Once you have been diagnosed as having a food allergy, your treatment will involve two important factors:
- providing you with information and advice about the best way to avoid coming into contact with the offending food stuff (often referred to as an elimination diet), and
- drawing up an emergency care plan that you can use if you accidently come into contact with the offending food.
Elimination diet
Depending on the type of food that you are allergic to, you may be referred to a dietician in case eliminating that food from your diet would have an adverse impact on your nutrition.
For example, an allergy to peanuts is unlikely to affect your diet, but an allergy to milk may mean that you will need to find alternative sources of calcium.
It is important to realise that as part of your elimination diet, you need to avoid all contact with the offending food. Therefore, as well as avoid eating or drinking the food, you will also need to avoid:
- inhaling the food - for example, accidentally sniffing some peanut dust,
- touching the food, and
- cross-contamination.
Cross-contamination is when utensils, such as knives and forks, or work surfaces, such as chopping boards, become contaminated with the offending food through shared use.
Reading labels
As part of your elimination diet it is very important that you read the list of ingredients on the label of any pre-packed food or drink products that you buy.
Under European Union law, any pre-packed food or drink that is sold in the UK, must clearly state on the label if it contains the following ingredients:
- celery,
- cereals that contain gluten (including wheat, rye, barley, and oats),
- crustaceans (including prawns, crabs, and lobsters),
- eggs,
- fish,
- lupin - lupins are common garden plants, and the seeds from some varieties are sometimes used to make flour,
- milk,
- molluscs (including mussels and oysters),
- mustard,
- tree nuts, such as almonds, hazelnuts, walnuts, Brazil nuts, cashews, pecans, pistachios, and macadamia nuts,
- peanuts,
- sesame seeds,
- soybeans, and
- sulphur dioxide and sulphites (preservatives that are used in some foods and drinks) at levels above 10mg per kg or per litre.
Many pre-packed food (but not all) contain allergy advice warning labels if they contain a food that is known to commonly cause an allergic reaction, such as peanuts, eggs, or milk.
You should also look out for ‘may contain’ labels, such as ‘may contain traces of peanut’. Manufacturers sometimes put this label on their products to warn consumers that they may have become contaminated with another food product during the manufacturing process. If you are severely allergic to a particular food type, you should also avoid these foods because there is no guarantee that they will be safe.
You should also be aware that some non-food products contain traces of allergy-causing food. For example:
- some soaps and shampoos contain traces of soy, egg, and tree nut oil,
- some pet foods contain traces of milk and peanuts, and
- some glues and the adhesive labels that are used on envelopes and stamps contain traces of wheat.
Again, it is important that you read the labels of any non-food products which you may come into close physical contact with.
Unpackaged food
Unpackaged food does not need to be labelled in the same way as packaged food so there is a higher risk of accidental exposure, usually from cross-contamination.
Examples of unpackaged food include food sold from:
- bakeries,
- delis,
- salad bars,
- ‘ready-to-eat’ sandwich shops,
- take-aways, and
- restaurants.
If you have a severe food allergy, you may want to avoid eating unpackaged food.
Eating out
If your food allergy is not severe, there is no reason why you cannot visit restaurants as long as you remember to stick to the advice below.
- Let the staff know - when making a booking at the restaurant, make sure that the staff are aware of your allergy and ask for a firm guarantee that any food you will be served will be allergy-free. If the staff cannot offer such a guarantee, you should choose another restaurant.
The Food Standard Agency (FSA) also offers chef cards that provide information about your food allergy, which can give to restaurant staff. As well as informing the chef and kitchen staff who are involved in cooking your food, you should also let waiters and waitresses know so that they understand the importance of avoiding cross-contamination when serving you.
- Read the menu carefully and check for ‘hidden ingredients’ - some food types contain traces of other foods which can trigger allergies that restaurant staff may have overlooked. For example, some desserts contain traces of nuts, some sauces contain traces of wheat, and peanuts and some crisps contain traces of milk.
- Use the ‘taste-test’ - before you begin to eat, take a tiny portion of the food and rub it against your lips to see if you experience a tingling or burning sensation. If you do, it suggests that the food will cause you to have an allergic reaction. However, the ‘taste-test’ does not always work for all foods, so it should not be used as a substitute for not following the advice above.
- Prepare for the worst - if you follow the advice outlined above, you should not experience any problems, although it is also a good idea to prepare for any eventuality. Always take your anti-allergy medication with you when eating out, particularly if you have been given an auto-injector of adrenalin (see below).
Children
The above advice regarding diet also applies to children with a food allergy. There is also some additional advice that you should follow if your child has a food allergy, which is explained below.
- Notify the school about your child’s allergy - depending on the potential severity of your child’s allergy, it may be useful to provide the staff at their school with an emergency action plan in case of accidental exposure.
You should arrange with the school nurse, or other appropriate staff member, to hold a supply of adrenalin, and to administer it if necessary. Food allergy bracelets are also available, which explain how other people can help your child in the event of an emergency.
- Let other parents know - young children may easily forget about their food allergy and accept food that they should not have when visiting other children. Informing the parents of your child’s friends about their allergy should help prevent this.
- Educate your child - once your child is old enough to understand, it is important that you provide them with clear, simple instructions about what foods to avoid, and what they should do in the case of accidental exposure.
Emergency care plan
As part of your emergency care plan you will usually be given two types of medication that you should keep with you at all times:
- antihistamine tablets and/or gels - which can be used to manage the symptoms of a mild to moderate allergic reaction, and
- adrenaline - which is used to manage the symptoms of anaphylaxis.
Antihistamines works by blocking the effects of the protein, histamine, which is responsible for most of the symptoms that develop during an allergic reaction.
Adrenaline works by narrowing your blood vessels and countering the effects of low blood pressure, and by opening up your airways to help ease your breathing difficulties.
You will usually be given a device that is known as an adrenaline auto-injector pen. This looks similar to a felt-tip pen and consists of a syringe and a pre-packaged dose of adrenaline.
If you think that you are experiencing an anaphylactic reaction, you should inject yourself in your thigh, or upper arm, with the pen before dialling 999 to request an ambulance.
There are two auto-injector pens available:
The adrenaline held inside the pen can go out of date, so it is important that you check the date information on the label and replace it when necessary.
