Being Well 503:  Food Allergies
18
October

By Adem Lewis / in , , /


>>Lori Casey:
According to the Food Allergy Research and Education Group, 15 million Americans and
one in 13 children have some type of food allergy.
Today on Being Well, registered dietician Jennifer Hills will be in the studio to tell
us more about food allergies. What are they, how are they diagnosed, and
most importantly, how to manage them. We’ll have that and the latest medical news
coming up on Being Well. [Music Plays] Production of Being Well is made possible
in part by: Sarah Bush Lincoln Health System, supporting
healthy lifestyles. Eating a heart healthy diet, staying active
managing stress, and regular check-ups are ways of reducing your health risks.
Proper health is important to all at Sarah Bush Lincoln Health System.
Information available at sarahbush.org. Additional funding by Jazzercise of Charleston.>>Lori: Well, today we’re talking about food
allergies, and I’m so pleased that Jennifer Hills, registered dietician from Sarah Bush
Lincoln Health System, is here. Jennifer, tell us a little about yourself
and what you do at Sarah Bush.>>Jennifer Hills:
Well, I’m a registered dietician at Sarah Bush, just like you said.
I am an Eastern Illinois University alumni with both my bachelor’s and master’s degrees.
I’ve been with Sarah Bush for five years now, almost.
And my main area of work is with adult acute care patients, but I also work as an outpatient
dietician, doing counseling for diabetes, cardiovascular disease, food allergies, along
with weight management and obesity.>>Lori Casey:
Okay, and that’s why we have you here. I saw through the media that you were doing
a talk on food allergies, and I thought that’s a topic we haven’t covered on this show, and
it’s something a lot of people are afflicted by.
>>Jennifer Hills: Definitely.
>>Lori Casey: Let’s start by just telling us a little bit
about what defines a food allergy.>>Jennifer Hills:
A food allergy is an immunologic response to a protein in food; the body just reacts
to that protein. For most of us, it’s harmless, but for some
patients, it does cause that reaction.>>Lori Casey:
So, what are some of the reactions that people will have when they ingest a food that they’re
allergic to?>>Jennifer Hills:
Some of the mild reactions can be things such as just itching of the mouth, or nose, or
ears, we might see hives or eczema, some patients have GI issues where they’ll have nausea,
diarrhea, vomiting, and then we start to move into some of the more severe reactions, which
can be where we start to see swelling of the tongue, the throat, and then that progresses
into what we call anaphylactic shock, where it’s the complete circulation system will
shut down that will cause a decrease in blood pressure, and that ultimately can lead to
death if it’s not treated.>>Lori Casey:
And those are the people that probably need to carry that EpiPen that you jab…
>>Jennifer Hills: Yes, those are the patients that we want to
carry their EpiPen and know how to use it, and to also talk to coworkers, friends, family,
and instruct their family members and those that they’re close to on how to use it so
that they can be treated in the event that that would happen.
>>Lori Casey: Well, speaking of the EpiPen, I was watching
TV the other night, and I saw an ad for EpiPen. It was for the mother putting her daughter
on the bus, like, you know, and taking the EpiPen with.
It seems to me, and I don’t know if this is true or not, that allergies are on the increase,
especially those more severe allergic reactions. Is that true?
>>Jennifer Hills: We are seeing an increase in food allergies.
Currently, we’re seeing about a 50% increase from 1997 to 2011.
So, they are out there. Research is not telling us why there’s such
an increase in them. We’re not really sure why we’re seeing that.
Professionally, I think maybe we’re just better at diagnosing them.
Those were patients that we just said, oh, they have a sensitive stomach, and now we’re
better able to put a label on that and to define what’s actually going on with them.
>>Lori Casey: Well, I would like you, before we go on I
want you to tell me what’s the difference: is an allergy the same as a food intolerance?
Like if you have intolerance for lactose or gluten, is that the same thing as being allergic?
>>Jennifer Hills: No, those are two separate things.
The allergy is that immune response to the protein in food.
Typically, in allergy we see onset of symptoms within minutes to just a couple hours of ingesting
that food. Whereas, intolerance usually is a lot more
delayed, and it’s typically just the GI system that’s involved in the reaction.
Unlike with the food allergy, it can be lots of different systems happening.
>>Lori Casey: Alright.
So, we’ve got that part cleared up. Let’s talk a little, what are some of the
most common things that, food allergies out there?
>>Jennifer Hills: We call them the top eight food allergies
that are out there. Those are milk, eggs, soy, fish, shellfish,
wheat, peanuts, and tree nuts are the top eight.
>>Lori Casey: So, you can have the intolerance for wheat,
but you can also be allergic.>>Jennifer Hills:
Exactly.>>Lori Casey:
So, to clarify, it’s two…>>Jennifer Hills:
You can have two different, there’s two different systems that are at play there.
>>Lori Casey: Okay.
So again, how do you know if one’s intolerance or one’s an allergy to wheat?
>>Jennifer Hills: If it’s an allergy to wheat, we’re going to
see much more of those complete system responses. We’re going to see the runny nose or coughing,
hives, eczema, and then on into some of the more severe things where we might start to
see swelling of the throat, and those kinds of things.
Whereas, the intolerance is really just the GI discomfort, usually several hours after
the food is eaten.>>Lori Casey:
Okay. So, can you kind of explain for us in layman’s
terms, like say I’m allergic to shellfish, and I eat shellfish, what’s happening inside
my body, or my cells? I guess I don’t really even know, so I’m asking
you.>>Jennifer Hills:
Well, that’s okay.>>Lori Casey:
What’s going on in our body when we take something that we’re allergic to?
>>Jennifer Hills: The food that you eat that you may be allergic
to has protein in it, and when you ingest that protein, our body is creating antibodies
against that protein. So, every time you eat that food or ingest
that food, those antibodies are released, and that’s what causes that allergic reaction
that we may see. Whereas, a food intolerance isn’t, there’s
not antibodies, there’s not that whole system reaction that we see.
>>Lori Casey: Okay.
So, let’s start from very young children.>>Jennifer Hills:
Sure.>>Lori Casey:
If you’ve got mothers out there that, you know, they’re not sure if they’re child is
allergic to something, how do you go about diagnosing allergens or things that people
are allergic to in young children?>>Jennifer Hills:
In young children, typically the mom, or a parent, or grandparent’s going to be the first
one that’s going to notice that there’s something going on.
What we typically recommend is talking to your physician first.
A food diary or food log is a great way to start diagnosing those problems.
If you can track into every time they drink milk, there’s something that happens, or every
time they eat a piece of wheat bread, something happens.
That can help doctors start to see if there is some kind of trend.
Typically, what will happen then is the doctor will send you onto an allergist who will start
to do some of that allergy testing. We see different types of allergy testing.
They can test by skin prick, which is where they’ll kind of make a rough area on the skin
and let the protein of different food items seep in, and watch for some kind of reaction
to happen. We can draw blood and do blood tests to check
for food allergies. And then, if those are inconclusive, what
they’ll typically do is the food elimination, where they’ll say eliminate that food completely
from the diet, and then if the symptoms resolve, then we can pretty much be sure that that’s
what was causing it. If they’re still not sure, then they can start
to add back that same food to see if the reaction occurs again.
And if we’ve eliminated it, and we’re still not sure, and then we start to add it back
and the reaction continues to happen, then we can know that that’s probably what it is.
>>Lori Casey: Okay.
Tell us about the connection between breastfeeding and allergies.
>>Jennifer Hills: Breastfeeding is a nice preventative measure
for food allergies. Typically, we encourage new moms to breastfeed
at least the first six months to give that protective benefit, and then to delay adding
in some solid foods, rice cereal, any kinds of cereal or baby foods at least until four
to six months of age.>>Lori Casey:
So, what if you don’t breastfeed? Does that mean that your children are going
to get allergies?>>Jennifer Hills:
No, no, no, no, no, no. It’s just a protective quality that can help
prevent them, but there’s nothing that says that babies that are formula fed are going
to develop food allergies.>>Lori Casey:
Okay. So, how are allergies tested in maybe older
children or adults? Is it a different process for small children
versus adults?>>Jennifer Hills:
It’s pretty much the same. Food allergies can happen at any age.
So, even those of us that have moved into adulthood, we know we’re still at risk at
times for having food allergies develop. And if an adult thinks that something has
happened, then they need to talk to their physician and kind of go through those same
steps to have that confirmed.>>Lori Casey:
Of the, you mentioned the top eight; if you’re allergic to any one of those as a child, will
you ever outgrow those?>>Jennifer Hills:
Typically, we don’t see children outgrowing four of them, which are the fish, the shellfish,
the tree nuts, and the peanuts. Excuse me.
We don’t see those outgrown. Milk, soy, and eggs can sometimes be outgrown,
usually by the age of 16. So, if you’re still having reactions at the
age of 16, it’s probably going to be a lifelong allergy.
But if the reactions have decreased at that point in time, then we can safely say that
they may have outgrown those allergies.>>Lori Casey:
So, what do you recommend for a parent if they, you know, if their child was allergic
to those, you know, the ones that you mentioned that can be outgrown, how do you safely kind
of introduce those? I mean, it sounds kind of scary to say, here,
drink this milk. We’ll see if you are allergic…
>>Jennifer Hills: And let’s see if you have another reaction.
>>Lori Casey: How do you go about doing that?
>>Jennifer Hills: Typically, it’s under the advice of the allergist,
and they will usually start introducing those things in the office, so that you’re under
medical supervision as they do that. Because just in case there would still be
some kind of severe reaction, you would be under medical supervision right then.
I wouldn’t ever recommend doing it at home just on a trial basis, just in case.
But under the medical supervision, they can start to add those in.
Or as kids get older, they get a little more free with their diet, mom and dad aren’t controlling
things as much, and they may just naturally find, oh, you know, I used to be allergic
to milk, but now I go out with my friends and I eat a cheeseburger, and I do just fine
with the cheese on the cheeseburger; maybe my allergy is not as severe as it used to
be. So, sometimes just over the course of being
a teenager, they find out that they’re not as allergic as they once were.
>>Lori Casey: Alright.
So, if you as the parent have allergies, are you going to pass that along to your children?
>>Jennifer Hills: It’s not necessarily that you will definitely
pass them along; there is a stronger relation between parents that have food allergies and
any other kind of allergic response. So, if they have environmental allergies or
some kind of skin condition like atopic dermatitis or eczema as an adult, those are things that
may predetermine that your children can have food allergies.
It’s not a for sure thing, but they are risk factors for your children.
>>Lori Casey: Okay.
So, if you suffer from seasonal allergies like hay fever, it’s harvest season or pollen
season, you get that runny nose, are you more susceptible to food allergies, or does one
have nothing to do with the other?>>Jennifer Hills:
They really don’t have anything to do with each other.
Seasonal allergies don’t really lead to food allergies.
However, we do see the reverse, that food allergies, people who have them tend to have
some of those other allergic diseases that we see, like allergies to pollen and those
kinds of things, and then the skin conditions. So, the reverse is true that food allergies
can come some of, or can be linked to some of the other allergic diseases, but not that
environmental allergies can cause food allergies.>>Lori Casey:
Okay. It gets a little complicated.
>>Jennifer Hills: It does get a little complicated.
>>Lori Casey: Alright, so when I was looking up some research
for this show, I read about cross reactivity.>>Jennifer Hills:
Mmhmm.>>Lori Casey:
You need to explain that to our viewers.>>Jennifer Hills:
Cross reactivity, we can see that there are reactions within a single food group.
For instance, if you’re allergic to one tree nut, like walnuts, we may find that you are
allergic to other tree nuts in that same family. But that doesn’t mean that you may be allergic
to peanuts, per say, but something within the same treenut family, we do see some of
that happening, as well.>>Lori Casey:
Okay.>>Jennifer Hills:
And the same holds true with shellfish. If you’re allergic to one type of shellfish,
you may be allergic to other ones, as well.>>Lori Casey:
So, are there, and speaking of fish because my oldest sister has been allergic to fish
her whole life, are there some people that are maybe only allergic to, you know, swimming
kind of fish, but not shellfish, or…?>>Jennifer Hills:
You can be. You can be allergic to one, or the other or
both combined. It just kind of depends on your body and your
antibodies that you’ve developed over the years.
But yes, she can be allergic to one and not the other.
I have a co-worker who’s allergic to walnuts, and she just avoids all nuts period because
she’s not sure of her cross reactivity and doesn’t want to have a reaction, so she just
avoids them all just to be on the safe side.>>Lori Casey:
So, what do you do if you come in contact, maybe the first time, you didn’t know, maybe
you never had shrimp growing up and, you know, you’re out for the first time as an adult,
and you go to a party, and you have shrimp, and all of a sudden, uh oh; what do you do?
>>Jennifer Hills: You want to seek medical attention immediately.
And it kind of depends on the reaction that you have.
You may just feel kind of funny. Some people, you know, will feel like their
throat’s kind of itchy, or they’ll start coughing, or have a runny nose, and not be really sure
that that’s what’s happening to them. Other people, on the other hand, will have
the very severe reaction with the, you know, the swelling and the not being able to breathe,
and all of these things. And of course, at that point in time you want
to call an ambulance and head to the ER immediately to be treated.
>>Lori Casey: Okay.
So, we, you know, it’s the EpiPen. Explain what that is.
What does it have in it, and who really needs to carry something like that?
>>Jennifer Hills: An EpiPen contains epinephrine, which is a
hormone to combat the antibodies that are being made in the body, and it slows that
response down. When someone is having difficulty breathing,
the EpiPen will kind of relax all of that, so that they can breathe and get through the
reaction. People who have any kind of severe food allergy
need to have one with them at all times. And again, anyone that works with them or
is close to them needs to know where it is and how to use it.
My co-worker who has the walnut allergy, she says it’s in my purse and you have my permission
to use it, because there’s always that chance, even though she’s very safe and knows exactly
what she’s doing, there’s still that chance that she could come into contact with it and
that we would need to do that for her. So, it’s a very important thing to have.
Children at school, their teachers need to be aware, the staff at the school needs to
be aware that they have the food allergy and where that EpiPen is carried, whether it be
in a backpack or if they keep it in their desk, so that it can be used at any time.
>>Lori Casey: And there’s a certain place that it’s supposed
to be injected, the EpiPen.>>Jennifer Hills:
Yes. Typically, we put it in the thighs, is the
best place to put it and, you know, through clothes is okay.
The quicker you can get it injected, the better. So typically, we see it used in the upper
thighs.>>Lori Casey:
And why is it there versus, you know, in your arm or in your neck, or something?
>>Jennifer Hills: I think it would hurt very bad if it was in
the neck. I think it’s because of kind of the ratio
of muscle to fat that we find in the thigh, and how much it’s absorbed from there.
>>Lori Casey: Okay.
And so, if you need an EpiPen, make sure you have one.
And make sure that those around you have them. Are there, can there sometimes be hidden allergens
in our food? Can we be allergic to food additives that
maybe we don’t often think of? I mean, you think of like the actual food
itself: mild, shellfish. Can you talk about that?
>>Jennifer Hills: 80% of food allergies are to those top eight
that we talked about earlier, but there are 20% of allergies that are not those top eight
things, and they can be things like food additives or just other foods in general.
Knowing how to read labels, either getting education from the allergist, coming to see
a registered dietician. We can take you through how to read the food
label properly to pick up on any of those terminology that may not always clue you in
that that’s what it is. Not all food labels are going to say ‘milk’
on them; there’s going to be lots of words to describe milk.
So, having that education and when you find out that you have a food allergy can help
you to better read food labels to identify which ones are safe and which ones aren’t.
>>Lori Casey: So, what would be some of the things that
you would point out to people as common? I mean, milk, for example; how is that sometimes
labeled on a food label?>>Jennifer Hills:
You might see it labeled as lactose, or some other lactose derivative, or whey, or whey
protein; all of those things can signal to you that there’s milk in that product.
>>Lori Casey: Okay, so just be a smart food label reader,
and if you’re suffering from allergies, you know, get some help from a registered dietician.
>>Jennifer Hills: Absolutely.
>>Lori Casey: So, what are the basic treatment options for,
like, mild, other than just avoiding the food? Say, you do ingest something and you have
kind of that itchiness inside the mouth maybe, you know, something, how do you go about treating
those?>>Jennifer Hill:
Benadryl is probably going to be your best bet to get you through those mild symptoms.
Really, the only way to prevent them is that strict avoidance of anything that that food
product may be in. Really, it’s the avoidance, or if you have
a mild symptom, something, you know, some kind of antihistamine to kind of combat the
antibodies that your body is making. Or then, we go into the more extreme cases
where we need to use the EpiPen and seek medical attention.
>>Lori Casey: So, if you do have a mild allergy and say,
I don’t know, you’re in the middle of nowhere with no access to Benadryl, how long can those
symptoms last? Say you take a bite of something, and you
know you’re allergic to it, and you spit it out or whatever, how long can that sort of
reaction keep going?>>Jennifer Hills:
We can see reactions start within minutes of ingesting the food up to one to two hours
after. Some research says that we can see reactions
up to 72 hours after eating that food product. So, it can stay with you for quite some time.
So, if you are out in the middle of nowhere, heading towards a hospital or a clinic where
there are medical professionals that can help with that would be a good idea, just in case
that immediate response, or that severe response is delayed.
>>Lori Casey: So, if you have some mild allergies, at what
point do you think someone should see their doctor?
I mean, can you get through life, oh, I know I’m allergic to, you know, peanuts, do I need
to see my doctor for that?>>Jennifer Hills:
Not necessarily, unless you think that there’s some cross reactivity happening, and then
you may want to see your doctor to get that referral to an allergist, who can do more
definitive treatment and more definitive diagnosis of that, and they can give you better ideas
of how to treat it, how to live life with that kind of food allergy, rather than just
going, oh well, I know I should avoid that. They’re really going to drive home why it’s
important to do that.>>Lori Casey:
I was telling you as we were walking into the studio here, you know, in peanut allergies,
I don’t know how many years this, peanut allergies seem to come out as people really started
to be violently allergic to peanuts, and there were no peanuts anywhere: not on airplanes,
not in schools. I told you I flew recently, and they were
going away peanuts on the plane. Does it, have peanut allergies just become
more mainstream, or has it, are we not seeing such severe reactions?
>>Jennifer Hills: I would say it’s just more mainstream at this
point in time, and if you know you’re allergic, then you know you should avoid them.
>>Lori Casey: Hopefully, you’re not sitting next to the
person on the plane eating peanuts, and you’re allergic.
>>Jennifer Hills: Absolutely.
They just know, you know, we’re not going to cater, I guess, to those people as much.
And you know, schools are kind of going to peanut-free zones and all of those things
to protect their kids, and airlines may just not be following suit near as much as schools
and those kinds of things that we’re seeing.>>Lori Casey:
So, in these last few minutes, I want to ask you, give us some tips or advice on how do
you, on managing food allergies. It’s got to be challenging, especially for
children, you can’t watch what they eat all the time.
Talk about, you know, parents managing food allergies for their children, and how adults
we can manage our diet for food allergies.>>Jennifer Hills:
Okay. Managing food allergies is really that strict
avoidance. And I know it’s hard with children; I have
two of my own at home. And you can’t always, you know, watch every
minute bit of whatever they put in their mouth, but being as diligent as you can and eliminating
as much as you can out of your home, watching them when they’re out in public and around
other children, and just being prepared if there is a reaction to something.
Because, it’s not always going to be 100% avoidable, even the most diligent parents
are still going to see children with some kind of reaction at some point in time.
So, just being very prepared and staying very calm when that does happen.
And adults, it’s the same thing. We’re much more able to control what we put
in our mouths, and so just being aware of what’s in food items, reading labels, and
just being very smart about what you choose to eat is the best way to manage them.
>>Lori Casey: Alright.
Well, that was a great way to wrap things up.
Jennifer, thanks for coming on Being Well and talking to us about food allergies today.
We appreciate your time.>>Jennifer Hills:
Thanks for having me. [music]
There’s nothing like a good night’s sleep. But for people with obstructive sleep apnea,
decent shut eye is hard to get. They often snore and repeatedly stop breathing during
the night. This not only causes daytime sleepiness, but also other health issues. More on risks
of sleep apnea and what you can do about it from Mayo Clinic.
As an elementary school principal, Todd Kieffer runs at top speed most of the
time. But that wasn’t so easy when he struggled with symptoms of obstructive
sleep apnea. I was extremely tired during the day. I
didn’t feel like I had the stamina to keep going, keep going, keep going.
Todd hadn’t had a decent night’s sleep in
years. I knew I had a problem because my
entire family couldn’t sleep. Loud snoring. Then he’d stop breathing.
Then I’d do a snort and kind of wake up. Obstructive sleep apnea can deprive you
of sound sleep and make you tired during the day. It can also cause serious
health issues. I can’t help but think that it’s going
to have some impact on your health down
the road. Usually we talk about cardiovascular
disease as the major problem. If you have severe, untreated sleep apnea,
your risk of dying from a heart attack and stroke is quite a bit higher than the
normal population. Sleep specialist Dr. Joseph Kaplan says
obstructive sleep apnea may also aggravate diabetes, and it may
contribute to mental slowing and memory difficulties. Plus the associated daytime
sleepiness increases the likelihood of motor vehicle accidents from driving
drowsy. So what do you do if you think you have it? A sleep study during which
you go in for over-night monitoring can help your doctor confirm the diagnosis.
He said you actually stopped breathing 70 times every hour.
No wonder Todd was always tired. You see, snoring happens when the back of
your tongue and throat relax and restrict air flow. If you have obstructive sleep
apnea, your throat relaxes to the point where it blocks breathing. A C-PAP
machine is a device you wear over your nose. It provides air pressure while you
breathe which keeps the back of your throat open.
The device made a huge difference in Todd’s life.
Because I know that in the morning I’m going to be so much more alert.
More productive, healthier and better able to keep up with the kids. For
Medical Edge, I’m Vivien Williams. Celebrities Tom Hanks and Hallie Berry both
have type 2 diabetes and more and more Americans are diagnosed every year.
Holly Fur-Fur takes a look at what people can do to try to prevent diabetes or to live
healthy with the disease. Having high blood sugar – also called prediabetes
– doesn’t mean you’re destined to develop type 2 diabetes.
Making healthy lifestyle changes such as eating a balanced diet, exercising, and dropping
excess weight may help prevent the disease.   The American diabetes association says for
some people at risk, taking the drug metformin may help too.  
In healthy people, sugar enters the blood stream after we eat. Then the hormone insulin
gets involved– helping the body’s cells absorb the sugar and turn it into energy.  
In people with pre-diabetes this process starts to work less efficiently and sugar builds
up in your blood stream. With type 2 diabetes things worsen and people often have to be
treated with insulin. If you already have diabetes, you can still
make lifestyle changes to help control the disease.  In people who are overweight,
losing only 5 – 10 percent of their body weight can help improve their condition.
And when it comes to food, instead of a restrictive diet, focus on cutting the fat and calories
but don’t skimp on fruits, vegetables and whole grains.
For today’s health minute, I’m holly firfer.   Production of Being Well is made possible
in part by: Sarah Bush Lincoln Health System, supporting
healthy lifestyles. Eating a heart healthy diet, staying active
managing stress, and regular check-ups are ways of reducing your health risks.
Proper health is important to all at Sarah Bush Lincoln Health System.
Information available at sarahbush.org. Additional funding by Jazzercise of Charleston.
[music]


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