Tom Walton and Debby Fortune were having dinner at Cafe Beaujolais in Mendocino when Walton, in timeless spousal tradition, snitched a scallop from his wife’s plate. Two minutes later, he was on the floor, staring up at a crowd of concerned faces.
“One advantage of having a problem in a well-to-do restaurant is that I apparently collapsed backwards onto two doctors and a dentist,” recalls Walton, a Berkeley public relations professional. The doctors sent his wife out for an antihistamine, and Walton quickly recovered.
His frightening faint 10 years ago was Walton’s first clue that he might have a serious food allergy, an unwarranted immune system reaction to a harmless substance. Without testing, Walton can’t be sure that scallops are his nemesis, but he has steered clear of them since.
Although experts aren’t sure that food allergies are on the rise, life-threatening reactions apparently are. Those who suffer these hypersensitive reactions say they still face too much skepticism and ignorance, especially in restaurants.
“People think you’ll get a sniffle or a sneeze, that it’s no big deal,” says Cherie Fehrman, a San Francisco interior designer who is allergic to milk products and some chemical food additives. “They don’t realize you could be dead in 30 seconds.”
Chefs who don’t understand her problem or don’t take it seriously have made restaurant-going a nightmare, Fehrman says. “They say, `I just added a pat of butter. I couldn’t believe that could make a difference,’ or `There was no butter in the dish, but I put in just a little cream.’
“I’m terrified to eat out,” Fehrman admits. “I just take food with me. I’m the one there with a glass of water and my salad.”
Heidi Krahling, chef-owner of Insalata’s in San Anselmo, Calif., admits she erred years ago when a customer asked if a pasta sauce contained basil. Preoccupied with orders, Krahling mistakenly said no. The customer, who became ill, demanded compensation.
“I couldn’t imagine someone being allergic to an herb,” Krahling says.
A basil allergy would be unlikely but not impossible, doctors say. “There’s not a whole lot that’s unheard of,” says Dr. Russell Leong, a San Francisco allergist. At least 160 foods — including kiwi fruit, caraway seeds and tomatoes — have been implicated in allergic reactions, but the numbers of those reactions is exceedingly low. A mere eight foods — milk, soy, eggs, wheat, fish, shellfish, peanuts and tree nuts — account for 90 percent of allergic reactions.
Experts estimate that perhaps 5 percent of children suffer from food allergies, which they often outgrow; estimates of adult food allergy drop to 1 percent to 2 percent. But for these unlucky few, even a taste of the problem food can be life-threatening. One peanut-allergic college freshman died after eating two bites of chili that contained peanut butter.
As uncommon as food allergies are, a surprisingly large number of people believe they have them. One peer-reviewed study suggests that more than 15 million Americans think they have food allergies, three times the actual number. The discrepancy, experts say, derives in part from mistaking intolerance for allergy.
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True allergic reactions involve the immune system. Exposed to a substance it mistakenly perceives as a threat, the body makes immunoglobulin E, or IgE, antibodies. When the person is exposed to the food again, the antibodies attack, causing symptoms that may range from sneezing to anaphylaxis — a collection of severe symptoms such as shock that can cause death in minutes.
Allergists use skin tests and blood tests to verify food allergies. In skin testing, they scratch or prick the skin with a liquid extract of the food in question and look for welts or hives. In blood testing, they look for IgE antibodies to the food. Both methods can give false positives, so a firm diagnosis may require a double-blind food challenge, in which neither patient nor doctor knows whether the patient is getting a placebo or the real thing.
Allergists see many patients who suffer from food intolerance or food idiosyncrasy, not allergy. Intolerances, such as lactose intolerance, usually affect digestion or metabolism, although John Scharffenberger has a different response.
A former sparkling-wine producer in Mendocino County, Scharffenberger can drink sparkling wine, white wine and aged red Burgundy with impunity, but other red wines give him headaches and acute sinusitis. His problem, an allergist told him, was intolerance of an amino acid in red wine; pinot noir, the grape used in Burgundy, has less of the amino acid than other red wines and the acid dissipates with time.
How many people truly suffer from wine allergy, a common complaint? “By the academic definition, probably none,” says Dr. Herbert Kaufman, a San Francisco allergist who has studied red-wine headache.
Adverse reactions to wine aren’t uncommon, Kaufman says, but they aren’t allergies because they don’t involve antibodies. Kaufman theorizes the headaches are caused by wine components that activate prostaglandins; taking a prostaglandin inhibitor such as aspirin before drinking can prevent the headache.
Then there are countless people who believe they are allergic to sulfites in wine. In truth, only about 150,000 Americans are sulfite-sensitive, researchers say. They may sneeze, wheeze or have even more severe reactions to wine, beer, dried fruit, fruit drinks or the many other sulfite-containing foods. According to literature from the International Food Information Council, people who respond adversely to sulfites or, like Fehrman, to monosodium glutamate and food dyes, are experiencing a food idiosyncrasy, not an allergy.
As for true food allergies, there’s no proof they are on the rise but many allergists and allergy educators believe they are. “Schools used to have one or two students with food allergies. Now it’s not uncommon to have one or two per class,” says Anne Munoz-Furlong, founder of the Food Allergy Network, a non-profit group in Fairfax, Va. Dr. Hugh Sampson, a leading allergy researcher at Mount Sinai Medical Center in New York, says colleagues who used to see one peanut-allergic patient in three months now may see three a day.
Better diagnosis may partly explain why food allergies appear to be growing. But Munoz-Furlong believes our changing diet also plays a role. Just one generation ago, she argues, people ate simpler food: Dinner was a potato, another vegetable, some meat. Now, at an early age, children consume nuts, for example, in packaged cookies, salad toppings, trail mixes and cereals.
“Perhaps the immune system is too immature,” says Munoz-Furlong, a theory Leong and other allergists echo. Especially in families with a history of allergy, parents might be wise, they say, to withhold peanuts, tree nuts, fish and shellfish for a child’s first two or three years.
Los Angeles allergist Dr. Gary Rachelefsky isn’t so sure food allergies are growing, although he is definitely seeing more patients who complain of them. In most cases, Rachelefsky says, food is not causing the fatigue, headaches, joint pain and discomfort that send these people in for help.
“I hope this story will dispel the myth that food allergies are causing a lot of people’s symptoms and that they’re easy to diagnose and treat,” he says. “There are a lot of doctors who do manipulation in diets and for naught, especially in children. They’ll take kids off foods and (the kids) don’t grow well. They don’t use science to evaluate them properly.”
For people with true food allergies, the only effective treatment is avoidance. Pollen and animal allergies often can be moderated with desensitization shots — injecting the patient with ever-increasing amounts of the allergen — but food desensitization shots are too dangerous. But in a medical breakthrough, Sampson and colleagues are nearing human trials of a peanut vaccine that could be a prototype for tackling other food allergens. Using recombinant DNA techniques, they have identified and isolated the protein in the peanut responsible for the reaction and altered the protein so IgE antibodies can’t bind to it.
“It allows us to inject the responsible proteinwithout the possibility of anaphylactic reaction,” Sampson says.
Until these vaccines are approved, however, food allergy sufferers will have to continue the avoidance routines that for many have become second nature: the label reading, questioning and second- guessing.
Allergy Resources
– American Academy of Allergy, Asthma & Immunology, 611 E. Wells St., Milwaukee, WI. 53202; 800-822-2762. Web site: www.aaaai.org
– The Food Allergy Network, 10400 Eaton Pl., Suite 107, Fairfax, VA 22030; 800-929-4040. Web site: www.foodallergy.org
– International Food Information Council Foundation, 1100 Connecticut Ave. N.W., Suite 430, Washington, D.C. 20036; 202-296-6540. Web site: www.ificinfo.health.org