K. Archana recently went through a rather nasty ordeal after eating a takeaway dessert ordered from a restaurant. She had severe cramps for several hours. The symptoms were familiar to her. She has this reaction when she eats anything with eggs. However, this time, she specifically mentioned her allergy and asked for something that did not have eggs in it.
The 39-year-old said she has been allergic to eggs since her childhood. Her first memories are of a severe reaction after visiting a restaurant in her hometown, Coimbatore. “It was a vegetarian restaurant, and I had naan. It was the first time I was trying naan. When I returned home, I threw up, something that happens after eating anything that contains eggs.” When her father confronted the restaurant later, he was told that naan was glazed with eggs.
In her teens, the reaction changed. An accidental ingestion resulted in multiple visits to the toilet and severe stomach cramps that took several hours to subside. “I have always been careful. But recently, when I ordered tiramisu after confirming with the restaurant that it had no eggs, I had an allergic reaction,” she said.
Westernisation of diet
Ms. Archana’s reaction to a food item is not new or rare. Paediatricians cite literature on food allergies in children. They say children could suffer from egg, seafood, and nut allergies. All the paediatricians that this correspondent spoke to believe that allergies are a result of ‘westernisation.’ . Paediatricians say common allergies include those that manifest after consuming eggs, nuts and seafood.
R. Asokan, consultant paediatrician at Surya Hospital, said, “I have not seen groundnut or other nut allergies (in my practice), but allergies to non-vegetarian food or even eggs, I have. Some people have a genetic predisposition. For some, it could be acquired.” Allergies could be persistent or random. “I may see one or two cases of persistent allergies. Sometimes when we desensitise them, the patient will not show the usual allergic reaction for a while. Then we may reintroduce the food, and the person could be free of the allergy,” he explained.
Dr. Asokan compares allergic reactions to policing. “It is enough to use the police to control a crowd in a civilian area. For a normal infection, we use the Immunoglobulin G molecule. Some individuals instead require Immunoglobulin E, the equivalent of an army. When they use that, a lot of damage occurs. That is what we refer to as an allergy,” he said.
The body reacts differently to a food item it has been exposed to. “It reacts differently to antigens like infection, bacteria, viruses, and protein molecules. We don’t know why they use immunoglobulin E differently. It is probably genetically mediated. It is a choice the body makes,” he remarked.
So, is there truth to the statement that breast-fed babies are not as easily susceptible to allergies?
Among breastfed children, the protein intake is low, so the allergy potential is low, Dr. Asokan explained. “Cow’s milk contains as much as 4% protein. Breast milk has only 1%. When the body digests milk, it is converted into chemicals such as amino acids and peptides. We do not absorb the peptides normally but digest them further to make amino acids,” the paediatrician said. Unlike adults, newborns absorb amino acids. “When a baby is getting peptides into the system, it triggers the allergy potential. The formula in cow’s milk increases the potential for allergy. If a baby is breastfed for the first six months, then the chances of allergy disorders such as eczema, atopic dermatitis, are low,” he added.
Food intolerance
Allergy specialists such as Suresh Natarajan make a distinction between food allergies and food intolerance. “When there is a reaction every time a child eats a food, that is an allergic reaction. However in the case of food intolerance, the reaction occurs randomly, occasionally, and not every time.” Dr. Suresh is a paediatric allergy specialist currently associated with Apollo Children’s Hospital, Chennai.
Usually the allergy runs in the family. For example, in the grandparents, it may show up as respiratory allergy symptoms when they are in their 5th or 6th decade. In the parents of children with allergies it often manifests as respiratory symptoms in their 3rd or 4th decade itself. However, the child will develop allergy symptoms very early, even in their first decade of life. As a generation passes, the respiratory allergy could turn to food allergy in the child,” he explained.
There has indeed been a rise in food allergies, he said. When people come to him with complaints of allergies he runs tests on them. “We do an allergy skin test. An allergen drop is applied to the skin, and a lancet is used to test the reaction. If within 10 minutes there is an allergy, they will have a weal. And if they react like that, we advise them to avoid that food, or the allergen responsible,” Dr. Suresh said.
The skin test is the gold standard method to diagnose an allergy, he added. “It is a painless test done as an outpatient procedure in the allergist’s clinic. “There are also blood tests available, but they are often associated with false positives,” he said.
Diagnosis of allergies
Sometimes children are diagnosed as having food allergies based on blood tests. They are advised to avoid the particular food item, but the problem persists in a majority of patients, he said. In such cases an allergist must be consulted, and a skin test will help in diagnosing the problem accurately.
Allergies could be mild or severe. Some children could develop rashes or even proceed to have anaphylaxis, a severe allergic reaction that could be life-threatening, he added. “The proportion of anaphylaxis due to food allergy is increasing. The condition of such children should be confirmed, and parents should be trained to care for them,” Dr. Suresh said. He added: “Since the presentation of an allergic reaction spans a spectrum, the main treatment for food allergies is avoidance.“
Unlike in the west, there is no data on allergies in India, he said. However, in his practice, he has seen the number of cases increasing dramatically. “In every family there may be allergies, but unless it is disturbing, they won’t come for medical care,” he said.
He said breast feeding is a protective factor. “Allergy is a disease of the West and as we become a developed country it is being seen more often,” he said.
(sujatha.r@thehindu.co.in)
Published - September 05, 2024 11:45 pm IST
