Fare-Minded

Call it the diagnosis du jour, or at least the self-diagnosis du jour.

About 30% of Americans believe they have food allergies, according to a report published last year in the Journal of Allergy and Clinical Immunology.

They’re the diners you hear asking: “Does this dish have nuts?” They’re the shoppers squinting at the ingredient labels to be sure they’re avoiding the foods they think make them sick.

But researchers and allergists say “food allergy” is an overused, misunderstood term. There is a yawning gap, they add, between the number of people who think they have food allergies and the number who actually do.

But the size of that gap is a matter for debate.

According to numerous medical journal reports, only about 2% of adults and 8% of children (who tend to outgrow at least some allergies) suffer from food allergies, in which the immune system overreacts to a food, leading to symptoms ranging from itching or swelling of the lips, mouth and throat to nausea, vomiting or the more severe allergic reaction called anaphylaxis.

In this life-threatening condition, the body releases a flood of histamine and other chemicals to combat the allergen, which can lead to symptoms such as a sudden drop in blood pressure and constriction of the airways in the lungs.

Most likely to provoke allergic reactions are peanuts, soybeans, milk, eggs, wheat, shellfish, fish, fruit and “tree nuts” such as walnuts, although other foods cause reactions as well.

Many people who think they have food allergies actually have food intolerances, defined as abnormal physical responses to foods with no immunologic involvement. But lately, researchers and allergists say the number of people with food allergies may be on the rise.

In particular, the prevalence of peanut allergies seems to have increased over the past two decades, says Dr. Hugh Sampson, director of the Pediatric Clinical Research Center at Johns Hopkins University School of Medicine, who published his findings last year in the British Medical Journal.

In groups of children referred to his center for evaluation of possible food allergy, peanut sensitivity increased by 55% over the span of a decade and allergic reactions increased by 95%. He blames the rise on increased exposure to the food earlier in life. The average American, he notes, eats about 11 pounds of peanut-containing products a year, such as peanut butter, sweets, baked goods and table nuts.

Likewise, soybean allergies may be on the rise, other experts say, because soybeans are increasingly included as a protein source and extender in foods.

Americans’ tendency to eat more meals out may also be contributing to a rise in allergic reactions. “You’re eating a lot of food that you don’t know the origin of,” says Mark S. Meskin, associate professor of food, nutrition and consumer sciences at the Cal State Pomona.

The number of food products recalled because of consumer complaints of allergic reactions has increased too. In 1996, there were 17 such recalls, up from seven in 1995, says Karen Carson of the Food and Drug Administration’s Center for Food Safety and Applied Nutrition.

Whether food allergies actually are increasing--or awareness is simply rising--food manufacturers and restaurant owners are stepping up efforts to help the allergy-prone avoid their forbidden foods.

At General Mills, ingredients that tend to cause allergic reactions in susceptible individuals are now highlighted on some food labels, says spokeswoman Pam Becker. If the product is new or reformulated, ingredients such as peanuts are boldfaced in the ingredients list, she says, and the label also points out their presence. “We’ve been doing this for about a year,” Becker says.

Manufacturers also urge consumers with questions about possible allergens in foods to call the toll-free information lines listed on product labels.

At Hershey Foods, as at other manufacturers, there is an effort to segregate allergen-free manufacturing sites from allergen-containing sites, says the company’s John C. Long. If that’s not possible, he says, dedicated allergen-free equipment is used or extensive cleaning is done between batches. If there is any doubt, a statement on the label warns consumers that the company cannot be certain the food is allergen-free, he says.

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Manufacturers are also working more closely with Food Allergy Network, a Fairfax, Va., nonprofit organization founded by Anne Munoz-Furlong after her daughter, now 13, was found to have food allergies as an infant.

“Last year, we sent out 23 special alerts,” Munoz-Furlong says. The alerts informed members of ingredient changes, recalls or packaging mishaps. The network’s bimonthly newsletter includes information on recipe adaptation, allergy testing and other topics. (Membership is $24 a year; for information, call [800] 929-4040.)

Restaurant operators are also trying to be sensitive to the needs of their allergic customers. “We run periodic reminder articles in our newsletter,” says Bob Harrington, spokesman for the National Restaurant Assn., a Washington, D.C.-based trade group whose 32,000 members represent 175,000 restaurants.

Recently, the association distributed wall charts about food allergies to educate their members. Harrington says restaurant workers are also encouraged to make the extra effort to double-check ingredients in a dish a diner asks about and to err on the side of caution.

On their own, allergy-prone consumers can take a number of other steps.

* If you have a family history of food or seasonal allergies or asthma, delay giving your child peanuts or peanut butter until he or she is 3, suggest Sampson and other experts. Mothers with a family history of allergy should also avoid eating peanut products while nursing, Sampson says. (Heredity is believed to play a role in food allergies.)

* Pay close attention to a child’s reaction when introducing foods. Kim Halter of Brentwood in Northern California recalls giving son Ian, now 4, a piece of toast with a smidgen of peanut butter on it when he was a year old. Suddenly, he had hives around his mouth--and was found later to have a severe allergy to peanuts.

* If you are highly allergic, ask your doctor about carrying epinephrine (adrenaline) for emergencies.

* If your child is allergic to certain foods, ask for a school meeting before the year begins. Include the classroom teacher, principal, school nurse and the student. “Come up with a plan for managing the allergy,” Munoz-Furlong says.

* Don’t be shy about questioning a waiter or waitress before ordering. Stacie Griffith, a 31-year-old Los Angeles television producer who is allergic to peanuts, always asks servers about contents of unfamiliar dishes. “They think I’m being fussy,” she says.

But even with close questioning, she knows there are no guarantees. In the past decade, she has experienced five allergic reactions to food after being assured that it contained no peanuts. In one instance, she ate a calzone that the chef insisted was peanut-free. She figures the cooking surface had peanut residue from the previous dish.

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Allergic?

They Can Help

Resources for those concerned about food allergies:

* The American College of Asthma and Allergy, (800) 842-7777.

* The American Academy of Allergy, Asthma and Immunology, (800) 822-2762.

* The Food Allergy Network, (800) 929-4040.