moderate food allergy

Moderate food allergy is neither a "minor problem" that can be cured in two days, nor a "terminal disease" that requires lifelong complete taboos. It is an abnormal immune response mediated by IgE or non-IgE, between a mild transient irritation reaction and a severe anaphylactic shock. Clinical data shows that more than 85% of patients can consume most daily foods normally through standardized management and only need to avoid high-risk categories with clear allergens. Less than 15% of patients truly require lifelong complete taboos.

Last month, I accompanied my best friend to the allergist for a follow-up examination. She was diagnosed with a moderate allergy to mango three years ago. The first time she was allergic was when she ate two bites of mango pancake at a college dinner. At that time, her mouth was swollen like two sausages, and a hives appeared on her arms. She thought it was a fever, so she took a loratadine tablet and ignored it. It was not until she suddenly couldn't breathe after eating dried mango that she went to the hospital and did an oral challenge test to confirm the diagnosis.

Many people's judgment of moderate allergies relies solely on popular science comparisons on the Internet. Either they are so scared that they dare not eat anything even if they get a rash, or they think "it's just itchy and it will be over". In fact, both of these are quite extreme. There are actually two different ideas in the allergology community for the management of moderate allergies: the traditional one advocates completely avoiding allergens, carrying emergency medicine with you, and minimizing the risk of triggering. The advantage of this idea is that it is safe and almost no acute or severe reactions will occur. However, the disadvantages are also obvious. Many patients will overly restrict food. For example, if they are moderately allergic to wheat, they will not eat all pasta at all. On the contrary, they are prone to malnutrition, especially in children, who may also develop psychological problems such as low self-esteem. Another school of thought supported by evidence-based medicine in the past five years is low-dose tolerance induction, which means that under the close supervision of doctors, you start with very small amounts of allergenic foods and slowly increase the amount to gradually induce the body to form immune tolerance. For example, the junior high school student I met when I was a volunteer in the department relied on tolerance induction for half a year. From touching a little wheat, he got a rash, and now he can eat steamed buns normally without any problem, but he cannot eat crispy chips made of raw wheat flour. Of course, this method is not suitable for everyone. If you experience near-severe reactions such as foreign body sensation in the throat and chest tightness every time you come into contact with allergens, doctors generally will not recommend that you undergo tolerance induction. Safety is the first priority.

It's interesting to say that many people with moderate allergies have experienced being called "pretentious". My best friend had this happen to her. At a relative gathering, someone gave her a piece of mango cake and said, "Isn't it just a small allergy? What will happen if you take one bite? You are just too spoiled." She couldn't bear to eat even half a mouthful. She suffered from abdominal pain and diarrhea until 3 o'clock that night. Her eyes were so swollen that she could hardly open them when she woke up the next day. From then on, no one dared to persuade her to eat mangoes. In fact, many people cannot distinguish between food allergies and food intolerances. For example, they have diarrhea when drinking milk. Many people think it is lactose intolerance. In fact, about 30% of cases are moderate milk protein allergies. To put it bluntly, intolerance is the body's lack of digestive enzymes. At most, it is gastrointestinal discomfort and will not trigger an immune response. Allergy is when your immune system treats this food as an intruder. In serious cases, it can be really fatal.

Many people go for a blood test and are frightened when they see a high IgE value. In fact, the false positive rate of blood tests and skin pricks is very high. Almost 40% of people test out that they have high IgE to a certain food, but they actually have no reaction at all after eating it. This is not considered an allergy at all, let alone a taboo. The gold standard for judging a moderate allergy is actually an oral provocation test, and it should be combined with your own actual reaction: if every time you eat the same food, you will experience symptoms such as scattered urticaria, persistent abdominal pain and diarrhea, and edema of the lips or eyelids, but there are no severe reactions such as difficulty breathing, laryngeal edema, or a drop in blood pressure, and you must take antihistamines to relieve it, then it is basically a moderate allergy.

Nowadays, many bloggers on the Internet say that "food allergies are a false concept and can be cured by conditioning the stomach." This is actually not entirely wrong, especially for moderate allergies to milk and eggs in childhood. As the intestinal barrier function improves before the age of 6, the self-healing rate can reach 60%. It is true that many children are allergic to eggs when they are young, and it will be better when they grow up. But if you are allergic to nuts or seafood, don’t believe in lies that can be cured by any treatment. The self-healing rate of this type of allergy is less than 10%. If you blindly “test your sensitivity”, if you happen to catch a cold or stay up late when your immunity is low, it is very likely that the moderate reaction will directly escalate to anaphylactic shock. Last year, I met a young man with a moderate allergy to shrimp. He would get a rash after eating one bite. That time he ate three crayfish after staying up for three days and was sent to the emergency room for emergency treatment.

In fact, moderate allergies are really not that scary. There is no need to study the ingredient list every day until your hair falls out, and don’t try to make fun of your body. Carry a loratadine with you, and don’t touch anything that is clearly allergic. If you want to try it, go to a doctor to evaluate whether you can tolerate it. Do whatever makes you feel comfortable. After all, eating delicious food is a happy thing, and there is no need to make yourself suffer just for a few bites.