How Food Allergy Is Treated

The treatment of food allergies not only involves medications and therapies to treat or alleviate allergy symptoms but also lifestyle practices to avoid exposure to allergy-triggering substances in foods (known as allergens).

Today, there is a wide range of treatments available to help you deal with food allergies, whether they are causing mild symptoms like mouth tingling and diarrhea or potentially serious ones like anaphylaxis.

This article looks at the various home, over-the-counter (OTC), prescription, and complementary treatments used to manage or ease food allergies. It also describes some of the specialist immunotherapy techniques used to reduce your sensitivity to common food allergens.

Home Remedies and Lifestyle

There is no cure for food allergies. The only sure-fire way to avoid an allergic response is to omit known allergens from your diet.

This is not always as straightforward as it may seem, as it can be difficult to identify your exact trigger out of all the foods you eat. Moreover, people with "true" food allergies are often cross-reactive to a wide range of foods.

There are tests and procedures that can help pinpoint the culprits—like skin-prick tests and elimination diets administered by an allergist—but arguably the easiest way to do so is to keep a food diary. By keeping a record of everything you eat and every time you have a reaction, you can gradually narrow down the suspects.

Once you've identified your food allergens, you can start building strategies to not only avoid them but reduce the risk of cross-contamination as well.

Reading Food Labels

We live in a processed-food culture. According to a 2016 study in the Journal of Nutrition, no less than 61% of calories consumed by Americans come from highly processed foods and beverages.

Beyond the nutritional concerns, eating packaged or processed foods increases the risk of exposure to hidden food allergens. This requires people to be especially vigilant when reading food labels.

The Food Allergy Labeling and Consumer Protection Act of 2004 mandates that manufacturers prominently indicate if any of the eight most common food allergens are included in their product, even if they are only additives. In addition, the manufacturer must state the specific type of nut, fish, or crustacean used so that the consumer can make an informed choice.

People with food allergies also need to educate themselves about the various names that may be used to identify food allergens. Examples include:

• Dairy: Casein, caseinate, cheese, curds, ghee, kefir, lactalbumin, rennet, whey
• Egg: Albumin, globulin, mayonnaise, meringue
• Fish and shellfish: Crabsticks (processed pollock), crevette, puttanesca sauce (anchovies), scampi, Worcestershire sauce (anchovies)
• Peanuts and tree nuts: Marzipan, nougat, pignoli, satay sauce (peanuts)
• Soy: Edamame, miso, tempeh, tamari, textured vegetable protein (TVP), tofu
• Wheat: Bulgar, couscous, durum, einkorn, emmet, farina, Kamut, seitan, semolina, spelt

To be safe, learn the scientific and alternative names of any foods you are allergic to.

Avoiding Cross-Contamination

If you have severe food allergies, you would need to take steps to avoid cross-contamination at home and in restaurants. This is especially true if you have a history of anaphylaxis, a potentially life-threatening, whole-body reaction that can lead to shock, coma, and death if left untreated.

Cross-contamination is when food containing an allergen is accidentally transferred to food that does not contain the allergen. For some people, even a tiny amount of transferred allergen can trigger symptoms. 

For instance, 95% of people with peanut allergies will react to 1 milligram or more of peanut protein. The other 5% can react to amounts far less than this, sometimes severely.

In households where a family member is at high risk of anaphylaxis, every effort should be made to control the types of food that are brought into the house, including snacks or gifts from friends.

Other measures may be needed to avoid cross-contamination, including:

• Limiting problematic foods to certain parts of the kitchen
• Having dedicated storage, preparation, and dining spaces for allergen and allergen-free foods
• Having allergen-free utensils, preparation spaces, containers, cabinets, and drawers
• Teaching everyone how to properly clean surfaces and store problematic foods

If planning to dine out at a restaurant, do not hesitate to call in advance to advise the kitchen of your dietary concerns. You can also carry "chef cards" to pass to the kitchen describing the nature of your allergy and the foods you can and cannot eat.

As a general rule, avoid salad bars, buffet-style restaurants, and ice cream parlors if you have a history of severe food allergies. These are places where the risk of cross-contamination is high.

Over-the-Counter (OTC) Therapies

Mild to moderate food allergies may cause a runny nose, sneezing, and an itchy mouth or skin. In cases like these, an over-the-counter oral antihistamine can often help.

Also known as H1 blockers, antihistamines work by inhibiting the action of a chemical known as histamine that the immune system produces in response to an allergen.

Options include first-generation antihistamines that tend to cause drowsiness and second-generation antihistamines that are more non-drowsy.

The list of antihistamines includes:

• First-generation H1 blockers: Benadryl (diphenhydramine), Chlor-Trimeton (chlorpheniramine), Tavist (clemastine)
• Second-generation H1 blockers: Allegra (fexofenadine), Claritin (loratadine), Zyrtec (cetirizine).

Although both are effective in treating food allergies, first-generation drugs like Benadryl may be useful if the symptoms are interfering with sleep. By contrast, antihistamines like Zyrtec are more appropriate if you have to work or drive.

Side effects include dry mouth, dizziness, nausea, restlessness, blurred vision, vomiting, and difficulty urinating.

Prescriptions

Food allergies can sometimes be severe and require prescription medications, including injectable drugs used to treat anaphylaxis.

Generally speaking, all severe food allergies are treated as medical emergencies even if they do not appear to be life-threatening. This is because the symptoms of anaphylaxis are highly unpredictable and can suddenly turn deadly if not treated appropriately.

Even if you've had only minor allergy symptoms in the past, you can still develop anaphylaxis, often without warning.

Epinephrine

Epinephrine (adrenaline) is the first-line treatment for anaphylaxis and the only drug that can reverse anaphylaxis symptoms. It is delivered by an injection into the muscle of the thigh, ideally within minutes of the appearance of symptoms.

Epinephrine works by causing vasoconstriction (the narrowing of blood vessels). This rapidly reverses the swelling of tissues in the lungs and throat while countering potentially deadly drops in blood pressure that could lead to shock.

The effects of epinephrine are fast but don't last long. Once injected, additional medical interventions are needed without exception.

Other Medications

Once epinephrine has been delivered, other drugs may be needed to fully resolve the anaphylaxis symptoms. Option include:

• Intravenous antihistamines: There are given intravenously (into a vein) to rapidly counter the effects of histamine. Diphenhydramine is commonly used.
• Corticosteroid drugs: Also known as steroids, these drugs are given either orally or intravenously to reduce inflammation and prevent a recurrence of symptoms. Prednisone is one of the more common options.
  
• Short-acting bronchodilators: Popularly known as rescue inhalers, these drugs are inhaled to rapidly ease shortness of breath and wheezing. Inhalants like albuterol are especially useful.

Additionally, anyone at high risk of anaphylaxis should carry a prefilled epinephrine auto-injector, called an EpiPen, in case of an emergency.

Specialist-Driven Procedures

Although the avoidance of food allergens remains the first-line approach to managing food allergies, there are ways to reduce your sensitivity to allergens if you are at risk of a severe reaction.

Allergen immunotherapy (AIT) is a therapy used by allergists in which you are exposed to gradually increasing amounts of a known food allergen. By doing so, your body will slowly become accustomed and less responsive to the allergen.

Allergen immunotherapy can take several forms in people with food allergies:

• Oral allergen immunotherapy (OIT): This involves eating gradually increasing amounts of allergy-causing foods under the observation of an allergist.
• Sublingual immunotherapy (SLIT): These are allergen drops given sublingually (under the tongue) that can be administered daily at home.
• Epicutaneous immunotherapy (EPIT): These are adhesive transdermal patches applied to the skin. The patches deliver continuous amounts of an allergen throughout the day.

According to a 2018 review of studies in the journal Children, OIT is the most effective way to treat milk, egg, peanut, tree nut, fruit, and vegetable allergies in kids.

SLIT was only moderately effective in treating milk, peanuts, hazelnut, and kiwi allergies, while EPIT achieved variable results with milk and peanut allergies.

Palforzia (Arachis Hypogaea Allergen Powder)

In February 2020, the Food and Drug Administration (FDA) approved Palforzia (Arachis hypogaea allergen powder) as a form of OIT for children with peanut allergies. It is a powdered protein made from peanuts that is used in conjunction with a peanut-avoidance diet.

Palforzia is not intended to cure peanut allergies but is used on an ongoing basis to reduce the frequency and severity of symptoms, including anaphylaxis.

Palforzia is approved for children 4 through 17 years of age. The dose can be increased under the direction of an allergist, from as little as 0.5 milligrams (mg) per day to as much as 300 mg per day.

Complementary and Alternative Medicine (CAM)

Complementary and alternative medicines (CAM) are widely used in the United States to treat all types of allergies. At present, there is little evidence that they offer any benefit to people with food allergies.

One of the most touted therapies is a Chinese herbal remedy known as FAHF-2. The oral drug is based on the classical Chinese formula Wu Mei Wan and contains nine herbal ingredients, including gan giang (ginger) and dang gui (angelica root).

A 2016 study in the Journal of Allergy and Clinical Immunology reported that FAHF-2, taken three times daily for six months, performed no better than a sham placebo in reducing the severity or frequency of food allergy symptoms.

Other therapies, including acupuncture and probiotics, have been proposed, but there remains little evidence to support their use or safety.

Given the limited research and potential harms, it is too soon to recommend any complementary or alternative therapy for people with food allergies.

Summary

The treatment of food allergies encompasses over-the-counter antihistamines to treat mild allergy symptoms and prescription drugs like epinephrine to treat anaphylaxis.

People with severe food allergies can undergo allergen immunotherapy (AIT) to gradually desensitize them to allergy-causing foods. This includes Palforzia, a peanut-derived powder taken by mouth that can reduce the severity and frequency of attacks in children with peanut allergies.

Lifestyle factors, such as the identification and avoidance of food allergens, are also central to the management of food allergies.

A Word From Verywell

The identification of food allergens is your first step to avoiding allergic reactions. But if you have no idea what is causing your symptoms, speak with an allergist who can perform tests and procedures to identify the culprit.

In some cases, the cause may not be an allergy after all but turn out to be a food intolerance instead. This is important to know as the two involve entirely different immune responses and are treated differently,