House CallAug/Sep 2013 Issue

Allergies Q & A: Asthma Triggers, Allergic Reactions, & More

Medical experts answer your questions about asthma, anaphylaxis and food allergies.

Anaphylaxis Canada recently released Living Confidently with Food Allergy, a free handbook that gives families the tools they need to safely manage food allergies. We're pleased to excerpt a few highlights here. The entire contents of this handbook, including relevant references, can be found at and

Asthma Triggers

Can exercise bring on an asthma attack?

Yes. In susceptible people, asthma can be triggered by exercise. Asthma symptoms include cough, shortness of breath, wheezing and tightness of the chest. Other common asthma triggers are dust mites, pets, pollen, smoking, air pollution, viral infection, chemical fumes and cold weather.

Allergic Reactions

What are the common symptoms of an allergic reaction?

An allergic reaction can involve any of the following symptoms, which may appear alone or in any combination. On the skin, there can be hives, swelling, itching, warmth and/or redness. With the respiratory system, there can be coughing, wheezing, shortness of breath, chest pain or tightness, throat tightness, trouble swallowing, hoarse voice, nasal congestion or hay fever-like symptoms (sneezing, runny or itchy nose, itchy or watery eyes). It can impact the gastrointestinal system with nausea, stomach pain or cramps, vomiting, diarrhea. It can strike the cardiovascular system with dizziness or a feeling of being lightheaded, pale/blue color, weak pulse, fainting, shock, loss of consciousness.

An allergic reaction can prompt brain-related symptoms, such as anxiety, headaches and feelings of “impending doom” (the feeling that something really bad is about to happen). In women, it can even bring on uterine cramps. For more specifics about allergic reactions, check with your doctor.

Reaction Speed

How fast can a food reaction occur?

Most allergic reactions happen within minutes but some can occur a few hours after exposure.

Next Time

Can my doctor predict how bad a reaction will be?

Probably not. At present, tests cannot tell doctors how severe a person’s allergic reaction will be. It is also difficult to tell exactly which specific patients are at risk for a severe reaction.

Even if your early symptoms seem mild, do not ignore them, especially if you have had a severe reaction in the past.

At-Risk Groups

What group of those with food allergies is most at risk for severe reactions?

Children with both food allergy and asthma are at risk of having a more severe allergic reaction than those with just asthma alone or those who have a food allergy without asthma.

Teenagers are also at risk. They tend to spend more time outside of the home and take on more of a lead role in managing their food allergies. At the same time, they face increased pressure to fit in with their peers. Some teens engage in risky behaviors, such as not reading labels, knowingly eating foods that could contain their allergen or not carrying emergency medicine when they are out with friends. These behaviors increase the risk for allergic reactions and death.

Skin Contact

Can someone develop a serious allergic reaction from just touching an allergen?

In most cases, healthy skin does a good job of keeping allergens out of our bodies and serious reactions from skin contact are rare. But skin contact can cause hives or other skin symptoms where the allergen touches the skin.

If an allergen comes in contact with your skin, wash it off to decrease the chance that it will accidentally get into your mouth, eyes or nose where it can possibly cause a more serious reaction. Washing hands before eating or touching the eyes, nose or mouth is key. This is especially important for young children, who frequently put their fingers in their mouths, as well as their eyes and nose.

About Epinephrine

Is epinephrine dangerous? Are there side effects?

Epinephrine is generally safe to use in normally healthy individuals. It rarely causes harm, even if given when not needed. Possible side effects can include rapid heart rate, paleness, dizziness, weakness, tremors and headache. These side effects are generally mild and go away within a few minutes.

Dose Again?

Is it ever okay to give a second dose of epinephrine?

If allergic symptoms come back after the first dose or if they worsen, a second dose of epinephrine can be given as early as 5 to 15 minutes after the first dose. For instructions about administering epinephrine, consult your doctor. A second wave of anaphylaxis, called a biphasic reaction, can happen after the initial symptoms have resolved. This can occur after the first reaction, even several hours afterwards.

Epinephrine can wear off and the person may need more, as well as other treatment. This is why it’s important that anyone having anaphylaxis be quickly taken to the emergency department to be seen by a doctor.

Asthma or Anaphylaxis?

I’m worried about confusing asthma symptoms with anaphylaxis. What if I give my child the wrong medication?

Many parents worry they might mistake anaphylaxis symptoms for an asthma attack or the other way around. Epinephrine works to treat both asthma and a severe allergic reaction. Before modern asthma medications were available, epinephrine was used to treat asthma attacks.

If you suspect your child is having an anaphylactic reaction, give the epinephrine auto-injector immediately. Keep in mind that antihistamines are slow to act and have not been proven to stop anaphylaxis. Give other medications, such as asthma drugs and antihistamines, after administering epinephrine. Consult your doctor for specific instructions.

Medical ID

If I have severe allergies, should I be wearing a medical bracelet?

Yes. If you are alone and become unconscious due to an allergic reaction, your identification jewelry can provide others with critical information about your allergy so that you can receive proper medical attention. Medical ID’s are also very important for children who are too young to adequately describe their allergy.

Product Labels

Are vitamins labeled for food allergens?

No. Non-food items, like vitamins, skin creams and other personal care products and pet food, can contain unlabeled allergens. Contact the manufacturer directly to determine whether ingredients are safe for you. Two examples of child-favorite products that can have hidden ingredients are modeling clay, which may contain wheat (gluten), and finger paint, which may contain eggs.

Age-Appropriate Message

My daughter was just diagnosed with severe allergies. I want to explain this to her in a positive way. Can you help?

Your child learns from you, especially from your attitude and what you do. When your language, behavior and overall attitude show that you are confident, your child will feel the same. The lessons you teach your child when she is young will help her successfully self-manage her allergies as she grows older.

Do not use terrifying words to describe her medical condition, such as “deadly food allergies,” or “this food can kill you.” Remember that your youngster is also listening to conversations that you have with others, so be mindful of this when speaking about her allergies to caregivers, teachers and family members.

Talk about the fact that food allergies can be managed. For young children, phrases like “eggs can make you sick” or “peanuts are not safe for your body” may work. As children grow older, they’re more able to understand the role of the immune system. For example, “the immune system, the part of the body that usually fights germs, mistakes the food for something harmful. When the immune system fights back, that causes the allergic reaction.”

Bulk Bins

Are bulk bins in the grocery store safe for those with anaphylaxis?

No. Even if bins are well labeled, do not buy food this way. Shoppers may have used the same scoops in different bins, which can cause cross contamination.

Breathe In

Is it possible to inhale an allergen and develop a problem?

In some cases, allergic reactions can happen when food proteins are inhaled. This can occur through steam, such as when cooking food (fish sizzling in the pan). It can occur when food is released into the air in particulate form (powdered milk blown into the air). Small amounts can also get into the air when food (like tree nuts or peanuts) is crushed or ground up. Although these reactions are usually mild, people reported severe reactions in rare cases.

Major Food Allergens

Do the United States and Canada have the same “Big 8” food allergens?

Not exactly. In the United States, the major allergens are wheat, milk, eggs, tree nuts, peanuts, fish, crustacean shellfish and soy. In Canada, the priority allergens are wheat, milk, eggs, soy, peanuts, tree nuts, fish, crustacean, shellfish, sulphites, mustard and sesame.

Advisory Statements

Should I consume a food with “may contain” or “processed in a facility that also processes…” on its label?

No. Do not eat food products labeled with these types of precautionary statements. You can’t know if there is a risk based on this type of language, even if you have had the product before. Food companies may change ingredients without informing consumers. In addition, researchers have found that some products with these statements actually contain enough allergen to cause an allergic reaction.

Keep in mind that companies choose voluntarily to use precautionary statements. They are not required by law to do this.

Excerpts published with permission from Living Confidently with Food Allergy (© 2013 Anaphylaxis Canada), a free handbook written by Michael Pistiner, MD, MMSc, Jennifer LeBovidge, PhD, and Anaphylaxis Canada (Laura Bantock, director, western region; Lauren James, development coordinator; Laurie Harada, executive director). Living Confidently with Food Allergy is a North American collaborative effort led by Anaphylaxis Canada. It uses evidence-based information in a practical way to give parents the tools to keep their children safe while addressing their emotional needs. For specific references related to the information covered in this article, see Living Confidently with Food Allergy, available visa and This information is not a replacement for professional medical advice. All matters regarding your health should be supervised by a licensed health-care professional.

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