Asthma is a chronic disease that occurs when irritants trigger swelling of the airways, tissues of the lungs, making it difficult to breathe. Numerous factors trigger asthma, including various allergens (from dust, molds, pollen and animals), air pollutants (cigarette smoke, auto exhaust or smog), colds and respiratory infections; weather changes; exercise or certain medications.
Asthma attacks triggered or exacerbated by foods are rare: food allergy and asthma may coexist, but asthma alone as a manifestation of a food allergy is rare. Asthma may develop in about 5% of individuals who suffer from food allergy and current asthma may be triggered by foods among 6-8% of children and 2% of adults.
Food-induced asthma should be suspected in the following situations:
- asthma that starts early in life, especially in those with concomitant atopic dermatitis;
- wheeze occurs after specific foods are taken; or
- asthma is poorly controlled even with appropriate medication and aeroallergen avoidance.
Very few foods are confirmed to be causes of asthma. Among major food allergens, milk and egg are the common food allergens identified in children less than 3 years old, whilst peanut and egg are the common food allergens in toddlers older than 3 years of age.
Other food allergens include sulfites and sulfiting agents in foods (found in dried fruits, prepared potatoes, wine, bottled lemon or lime juice, and shrimp). In individuals with food allergies, foods may cause asthma reactions especially when they are inhaled, as it can happen with flour or with aerosolized food particles, such as fish and shellfish during cooking.
There are not proven data linking asthma to other food ingredients such as food dyes and colors, food preservatives (such as BHA and BHT, two antioxidants compounds that are often added to foods to preserve fats) and food additives (such as the flavor enhancer monosodium glutamate, the sugar substitutes aspartame, and the nitrite used for the curing of meat by prevention of bacterial growth).
Even if foods are generally not causing asthma, presence of some special food allergies can increase the possibility to develop non food related asthma later in life. For example, Cow Milk Proteins Allergy in toddlers in their first 5 years of life, especially if associated with atopic eczema, is considered to be a risk factor for the future development of asthma.
Allergy in children to egg proteins, peanut and shrimps are also considered factors increasing the risk of developing asthma in adulthood.
In reverse, asthma seems to be a risk factor for food allergy: people with underlying asthma are more likely to experience severe food allergic reactions. Scientific data show that, compared with non-asthmatic children, asthmatic children have a 14-fold higher risk of developing a severe allergic reaction to food.
In general, food-induced asthma occurs within minutes to 1 hour following food ingestion, even if a late response, occurring 4 to 6 hours after food ingestion, has also been reported.
Patients may develop pruritus, excessive tear production, runny nose or itch in the mouth. This could progress to deep, repetitive coughing, shortness of breath, and wheezing.
Diagnosis of food-induced asthma is very difficult and starts with a suspected close association between certain food and asthma symptoms. Definitive confirmation of diagnosis comes from the food challenging test, to be performed under strict medical supervision.
The most effective approach to treating food-allergy-related asthma is to avoid the offending food or food ingredient and keep symptoms under control. Always follow the care plan developed by the physician.
- The International Food Information Council
- D. Ozol, E. Mete. Asthma and Food Allergy. Current Opinion in Pulmonary Medicine 2008;14(1):9-12
- DKK Ng, KB Tang. Food induced asthma attacks in children. The Hong Kong Practitioner 2001; 23:52-55
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