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T M C P U L S E | F E B R U A R Y 2 02 0 25 Amy Barbuto prepares cornbread in her kitchen using ingredients that do not contain any wheat or gluten. Barbuto developed a severe allergy to wheat and gluten at age 22. When a person suspects a food allergy, the first thing to do is to consult a primary care physician to make sure it is, in fact, an allergy. "Somebody who may be thinking they have food allergies might actu- ally be having other more severe GI problems, which do need to be diag- nosed on time, and the patient may need treatment and medications," Hassan said. Food allergies are diagnosed by a skin prick test, during which a health care professional places a sample of the suspected food aller- gen on either the forearm or back of the patient and gently scratches, without breaking the skin or causing bleeding. If a visible reaction is present on the skin, blood is drawn to determine the levels of IgE anti- bodies the patient's immune system is producing. Once a food allergy is diagnosed and confirmed, experts say patients should always carry an EpiPen—to give themselves an injection of epinephrine—and completely avoid the food allergen. "If they're highly allergic, not only do they have to avoid that, but family members and friends also have to be educated," Hassan said, especially "if they are eating that [food] beside that person and then they're touching that person with their hands or fingers." Unfortunately, even with due diligence and taking every precau- tion, accidental exposure can still happen. "For a long time, we didn't eat out," Barbuto said. "It was safer to just eat at home. From a quality of life standpoint, we tried eating out at a couple of places, just so that we could feel a little more normal. We only go to a couple of places. We talk to them—talk to the managers, talk to the chefs—to make sure everybody's aware, but unfortu- nately, the risk of going out to eat with a food allergy is that something can happen." When people experience difficulty breathing from allergic reactions in public, it is important that they not isolate themselves. "It's OK to be in distress in front of others because they can help you," Sur said. "But if you feel that you don't want to embarrass others and go to the restroom, you close the door and there's no one else there. That's the worst possible mistake you can make." Can adult-onset food aller- gies disappear just as quickly as they appeared? Yes, Hassan said—theoretically. The more you become exposed, the more IgE antibodies your body makes, she said. "The opposite is also true, that the less you get exposed, the anti- body levels drop," she added. "Now, does it drop to a certain threshold below which you won't have a reaction? Theoretically, it's possible, but would I actually want to test out a patient if they have had anaphy- laxis? No, I probably wouldn't."