Introduction

Although many people have bad reactions to certain foods, a true food allergy — a reaction triggered by the immune system — isn’t as common as you might think. But, the number of people who have a food allergy is growing. About 2 percent of adults and 6 percent of children have a true food allergy. Far more people have food intolerance, unpleasant symptoms triggered by food. Unlike a true food allergy though, a food intolerance doesn’t involve the immune system.

This is little consolation if you’ve had a bad experience with a particular food and fear a recurrence. But it is an important distinction, because a true food allergy — also called a food hypersensitivity — can cause serious problems and even death.

If you have a reaction to a particular food, tell your doctor about it. Tests can help diagnose a food allergy so that you can take steps to avoid a repeat problem.

Signs and symptoms

For some people, an allergic reaction to a particular food may be uncomfortable but not serious. For other people, an allergic food reaction can be frightening and even life-threatening. Signs and symptoms of a food allergy usually develop within a few minutes to an hour after eating the offending food.

The most common signs and symptoms of a true food allergy include:

• Tingling in the mouth
• Hives, itching or eczema
• Swelling of the lips, face, tongue and throat, or other parts of the body
• Wheezing, nasal congestion or trouble breathing
• Abdominal pain, diarrhea, nausea or vomiting
• Dizziness, lightheadedness or fainting

The symptoms you have depend on what type of food allergy you have.

In a severe allergic reaction to food — called anaphylaxis — you may have more extreme symptoms including these life-threatening signs and symptoms:

• Constriction of airways, including a swollen throat or a lump in your throat, that makes it difficult to breathe
• Shock, with a severe drop in blood pressure
• Rapid pulse
• Dizziness, lightheadedness or loss of consciousness

Emergency treatment is critical in treating anaphylaxis. Food anaphylaxis is responsible for thousands of emergency room visits and as many as 200 deaths in the United States each year.

Exercise-induced food allergy
Some people have an allergic reaction to a food that is triggered by exercise. As the body is stimulated by exercise, a person with an exercise-induced food allergy may feel itchy and lightheaded. In severe cases, it can cause reactions such as hives or anaphylaxis. Not eating for a couple of hours before exercising can prevent this problem.

Oral allergy syndrome
Some fresh fruits and vegetables can trigger a mild allergic reaction that causes the mouth to tingle or itch. This is an example of cross-reactivity — proteins in fruits and vegetables cause the reaction because they’re similar to those allergy-causing proteins found in certain pollens. For example, if you’re allergic to ragweed, you may also react to melons; if you’re allergic to birch pollen, you may also react to apples. Most cooked fruits and vegetables generally do not cause cross-reactive oral allergy symptoms.

Common cross-reactivity between pollens and fruits and vegetables:

Causes

In a true food allergy, your immune system mistakenly identifies a specific food or a component of food as a harmful substance. Your immune system triggers certain cells to produce immunoglobulin E (IgE) antibodies to fight the culprit food or food component (the allergen). The next time you eat even the smallest amount of that food, the IgE antibodies sense it and signal your immune system to release histamine and other chemicals into your bloodstream.

These chemicals cause a range of allergic signs and symptoms. Histamine is partly responsible for most allergic responses, including dripping nose, itchy eyes, dry throat, rashes and hives, nausea, diarrhea, labored breathing and even anaphylactic shock.

The great majority of food allergies are triggered by certain proteins in:

• Eggs
• Peanuts
• Fish
• Shellfish, such as shrimp, lobster and crab
• Tree nuts, such as walnuts and pecans

In children, food allergies are also commonly triggered by proteins in these foods:

• Cow’s milk
• Wheat
• Soybeans

Chocolate, long thought by some parents to be a culprit among children, seldom is a cause of food allergy.

Food intolerance and other conditions: Not food allergies
Other reactions to food don’t involve your immune system or the release of histamine. These reactions aren’t true food allergies. Instead, they may be a food intolerance. Because a food intolerance may involve some of the same signs and symptoms as a food allergy does — such as nausea, vomiting, cramping and diarrhea — people often confuse the two.

If you have a food intolerance, you may be able to eat small amounts of problem foods without a reaction. By contrast, if you have a true food allergy, even a tiny amount of food may trigger an allergic reaction.

One of the tricky aspects of diagnosing food intolerance is that some people are sensitive not to the food itself but to a substance or ingredient used in the preparation of the food. For example, sulfite preservatives can trigger asthma signs and symptoms in sensitive people.

Common non-allergy related problems include:

• Absence of an enzyme needed to fully digest a food. You may not have adequate amounts of some enzymes needed to digest certain foods. Insufficient quantities of the enzyme lactase, for example, make it difficult to digest lactose, the main sugar in milk products. Lactose intolerance can cause bloating, cramping, diarrhea and excess gas.
• Irritable bowel syndrome. Certain foods may trigger the signs and symptoms of irritable bowel syndrome. You may find that certain foods will cause cramping, constipation or diarrhea. Steer clear of these foods to avoid the symptoms.
• Food poisoning. Sometimes food poisoning can mimic an allergic reaction. Some types of mushrooms and rhubarb, for example, can be toxic. Bacteria in spoiled tuna and other fish also can make a toxin that triggers adverse reactions.
• Recurring stress or psychological factors. Sometimes the mere thought of a food may make you sick. The reason is not fully understood.

Risk factors

Certain factors may put you at greater risk of developing a food allergy:

• Family history. You’re at increased risk of food allergies if other allergies, such as hay fever, asthma, hives or eczema, are common in your family. A child who has one parent with an allergy has about a 50 percent chance of developing an allergy. If both parents suffer from allergies, the child has about a 70 percent chance of developing an allergy.
• Age. Food allergies are most common in children, especially toddlers and infants. As you grow older, your digestive system matures and your body is less likely to absorb food or food components that trigger allergies. Fortunately, children typically outgrow allergies to milk, soy, wheat and eggs. Severe allergies and allergies to nuts and shellfish are more likely to be lifelong.

When to seek medical advice

See a doctor or allergist if you experience food allergy symptoms shortly after eating. If possible, see your doctor when the allergic reaction is occurring. This will aid in making a diagnosis.

Seek emergency treatment if you develop any signs or symptoms of anaphylaxis, such as:

• Constriction of airways that makes it difficult to breathe
• Shock, with a severe drop in blood pressure
• Rapid pulse
• Dizziness or lightheadedness

Screening and diagnosis

The following may help determine if you have a true food allergy, rather than a food intolerance, food poisoning or some other gastrointestinal condition.

• Description of your symptoms. Be prepared to tell your doctor a history of your symptoms — which foods, and how much, seem to cause problems — and whether you have a family history of food or other allergies.
• Food diary. Your doctor may ask you to keep a food diary of your eating habits, symptoms and medications to pinpoint the problem.
• Elimination diet. You may be asked to eliminate suspect foods for a week or two, and then add the food items back into your diet one at a time. This process can help link symptoms to specific foods. However, this isn’t a foolproof method. Psychological factors as well as physical factors can come into play. For example, if you think you’re sensitive to a food, a response could be triggered that may not be a true allergic one. If you’ve had a severe reaction to foods, this method cannot safely be used.
• Physical examination. A careful exam can identify or exclude other medical problems.
• Skin test. A skin prick test can determine your reaction to particular foods. In this test, small amounts of suspected foods are placed on the skin of your forearm or back. Your skin is then pricked with a needle, to allow a tiny amount of the substance beneath your skin surface. If you’re allergic to a particular substance being tested, you develop a raised bump or reaction.
• Blood test. A blood test can measure your immune system’s response to particular foods by assessing the amount of allergy-type antibodies in your bloodstream, known as immunoglobulin E (IgE) antibodies. For this test, you give a blood sample in your doctor’s office. Your sample is then sent to a medical laboratory, where different foods can be tested. However, these blood tests aren’t 100 percent accurate.

Treatment

The only way to avoid an allergic reaction is to avoid the foods that cause signs and symptoms.

However, despite your best efforts, you may come into contact with a food that causes a reaction. In this case, you may need an emergency injection of adrenaline (epinephrine) and a trip to the emergency room. In fact, if you have a severe allergy, your doctor may prescribe you injectable epinephrine, such as EpiPen or Twinject. You need to carry this medication with you at all times so that you or someone you’re with can give you an emergency injection if needed. Prompt treatment with an epinephrine injection is critical in treating an anaphylactic reaction.

For less severe allergies, your doctor may prescribe antihistamines, which can be taken after exposure to an allergen to control your reaction and help relieve discomfort. Creams may relieve skin reactions.

Children often outgrow food allergies, especially to milk and soy. They are less likely to outgrow an allergy to peanuts, fish or shrimp.

Prevention

The best way to prevent an allergic reaction is to know and avoid foods that cause signs and symptoms. For some people, this is a mere inconvenience, but others find it a greater hardship. For instance, if nuts are a staple part of your diet, it can be a challenge to come up with a substitute that has equal nutritional value. Also some foods — when used as ingredients in certain dishes — may be well hidden. This is especially true in restaurants and in other social settings.

If you know you have a food allergy, follow these steps:

• Know what you’re eating and drinking. Be sure to read food labels carefully.
• If you have already had a severe reaction, wear a medical alert bracelet or necklace that lets others know that you have a food allergy in case you have a reaction and you’re unable to communicate.
• Talk with your doctor about carrying emergency epinephrine (adrenaline).
• If you have asthma, be sure to ask if sulfites have been added to foods when dining in restaurants. When shopping for foods, check labels for the terms “sodium bisulfite,” “potassium bisulfite,” “sodium sulfite,” “sulfur dioxide” and “potassium metabisulfite.”

If your child has a food allergy, take these precautions to ensure his or her safety:

• Notify key people that your child has a food allergy. Talk with child care providers, school personnel, parents of your child’s friends, and other adults who regularly interact with your child. Emphasize that an allergic reaction can be life-threatening and requires immediate action. Make sure that your child also knows to ask for help right away if he or she reacts to food.
• Explain food allergy symptoms. Teach the adults who spend time with your child how to recognize signs and symptoms of an allergic reaction.
• Write an action plan. Your plan should describe how to care for your child when he or she has an allergic reaction to food. Provide a copy of the plan to your child’s school nurse and others who care for and supervise your child.
• Have your child wear a medical alert bracelet or necklace. This alert lists your child’s allergy symptoms and explains how others can provide first aid in an emergency.

Introduction

Penicillin and related antibiotics are effective for treating bacterial infections. But if you have a penicillin allergy, taking these drugs can be dangerous.

Penicillin and related antibiotics can cause an allergic reaction in some people. Not all adverse reactions to penicillin are a sign of an allergic reaction. True allergic reactions involve the immune system and can cause signs and symptoms that range from an annoying rash to a life-threatening reaction (anaphylaxis) with low blood pressure and trouble breathing.

It isn’t clear why some people develop penicillin allergy while others don’t. Treating an allergic reaction may require taking medications or, in the case of a serious reaction, emergency care.

Signs and symptoms

Signs and symptoms of a penicillin allergy include:

• Hives
• Rash
• Itchy skin
• Wheezing
• Swollen lips, tongue or face (angioedema)

Tell your doctor if you notice any of the signs or symptoms of penicillin allergy. He or she can determine if you’re having an allergic reaction and may prescribe an alternate antibiotic.

Anaphylactic reactions
The most serious allergic reaction to penicillin is an anaphylactic (an-uh-fuh-LAK-tik) response, which can be life-threatening. Anaphylactic reactions develop immediately after penicillin exposure in highly sensitive people. Anaphylactic reactions cause the airways to constrict and low blood pressure. Signs and symptoms include:

• Constriction of the airways, including wheezing and a swollen tongue or throat, that results in difficulty breathing
• Shock associated with a marked decrease in blood pressure
• Weak and rapid pulse
• Dizziness or fainting
• Hives and itching
• Flushed or pale skin
• Nausea, vomiting or diarrhea

Seek emergency medical care if you think you or someone else is having an anaphylactic reaction.

Causes

Penicillin allergy occurs when your immune system responds to the drug as if it were a harmful substance instead of a helpful remedy. Your immune system creates antibodies to attack the medication. Chemicals released by your immune cells can cause the signs and symptoms associated with an allergic reaction.

Penicillin belongs to a family of drugs called beta-lactam antibiotics. These drugs include penicillin and amoxicillin, which are relatively inexpensive and effective at treating many common bacterial infections. Such infections include skin, ear, sinus and upper respiratory infections.

Taken orally or injected, penicillin works by stopping the growth of bacteria in your body. Several varieties of penicillin exist, and each targets a different infection in a different part of your body. You may have heard of some of the other drugs in the penicillin family, including:

• Amoxicillin
• Ampicillin
• Dicloxacillin
• Nafcillin
• Penicillin V
• Penicillin G

Some people allergic to penicillin may also be allergic to cephalosporins, a class of antibiotics closely related to penicillin. Around 4 percent of those with a known penicillin allergy have an allergic response to these medications.

You aren’t born allergic to penicillin, but you can develop penicillin allergy once you’ve been exposed to the drug. After that, re-exposure to penicillin or related antibiotics can trigger an allergic reaction.

Risk factors

It isn’t clear why some people develop penicillin allergies while others don’t. However, certain people seem to be at greater risk of developing a penicillin allergy than others are. Heredity may play a role, as well as exposure to multiple medications over time.

While anyone can have an allergic reaction to drugs in the penicillin family, you appear to be at higher risk if:

• You’re female
• You have HIV/AIDS
• You have cystic fibrosis
• You’ve had allergic reactions to penicillin or another drug in the past

When to seek medical advice

Talk to your doctor if you think you’re allergic to penicillin or if you experience any signs or symptoms of penicillin allergy. If possible, see your doctor when the allergic reaction is occurring. This will aid in making a diagnosis.

Seek emergency medical treatment if you develop any signs or symptoms of anaphylaxis.

Screening and diagnosis

Your doctor will want to know about your past reactions to penicillin and may exam you to identify or exclude other medical problems. He or she may also recommend a skin test. This test, in which your skin is injected with small amounts of penicillin, can determine your sensitivity to the drug. A small amount of penicillin is injected into the skin of your forearm or back. If you’re allergic to the particular substance being tested, you develop a red, raised bump or reaction. Only specialized allergy centers perform skin tests for penicillin allergy.

Treatment

If you’re having an allergic reaction after taking penicillin or another drug in the penicillin family, your doctor will have you stop taking the medication. In most cases, penicillin allergy treatment consists of avoiding penicillin and using another antibiotic instead.

Treatment for signs and symptoms depends on what kind of reaction you have.

• Anaphylaxis is the most rare and serious possible allergic drug reaction. It can be life-threatening and requires an injection of epinephrine (adrenaline) and emergency care to maintain blood pressure and support breathing.
• Rashes or hives may improve when treated with an antihistamine such as diphenhydramine (Benadryl, others). More severe reactions may require treatment with oral or injected corticosteroids.

Prevention

The best way to avoid an allergic reaction to penicillin is to avoid penicillin and similar antibiotics altogether. If you’re allergic to penicillin, it doesn’t mean you’re necessarily allergic to all antibiotics. Your doctor may be able to give you an antibiotic that’s distantly related to penicillin without causing any problems. A number of antibiotics completely unrelated to penicillin also are available.

For some infections, it may be absolutely necessary for you to take penicillin. In these cases, and if you previously experienced a reaction to penicillin, an allergy skin test may be important. If the skin test reveals that you’re sensitive to penicillin, your doctor may recommend desensitization.

During the desensitization process, you receive small but gradually increasing doses of penicillin orally or intravenously. Because desensitization can trigger an allergic reaction, it’s attempted only in a controlled setting, usually a hospital — and only when penicillin is absolutely necessary. Your desensitization lasts only as long as you continue taking penicillin. If you stop and then need to take penicillin again later, you’ll need to go through the desensitization process again.

The process of desensitization generally takes one to two days. However, it doesn’t work in all cases.

Self-care

If you think you’ve had reactions to penicillin in the past, be sure to tell your doctor and other medical professionals, including your dentist. Let your doctor know about any new reactions you notice when taking your medication. If your doctor determines that you’re allergic to penicillin, it’s a good idea to wear a medical alert bracelet that describes your allergy. You might also want to carry an alert card in your wallet or purse. These items are available over-the-counter at most drugstores or can be purchased on the Internet.