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Living with Food and Nut Allergies

There has been a substantial increase in food and nut allergies in recent years. Over 15 million Americans are now affected by food allergy, and roughly one percent of Americans have a peanut or tree nut allergy. Although the vast majority of these individuals do very well with the avoidance of their food allergen, serious and unexpected reactions can occur.

Listen in as S Shahzad Mustafa, MD discusses food allergies and the latest treatments that may help you to minimize allergies to various foods.  

For more information please visit Rochester Regional Health
Living with Food and Nut Allergies
Featured Speaker:
S Shahzad Mustafa, MD
S Shahzad Mustafa, MD is Rochester General Medical Group Physician.

Learn more about S Shahzad Mustafa, MD

Bill Klaproth (Host): There has been a substantial increase in food and nut allergies in recent years. Over 15 million Americans are now affected by food allergies, and roughly 1% of Americans have a peanut or a tree nut allergy. Here to help us learn more is Dr. Shahzad Mustafa of Rochester Regional Health, Allergy, Immunology and Rheumatology Department. Dr. Mustafa, thanks for your time. So, why is this problem of food and nut allergies growing?

Dr. Shahzad Mustafa (Guest): So, that’s a million dollar question, Bill. Thanks for having me. So, all allergic diseases are increasing in prevalence. By allergic diseases, I mean a couple of things--eczema, atopic dermatitis, asthma, allergic rhinitis, environmental allergies, hay fever is increasing, and food allergies are increasing also. There’s no exact reason that we know of why these allergic conditions are increasing but there is a leading theory about the hygiene hypothesis. Potentially, actually that we’re almost too clean, and it’s not doing us benefit, it may actually be doing harm. Allergic diseases are really only in the first world Westernized developed nations like America, Europe, Australia. It’s very rare to find them in underdeveloped countries like Africa, India, China. Interestingly, even in America, if you’re raised on a farm, your risk of having an allergic disease is way less than if you’re raised less than 30 miles away in an urban setting. So, I think it’s a lot to do with exposures--the things we’re being exposed to, the things we’re not being exposed to, and how those exposures are affecting our immune system and our immune response to what typically is pretty benign harmless stuff like food and pollen. Specifically for food allergy, previously the recommendation was to delay the introduction of highly allergenic foods. So, 10 years ago, we were telling parents to not give their kids peanuts and eggs until they were older. That, in fact, was wrong, and it has been proven that earlier introduction of foods decreases your risk of allergy as opposed to later introduction of food. So, for food allergy in particular, this delayed introduction of highly allergenic food such as milk and eggs and peanuts and nuts was actually counterproductive and may have actually contributed to the rise of food allergies instead of decrease, which we were hoping was the case.

Bill: So, when you say that we’re almost too clean, what happens then? Our immune system says, “Nothing to attack here. Oh, there’s something new. What’s this peanut thing? Let’s go after it.” Something like that?

Dr. Mustafa: Yes. So, our immune system is wired to survey for foreign, and then it surveys for foreign like bacteria and viruses, and then it recognizes it and kills it. We’re almost--this is a little bit overly simplistic, obviously--but too clean so we’re not being exposed to those typical bacteria and viruses that we were decades ago, and our immune system is almost bored. It’s surveying for foreign, and even though it’s benign, it’s overreacting to it, like food is foreign to us but our immune system should be smart enough to realize it’s food, it’s not a big deal, no big deal, but, in fact, its overreacting. Pollen, trees, weeds, molds, dust mites, pets--it’s pretty benign, not dangerous but our immune system is almost overreacting to it. So, there’s a lot of literature and science on exposure to bacteria, microbiome, microbiota, and what bacteria we’re exposed to and not, and how that helps in development in response of our immune system. It’s very interesting stuff and we have a lot more learn about it.

Bill: That is, and a human body is so darn amazing. But, that’s why you say kids on a farm have less allergic reactions because they’re exposed to more stuff early on in life.

Dr. Mustafa: Yes, we think they’re exposed to more bacteria, more other triggers for their immune system so they have less allergic conditions, not necessarily allergic reactions. But they have less asthma, they have less environmental allergies, they have less food allergies. But every ying has a yang--there’s a counterpoint to everything. There are less allergies in Africa but infectious complications are way higher in Africa. So, although we have a lot less infectious problems in America--very few people in America die of gastroenteritis or dysentery, and that remains one of the leading causes of death in Africa. So, we have less infections but we have more allergy. And that--you got to strike the right balance. If you’re living on a farm and drinking unpasteurized milk, you have a higher risk of infection and listeria but you may have a lower risk of milk allergy; whereas, if you’re drinking pasteurized milk, your risk of infection from the milk is very low but your risk of allergy may be a little bit higher. So, that’s lots to think about.

Bill: So, when you say that it’s delaying the introduction of certain foods probably was the wrong thing to do because you’ve got to be exposed to it first, which I guess the doctors call “sensitization”. So, what are the current guidelines then for introducing certain foods?

Dr. Mustafa: That’s a great question. So, the guidelines right now essentially say that once an infant starts eating solid foods, typically around four to six months of age, there is no reason to delay the introduction of any highly allergenic foods or any foods. That includes eggs, peanuts, nuts, wheat, soy, seafood, sesame, nuts, doesn’t matter. There’s further data that goes on to say for peanuts, specifically, earlier introduction seems to significantly decrease the risk of allergy as compared to later introduction beyond a year of age. So, for peanut we have a little more information than all other foods, and we really do want to get that in a diet before a year of age rather than after. Can we extrapolate those studies to other foods such as eggs and nuts and sesame? I would say probably but I don’t have the studies to quite support that yet. I think in theory it makes sense and that’s what we do in practice but I don’t have the studies--for peanut, we have those studies that are quite conclusive. The exception to the rule becomes in a kid who has a sibling or a parent with a food allergy. There, the risk of allergic conditions, allergic food allergy go up. So, you probably want to consult with an allergist prior to introducing certain foods but the recommendations and guidelines are a little bit in flux dynamic being written really as we speak. This is fairly new stuff, so we don’t quite have those guidelines. So, generally, introduce foods before a year rather than later. If you have a significant family history of food allergies, siblings, parents with food allergies, probably best to consult with an allergist before introducing foods.

Bill: And, then, what symptoms should a parent be on the lookout for? It’s okay to introduce the foods early as you say but what are the symptoms or things should a parent look out for?

Dr. Mustafa: Yes, so allergic reactions are pretty stereotypic. They’re pretty quick on quick off, 90% start within 20 minutes of exposure to a food and 99% within 2 hours. They’re not generally vague. 80% of allergic reactions will have some skin findings, a rash, hives often. Other common symptoms are abdominal stuff, potentially nausea, vomiting, difficulty breathing. You can have swelling. So, these things happen pretty quickly, and although we eat about 10,000 foods in our diet, only about 8 foods account for about 98% of our allergies. Those foods are milk and eggs, peanuts and tree nuts, wheat and soy, seafood and sesame. It’s much less common to be allergic to celery and carrots as compared to peanuts and milk and eggs. So, every food has a different risk but those are the kind of symptoms. Rashes are common, trouble breathing, swelling, you can have some gastrointestinal symptoms pretty quick, usually within 20 minutes of exposure, and almost always within 2 hours.

Bill: Okay, a two part question here. In general for someone with a food allergy, is it as simple as staying away from those foods for the rest of your life, and can you grow out of a food allergy eventually?

Dr. Mustafa: Absolutely. So, most children outgrow food allergies. You can develop a food allergy at any stage in life. So, most children outgrow milk and egg allergies. Almost all outgrow wheat and soy allergy. The allergies that tend to stick with a few kids and the allergies that tend to pop up later in life, are peanuts, tree nuts and seafood. But, even peanuts and tree nuts, 15% to 20% of kids can outgrow those allergies. So, the management of food allergy right now is avoidance and carrying epinephrine in case of a significant allergic reaction. So, everyone with food allergy needs to avoid the food and carry epinephrine. But I would strongly suggest that anyone with a food allergy should see an allergist because there’s a lot of implications and subtleties to the management of food allergy. For example, kids who are allergic to milk and eggs, can often tolerate milk and eggs in baked goods, cooked foods. And not only does that help with quality of life and broadening their diet, but it may even help speed up their resolution of the allergy. And, really, the only right physician to get to those subtleties in the management of the food allergy is a board certified allergist who’s familiar with the management of food allergy.

Bill: Well, this has been very informative, and thank you, Dr. Mustafa. If you could wrap it up for us, why should someone choose Rochester Regional for their food and nut allergy, immunology and rheumatology needs?

Dr. Mustafa: Yes. So, we have a great practice. We have great access and multiple offices throughout Monroe County and even Wayne County. We have multiple board certified allergists, immunologists, rheumatologists, and we do a really good job of providing evidence-based, care-based under most recent research in a more compassionate and individualized way and I think we do a great job of it. Rochester is a community with a great allergy community beyond Rochester Regional Health, too, but I think we do a particularly good job of taking care of folks, particularly with food allergies.

Bill: Well, Dr. Mustafa, thank you again. You’re listening to Rock Your Health Radio with Rochester Regional Health. For more information, you can go to That’s . I'm Bill Klaproth. Thanks for listening.