How to prevent food allergy flare-ups

By staying informed about how to prevent food triggers, and what to look out for when shopping and eating out, you can prevent food allergy flare-ups. 

Yolandé Venter, a registered dietitian at Mediclinic Paarl, stresses the need to differentiate between a true food allergy and food intolerance. While food intolerance is when a certain food or ingredient irritates the person’s gut, which impacts the digestive system, only a true food allergy involves the immune system.

“With food allergies, an immune response toward a certain food, component or ingredient may vary between mild symptoms to life-threatening and fatal reactions,” she explains. “Food intolerance is dose dependant, whereas allergic reactions can be triggered by microscopic amounts of the allergen.”

Eliminate food triggers from your diet

To avoid allergy triggers, says Venter, one must avoid all foods or ingredients which cause an allergic reaction. “Allergic triggers may be present as hidden ingredients in food items, for example additives, preservatives, colourants and so on.  Always read food labels and if you’re unsure about any ingredients, do not consume the food item.” 

With food allergies, cross-reactions may occur. “This means the body may recognise and launch an immune response against another protein with similar features to the allergic trigger,” Venter explains. “For example, individuals with cow’s milk protein allergy may also have an allergic response to goat’s milk protein or soy protein.” While it’s not ideal to exclude foods or food groups from the diet unnecessarily, an awareness of the possibility of cross-reactions aids successful management.

If total food groups must be excluded, a dietitian can help to prevent nutrient deficiencies from forming by incorporating other dietary alternatives into the diet or by suggesting supplementation. Food allergens may also be present in non-food products like medication, lotions, toothpaste and so on, Venter adds, so read the product ingredient list and investigate hypo-allergenic options.

Understanding labels on packaged foods

According to the Directorate of Food Control (under the Department of Health), food labels must include the listed major allergens in South Africa, namely:

• Cow’s milk
• Peanuts
• Tree nuts
• Soya
• Significant cereals
• Egg
• Shellfish
• Fish

If your allergen is not covered, look out for label wording like “natural flavourings”.

“Reading a food label for allergens may be different to just reading it for nutritional value information as allergens are given different names,” Venter adds. “For example, cow’s milk protein may be listed as whey, casein or sodium caseinate.” Know the different names of your allergens.

“Food labels have a specific section below the ingredient list stating ‘allergens’,” she continues. “It may use the words ‘contains,’ ‘may contain’, or ‘manufactured in a factory that processes’, followed by the name of the major food allergen. The first statement means that the product contains the allergen as an ingredient, whereas the latter two indicate that, although the allergen is not added into the recipe, it may contain a small amount due to contamination.”

If you travel or buy imported products, know that food labelling regulations vary by country. 

Always read the labels, says Venter, even on products you know. “Food manufacturers are allowed to change the ingredients of their products without changing the packaging.” For example, holiday editions of chocolates may be updated to say “contains traces of peanuts”.

How to dine out safely

Before eating out, speak to the restaurant owner or chef, Venter suggests. “Tell them about your allergy and ask whether they cater for food allergies, have full ingredient lists available for each menu option, use separate cutting boards in the kitchen to help prevent allergen contamination, and so on.”

Where possible, browse the menu beforehand, choose a dish and give the restaurant a list of your food allergies so the chef can prepare you a safe meal. Ordering a freshly prepared à la carte meal may be safer than going to a buffet or a restaurant with pre-prepared meals, where cross-contamination can occur when the same utensils are used to dish up different foods.

“Also avoid restaurants known to use your trigger allergen in their meals, for example, avoid seafood restaurants altogether if you have a shellfish allergy,” Venter adds.

Regardless of how well you and the chef prepare, accidents can happen, she cautions. “Be prepared. Always have your prescribed epinephrine auto-injector or any prescription medication with you in a sealed bag with written instructions.” 

Who to inform

“If a child is allergic, tell the class teacher, the appointed school nurse, and all helpers and assistants,” says Venter. “With an anaphylactic allergy, the team should be given a specific written emergency plan and marked prescribed medication in case of accidental allergen exposure.” Classmates and their parents should also be informed.

Adults in the workplace should share the information with their employer, occupational health and safety practitioner, and colleagues. “Consider wearing a medic-alert bracelet with your listed allergies in case of emergency,” Venter adds. “If you or your child is admitted to an emergency unit, discuss your food allergies with the admitting doctor as some medications may contain food allergens. For example, the sedative Propofol contains egg and soy derivatives.”