaxis; however, these airborne particulates can cause symptoms such as itchy eyes, a runny nose, a cough, congestion, and difficulty breathing.

Airborne food particulates can also trigger two forms of occupational asthma: 1) baker’s asthma, following exposure to powdered allergen substances such as dried egg powder, soy flour, or wheat flour during baking; and 2) crab asthma, which is caused by dust and fume exposure from steaming, cooking, or scrubbing crab in processing plants. Both forms of asthma are considered allergic diseases because of the role allergenic proteins play in the respiratory response.

Notably, airborne allergic reactions aren’t limited to food. In at least one case, a chemical fragrance was the culprit. After a teenager named Brandon started developing headaches and hives at school, he connected his symptoms to Axe Body Spray. His allergy to the spray worsened, eventually leading to anaphylactic shock. Laws protecting manufacturers like Axe barred disclosure of the spray’s full ingredients list, preventing his family from discovering the allergenic trigger. Brandon had to leave school because of the exposure risks. 

Suffice it to say, airborne allergenic reactions extend beyond food. 

Most reported airborne reactions, however, continue to stem from common allergenic foods. Since peanut is the number one trigger of food-related anaphylaxis, the extent to which peanut particulates pose a risk is a common question in the food allergy community. 

In a 2003 study of 30 children with severe peanut allergies, researchers examined the extent to which inhalation and skin exposure elicited a reaction. For the skin test, one third of children experienced reddening or skin flares after peanut butter was pressed to their skin for one minute. Conversely, no child experienced respiratory symptoms after sitting in close proximity to three ounces of peanut butter for ten minutes.

The topic of aerosolized allergenic reactions has stirred enough controversy among food-allergic travelers that Southwest Airlines stopped serving peanuts on all flights starting in August 2018, and JetBlue does not serve peanuts on its aircrafts.

Food for thought? We think so. Have you experienced an airborne allergen causing an allergic reaction? Please share your experience if so! 

- Meg and the Allergy Amulet Team 

This piece was written by the Allergy Amulet team and reviewed by Allergy Amulet advisors Dr. John Lee and Dr. Jordan Scott. 

Dr. John Lee is the Clinical Director of the Food Allergy Program at Boston Children’s Hospital. Dr. Lee is widely recognized for his work in food allergy, and his commitment to patient health. 

Dr. Scott is an allergist/immunologist and operates several private allergy clinics throughout the Boston area. He is on the board of overseers at Boston Children’s Hospital, and the past President of the Massachusetts Allergy and Asthma Society. 

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You Down with EoE? No Thanks, Not Me.

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Every now and again our team at Allergy Amulet likes to post blogs about lesser-known conditions that affect the food allergy population (our people)! One such blog, I’ll Take My Allergies Medium Rare, covers some uncommon (but very real) forms of allergy. Today’s installment is no different! Have you ever heard of a condition called Eosinophilic Esophagitis (E-o-sin-o-fill-ik Uh-sof-uh-jie-tis), or EoE for short?

What is it?

If you have EoE, a large number of white blood cells (eosinophils) build up in the lining of the esophagus (the tube that connects your mouth to your stomach). This buildup is a reaction to food, airborne allergens, or acid reflux, and can inflame and injure esophageal tissue. EoE is a recognized chronic allergic/immune condition, and is not typically outgrown (but it can be managed)! EoE is a relatively new disease, as it has only been identified in the past two decades. Accordingly, there is still much to learn about this complex condition.

Who does it affect?

EoE affects approximately 1 out of every 2,000 people in the United States. In recent years, allergists and gastroenterologists are seeing an increasing number of patients with EoE—this is presumably due in large part to greater physician awareness about the condition. Most patients with EoE are considered atopic, meaning they have a family history of allergies, asthma, or symptoms of one or more allergic disorders. These can include food allergies, eczema, seasonal allergies, and asthma. For patients with environmental allergies, their EoE may be worse during pollen season. Allergic reactions to food are the main cause of EoE in many patients, and foods such as dairy, soy, wheat, and eggs are often the main culprits. Interestingly, according to Dr. Jordan Scott of Boston Children’s Hospital, the development of EoE has occurred as a side effect of oral immunotherapy for food allergies in up to 3% of cases.

What are the symptoms?

EoE symptoms vary depending on age. Infants and toddlers may refuse food or fail to gain weight. School-age children often experience difficulty swallowing, vomiting, or have recurrent abdominal pain. Teens and adults generally have trouble swallowing, especially dry or dense solid foods. In some cases food can get trapped in the esophagus, which can lead to choking.   

How is it diagnosed?

There are certain criteria for diagnosing EoE that most allergists, gastroenterologists, and pathologists agree on: symptoms consistent with EoE, an upper endoscopy procedure (lets the doctor see what’s happening in your esophagus), and an esophageal biopsy (tissue samples of the esophagus are taken and analyzed). A specialist may also recommend further evaluation (e.g., a gastroenterologist may refer a patient to an allergist for food allergy testing and vice versa).

Is there a silver lining? 

The rise in EoE cases has led to greater physician awareness and further research around the condition. Additionally, a wide variety of treatments have been identified for those managing EoE, such as:

1.    Empiric elimination diet—removing major food allergens (e.g., dairy or wheat) from your diet and gradually adding them back in one at a time under close physician watch and guidance. This diet is often most successful with the help of a dietitian, as it can be tough to manage.

2.    Elemental diet—all sources of protein are removed from the diet and replaced by an amino acid formula, oils, and simple sugars. This treatment is often reserved for children with several food allergies who have not responded to other treatments.

3.    Medical therapy—swallowing small doses of oral corticosteroids has proven effective for managing inflammation. Proton pump inhibitors are also used to control acid production. 

Each of these treatments has its advantages and disadvantages, so it’s helpful to first discuss them with your physician before trying any one approach. One challenge with treatment, according to Dr. Scott, is that patients must typically undergo multiple endoscopy procedures to ensure that esophageal inflammation is improving with meds, dietary avoidance, or both.

The good news is that you don’t have to go it alone! There are numerous support groups and organizations out there that can help, such as APFED and CURED. When it comes to understanding and managing immune conditions, having a trusted support network is key!

- Meg and the Allergy Amulet Team 

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