Monday, May 17, 2010

Reading Past the NY Times Headline

by Kelley Lindberg

This week, several friends have forwarded me the New York Times story, “Doubt Is Cast on Many Reports of Food Allergies.”

Stories like this make me sigh. On the one hand, the information in the story is accurate. On the other hand, the headline appears intended to fuel controversy, not spread helpful information. A better, more constructive headline would have been something like:

     “Think You Have Food Allergies? See a Specialist before Panicking”

or perhaps:

     “Diagnosing Food Allergies is Tricky – It May Take More Than a Skin Test.”

Many people think they have food allergies, while they probably have an intolerance or sensitivity instead – completely different diseases. For example, often people confuse lactose intolerance with a true milk allergy, yet they are completely different illnesses. With lactose intolerance, the body can’t digest milk proteins adequately. People with lactose intolerance can often tolerate small amounts of dairy, especially if it’s baked in something like bread. And they can often take a medication to help digest the milk proteins, which allows them to indulge in the occasional dairy treat. With a true milk allergy, the body’s immune system is involved, and medication can’t help. Lactose intolerance may give you an upset stomach, but it won’t send you into anaphylactic shock. A true milk allergy will.

And how many times have you heard someone complain that they’re allergic to cigarette smoke? It’s probably not a true allergy, but a different disease, such as reactive airway disease or asthma. It’s no less serious, but using the wrong name makes data difficult to track (leading to misleading reporting, like this article).

It’s also true that many general practice doctors are jumping on the bandwagon of skin-prick testing for everything, and calling any sign of a bump a positive test – end of discussion. General practitioners are great resources for many things – but you have to understand that they simply cannot have specialized, up-to-date knowledge about all possible human ailments. It’s not humanly possible to specialize in everything. They usually know a little bit about a lot of things. This can be vitally helpful when narrowing down possible causes of sickness and determining which type of specialist can help you further, but for anything as complicated and individual as food allergies, a board-certified allergist who keeps up with the latest allergy research, conferences, and journals is who you want to work with, not a busy general practitioner.

That’s because allergy testing is very much an art, not just a science. Interpreting results isn’t always cut-and-dried. Test results should be combined with careful analysis of the individual’s history, the family history, direct experiences, food challenges, and other aspects of your life that can help pinpoint exactly what is causing your problems.

I’ve met many people who are in the panicky “I’ve-just-been-diagnosed-and-I’m-allergic-to-everything!” stage. My first question is always “Who diagnosed you?” If it wasn’t a board-certified allergist, I strongly recommend they take the results to a board-certified specialist and continue digging. It’s not unheard of to have a positive skin-prick test to a food you’ve been eating without any problems. So eliminating the food without further research or testing may cause unnecessary stress at the grocery store or restaurant. Several of those people I’ve talked to have ended up working with an allergist and narrowing the list of what they’re really allergic to down to one, two, or three foods, making it easier to manage and less overwhelming. This might not hold true for everyone, but it’s common enough that it’s worth digging deeper.

So I think it’s important to find an allergist you trust and really work with him or her to get to the bottom of your true allergies.

The other interesting point in this article is its statistics, which may very well get lost in the “See? Those food allergy nutcases are making it all up” controversy:
  • “While there is no doubt that people can be allergic to certain foods, with reproducible responses ranging from a rash to a severe life-threatening reaction, the true incidence of food allergies is only about 8 percent for children and less than 5 percent for adults, said Dr. Marc Riedl, an author of the new paper and an allergist and immunologist at the University of California, Los Angeles.”
ONLY 8% in children? The more usual statistics that get quoted are 3 – 5%. So while I often tell people that about 1 out of every 20 kids is estimated to have a food allergy, this article says it’s closer to 3 out of every 25. That’s three in every classroom, instead of one in every classroom.

The article’s wording sounds like it’s pooh-poohing the incidence of food allergies, but then it tosses out a pretty high percentage rate as if it’s nothing.

So… Here’s what we should take away from this article. Diagnosing food allergies is difficult and varies from individual to individual, so find yourself an allergist certified by the American Academy of Allergy, Asthma, & Immunology (AAAAI) to help you find out if you’re really suffering from food allergies and how to deal with them if you are. (Click here to search for a board-certified allergist on the AAAAI website). And don’t let people tell you food allergies are a hoax. Even this article’s statistics are alarming, despite its misdirecting headline.


Anonymous said...

Great information. I was once tested for allergies with a blank skin test. They wanted to show my mom what they were going to do without actually testing me. They told her, see if we did the actual tests, anything she'd be allergic to would show up with a bump. Well too bad I showed up with a bump in every spot on that 'empty' skin test!

Kelley J. P. Lindberg said...

Yes, that happens. Your skin can be so sensitive you react to just the irritation of the poke, not to the serum. Another reason to work closely with your allergist! Thanks for sharing!