Allergy Myths – don’t be fooled!

The Pediatric Insider

© 2018 Roy Benaroch, MD

Allergy issues are a big problem – both food and environmental allergies cause quite a bit of misery, and sometimes serious health problems, too. But there are a lot of myths swirling around the world of allergy, too. It’s time for a pop-those-myths listicle!

#1 WRONG: Food allergies are common

Many people think they’re allergic to foods, but rigorous studies using the best, most reliable diagnostic tools find food allergies to be present in about 2-8% of the population. Most of these reactions are mild. True, life-threatening food allergies are quite rare—in the United States, about 150 people die each year from food allergies, which is only a little higher than the number of people struck by lightning.

But: food allergy rates are rising, and we don’t want to be too complacent. When allergies do occur, they can be serious. The best approach is good, science-based prevention, evaluation, and treatment.

 

#2 WRONG: Most reactions to food are allergies

An allergy refers to a specific kind of reaction, most commonly hives or wheezing. Other, more common reactions include lactose intolerance (an inability to digest milk sugar, leading to abdominal cramps and diarrhea) and gastroesophageal reflux related to spicy or acidic foods. The distinction is important because rare, very serious allergic reactions can occur. If the reaction was not allergic in nature, it will not be life-threatening if exposure occurs again.

 

#3 WRONG: Most reactions to medicines are allergies

The most common adverse reaction to a medication is a rash, but these are usually not caused by allergy (the only common truly allergic rash is hives, which are raised, itchy areas that move about the body.) Most people labeled as “allergic” to penicillin are not in fact allergic, and can safely use this medication. Only a careful history and exam can determine this—there is no accurate test to confirm or refute true drug allergies. If you or your child is thought of as drug allergic, review the exact circumstances with your physician to see if it is a good idea to try the medication again (do NOT do this on your own!)

 

#4 WRONG: People who are allergic to a medicine should never take it again

Certainly, if a life-threatening reaction occurred you need to be very careful. And be much, much more wary of medications given as a shot or intravenously (I’m not sure anyone has ever died as a result of an allergic reaction to oral penicillin.) But unless the reaction was a true allergic reaction, usually manifested by hives or wheezing, a medication can usually be given safely in the future (again, do NOT do this on your own!)

 

#5 WRONG: People with egg allergy shouldn’t get a flu or MMR vaccine

Flu vaccines are safe in people with egg allergy – great studies have proven this. People with egg allergies can get routine flu immunizations, and are not at elevated risk of reactions (this is reflected in current guidelines – if anyone tells you differently, they’re not keeping up with the science.)

And egg allergy was never a contraindication to MMR. That was a myth. MMRs can safely be given to anyone with egg allergies.

 

#6 WRONG: Allergy testing can tell you if a child is allergic to something

Hoo boy, doctors misunderstand this one, too. The way to know if a person is allergic is entirely in the history: do symptoms of allergy occur upon exposure? If they do, that’s allergy; if they don’t, that is not allergy. If the history is clear, the diagnosis is nailed, done, confirmed, and set. No tests are needed; in fact, tests are quite likely to confuse the picture.

Allergy tests are for when the history is not clear, to help separate exposures that are “likely” from “less likely”, so that further history can be explored and attempts at avoidance attempted to see what the response is. Allergy testing, either with blood tests or skin testing, is far too inaccurate to be used in any other way.

Be especially wary of web-based labs that promise extensive “sensitivity” testing to investigate vague symptoms like weight gain, abdominal pain, low energy, fatigue, and behavior problems. These symptoms are not caused by allergy, though fraudulent testing will inevitably lead to false positives and incitements to purchase detoxifying supplements. This is expensive quackery. Stay away!

 

#7 WRONG: Hives are usually caused by allergies to foods

In adults, this might be true; but in kids, hives are more often triggered by minor infections than by food exposures. Sure, if there are hives you ought to think about potential new foods, and if there is a correlation you ought to look into that. But in the majority of cases in pediatrics, isolated or even recurrent episodes of hives are not from food allergies.

 

#8 WRONG: Specific allergies run in families

“Don’t give him penicillin! Mom’s allergic!” While the predisposition to allergies, asthma, and hay fever run in families, it isn’t to the same specific trigger. Junior has a mom with shrimp allergies? That means that he might more likely have food allergies of his own, but not more likely to shrimp than to peanut or egg or anything else. Same for medication allergies.

 

#9: WRONG: The best way to avoid food allergies is to avoid or delay giving the food.

This is an old myth that won’t die – but it’s completely wrong. In fact, it’s backwards. One of the best ways to prevent the development of food allergies is to start complementary foods between 4-6 months of life, and to quickly give a wide variety of all foods (avoid honey and anything that’s a choking hazard.)

 

If your physician is telling you myths from the above list, it’s time to ask for a referral to an allergist to get the best information. If it’s an allergist tell you one of these myths, well, I’m stumped.

Adapted from an earlier post

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