Effects That Allergies Have in The Body

Introduction
An increasing number of people need to avoid eating certain types of food because they are allergic or
intolerant to them.

Watch our food hypersensitivity video where we explain what food allergy, food intolerance and coeliac
disease are.
Module objectives
This module explains the types of symptoms people with food hypersensitivity may experience. These
vary from mild symptoms to life-threatening emergencies, such as anaphylaxis.

After working through this module, you will be able to:

 understand the risks of someone with a food hypersensitivity ingesting food which may cause a
reaction

 explain the difference between a food allergy, a food intolerance and coeliac disease

 understand what to do if someone has anaphylaxis

Food hypersensitivity
The term food hypersensitivity is used to describe people who experience an adverse physical reaction to
food, which is otherwise harmless. This includes the conditions of food allergy, food intolerance and
coeliac disease.

More information
For further information on allergy and intolerance, see the allergy guidance on the FSA
website.

Food allergy
Cause

A food allergy is when the body’s immune system (which is the body's defence against infection)
mistakenly treats the protein in food as a threat. The body responds to this threat by releasing a number of
chemicals in the body. These chemicals cause the symptoms of an allergic reaction (see below).

People with a food allergy can react differently when they are exposed to allergens. The type and severity
of the reaction depends on a number of factors including the individual, the severity of their allergy, the
amount of allergen they’ve been exposed to and other factors such as exercise, lack of sleep or
medication, which can increase an individual's sensitivity.
Very small amounts of allergens can cause severe adverse reactions. The most severe and potentially life-
threatening reaction to an allergen is anaphylaxis.
Symptoms

The most common symptoms of an allergic reaction include:

 tingling or itching in the mouth

 a raised, itchy red rash (hives) – in some cases, the skin can turn red and itchy, but
without a raised rash
 swelling of the face, mouth (angioedema), throat or other areas of the body
 difficulty swallowing
 wheezing or shortness of breath
 feeling dizzy and lightheaded
 feeling sick (nausea) or vomiting
 abdominal pain or diarrhoea
 hay fever-like symptoms, such as sneezing or itchy eyes (allergic conjunctivitis)

More information
Food allergies are divided into three types, depending on symptoms and when they occur.

IgE-mediated food allergy

This type of allergy is the most common. It is triggered by the immune system producing an antibody
called immunoglobulin E (IgE). Symptoms can appear from minutes up to two hours after eating the
allergen. There is a greater risk of anaphylaxis with this type of allergy.

Non-IgE-mediated food allergy

This allergy is often difficult to diagnose, as symptoms take much longer to show (up to several hours). It
is not caused by IgE antibodies but by other components of the immune system.

Mixed IgE and non-IgE-mediated food allergies

Some people may experience symptoms from both types of allergies. This is known as mixed IgE and
non-IgE-mediated food allergies.

For more details on food allergy, visit the NHS website.

ALLERGY NHS
Food intolerance
Cause

A food intolerance is more common than a food allergy. Food intolerances are thought to affect 1 in 10
people. Food intolerances do not involve the immune system. Instead, a food intolerance involves the
digestive system and can cause difficulty digesting certain foods leading to symptoms such as abdominal
pain, gas and diarrhoea. Those who are affected often rely on allergen labelling to avoid the foods that
make them ill.
Symptoms

In general, people who have a food intolerance tend to experience:

 tummy pain, bloating, wind and/or diarrhoea

 skin rashes and itching

While reactions caused by a food intolerance are not life-threatening, the effects can take a long time to
resolve, sometimes lasting for days or weeks. When managing food safety within their business, FBOs
need to treat allergies and intolerances equally, as consumers react to different levels of food.

For more information on food intolerance, visit the NHS website.

INTOLERANCE NHS
More information
The following information provides a summary of adverse food reactions.
Adverse food reaction
Immune mediated

(food allergy and coeliac disease)

 IgE mediated (for example,  acute urticaria oral allergy syndrome)

 non-IgE mediated (for example, food protein-induced enteropathy, coeliac disease)
 mixed IgE and Non-IgE mediated (for example,  eosinophilic gastroenteritis)
 cell mediated (for example,  allergic contact dermatitis)

Non-immune mediated

(primarily food intolerances)

 metabolic (for example,  lactose intolerance)

 pharmacologic (for example,  caffeine)
 toxic (for example, scombroid fish poisoning)
 other - idiopathic/undefined (for example, sulphites)

Coeliac disease
Cause

Coeliac disease is a serious auto-immune condition triggered by consuming gluten, which leads to
damage of the gut lining.  This has a severe impact on a person’s ability to absorb nutrients from food.
Gluten are proteins found in wheat, rye, barley, oats, spelt and kamut (a commercial name for Khorasan
wheat).
It is worth noting that oats do not naturally contain gluten. However, oats are often produced with other
cereals containing gluten, which mean there is a risk of cross-contamination. Oats also contain avenin,
which is a protein similar to gluten, but research has shown most of those with coeliac disease can tolerate
uncontaminated oats, although a small number may still be sensitive.

For more information and advice on oats, visit the Coeliac UK website.
OATS ADVICE
Symptoms
Symptoms of coeliac disease can range from mild to severe and include:

 bloating 
 diarrhoea 
 nausea 
 wind 
 tiredness 
 constipation 
 anaemia 
 mouth ulcers 
 headaches 
 weight loss 
 hair loss 
 skin problems 
 short stature 
 depression 
 infertility 
 joint or bone pain 
Some symptoms may be confused with irritable bowel syndrome (IBS) or gluten intolerance, while other
symptoms may be related to stress or ageing. Therefore, it can be difficult to get an accurate diagnosis.
Following a gluten-free diet can stop the symptoms.

It is important to note that allergies to specific cereals such as wheat, barley and rye, should not be

confused with a gluten intolerance or coeliac disease as the proteins responsible for triggering an adverse

physical reaction are different for food allergy and thus, should be considered separately. The cereal(s)

containing gluten in a ‘gluten-free’ product will have significantly lowered levels of gluten (20 parts per

million or less). However, the product will still contain the cereal specific allergen (such as wheat, barley

or rye). Therefore, such a product will be safe to eat for a consumer with a gluten intolerance or coeliac

disease, but not for a consumer with allergies to the specific cereal used in the product.

For example, a ‘gluten-free’ beer which used wheat as an ingredient will be safe to consume for a

consumer who has coeliac disease, but not for a consumer who is allergic to wheat.
More information
For more information on labelling requirements for gluten-free products, see our module on voluntary
labelling.
You can find more information on coeliac disease on Coeliac UK website.
COELIAC UK

Anaphylaxis
Cause

Someone who has a food allergy can go into anaphylactic shock when their body’s immune system
mistakenly treats the protein in food as a threat.

Symptoms

Anaphylaxis is a potentially life-threatening allergic reaction. The symptoms of anaphylaxis include:

 persistent cough
 vocal changes
 breathing difficulties – such as fast, shallow breathing
 wheezing
 a fast heartbeat
 feeling lightheaded or faint
 confusion and anxiety
 clammy (sweaty) skin
 collapsing or losing consciousness

There may also be other symptoms, including an itchy, raised rash (hives); feeling or being sick; swelling
(angioedema) or stomach pain.
What to do if someone has anaphylaxis
If someone has symptoms of anaphylaxis, the NHS advises that you should:

1. Use an adrenaline auto-injector if the person has one – but make sure you know
how to use it correctly first
2. Call 999 for an ambulance immediately (even if they start to feel better) – mention
that you think the person has anaphylaxis
3. Remove any trigger if possible
4. Lie the person down flat and raise their legs – unless they are unconscious, pregnant
or having breathing difficulties
5. Give another injection after 5 minutes - if the symptoms do not improve and a second
auto-injector is available

If you are having an anaphylactic reaction, you can follow these steps yourself if you feel able to.

Anaphylaxis is a severe and potentially life-threatening reaction to a trigger such as an

allergy.
Symptoms of anaphylaxis

Anaphylaxis usually develops suddenly and gets worse very quickly.

The symptoms include:

 feeling lightheaded or faint
 breathing difficulties – such as fast, shallow breathing
 wheezing
 a fast heartbeat
 clammy skin
 confusion and anxiety
 collapsing or losing consciousness
There may also be other allergy symptoms, including an itchy, raised rash (hives); feeling or
being sick; swelling (angioedema) or stomach pain.

What to do if someone has anaphylaxis

Anaphylaxis is a medical emergency. It can be very serious if not treated quickly.

If someone has symptoms of anaphylaxis:

1. Use an adrenaline auto-injector if the person has one – but make sure you know how to use it
correctly first.
2. Call 999 for an ambulance immediately (even if they start to feel better) – mention that you
think the person has anaphylaxis.
3. Remove any trigger if possible – for example, carefully remove any stinger stuck in the skin.
4. Lie the person down and raise their legs – unless they're having breathing difficulties and need
to sit up to help them breathe. If they're pregnant, lie them down on their left side.
5. Give another injection after 5 minutes if the symptoms do not improve and a second auto-
injector is available.
If you're having an anaphylactic reaction, you can follow these steps yourself if you feel able to.

Read about how to treat anaphylaxis for more advice about using auto-injectors and correct
positioning.

Triggers of anaphylaxis

Anaphylaxis is the result of the immune system, the body's natural defence system, overreacting
to a trigger.
This is often something you're allergic to, but not always.

Common anaphylaxis triggers include:

 foods – including nuts, milk, fish, shellfish, eggs and some fruits
 medicines – including some antibiotics and non-steroidal anti-inflammatory drugs
(NSAIDs) like aspirin
 insect stings – particularly wasp and bee stings
 general anaesthetic
 contrast agents – dyes used in some medical tests to help certain areas of your body show up
better on scans
 latex – a type of rubber found in some rubber gloves and condoms
In some cases, there's no obvious trigger. This is known as idiopathic anaphylaxis.

Preventing anaphylaxis

If you have a serious allergy or have experienced anaphylaxis before, it's important to try to
prevent future episodes.

The following can help reduce your risk:

 identify any triggers – you may be referred to an allergy clinic for allergy tests to check for
anything that could trigger anaphylaxis
 avoid triggers whenever possible – for example, be careful when food shopping or eating out if
you have a food allergy
 carry 2 in-date adrenaline auto-injectors at all times – give yourself an injection whenever you
think you may be experiencing anaphylaxis, even if you're not completely sure
Adrenaline auto-injectors

People with potentially serious allergies are often prescribed adrenaline auto-injectors to carry at
all times. These can help stop an anaphylactic reaction becoming life threatening.

They should be used as soon as a serious reaction is suspected, either by the person experiencing
anaphylaxis or someone helping them.

Make sure you're aware how to use your type of auto-injector correctly. And, carry 2 of them
with you at all times.

There are 3 main types of adrenaline auto-injector, which are used in slightly different ways.

These are:
  EpiPen – find out how to use an EpiPen
 Jext – find out how to use Jext
 Emerade – find out how to use Emerade
Instructions are also included on the side of each injector if you forget how to use it or someone
else needs to give you the injection.

Positioning and resuscitation

Someone experiencing anaphylaxis should be placed in the correct position:

 most people should lie flat with their legs raised

 if they're pregnant they should lie on their left side
 people having trouble breathing should sit up for a short time to help make breathing easier,
and then lie down again when possible
 avoid a sudden change to an upright posture such as standing or sitting up – this can cause a
dangerous fall in blood pressure
If the person's breathing or heart stops, cardiopulmonary resuscitation (CPR) should be
performed immediately.

In hospital

You will need to go to hospital for observation – usually for 6-12 hours – as the symptoms can
occasionally return during this period.

While in hospital:

 an oxygen mask may be used to help breathing

 fluids may be given directly into a vein to help increase blood pressure
 additional medicines such as antihistamines and steroids may be used to help relieve symptoms
 blood tests may be carried out to confirm anaphylaxis
You should be able to go home when the symptoms are under control and it's thought they will
not return quickly. This will usually be after a few hours, but may be longer if the reaction was
severe.

You may be asked to take antihistamines (an anti-allergy medicine) and steroid tablets for a few
days after leaving hospital to help stop your symptoms returning.

You will also probably be asked to attend a follow-up appointment with an allergy specialist so
you can be given advice about how you can avoid further episodes of anaphylaxis.
Adrenaline auto-injectors may be provided for emergency use between leaving hospital and
attending the follow-up appointment.

Prevention
Identify triggers

Finding out if you're allergic to anything that could trigger anaphylaxis can help you avoid these
triggers in the future.

If you've had anaphylaxis and have not already been diagnosed with an allergy, you should be
referred to an allergy clinic for tests to identify any triggers.

The most commonly used tests are:

 a skin prick test – your skin is pricked with a tiny amount of a suspected allergen to see if it
reacts
 a blood test – a sample of your blood is taken to test its reaction to a suspected allergen
Read more about diagnosing allergies and allergy testing.

Avoid triggers

If a trigger has been identified, you'll need to take steps to avoid it in the future whenever
possible. Read our advice about avoiding some specific triggers.

Food

You can reduce the chances of being exposed to a food allergen by:

 checking food labels and ingredients

 letting staff at a restaurant know what you're allergic to so it's not included in your meal
 remembering some types of food may contain small traces of potential allergens – for example,
some sauces contain wheat and peanuts
Read about living with a food allergy

Insect stings

You can reduce your risk of being stung by an insect by taking basic precautions, such as:

 moving away from wasps, hornets or bees slowly without panicking – do not wave your arms
around or swat at them
 using an insect repellent if you spend time outdoors, particularly in the summer
  being careful drinking out of cans when there are insects around – insects may fly or crawl inside
the can and sting you in the mouth when you take a drink
 not walking around outside with bare feet
Some specialist allergy centres can also offer special treatment to help desensitise you to insect
stings (immunotherapy).

Read more about preventing insect stings

Medicines

If you're allergic to certain types of medicines, there are normally alternatives that can be safely
used.

For example, if you're allergic to:

 penicillin – you can normally safely take a different group of antibiotics known as macrolides
 non-steroidal anti-inflammatory drugs (NSAIDs) , such as ibuprofen and aspirin – you can
normally safely take paracetamol; read the ingredients of things like colds medicines carefully to
make sure they do not contain NSAIDs
 one type of general anaesthetic – others are available, or it may be possible to perform surgery
using a local anaesthetic or an epidural injection
Always tell any healthcare professional about medicine allergies you have, as they may not be
aware of them.

Carry adrenaline auto-injectors

You may be prescribed an adrenaline auto-injector if there's an ongoing risk you could develop
anaphylaxis.

There are 3 types of auto-injector – EpiPen, Jext and Emerade – that are each slightly different.

It's important to remember the following:

 carry 2 in-date auto-injectors at all times – there should be no exceptions; you may also be
advised to get an emergency card or bracelet with full details of your allergy and doctor's
contact details to alert others
 make sure you and any carers know when and how to use your auto-injector – read the leaflet
that comes with it and practise with a training device, which you can get from the manufacturer
 extremes of heat can make adrenaline less effective – so do not leave your auto-injector in the
fridge or your car's glove compartment, for example
 check the expiry date regularly and replace it before it expires – an out-of-date injector will
offer limited protection
  manufacturers offer a reminder service, where you can be contacted near the expiry
date – check the information leaflet that comes with your medicine for more information
 do not delay injecting yourself if you think you may be experiencing anaphylaxis, even if your
initial symptoms are mild – it's better to use adrenaline early and then find out it was a false
alarm than delay treatment until you're sure you're experiencing severe anaphylaxis
If your child has an auto-injector, they will need to change over to an adult dose once they reach
30kg (approximately 4.5 stone).