Food Allergies A Complete Guide for Eating When Your Life

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“An indispensable book for anyone who has food allergies or any parent of a child with food
allergies. As an allergist treating food-allergic patients every day, I keep this book within easy reach,
on my bookshelf. It’s a unique source of knowledge for those of us who treat such patients.”
PHIL LIEBERMAN, MD
Division of Allergy and Immunology,
University of Tennessee College of Medicine

“A must-read for teens and adults with food allergies, and for anyone living with or caring for
someone with food allergies. Here they will find answers to many of their questions as well as
interesting case histories and essential principles of diagnosis and treatment, including a realistic
overview of future approaches.”
F. ESTELLE R. SIMONS, MD
World Allergy Organization
Special Committee on Anaphylaxis

“Dr. Sicherer draws on his years of experience as a master clinician, researcher, author, and thought
leader in this field to provide practical advice and countless insights that are sure to provide the
reader with the knowledge needed to understand and manage food allergies. The question-and-
answer format makes this comprehensive book highly accessible to people with food allergies and
parents of children with food allergies, while the extensive insights and depth of detail make it an
important resource for health care providers as well. Dr. Sicherer describes in detail how to integrate
food allergies into a family lifestyle. A family’s ability to anticipate a food reaction and then treat the
symptoms if they happen—and not expect a reaction to happen all the time—helps a family cope
thoughtfully with food allergies in a child.”
A. WESLEY BURKS, MD
American Academy of Allergy, Asthma & Immunology

“In this definitive guide to food allergies, Scott Sicherer offers his readers a complete food allergy
education. He demystifies everything from science to symptoms to label reading, and offers
encouragement for living life to its fullest—in spite of food allergies. Destined to be the go-to
resource for patients and parents striving to live well with food allergies.”
GWEN SMITH
Editor, Allergic Living magazine
“Dr. Sicherer answers all the questions parents and others have about food allergies. From practical
considerations, to emotional issues, to the latest in the search for a cure—it’s all here. The easy-to-
read question-­and-­answer format will make this a reference book you reach for time and again. I
wholeheartedly recommend it!”
ANNE MUÑOZ-FURLONG
The Food Allergy & Anaphylaxis Network

“Food Allergies is required reading for patients, parents, and physicians who want to help patients
who have food allergies—young or old. Parents should keep a copy of this book next to
Understanding and Managing Your Child’s Food Allergies (also by Dr. Sicherer) so they can better
understand food allergies, obtain better medical care, and ultimately enjoy a better quality of life. As
a parent of children with life-threatening food allergies, these are my essential reference books.”
AMIE RAPPOPORT MCKENNA
mother of children with severe food allergies
FOOD ALLERGIES
A Johns Hopkins Press Health Book
Note to the Reader: This book is not meant to substitute for medical care and treatment should not be
based solely on its contents. Instead, treatment must be developed in a dialogue between the
individual and his or her physician. Our book has been written to help with that dialogue.

Drug dosage: The author and publisher have made reasonable efforts to determine that the
selection of drugs discussed in this text conform to the practices of the general medical community.
The medications described do not necessarily have specific approval by the US Food and Drug
Administration for use in the diseases for which they are recommended. In view of ongoing research,
changes in governmental regulation, and the constant flow of information relating to drug therapy
and drug reactions, the reader is urged to check the package insert of each drug for any change in
indications and dosage and for warnings and precautions. This is particularly important when the
recommended agent is a new and/or infrequently used drug.
Copyright © 2013, 2017 Scott H. Sicherer, MD
All rights reserved. Published 2017

Johns Hopkins University Press

Library of Congress cataloging data is available.

ISBN-13: 978-1-4214-2337-1 (hardcover)

A catalog record for this book is available from the British Library.

The Allergy and Anaphylaxis Emergency Plan is reprinted with permission from the American
Academy of Pediatrics.

Special discounts are available for bulk purchases of this book. For more information, please contact
Special Sales at 410-516-6936 or [email protected].

Johns Hopkins University Press uses environmentally friendly book materials, including recycled
text paper that is composed of at least 30 percent post-consumer waste, whenever possible.
CONTENTS

Preface
Introduction, by Hugh A. Sampson, MD

Chapter 1
What Are the BASIC FACTS about Food Allergy?
Allergy and Other Adverse Reactions to Foods
Symptoms and Illnesses
Severity
When Symptoms Are Not a Food Allergy
Masqueraders of Food Allergy
Prevalence of Food Allergies
Causes and Triggers of Food Allergies
Peanuts
Eggs
Cow’s Milk
Wheat and Other Grains
Tree Nuts
Seeds
Soy
Legumes
Vegetables and Starches
Fruits
Meats
Fish
Shellfish
Spices
Alcoholic Beverages
Miscellaneous Food Allergens and Colors, Additives, Preservatives, and Latex
Chapter Lessons in Action
Chapter 2
What Do I Need to Tell the Doctor to Help Get a FOOD ALLERGY
DIAGNOSIS?
When to Talk to Your Doctor
How to Prepare for a Doctor Visit
Finding the Right Doctor and Other Health Professionals
Complementary and Alternative Therapies

Chapter 3
These Food ALLERGY TESTS Are Confusing! What Do They Mean?
General Questions about Testing
Skin Tests
Blood Tests (and How They Compare with Skin Tests)
Component Tests / Molecular Diagnostics
Elimination Diets
Oral Food Challenges (Feeding Tests)
Additional Tests
Unproven and Disproven Tests
Improved Diagnostic Tests
Chapter Lessons in Action

Chapter 4
What Is ANAPHYLAXIS and How Do I Treat It?
General Questions about Anaphylaxis
Epinephrine
Antihistamines
Additional Medications and Treatments for Anaphylaxis
Written Emergency Plans, Education, Medical Identification Jewelry, Management Issues
Chapter Lessons in Action

Chapter 5
What CHRONIC HEALTH PROBLEMS Are Caused by Food
Allergy?
General Questions about Chronic Illnesses and Foods
Respiratory Symptoms
Hives and Swelling
Atopic Dermatitis (Eczema)
Gastrointestinal, Digestive Illnesses
Colic, Constipation, Irritable Bowel Syndrome, and Reflux
Celiac Disease (Gluten-Sensitive Enteropathy)
Proctocolitis (Food Protein–Induced Proctocolitis)
Food Protein–Induced Enterocolitis Syndrome
Food Protein Enteropathy and Protein Intolerance
Eosinophilic Esophagitis and Other Eosinophilic Gut Diseases
Chronic Illnesses That Are Not Related to Food Allergies
Chapter Lessons in Action

Chapter 6
How Do I AVOID ALLERGIC REACTIONS to Foods?
General Questions about Avoiding Allergic Reactions
Cross-Contact
Amounts That Trigger a Reaction and Casual Exposure
Avoidance at Home
Purchasing Manufactured Products
Restaurants
Social Outings and Family Gatherings
School
Camp
Work
Travel
Dating and Relationships
Age-Related Responsibilities
Special Exposure Risks
Chapter Lessons in Action

Chapter 7
How Do I Manage a Food Allergy While Living a Normal and Healthy
LIFESTYLE, with ADEQUATE NUTRITION?
General Questions about Lifestyle and Quality of Life
Emotional Concerns and Anxiety
Interpersonal Relationships and Bullying
Nutrition
Chapter Lessons in Action

Chapter 8
Will These Food Allergies Ever GO AWAY?
General Questions about Food Allergy Resolution
The Course of Allergies to Specific Foods
The Course of Illnesses Caused by Food Allergies
Evaluations for Resolution of Food Allergy
Recurrence of a Food Allergy and Development of New Food Allergies
Factors Affecting the Course of Food Allergies
Chapter Lessons in Action

Chapter 9
Is There Any Way to PREVENT Food Allergies?
General Questions about Risk Factors and Prevention Strategies
Pregnancy Diets
Breast Feeding and Formulas
Introducing Solid Foods
Current Recommendations
Nondietary Aspects of Prevention
Chapter Lessons in Action

Chapter 10
Will There Be a CURE or BETTER TREATMENT of Food Allergy?
General Questions about Food Allergy Research
Approaches to Treat Any Type of Food Allergy
Approaches to Treat Allergies to Specific Foods
Treatments of Specific Food-Allergic Diseases
Unproven Treatments
Participating in Food Allergy Research
Chapter 11
How Do I Get MORE HELP and INFORMATION to Manage Food
Allergies?
Educational Resources
Support Groups, Advocacy, and Research
Handy Forms
Selected Medical References

Index
PREFACE

This book is dedicated to people with food allergies and those who care for
them. It is the result of thousands of questions I have been asked by adults
and children with food allergies, parents of children with food allergies, as
well as allergists, medical students, physicians in training, pediatricians, the
media, government officials, researchers, teachers, school nurses, and
others. Your questions have led me at times to seek answers from you as
well as from others, from research, and through trial-and-error experiences.
It is my pleasure and privilege to present this book, which is designed to
give you what you have asked for: a place to find accurate, timely, detailed,
and helpful answers to questions on every aspect of food allergies.
In the years since the publication of the first edition of this book, there
have been amazing strides in diagnosis, prevention, and treatment of food
allergies. We now have tests that are better at determining a true allergy.
Incredibly, we have proof that peanut allergy can be prevented, and new
approaches may help prevent other food allergies as well. For the first time,
food allergy treatments are in the final stages of clinical study prior to
approval for widespread use, and an array of more options for therapy are
under study. In this second edition, I have updated every chapter to include
these and other amazing advances and new insights. I have also included
new Chapter Lessons in Action to illustrate important points and
applications of the new advances.
Of course, this book would not exist were it not for the work and
influences of many people, and so I also dedicate this second edition to the
many who have taught me over the years, including Hugh A. Sampson,
MD, Sally Noone, RN, Marion Groetch, RD, and Robert A. Wood, MD
(whom I also thank for his critical review of the manuscript). It is also
dedicated to my many colleagues at Mount Sinai’s Jaffe Food Allergy
Institute, and researchers and colleagues worldwide. I want to thank the
National Institute of Allergy and Infectious Diseases and Food Allergy
Research and Education for supporting my research. I thank the Jaffe family
for their foresight in establishing a food allergy institute at Mount Sinai in
New York, and also the many families and visionary philanthropists for
supporting our research and clinical care initiatives. Most importantly, I
thank the children, adults, and families who have altruistically contributed
to our understanding of food allergy by their participation in research
studies—they are absolutely the heroes who will help us to cure this
disease. Finally, I thank my wife, Mati, and children, Andrew, Zachary,
Maya, Sydnee, and Cassaddee . . . for everything.