Food allergies are not uncommon in today’s world. Practically most household has at least one person who has a food allergy, whether it is to the most prevalent peanut, eggs, fish, or milk, among others.

As per Kirti Chadha, Chief Scientific Officer and Senior Oncopathologist of Metropolis Healthcare Limited, A food allergy occurs when certain day-to-day food proteins are wrongly identified as harmful by our immune system, leading to a cascade of protective measures, including the release of inflammatory chemicals like histamine.

She says, “Even minimal exposure to the problematic food can trigger allergic or hypersensitivity reactions which vary in severity.”

According to reports although most food allergies develop during childhood, some may even develop later in life.

In an exclusive interaction with Kirti, she walks us through the role of food allergies, testing, and what happens in the lap.

Read on…

What are the most likely symptoms shown during food allergy?

Kirti: Food allergy symptoms may manifest typically within minutes to hours post-exposure and may include, hives or a rash on the skin, swelling of the lips or eyelids, an itchy throat, swelling of the tongue, mouth or face, hoarse voice, difficulty swallowing, wheezing, or shortness of breath, low blood pressure, nausea, vomiting, or diarrhea.

In severe cases, food allergies can lead to anaphylaxis, characterized by rapid-onset symptoms such as itchy rash, throat or tongue swelling, shortness of breath, and low blood pressure. Anaphylaxis can be life-threatening.

What type of food can make the allergy worsen?

Kirti: Repeated exposure to the allergen or triggering food or lack of timely and adequate treatment measures may often worsen the symptoms, at times proving fatal. Identifying the symptom-causing allergen by timely and effective testing strategies can help avoid these.

Comment on the role of food allergy testing in managing symptoms.

Kirti: Although asthma and respiratory-associated allergies continue to be predominant in the Indian scenario, recent studies have shown that close to six-eight per cent of children and three-four per cent of adults are affected by IgE-mediated food allergies.

The main goal of allergy testing is to find out what you’re allergic to so that you can get the right treatment. These tests can range from skin prick tests to blood tests and oral food challenges, that help identify the triggers.

However, oral food challenges are not as popular because they can have side effects. Specific IgE blood tests are simple and very good at spotting even mild sensitivities to food. Some experts also use skin prick tests, but they don’t give specific amounts, so they’re not great for tracking treatment progress.

Certain newer tests like the CRD (component resolved diagnosis), by Microarray- 4th generation allergy testing technology look at allergies on a molecular level. Being a comprehensive test covering 250 + total allergens, with an AI-driven automated report, it can offer a lot of insights on how to avoid problem foods and the best ways to treat allergies.

In the secret world of food allergy diagnostics, what happens in the lab?

Kirti: Distinguishing between food allergies and intolerances can be challenging. Food allergies can be further classified as IgE-mediated and non-IgE-mediated allergies. Total IgE tests are used for screening for allergies.

When combined with specific IgE-based blood tests, they provide a comprehensive testing solution that may aid in testing for different food allergens across age groups and populations. Total IgE may be elevated in many non-allergic conditions such as parasitic infections, vasculitis, and rare hyper IgE syndrome. Hence a more specific test is needed that can definitely say whether the patient has an allergy or not.

The varied and customised panels based on the food preferences of the population, help detect allergen levels as well as the cross-reactivity. These food-based panels range from vegetarian, and non-vegetarian panels, to nuts panels, fruit panels, etc. catering to various allergies encountered by patients.

Has any research shown a definite solution?

Kirti: As stated previously, the incidence of food allergies in India is showing an increasing trend. Common food allergies include cow milk, eggs, tree nuts, peanuts, shellfish, wheat, soy, and fish. We conducted a two-year study (2020-2022) on 65431 patients for various allergens, among these those suspected of food allergies and opting for the food allergen-based panels showed positivity of 51.78 per cent.

The sensitivity and specificity of the allergens used is an important factor governing the results. Incidence of food allergy especially egg yolk and cow milk was highest in the 0-3 year age group, which however, is shown to reduce by the 6th year of life. This also coincides with studies conducted in the US and Japan. Food allergies being more prevalent in the pediatric age group can be attributed to the fact that biochemical and immunological barriers are underdeveloped during the initial period of life.

Food allergy testing is important to prevent the mismanagement of the disease. The availability of multiple panels using a combination of allergens & cross allergens has helped tackle this issue. It is important to raise awareness about timely testing and prevention by partnering with the national and international allergy societies to help flatten the allergy curve.

How can people with the said condition navigate through this lifestyle?

Kirti: People with food allergies can navigate their lifestyle by being vigilant and informed. While some countries provide allergen information in regular restaurants, in India, this practice is mainly seen in high-end places.

Food packaging can be a source of information, but many food vendors don’t follow allergen labelling rules. Therefore, there’s a crucial need for better regulation in the Indian food industry. As food allergies become more common, it’s important for home cooks and chefs to understand these concerns. It’s about making food safe and delicious for everyone.

First aid for near-death food allergy experience.

Kirti: Anaphylaxis, characterised by rapid-onset symptoms such as itchy rash, throat or tongue swelling, shortness of breath, and low blood pressure can be life-threatening. In such extreme situations, the immediate step would be to try and calm the affected person, use a cold compress, make the person as comfortable as possible, and get immediate and quick access to a health care provider or an emergency room for immediate treatment measure and try and avoid any fatality.

What are your thoughts on the future of food allergy testing in India?

Kirti: Allergy testing and diagnostics is a constantly evolving field. With emerging food allergy trends across the globe, the need for testing solutions to detect and avoid these is rapidly on the rise. The advent of CRD (component resolved diagnosis) by Microarray- 4th generation allergy testing technology, is a step in this direction.

It offers comprehensive coverage of 250+ allergens, with a considerable reduction in cross-reactivity and an AI-based report. Another important test offering is the Drug Panel test, a valuable tool for diagnosing and managing drug allergies. It is a unique panel catering to the Indian population and is useful for patients with a known history of drug allergies and can be an important tool in pre-operative assessment and anesthetic procedures.