Multiple food allergies

Multiple food allergies are by no means "weak" or "too squeamish". They are pathological immune responses produced by the immune system to specific food proteins. Currently, there is no cure globally. The most reliable response logic is "accurate identification of allergens + strict avoidance of contact + standing emergency response plan." Blind taboos or indifference to exposure may cause irreversible health damage.

When I worked as a follow-up assistant in the allergology department in the past two years, I saw too many patients who had extreme understanding of the disease. The one who impressed me most was a 23-year-old girl from Yanyi who still had light brown scars on her wrists from the last allergic rash. She sat in the clinic and cried while clutching the allergen report sheet. There were 17 positive items listed, ranging from wheat and eggs that she eats daily, to mangoes and peaches that make it itchy when touched, and even soybeans that she often eats. She had heard on the Internet that "you should avoid all hairy things when you are allergic". For half a year, she boiled vegetables with rice without even adding soy sauce. Finally, her hemoglobin dropped to 80. She fainted in the laboratory and was sent to her by a classmate. Only then did she realize that of the dozen or so things she was allergic to, half of them were false positives in the test, and she would not have any reaction at all after eating them.

To be honest, many people now go for "food intolerance tests" with hundreds or thousands of items when they are allergic, and then follow the report list to avoid all foods. They are simply fooled. We need to clear up a common sense first: what we often call food allergy is an immediate allergic reaction mediated by IgE. Severe cases can cause laryngeal edema and shock in a few minutes. Most food intolerance tests on the market check for IgG. The clinical significance of this indicator is still controversial in the academic circle. Many institutions confuse it with allergies and deceive people into buying high-priced probiotics and desensitization products, which are all IQ taxes. If you really want to check for allergens, first carefully keep a food diary for half a month. It is more accurate than any other test. Write down a note of what you ate on the day when you had a reaction and take it to the doctor's office to see. It is much more reliable than blindly following a cold positive report.

Currently, there is no unified standard answer for clinical intervention for multiple food allergies. Doctors from both schools of thought have their own valid opinions. One group advocates absolute avoidance: as long as you have a history of severe allergic reactions - such as being out of breath, having wheals all over your body, or even going into shock after eating, don't take any chances. You can't touch even one bite of the corresponding food, and you must prevent cross-contamination. I followed up a 4-year-old boy who was severely allergic to peanuts. His mother kept a close eye on him and never let him touch outside food. Last time, a kindergarten classmate secretly stuffed half a piece of peanut cake into his mouth. He was sent to the ICU for rescue for three days before he was out of danger. With this level of allergy, let alone trying to "tolerate" it, even a little bit of it could be fatal.

The other group's low-dose tolerance-inducing regimen has been supported by more and more clinical data in recent years, but its scope of application is very narrow: it is only suitable for patients with very mild allergic reactions, only local rashes, some gastrointestinal discomfort, and never serious systemic reactions. We once had a patient who was mildly allergic to mangoes. He developed a few small rashes on his lips every time he ate the most. Under the full monitoring of an allergist, he started eating 1g of mango pulp per week and slowly increased the amount. He persisted for 10 months, and now he can eat a whole mango normally without any problem. But I have to say this up front: This plan must not be tried at home. If a serious reaction occurs midway, it is easy to cause an accident without first aid conditions.

If you have friends with multiple food allergies, you should have seen their "strange" behavior at dinner parties: others pick up chopsticks to eat, but they have to ask about the ingredients of each dish first. When the waiter brings a cake, they flip over and look at the ingredient list. If they see a line that says "may contain nuts and peanuts", they will not touch it. It's not that they are being pretentious, they have really stepped into a trap. I once had hot pot with a patient who is allergic to shrimp. She specially brought her own small electric pot and dipping sauce, and even washed the dishes separately. She was afraid that the shrimp would be cooked in the public pot and the common dipping sauce would be mixed with shrimp powder, which would cause edema in the throat. I have also seen something even more exaggerated. Someone ate a cold dish, but it contained cucumbers cut on a chopping board with peanuts cut in it. He was out of breath on the spot and was sent to the emergency room.

People often ask me, "Do allergies get better as you grow older?" ”There is really no guarantee of this. It is true that about 60% of children who are allergic to milk and eggs in infants and young children will tolerate it by themselves by the age of about 3 years old. However, more than 70% of allergens such as peanuts, seafood, and wheat will remain with them for life. Don't deliberately feed your children allergic foods with the mentality of "it will be fine when they grow up". You really can't afford the consequences.

After being in contact with this group for a long time, I feel that they know how to take good care of themselves better than ordinary people. I can accurately tell the ingredient list of every commonly eaten food. I always have a card with allergy types and emergency phone numbers in my bag, as well as an epinephrine pen. Even when I go on a business trip and stay in a hotel, I have to bring a week's worth of non-added meal replacements, just for fear of being misunderstood by outsiders. In fact, in the final analysis, this is just a chronic disease like high blood pressure and diabetes. There is nothing special. There is no need to sympathize with them or think that they have too much to do. When eating together, just asking "What can't you eat?" is the greatest kindness.