Delayed Reactions

Allergies can develop at any age, and some symptoms are nothing to sneeze at

By Alexa Stanard

Sara Gleicher had a mean rash.

The Southfield resident returned from a 2013 trip to California with itchy, red bumps covering nearly her entire body. Gleicher, now 59, chalked it up to the hotel sheets. But the rash didn’t go away. Over the course of the next year, she saw five separate doctors, itching all the while.

“The first dermatologist did a bunch of blood tests and a biopsy and said it was dermatitis and that there was nothing we could do,” Gleicher says. “The second one said the same. The third suggested an allergy test but did a very selective test, which showed nothing.”

As a child, Gleicher had been allergic to tree nuts, poppy seeds, cat dander, grass, and pollen. She also had asthma and eczema.

“Finally, in early 2014, I went back to my primary care doctor and said, I want a full allergy test,” Gleicher says. “He sent me to a doctor I love, who did the full panel — and voila.”

The test revealed Gleicher was allergic to dairy, soy, fish, eggs, oranges, lentils, black beans, and peas. Gleicher was “floored” by the results, she says. She eliminated all the offending foods, and her rash cleared up.

In our allergy-anxious culture, most of the focus is (rightly) on kids. But adults can develop new allergies, too, both to foods and to things in their environment.


What Are Allergies?

Allergies are a reaction by the body’s immune system to a substance that has been inhaled, ingested, or touched.

Allergens — things like pet dander, pollen, and various foods — are typically harmless in themselves, but for the 20 percent of Americans who have allergies, they can cause reactions ranging from watery eyes to life-threatening anaphylaxis.

People with type 1 allergies produce an antibody called IgE in response to an offending substance. But an allergic reaction doesn’t happen typically upon first contact with the allergen, though.

“People aren’t born with the antibody IgE,” says Dr. James Baldwin, division chief of allergy and clinical immunology at the University of Michigan. “You only make it if you’re genetically predisposed and have seen the allergen before — you typically don’t react the first time because the IgE hasn’t formed. It’s usually on subsequent exposures or after several exposures.”

That delayed reaction is why a person can move to a new city and not have environmental allergies for the first season or two. Eventually, though, the antibodies cause the affected person’s blood cells to release histamine, which causes the physical symptoms we associate with allergies.

“Allergies can cause rash, difficulty breathing, swelling of the tongue and throat, often vomiting and diarrhea — it’s the body’s way of clearing the allergen out of the system,” says Dr. Elizabeth Secord, division chief for allergy, asthma, and immunology at Children’s Hospital of Michigan DMC. “Usually it’s not subtle. It’s important to seek medical attention because reactions can be life-threatening.”


Some Stick Around, Others Don’t

Allergies can come and go during a person’s life. Certain allergies, like that to wheat, are usually limited to children and outgrown by adulthood. Others, like those to seafood and tree nuts, are typically lifelong.

“Food allergies in young kids are different,” Secord says. “There are some food allergies that children have that they usually outgrow; the big ones are milk, soy, wheat, and egg. Kids tend to have them more than adults and they usually outgrow them.

“Then there are the big food allergies — fish, shellfish, tree nuts and peanut,” she adds. “If you have those, you tend to keep them. Some people do outgrow them, but usually if you’ve had an allergy to one of the big four, the advice is, there’s a lot of good foods in the world.”

It’s not clear why some allergies tend to stick around while others don’t. As we get older, our immune system weakens, making the body less able to muster a response to an invader.

“The good news is that as people age — late middle age to elderly — their allergies sometimes burn out,” Secord says. “The bad news is immune response reduces, too. The good responses are waning so the responses that make spring miserable are, too.”

Nonetheless, adults, especially those who had childhood allergies, can suddenly begin reacting to familiar foods or to their environments.

For Gleicher, most of the foods she has become allergic to are ones she ate often before her rash appeared; eliminating them caused her to lose 10 pounds.

“Now when I get a reaction, usually from cross-contamination at a restaurant, I take an antihistamine,” she says. “It’s a magic pill, but it leaves you feeling drowsy.

“The one fun thing is — I was always allergic to cats; I used to be so allergic I would just walk into a room where there were cats and my eyes would water up,” she adds. “But [recently] I went to D.C. and slept at a girlfriend’s place. Her two cats were all over me. [Now] I am not allergic at all.”

Such shifts are not entirely understood by researchers. But Gleicher’s physician, Southfield allergist-immunologist Dr. Annie Arrey-Mensah, says medicine’s tendency to function in silos can mean that symptoms like Gleicher’s are overlooked or misdiagnosed.

Gleicher, she says, presented with a history of asthma and eczema. Her symptoms combined with her childhood history of allergies, Arrey-Mensah says, made her “easy to diagnose,” despite the fact that her condition had been missed by several other doctors.

“We need to really focus more on the fact that skin conditions can be manifestations of systemic disease,” Arrey-Mensah says. “That’s where our field crosses with that of dermatology, and where we tend to miss the boat.”


Confusion Over Allergies

We now live in a culture increasingly concerned about chemicals in our air and water and additives in our food. That health consciousness is largely for the good, but when it comes to allergies, it can also create confusion.

Allergies are an immune-system reaction: If you eat dairy and, a few minutes later, your lips are swelling and you’re having trouble breathing, you’re probably allergic to dairy. If you eat dairy and it leaves you feeling gassy, you’re not.

“The typical allergy to food happens within minutes of ingesting the food,” Secord says. “There are reports of up to a couple of hours, but something that happens a day later or two days later, that’s not an allergy.”

Baldwin says he daily sees patients who mistakenly believe they are allergic to various foods.

“There are many different ways foods can disagree with people; we call those all reactions,” Baldwin says. “There are several different mechanisms by which they can disagree [besides allergic reactions.] You can have toxic reactions, metabolic reactions, idiosyncratic reactions. People say, ‘I’m allergic to this food and I want a skin test.’ But a skin test will only help with type 1 — nothing else. ”

The difference between an allergy and a sensitivity or other type of reaction may not be meaningful to people whose symptoms are less than severe. But it’s important when the patient is a child, doctors say, because many parents associate certain foods with behavior problems in kids and decide their children are allergic.

“Allergic reactions to foods don’t cause behavioral problems,” Secord says. “Many things could cause behavioral problems, but allergies to foods do not.”

Baldwin encounters similar misunderstanding in his practice.

“If Johnny acts crazy when he has chocolate milk, it’s probably not because he’s milk-allergic,” Baldwin says. “There are other issues. And a skin test won’t help you [diagnose them].”

Secord says parents of children with special needs often have heightened concerns about allergies. “A lot of people who have children with autism and other neurological problems — I feel they’re taken advantage of,” she says. “People are desperate when their children are not OK, and they’re trying so hard to make something work. The kids are often put on very restrictive diets.

“I have an autistic child,” she adds. “The social part is very important. To be put on a diet where they can’t eat what the other kids are eating, is maybe not a kind thing to do.”

Parents of special-needs kids who think a given food could be contributing to their child’s problems should work with their pediatrician, a registered dietitian, or a nurse specializing in dietary health, Secord says, and should eliminate one food at a time to gauge impact.

“Fifteen years ago everyone was keeping their kids from drinking milk because it causes mucus,” she says. “Then it was wheat. But food fads are what they are, so maybe take it easy on the kids.”

Cleaning House

If you suffer from environmental allergies, your house is most likely a hotbed for what ails you.

Environmental allergens are hard to avoid, in part because they’re so pervasive and in part because they’re often invisible. Dust mites and pet dander, two major offenders, burrow into our carpet and towels and snuggle into our pillows and furniture. Pollen wafts in though open windows and makes the journey indoors on the soles of our shoes.

And let’s not forget about chemicals. Though pollutants like cleaning products, cigarette smoke, pesticides, and even air fresheners aren’t typically allergens, they are often irritants, causing headaches, shortness of breath, dizziness, and fatigue in those who are sensitive to them.

Follow these tips to help control environmental allergies and sensitivities:

  • Ditch the carpet, especially in the bedroom.
  • Keep pets out of the bedroom.
  • Remove stuffed animals. If your child can’t part with all of them, get the pile down to as few as possible, and then wash them in hot water.
  • Keep the windows closed.
  • Use air conditioning to reduce humidity.
  • Install a high-efficiency particulate air cleaner in your home.
  • Clean floors with a HEPA vacuum.
  • To kill dust mites, wash towels and bedding in water that is 130 degrees or hotter, and dry them in a hot dryer. (Avoid using an outdoor clothesline in the warm-weather months.)
  • Use hypo-allergenic bedding and allergy-proof covers for pillows and mattresses.

Uncovering Hidden Allergens

Knowing what your trigger foods are is just a part of managing allergies

By Dorothy Hernandez

As someone with several food allergies and celiac disease, Donna Organek is careful about what she eats. Since working with a nutritionist, she has started cooking at home more and reading food labels closely.

She also buys products with recognizable ingredients. “If I don’t know what it is I just don’t buy it,” says the Sterling Heights resident, 62.

Organek errs on the side of caution, but even that sometimes isn’t enough. She purchased turkey patties, whose label simply listed “natural flavorings.” Thinking it was OK, she ate it and later got a “grinding” headache. She had a reaction to the natural flavorings, which she discovered included cultured celery powder, among other things.

Reading food labels is essential, says Aarti Batavia, a registered dietitian who developed food allergies herself after moving to the U.S. from India. Some things to look out: colors and dyes, sorbates, sulfites, glutamates, and derivatives of wheat and sources of gluten such as yeast, hydrolyzed wheat protein, and malt (“it is disguised in so many names,” she says).

The Food Allergen Labeling and Consumer Protection Act (FALCPA) requires that the labels of foods that include any of the top eight allergens (milk, eggs, peanuts, tree nuts, wheat, soy, fish, shellfish) note the allergen in plain language either in the ingredient list or have the word “contains” followed by the name e.g. contains milk, wheat, etc. or in the list in parenthesis e.g. albumin (egg). Another thing to be aware of is that potential allergens other than the top eight might not be clearly listed.

Other than reading labels Batavia suggests cutting down on processed foods, where hidden food allergens may lurk. Some examples include Worcestershire sauce, which may have fish and soy, and dressings, which may have nuts, wheat, and soy. And don’t just stop at food, Batavia says. Medications may have lactose (milk sugar), and even licking stamps, which may have gluten, might be something to avoid. For Organek, even her communion at weekly Mass was an issue.

Here are some examples of unexpected sources of the top allergens, according to Food Allergy Research & Education.

  • Eggs: Eggs have been used to create the foam or topping on coffee drinks. Some brands of egg substitutes contain egg whites. The flu vaccine may also contain eggs.
  • Peanuts: These legumes are used heavily in African, Asian, and Mexican dishes, as well as sauces such as hot sauce, pesto, and gravy.
  • Tree nuts: They may be found in marinades, barbecue sauces, and some cold cuts, such as mortadella.
  • Dairy: Look out for casein, a milk protein that may be found in some brands of canned tuna and many non-dairy products. Some meats may contain casein as a binder.
  • Wheat: Wheat is found in some brands of ice cream, marinara sauce, potato chips, rice cakes, turkey patties and hot dogs, candy, processed meats, and imitation crabmeat.
  • Soy: This ingredient is something to be very careful of as soybeans and soy products are found in many foods such as baked goods, canned tuna and meat, canned broths and soups, imitation fish, meatloaf, and barbecue sauce. It’s also used as a filler and extender in many products.

Gluten-Less To the Max

If only 1 percent of Americans have celiac disease, why is the market for gluten-free products so robust?

By Alexa Stanard

It might be time for the American public to calm down about gluten.

Gluten, a protein found in wheat, rye, and barley, is the latest scourge of trend-minded dieters looking to lose weight and improve their health. The market for gluten-free products is projected to hit $15.6 billion by 2016; nearly every food, from cookies and bread to pizza, now comes in a gluten-free version.

However, unless you’re among the roughly 1 percent of Americans with celiac disease, skipping gluten likely won’t do you any good. In fact, gluten-free products are often higher in sugar and fat than their gluten-ous counterparts — and cost on average twice as much.

So how have so many Americans been induced to try an expensive diet so short on research-validated health benefits?

“I think people are desperate for getting better,” says Dr. Mitchell S. Cappell, chief of gastroenterology and hepatology at Beaumont Hospital in Royal Oak. “People have a lot of stress, and stress brings on gastrointestinal symptoms. People suffer greatly, so they go to see doctors and are told they can’t find anything. So they’re looking for an answer. They see the symptoms celiac disease can cause and think that’s what they’ve got.”

Indeed, celiac disease, a disorder that can cause serious, even life-threatening intestinal damage if the sufferer consumes gluten, is associated in adults with symptoms ranging from diarrhea to joint pain to anxiety. In other words, no matter what ails you, your symptoms probably overlap in part with those of celiac disease. (Gluten sensitivity, a controversial condition, may be a sensitivity to FODMAPs — see “Figuring Out FODMAPs” below.)

The condition, though relatively rare, is on the rise, for reasons not fully understood. It tends to run in families, and is more prevalent in people of European descent.

However, a lot of people have what might broadly be called tummy troubles, and many of those people are independently deciding that gluten is the culprit.

That concerns health professionals, for several reasons. If a person truly has celiac disease and has been abstaining from gluten for many months, diagnostic tests won’t pick up on the condition (the tests check for antibodies to gluten). Furthermore, someone with the disease must abstain from even small amounts of gluten, which is difficult to do without guidance from a doctor or nutritionist (gluten is found in an astounding array of products.) Other conditions, like acid reflux or irritable bowel syndrome, could remain undetected and untreated if they don’t see a doctor. “People need to step back,” Cappell says. “You wouldn’t self-diagnose a stomach ulcer. For every person with celiac there are probably 10 with reflux. It would be very unfortunate for them to decide they have celiac and treat themselves.”

For those who hope that cutting gluten will trim their waistline, “gluten-free” isn’t synonymous with healthy. “The market is flooded with products labeled gluten-free, so some people on the diet are actually gaining weight,” says Bethany Thayer, a registered dietitian nutritionist and the director for Henry Ford Health System’s Center for Health Promotion and Disease Prevention. In addition, she notes, many products containing gluten are enriched with vital nutrients like folic acid and iron.

“When you cut gluten out, it’s really important to talk with a registered dietitian to identify the nutrients you’re at risk of not getting and how can you get those nutrients, like from other grains,” she says.

Instead of being concerned about gluten, people should avoid foods that decades of research have established as unhealthy.

“If a person wants to improve their health, I would tell them first to lose weight, if they’re overweight, and to avoid the harmful foods — sugar, white bread, red meat,” Cappell says. “Don’t waste your time searching for gluten.”

Figuring Out FODMAPs

Gluten may be grabbing the headlines, but it’s FODMAPs that are exciting researchers.

The mouthful of an acronym stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols — and a growing body of research is linking consumption of these short-chain carbohydrates with worsening the symptoms of irritable bowel syndrome, including gas, diarrhea, and gastrointestinal discomfort.

The list of foods high in FODMAPs is lengthy and includes items like garlic, onions, apples, avocado and dairy. Many high-FODMAPs foods, like wheat and barley, also happen to contain gluten, which may be one reason why people who eliminate gluten swear their stomach feels better.

“We don’t know the cause of IBS, but FODMAPs have been looked at intensively recently,” says Dr. Mitchell S. Cappell. “Some good studies are showing that if you eliminate the FODMAPs, you can see improvement.”

However, he notes, a FODMAPs elimination diet is not easy to follow and should be done under the care of a doctor. The best approach is to eliminate one of the groups at a time (most people are only affected by one or two) and see if symptoms cease.