A whopping 600 million people on this planet are supposed to be vulnerable to that ubiquitous disorder called allergy caused by the environment, plants, medicines, industrial chemicals and every day foods to which they are exposed. Ominously the population affected by allergic reactions is steadily increasing every year and according to some estimates during a span of 15 years between 1997 and 2011 there was an increase of 50% in the population suffering from one or the other form of allergic disorder. This is attributed largely to the increasing awareness about hygiene and sanitation and the consequent desire of people to keep themselves "clean", "presentable and tolerable" and "keep away infections". Probably increasing use of hundreds of chemicals, especially man made with very little safety data regarding their allergic potential touching all activities of day to day living, must be responsible for the increasing cases of allergy though there are no reliable data to support such an inference conclusively. Another uncertainty is the real impact of wide scale consumption of genetically modified foods (GMO) consumed in many countries though no concrete evidence has yet been unearthed regarding their relationship. In a country like USA 80% of the diet of an average citizen is made up of GMO foods and the incidence of food allergy is highest in that country. Imagine almost 10% of the population in USA are affected by food allergy! According to some estimates the world is bearing a financial burden of more than $ 30 billion a year due to this disorder.
Why are people so scared of allergens which can be found every where and when exposure to them is continuous? A major reason is the potential for some of the allergens to cause even death as the ultimate outcome of a chain of events initiated by them in human beings affected by exposure to them though very few deaths have been reported because of allergens. What is alarming about the allergic reactions is that it can manifest suddenly with no warning and medical response time available may be too short with disastrous consequences. The non-uniform symptoms, besides being too varied, are difficult to be deciphered unless they are very severe. The situation gets more complicated when some of such symptoms occur due to non-allergic reactions or food intolerance or food poisoning and toxins. Symptoms of allergic reactions normally include red eyes, itchy rash, runny nose, shortness of breath, swelling and anaphylaxis where as food intolerance, mostly confined to the GI tract can manifest itself as migraine head ache, outbreak of acne, stomach ache or bloating of the body. Even indigestion can be termed as food intolerance. Major focus so far has been on food allergy caused by some foods and universally eight foods have been designated as allergic foods which are compulsorily to be declared on the label for the consumers to know about it and those allergic can avoid buying them. These foods are cow's milk, egg, wheat, soy, peanuts, tree nuts, fish and shellfish. More than 90% of allergic episodes are caused by these eight allergic foods.
Food allergies are reported more from industrially advanced countries though no one knows for sure why this is so. One factor could be the over dependence of the population on processed foods and industrially made food preparations to the extent of 80% of their daily intake. Here again it is difficult to find any correlation between processed foods and food allergy. Reduced consumption of natural foods which are not refined might be a reason as the characteristic features of GI tract can get altered due to lesser roughage and ease of digestion of processed foods. Scientific evidence shows that infants are more vulnerable to allergic foods as they do not have a strong GI tract with necessary checks and filters to prevent absorption of allergens into the blood stream causing undesirable immunological reactions. Thus children and youngsters below the age of 18 years are more vulnerable to allergic foods probably due to inadequately developed defence system in their guts. With age many of them are likely to come out of this syndrome due to full development of the gut system. Still change of food habits over 3 generations as has happened in many industrialized nations cannot be ruled out as the root cause of allergic population showing alarming increase these days.
What is disturbing in to day's world is indiscriminate use of chemicals by the processed food industry and though many of them have been approved by competent authorities these clearances are not based on substantial safety studies using critical mass of human subjects. While most people can tolerate them at least in the short term, their long term safety consequences are not very clear. In some people some of these chemicals can produce allergic symptoms which need to be watched by every consumer. Added to this are a flood of ingredients coming under the natural colors and flavors category which are allowed to be used without much restriction though they are to be included in front of the pack label declaration. What is perplexing is that no one is sure what is natural with the result most manufacturers use the word "natural" as long as they do not add any man made chemicals during processing. However these natural ingredients may be harmless in their original condition but many of them undergo transformational changes due to processing using technologies like extraction, fractionation, separation, distillation, hydrolysis , heating , roasting etc raising questions regarding generation of artifacts which may or may not be allergic. Many of the food additives listed under the ubiquitous category of additives to foods commonly referred to as -"Generally Recognized As Safe" or GRAS are potential allergens of future and probably more focus is needed to preempt development of such a dangerous situation in the coming years.
As food allergy is a major danger these days, it is prudent for every one to be aware of the symptoms and signals that can alert them regarding any episode involving them. By now it is well established that two types allergic manifestations can take place in human beings when the allergen gets into the blood stream. They can fasten on to the IgE antibodies when the reaction can be immediate or react with the immune cells or T-Cells when allergic response may become apparent in 4 to 24 hours. In contrast non-allergic or non-immune adverse reaction such as that happens due to food intolerance is mostly physiological reaction on account of some chemicals present in them. Such chemicals commonly used in processed foods include sulfites, bisulfites, sulphur dioxide, monosodium glutamate, etc or some present naturally like theobromine in cocoa products or caffeine in coffee brew or tyrosine in old cured cheese. There is also another problem with some foods which include toxins and poisons generated or contaminating them. Aflatoxin in pea nuts or poisonous mushrooms or lathyrus factor in kesari dal are classical examples. However the toxic food materials produce symptoms only after certain minimum quantities of such foods are ingested. In other words, they are dose dependent.
Consumption of foods which are allergic produce excessive amounts of food specific IgE antibodies and the allergens after entering the blood stream react with these antibodies, producing many chemicals including histamines, which affect the gut, skin, nose, lungs, heart and the circulatory system. Anaphylaxis is the extreme manifestation of allergy and the symptoms it produces include itchy rashes on the skin, throat irritation, swelling and low blood pressure. As most allergic reactions cause intense discomfort and some time panic, the most commonly practiced treatment is to immediately administer antihistamine drugs like epinephrine or adrenaline to those developing the symptoms. These days epinephrine auto injector pens are in the market which can deliver measured amounts of antidote with no time lost after symptoms develop.
For those with severe allergies, eating of processed foods can turn into a life-threatening activity. There is need for vigilance in checking for ingredients before buying a product,and one must be aware that "natural flavors," contained in some of them cannot be taken to be absolutely safe. Probably it is wise to follow the suggestions made by experienced allergy experts to avoid any food allergy reactions. these include:( a).if one experiences an allergic reaction and does not know the cause, "natural flavors" if present in in the food as declared on the label, must be included to the list of suspects. (b). If one had eaten a product before with no adverse effects, then the allergen to which one is sensitive must probably not in the product. However stress can exacerbate allergic reactions and even if product has only small amount of allergen it might show when under stressed condition. (c). further enquiry must be done with the manufacturer regarding the presence of the allergen of concern their "natural flavor." (c). It is alaways advisable to go for whole foods devoid of any additives. (d) The surest alternative is to prepare one's own foods from scratch which are safer than naturally flavored prepared foods.(e) one must also be aware that any foods served in a restaurant may also contain "natural flavors," which will not be disclosed on the menu and invariably allergen of concern may not be in the product description though it may still be in the ingredients used. The "natural flavor" loophole in ingredient labeling means that any food which lists "natural flavors" as an ingredient is potentially hazardous to sensitive people and there fore should be approached with caution.
Why is that food allergy is not taken aas a serious disorder in India? Possibly lack of authentic documentation by hospitals and practicing physicians could be one of the reasons. Some scattered reports however do indicate that food allergy does exist in the country to some extent and in most cases is confined to foods like Black gram, Pigeon pea (Tur or Arhar), French beans, Horse gram, Lentil, Mustard, Radish, some fruits and milk. No serious cases have been recorded and reported by the Health Ministry of the country warranting any action as of now. But there is no guarantee that the country is immune to this phenomenon in future. With the expansion of food processing sector consequent to economic liberalization and influx of foreign investments and technologies, there is likelihood of significant increase in incidence of food allergy in the coming years.
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