FOOD ALLERGY AND FOOD INTOLERANCE
Restaurants often ask you about your dietary restrictions such as food allergy or intolerance. Restaurant owners want to avoid complaints or claims following such misadventures. Two recent laws enacted by the government include FASTER act (Food Allergy Safety, Treatment, Education and Research Act) and Food Allergen Labeling and Consumer Protection Act are aimed to provide protection for people with food allergy/intolerance. The Center for Disease Control and Prevention (CDC) estimates six percent of U.S. population has food allergies, and 15-20 percent has various food intolerances.
What is the difference between food allergy and food intolerance? Many of us tend to lump them together. However, they are two different types of problems.
In food allergy, the immune system of the body reacts shortly after consuming certain food, mistakenly identifying the proteins in the food as an offensive agent. Immunoglobulin called Ig-E binds to the allergen and sets up a reaction. This response can be mild, moderate or severe on different people. Mild symptoms are rashes or hives, itching and tingling. More severe symptoms can be swelling of tongue, lips, face, nausea, vomiting, abdominal pain, shortness of breath. Very severe symptoms of anaphylaxis can also occur, resulting in drop in blood pressure, loss of consciousness, shock and even death.
The main food items that cause such food allergies are called the big nines – milk, eggs, peanuts, tree nuts, fish, shellfish, soy, wheat and sesame. Diagnosis is made regarding the history of allergic symptoms from childhood. Confirmation is done by allergy specialists who conduct skin tests, blood tests and controlled food challenges.
Treatment is by structured desensitization from childhood, use of antihistamines and sometimes corticosteroids. Epinephrine injection (Epi-pen) is used in severe reactions. More recently in February 2024, FDA approved Xolair (Omalizumab) for treatment of food allergy. A monoclonal antibody, given as a subcutaneous injection it binds to the immunoglobulin E (Ig-E) first, thus preventing the allergen getting to it.
For the affected individuals, it is important to be aware of food allergies and avoid such food items using extreme caution. Special attention to food items, preparations, and supplements are needed, particularly during parties and in restaurants. Allergenic items can get mixed in the food inadvertently. Better to be careful than be sorry.
Food intolerance on the other hand, is difficulty in digesting certain foods leading to varying discomforts. A very common form is lactose intolerance, where milk and other diary products are not digested due to deficiency of lactase enzyme. Another frequent condition is gluten intolerance, where gluten found in wheat, rye, barley and oats is poorly tolerated. It can be in a simple form of non-celiac gluten intolerance or in a more complicated long-term autoimmune disorder called celiac disease. In celiac disease, the immune system mistakenly considers gluten as an invader and destroys the lining of the small intestines. Fructose intolerance, histamine intolerance and intolerance to food additives such as sulfites and monosodium glutamate (MSG) are other types of food intolerances.
Symptoms of food intolerance can be abdominal symptoms of bloating, gas, diarrhea or constipation. They may also experience skin rashes, headaches, nasal congestion, fatigue or anxiety and depression. In the more serious celiac disease, one can develop malnutrition, malabsorption, vitamin deficiencies, anemia, osteoporosis and stunted growth in children.
Treatment of food intolerance is mainly by avoiding intake of such trigger food items. Slow desensitization can be tried. Lactase enzyme as supplement can be taken for those with lactose intolerance or probiotics.
In the case of gluten intolerance, it would be necessary to find out if it is non-celiac or celiac disorder is the cause. Consultation with a gastroenterologist or allergist, blood tests and small intestinal biopsy should clarify the situation. Celiac disease will need more aggressive long-term care and nutritional management to prevent malnutrition and related consequences.
Overall, food allergies and food intolerances can significantly affect the well-being and health of an individual. Some of the aftereffects can be serious with long-term complications. It is better to diagnose them early on and take preventive steps. With ongoing vigilance and management strategies, one can expect to live reasonably well.
Dr. Venkit S. Iyer, MD, FACS, is a retired general and vascular surgeon. He has authored six books: “Decision making in clinical surgery” first and second editions; “Aging well and reaching beyond,” “The Clinic,” “Geriatrics Handbook” and “Iyer’s story book for children.” They are available through Amazon or from the author. His website venkitiyer.com has necessary links and contact information.
Editor’s Note: Khaas Baat sincerely thanks Dr. Ravindra Nathan for his valuablecontributions through his monthly health column starting with our first year of publication.
EYE CARE
March is Workplace Vision Protection Month
Vision, a precious asset often overlooked until compromised, demands vigilant protection in the workplace. Be it a construction site, laboratory or office, proactive measures are indispensable to thwart potential eye injuries. This article explores the criticality of workplace eye safety, identifies prevalent hazards and offers preventive strategies.
Given their delicate nature and exposure to diverse risks, eyes are highly susceptible to injuries in work environments. Chemicals, projectiles, radiation, and digital screens are among the culprits contributing to workplace-related eye injuries, impacting personal well-being and productivity.
Common Hazards
1. Chemicals: Exposure to corrosive substances like acids or solvents can lead to severe eye damage if not promptly treated.
2. Flying particles: Dust, debris, or fragments from construction, machining, or grinding activities pose a threat of penetrating the eye.
3. Radiation: Welding arcs, lasers or UV light can result in eye burns or long-term damage without proper protection.
4. Impact: Mishandling of tools, machinery or equipment may cause blunt force trauma, ranging from minor scratches to severe lacerations.
5. Digital eye strain: Prolonged screen exposure can cause discomfort and dryness, collectively termed computer vision syndrome.
Prevention Strategies
1. Personal Protective Equipment (PPE): Ensure all personnel wear suitable eye protection such as safety glasses, goggles or face shields tailored to their work environment's hazards.
2. Hazard assessments: Regularly evaluate workplace conditions to pinpoint potential eye hazards and implement requisite controls such as machine guards or engineering solutions.
3. Training and education: Provide comprehensive instruction on eye safety practices encompassing proper PPE use, emergency protocols for eye injuries, and hazard awareness.
4. Eye care practices: Encourage periodic breaks, particularly during extended screen use, to alleviate digital eye strain. Emphasize prompt rinsing with water in cases of chemical exposure.
5. Regular eye exams: Advocate for routine eye checkups to promptly address any vision anomalies, ensuring optimal eye health for employees.
Management Options
Simple workplace accidents, including chemicals, foreign bodies or wind-assisted impacted particles can be addressed with minimally invasive treatments with your local eye doctor.
More invasive accidents and exposures need immediate treatment using advanced diagnostics and non-surgical or surgical interventions from ocular surface correction to corneal tear injuries, lens damage and or internal eye bleeding. These not only require management at the time of injury but also long-term follow-up, especially in situations like radiation or intense chemical exposures and possibly cause scarring in the future and adversely involves vision.
Preserving workplace eye safety necessitates proactive measures, education and sustained vigilance. By prioritizing preventive actions and fostering a culture of awareness, organizations can uphold employees' vision and well-being, fostering a safer and more productive work milieu. Remember, safeguarding eyesight today ensures a clearer, brighter vision for tomorrow.