FOOD ALLERGY The term "food allergy" refers to adverse immunologic reactions to food.

Food allergy is usually mediated by IgE antibody directed to specific food proteins. When a food protein is ingested, the IgE recognizes it on the surface of the cells & releases mediators like histamine resulting in the occurrence of symptoms. The allergic reactions mainly affect the skin, the gastrointestinal tract and the respiratory system. Both acute reactions and chronic disease may be caused. The symptoms might include a runny nose, an itchy skin rash, a tingling in the tongue, lips, or throat, swelling, abdominal pain, or wheezing. The foods most commonly causing these reactions in children are milk, egg, peanuts, soy, wheat, tree nuts, fish and shellfish. In adults, it includes peanuts, tree nuts, shellfish and fish. Food allergy is often confused with food intolerance. Food intolerance doesn't involve the immune system & it can be caused by a person's inability to digest certain substances, such as lactose. It is rarely dangerous. The symptoms of food intolerance include burping, indigestion, flatulence, loose stools, headaches, flushing, or nervousness. A person with food intolerance can usually eat small amounts of the particular food without having any symptoms. Skin Urticaria Acute urticaria is characterized by pruritic, raised lesions, sometimes accompanied by localized swelling. Lesions usually occur within one hour after ingestion of or contact with the causal food. Atopic Dermatitis Atopic dermatitis usually begins in early infancy and is characterized by a typical distribution in face, scalp and extremities with extreme pruritus and is chronic and relapsing. This inflammatory skin condition is frequently associated with allergic disorders like asthma and allergic rhinitis and with a family history of allergy. Dermatitis Herpetiformis Dermatitis herpetiformis is a chronic papulovesicular skin disorder in which lesions are distributed over the extensor surfaces of the elbows, knees and buttocks. This disorder is associated with a specific nonIgE-mediated immune sensitivity to gluten found in wheat, barley, oat and rye. The rash subsides with the elimination of gluten from the diet. Gastrointestinal Tract Oral Allergy Syndrome The oral allergy syndrome is characterized by pruritus and edema of the oral mucosa occurring after the ingestion of certain fresh fruits and vegetables like hazelnut, apple, carrot, celery, watermelon, cantaloupe and banana. The symptoms rarely progress beyond the mouth. The reaction occurs primarily in patients with allergic sensitivity to pollens. Patients are usually able to ingest cooked forms of the foods without symptoms because the responsible allergens are destroyed in the heat.

Celiac Disease Celiac disease is a condition that damages the lining of the small intestine and prevents it from absorbing nutrients. Celiac disease presents over a period of months with steatorrhea, flatulence and weight loss. Hypersensitivity to gluten found in wheat, barley, rye, and oats causes the disease. People who have a family member with celiac disease are at greater risk for developing the disease. Gluten free diet helps in the management of celiac disease. Respiratory Tract Rhinitis The upper respiratory tract can be a target of IgE-mediated food allergy. Symptoms may include nasal congestion, rhinorrhea, sneezing and pruritus. Gustatory rhinitis is rhinorrhea caused by spicy foods. This is not an immunologic reaction; it is mediated by neurologic mechanisms. Anaphylaxis Anaphylaxis refers to multiorgan reaction associated with IgE-mediated hypersensitivity. Fatal foodrelated anaphylaxis is more common in patients with underlying asthma. Food-associated, exerciseinduced anaphylaxis occurs when exercise follows the ingestion of a particular food to which IgEmediated sensitivity is usually present. Food allergy also plays an important role in childhood behavioral disorders like ADHD, Autism. Diagnosis The initial evaluation begins with a thorough history and physical examination. Prick-puncture Skin Test, In vitro tests for specific IgE like radioallergosorbent tests [RAST] and oral food challenges can be done. In prick-puncture skin test a small amount of the suspected food is placed on the skin of forearm or back. The skin is then pricked with a needle, to allow a tiny amount of the substance beneath the skin surface. If the person is allergic to a particular substance being tested, then a raised bump or reactions develop. RAST tests are less sensitive than skin prick tests, but they are considered accurate and useful. They can give information about the specific IgE concentration in a patient's blood. Oral food challenge consist of a gradual feeding of the test food under close observation. Oral food challenge is performed either therapeutically or for diagnostic reasons. Management Food allergy is treated mainly by dietary elimination of the offending foods as prevention is the best approach. Care must be taken in feeding a person with food allergies. Food labels and ingredients of any products bought must be noted carefully. It is therefore advised to avoid processed tinned and canned foods. The food related problems should be prevented by the regulation of food habits as follows. (i) Avoiding the foods which cause allergic reactions or intolerance If a person is allergic to: Milk: Avoid cheeses, butter, creams, and yogurt.

Eggs: Avoid cakes, cookies, pastries, mayonnaise, and egg substitutes. Soy: Avoid soybeans, soy nut butter, soy sauce, soy protein, soy oil, and tofu. Peanuts: Avoid any food that contains peanuts, as well as peanut flour or peanut oil. Tree nuts: Avoid almonds, Brazil nuts, walnuts, pecans, cashews, and macadamia nuts.

(ii) Preferentially eating foods in accordance with one's prakriti. Prakriti is described as the constitution of the individual which is determined genetically and is influenced by the environmental factors. Thus, biological responses to the food vary with the `prakriti of the person, time, place and season. Depending on the varying combinations of three doshas vata, pitta and kapha, broadly ten classes of prakritis are recognized as vata, pitta, kapha, vatapitta, vata- kapha, pitta-vata, pittakapha, kapha-vata, kapha-pitta and vata-pitta-kapha. (iii) Seasonal variations require alterations of food habits. The biological responses of the body vary with season and time of the day. Thus, the suitability of an individual to a particular food- item may be influenced by changes in climate and time of the day and therefore diet should be adjusted according to seasonal changes. (iv) Combining the foods to improve tolerance. Diet should be made wholesome by appropriate combination of different foods. Given below are few foods combining rules by Dr. Herbert Shelton: Never eat carbohydrate foods and acid foods at the same meal. Never eat a concentrated protein and a concentrated carbohydrate at the same meal. Never consume two concentrated proteins at the same meal. Do not consume fats with proteins. Use fats sparingly. Do not eat acid fruits with proteins. Do not combine sweet fruits with foods that require a long digestive time-foods such as proteins, starches and acid fruits. Eat one concentrated starch at a meal. Acid fruits may be used with sub-acid fruits. Sub-acid fruits may be used with sweet fruits. Do not combine fruit with any vegetables except lettuce and celery. Do not consume melons with any other foods. Milk is best taken alone.