MYSTERIOUS RASH: COULD IT BE A FOOD ALLERGY? (PART 2)
photo cred: egg hard boiled in the heart of KY by my Mom, stolen from her fridge and photographed by my brother- my older one who is her neighbor- because my Mom wasn't home when I needed someone to text me a pic to make this blog post on the east coast and I have not one egg on hand at my house. Special thanks to my eggscellent family for stepping up to give my eggzema post that creepy Unsolved Mysteries crime tv show vibe... especially my nieces for their art direction.
Welcome to Part 2 of my 3 part post on eczema and food allergies. In Part 1 we defined eczema and it's symptoms, and discussed medication and allergy testing as our primary topics. In today's post we'll identify common food allergens and some not so common ones, and I'll explain the elimination diet that was the tool that ultimately solved my mysterious allergy after allergy testing gave false negative results. I'll also discuss children and babies with eczema, and provide information for how to safely navigate breastfeeding while coping with food allergies.
1) COMMON FOOD ALLERGENS
It’s important to know that nearly any food can cause an allergic reaction. It’s equally important to be aware of the list of foods identified as the top 8 allergens, which cause 90 percent of food allergies in the US:
Outside of the top 8 allergens in the US, certain seeds like mustard and sesame are also common allergens and are noted in the list of top offenders in other countries. When my allergist was doing allergy testing for me and considering possible causes of my eczema, one possibility he mentioned at one time was histamine intolerance. Histamine intolerance refers to histamine that enters the body through certain foods. An intolerant person lacks the digestive enzyme to break down and absorb the histamine effectively and may suffer a range of symptoms like hives, stomach pain, headaches and eczema. Culprit foods with high levels of histamine include cheese, yeast, shellfish, some fruits and vegetables, chocolate, cured meats, most fish, red wine and beer. For more reading on histamine intolerance, check out this article in the Daily Mail, and this encouraging study from the US National Library of Medicine. Just this week I met someone who told me they suffer from a food related allergen that I'd never heard of before: it's called Balsam of Peru allergy. It's also worth knowing about if you're doing detective work and dealing with mysterious eczema. Balsam of Peru comes from the trunk of a tree grown in Central and South America, and contains a mix of a number of substances that are related to spices, fragrances and flavorings. A person with Balsam of Peru allergy might experience eczema when exposed to products containing Balsam of Peru or related chemicals or foods. For someone with Balsam of Peru allergy, avoidance of perfumes and scented products, as well as cinnamon, vanilla, cloves, paprika, curry, cardamom and nutmeg is key. Looking for "fragrance free" on labels is a must.
Food allergies can occur at any point in one's life from infancy to adulthood, and a person can become allergic to a food that they ate previously without any problems. Allergic reactions and symptoms, including eczema, can range from mild to severe, and can change without warning in any individual. A person who reacted with mild symptoms to a food could develop a severe reaction to the same food during a subsequent exposure to the allergen. I know of a child who had an severe allergic reaction when peanuts were thrown into the air from a parade float and her allergen was airborne- she did not even need to ingest the allergen and she experienced a life threatening reaction. In my case, my food allergies appeared suddenly at the age of 30, and increased from mild eczema to severe eczema over the course of one year before I was able to identify the allergen and eliminate my exposure and symptoms. My severe eczema included a rash on and around my mouth and swollen lips. Because of this symptom, my allergist had concerns that a future exposure to my allergens could lead to worse symptoms including a swollen tongue, or anaphylaxis, a whole-body reaction that can "impair breathing, cause a dramatic drop in your blood pressure and affect your heart rate. Anaphylaxis can come on within minutes of exposure to the trigger food. It can be fatal and must be treated promptly with an injection of epinephrine" (according to the American College of Allergies and Immunology).
3) ELIMINATION DIET
While skin prick and blood testing for food allergies is not always accurate, an Elimination diet is sometimes recommended by doctors, as was the case in my treatment. A classic elimination diet outlines a 21 day period in which the patient has eliminated suspect foods from her diet to see if symptoms disappear. In my case, I eliminated all of the top 8 allergens for the full 21 days. The three week period is significant as it is just long enough for the body to fully process any food fully out of it’s system. The patient slowly reintroduces the eliminated foods one by one, and a little at a time over the course of many days to observe and allow time for delayed reactions. Before you cut out foods from your diet, or especially that of your child, please consult with your doctor. Cutting foods means cutting nutrients that may need to be replaced with other foods in order to maintain a balanced diet during the elimination test. If you suspect a single food may be the cause of your eczema, you could of course very simply cut out that single food from your diet as a modified elimination test. You must adhere to the full 21 days and strict avoidance in order to have clear results. Perhaps the most challenging aspect to doing an accurate and effective elimination diet is knowing that some of the top 8 allergens lurk hidden in many processed foods and aren't clearly listed on labels. Dairy, eggs and soy are three allergens that are disguised in countless processed foods and products the average American consumes daily. As an example, I've listed alternative names for my allergen (soy) below:
Other Names for Soy
Soy is a common ingredient in many Asian cuisines, and may be identified by its name in other languages. Some of the names for soy are:
Edamame (fresh soybeans)
Miso (fermented soybean paste)
Soybean (curds, granules)
Tofu (dofu, kori-dofu)
Ingredients on a label are not always easy to recognize as soy. These ingredients are created from soy that has been processed in some way:
Hydrolyzed soy protein (HSP)
Mono- and diglycerides
MSG (monosodium glutamate)
Soy (albumin, cheese, fiber, grits, milk, nuts, sprouts, yogurt, ice cream, pasta)
Soy protein (concentrate, hydrolyzed, isolate)
Textured vegetable protein (TVP)
Possible Soy Ingredients
These ingredients may or may not contain soy. Call the manufacturer of the product to find out the source of the ingredient.
Hydrolyzed plant protein (HPP) or hydrolyzed vegetable protein (HVP)
Vegetable gum, starch, shortening, or oil
Foods That Likely Contain Soy
These foods often contain soy. You should be extra cautious about eating these foods if you are unable to get a complete ingredient list.
Asian cuisine (Korean, Japanese, Thai, Chinese, etc.)
Baked goods and baking mixes
Chicken (raw or cooked) that is processed with chicken broth
Energy bars, nutrition bars
Imitation dairy foods, such as soy milks, vegan cheese, or vegan ice cream
Meat products with fillers, for example, burgers or sausages
Nutrition supplements (vitamins)
Peanut butter and peanut butter substitutes
Sauces, gravies, and soups
Vegetarian meat substitutes: veggie burgers, imitation chicken patties, imitation lunch meats, imitation bacon bits, etc.
List copied from verywell.com, Resources:
The Food Allergy and Anaphylaxis Network: www.foodallergy.org
Sicherer S. Food Allergies: A Complete Guide to Eating When Your Life Depends on It
Joneja JV. The Health Professional's Guide to Food Allergies and Intolerances
When reintroducing your allergen it's important to consume the food in it's natural, whole food state. For example, instead of eating a cake from Walmart to reintroduce soy (which I may or may not have done in 2010 to rashly celebrate the end of my 21 day test), it would be better to eat edamame (soybean), or take a sip of 100% soy milk. Wait more 2-4 hours, then have another small amount. Do this for three days with no reaction before moving on the reintroduce another potential allergen.
4) BABIES AND TODDLERS WITH DAIRY ALLERGY
The foods most commonly associated with allergies in children in the US are Dairy, Eggs, and Peanuts. Dairy tops the list, and luckily most children quickly outgrow that particular allergy, while unfortunately egg and peanut allergy are more likely to persist into adulthood. When my daughter developed eczema on her legs as a baby (less than a year old), I consulted with the pediatric nurse at Yale over the phone. The nurse explained that while there are many possible causes of eczema in children, including contact allergies to wool, chemicals in detergents, and fragrances in lotions, she noted that dairy is the most common culprit. She suggested I omit dairy from my daughters diet and from mine (I was breastfeeding). I eliminated dairy from our diets immediately, and my daughters eczema disappeared within a week. I can't say scientifically whether there truly was a connection in this short instance and with such mild eczema, because roughly a year later I gave Greek yogurt to my toddler daughter, which she continues to eat at almost 3 years of age without any symptoms of allergy. It may have simply been a coincidence, or perhaps she did have a dairy allergy that she has outgrown. I have shared this information with other mom's of babies with eczema, and I've seen them have tremendous success in eliminating the eczema by avoiding dairy. If your baby is suffering, I say it's worth a try!
5) BREASTFEEDING AND FOOD ALLERGIES
I hear many mom's worry that something in their own diet could be causing their baby gas pain and fussiness. Fortunately, foods in mom's diet affect a baby in this way much less than we might assume because the proteins are actually broken down and changed when breastmilk is produced. That said, there's something to note again about dairy. According to the highly reputable source Kellymom, "A small percentage of breastfeeding mothers notice an obvious difference in their baby's behavior and/or health when they eat certain foods. Cow's milk products are the most common problem foods and the only foods conclusively linked by research to fussiness/gassiness in babies, but some babies do react to other foods. Food sensitivities in breastfed babies are not nearly as common as many breastfeeding mothers have been led to think, however."
In my case, a mom with food allergies, the concern is reversed. If my baby ingests food that I'm allergic to, I can suffer an allergic reaction through exposure by breastfeeding. Fascinatingly, baby's saliva enters the mothers nipple while nursing, in a miraculous instance of "back-wash", causing what scientists believe to be an immunologic response in the mother. Breastmilk is known to impart immunity for the baby and therefore highly recommended by the World Health Organization until at least the age of 2. The baby's saliva entering the mother's bloodstream is considered by scientists to enable the mother to produce custom, made-to-order nutritional content in her milk, which changes as needed on a constant basis. When a baby is sick, for example, the mother's body takes note by way of the saliva exchange, and breast milk increases in number of infection fighting cells called leukocytes. More can be read about this phenomenon in this 2015 article from Science News.
With regards to avoiding allergic reactions in a food allergic mother: the mother should eliminate her allergens from both her own diet and her baby's diet. It does not matter whether the baby nurses immediately after ingesting the mother's allergen, or many hours later, the effect will be the same since the allergy protein is in the baby's saliva for days, thereby entering the nursing mother's bloodstream unavoidably. The bottom line for a food allergic baby is to eliminate the baby's allergens from both the baby and the mother's diet, particularly if that food is dairy.
*Please stay tuned to PART 3 to conclude my 3 part series on eczema, which I’ll share later this week. I’ll discuss cross contamination and living with known food allergies.