Journal Article

Journal Article

Journal Citation

Kitts,D., Yuan,Y., Joneja,J., Scott,F., Szilagyi,A., Amiot,J. and Zarkadas,M. Adverse reactions to food constituents: Allergy, Intolerance, and Autoimmunity. Canadian Journal of Physiology and Pharmacology 1997 75(4):241-254

Article

FOOD ALLERGIES: GENDER DIFFERENCES IN INCIDENCE AND RESPONSE TO FOOD RESTRICTIONS

Janice M. Joneja, Ph.D., R.D.N. Co-ordinator, Allergy Nutrition Research Program, Vancouver Hospital and Health Sciences Centre, and Adjunct Professor, School of Family and Nutritional Sciences, U.B.C.

Source of observations: The Allergy Nutrition Program

The Allergy Nutrition Program at Vancouver Hospital and Health Sciences Centre was started in 1991 to provide counselling for persons of all ages in the detection and management of food allergies and intolerances. Research in adverse reactions to foods is carried out and the Program provides resources for health care professionals who are involved in the management of food allergies and intolerances. The clinic is unique in that it provides service to an extremely select population in which all other causes of symptoms have already been addressed and ruled out, and adverse reactions to foods is the only focus. More than 1,500 clients have been counselled in the clinic.

The management of food allergies and intolerances involves identification of the specific food components responsible for adverse reactions using well-defined elimination and challenge procedures. This is followed by formulation of a diet that eliminates the reactive foods and provides complete balanced nutrition from alternative sources.

INCIDENCE OF FOOD ALLERGIES: COMPARISON OF MALES AND FEMALES

Statistical analysis by gender of clients attending the Allergy Nutrition Clinic over a 4.5 year period October 1991 – March 1996

Total number of clients: 1372

Age	Male	% of total	Female	% of total	Total	Percentage
0-6 years	266	19.4	163	11.9	429	31.3
7-12 years	65	4.7	47	3.4	112	8.1
13-19 years	12	0.9	21	1.5	33	2.4
> 20 years	123	9.0	675	49.2	798	58.2

 

Total Males in all age groups:                           466          (34%)

Total Females in all age groups:                        906          (66%)

Gender comparisons in different age groups:

Age Group	Percentage male	Percentage female	Ratio Male to Female
0 – 6 years	62	38	1 : 0.6
7 – 12 years	58	42	1 : 0.7
13 – 19 years	36	64	1 : 1.75
> 20 years	15.4	84.6	1 : 5.5
Total all ages	34	66	1 : 2

 

 

Comments on gender comparisons

1. In children under the age of 6 years, males outnumber females almost two to one
2. This trend continues for children in the 7 – 12 year age category
3. From 13 to 19 years, females start to outnumber males by almost two to one
4. Adult females are more than five times more likely to seek help in managing their reactions than are males

Question :

Do these statistics reflect the actual incidence of adverse reactions to foods of males and females in each age category?

Answer :

Probably not

Reasons why clients attend the Allergy Nutrition Clinic

1. In the 0-6 years and 7-12 years age categories, children are brought to the Allergy Nutrition Clinic by their parents. The predominance of males reflects the common observation that boys, especially under the age of six years, have more allergy (IgE-mediated Type I hypersensitivity reaction) than girls. At puberty, boys tend to outgrow their earlier allergies {David 1993} .

2. At menarche, especially in the twelve month period preceding the onset of menstruation, girls sometimes develop symptoms such as urticaria and migraine headaches, which may have a component of food allergy in their etiology. This explains the greater number of females over males in this age category. Thereafter, hormonal fluctuations throughout a woman`s life tend to affect the degree of clinical expression of food allergies and intolerances.

3. Adult women seem to have a much higher incidence of food intolerance (non-immune-mediated reactions) than children. The incidence of non-immune mediated reactions to food additives in adults has been estimated to be as high as 40%-50% of the population {Lessof 1984}: Food allergy in this population is estimated to be less than 1% {Parker et al 1988; Bock 1985; 1987; Gallagher et al 1983}. Children have a much higher incidence of immune-mediated allergy, with estimated incidences of between 2% and 7% of all children under the age of six years. {Bahna and Heiner 1988; Kajosaari 1982}. Other reports indicate that up to 20% of children suffer from some form of adverse reaction to food {Lessof 1984} . The symptoms of food intolerance are generally much milder than immune-mediated allergy, and often overt clinical signs are not visible. Irritable bowel syndrome accounts for up to 50% of all reasons why adults seek counselling in the Clinic.

   NOTE Because there are no definitive laboratory tests to determine food allergies and intolerances, the reports of incidence of food allergy and/or intolerance in the medical and scientific literature are estimates only, and reflect the diverse methods of diagnosis used by the clinicians who are generating the report {David 1993}.

4. Adult males tend to ignore, deny, or disregard their food intolerances; adult women are more likely to seek help in managing their discomfort.

5. When parents bring their children to the clinic, discussion always includes the incidence of sensitivity reactions in first degree relatives. Mothers tend to have a history of seeking medical help for their own adverse reactions to food; Fathers may admit to their own history of suspected adverse reactions in the Clinic, but have rarely sought medical advice in the past.
6. Mothers are much more likely than fathers to bring their children to the Clinic, and to accept the fact that their child may have allergies.
7. Mothers tend to become very concerned about the possibility that their child has food allergies: Fathers tend to minimize the problem, and sometimes accuse their wives of being “over-protective” of the child, especially if it is a boy.

8. There is sometimes a tendency for parents to be concerned that the alternative diets prescribed to provide complete nutrition might contain “too much fat”.

RESPONSE OF BOYS VS GIRLS TO FOOD RESTRICTIONS

A pronounced difference in attitude has been evident between males and females in their response to the suggestion that they will be required to change their diet and their life-style. This attitude is most noticeable in the teenage years. Children in the 0-12 age group tend to reflect the attitudes of their parents to dietary changes, and no particular differences between boys and girls has been evident.

Case Histories :

Case 1 .

Scott is a seventeen-year-old Grade eleven student at a local high school. He was referred to the Allergy Nutrition Clinic after two anaphylactic reactions to peanuts requiring treatment in the hospital emergency room. The first had occurred after a meal with friends, when he experienced throat tightening, flushing, hives, digestive tract distress which progressed to chest tightness and breathing difficulty. He was rushed to the hospital where adrenalin and antihistamines had been administered. He subsequently consulted an allergist who determined that he was skin test positive to peanuts, and was told that he had suffered an anaphylactic reaction after ingesting them in his meal. He was prescribed an Epipen, had been instructed in its use, and told to assiduously avoid peanuts in any form. He was also told to avoid all nuts because of the danger of cross-contamination, and impressed with the idea that he was under the threat of instant death if he should inadvertently come into contact with even the most minute speck of peanut.

Scott’s response was instant outrage. Scott expressed his reaction as “I was very angry that food was controlling me!” He counteracted by buying a large bag of peanuts and eating the lot -in the emergency room of the hospital. Fortunately, he was close to immediate medical treatment and the ensuing anaphylactic reaction did not prove fatal.

Case 2 .

Carlos was a rather obese thirteen-year-old. He had suffered from chronic diarrhea and extremely extremely painful inflammation around the anus since early infancy. His family were greatly distressed by his howling during each bowel movement. The subsequent pain often required him to stay home from school, and he was finding it hard to keep up with his school work. Every gastrointestinal test had proved normal and no cause or relief for his symptoms could be offered. His parents were preparing to take him to the Mayo Clinic for assessment, in spite of their rather limited finances. Their visit to the Allergy Nutrition Clinic was a last resort before keeping their appointment in Rochester.

A disaccharide-restricted diet prescribed in the Allergy Nutrition Clinic led to almost immediate resolution of the diarrhea. Healing of the perianal inflammation followed soon after. Carlos’ appointment at the Mayo Clinic was cancelled with relief.

The improvement in Carlos’ symptoms continued as long as he avoided disaccharide sugars. However, being a typical thirteen-year-old he loved candies, chocolate bars and large containers of soft drinks, which he consumed with his friends after school. The consequent diarrhea and distress alerted his parents to the fact that he was consuming sugars in spite of their best efforts to restrain him.

Carlos is now sixteen years old and is quite familiar with his reaction to disaccharides, which has not changed in severity. However, he often chooses to defy his body and indulge his appetite for sugary foods with his friends. He finds that if he appears “different” he is not acceptable in his peer group and is in danger of being the butt of insulting jokes. He prefers to suffer the painful consequences rather than face social rejection. His family have learned to cover their ears when his bathroom howls become too loud.

Case 3 .

Susan was a slim, pale fifteen-year-old. She had experienced “stomach aches” as long as she could remember and had a history of allergy to pollens, dust, animal dander and some foods since early childhood. Her 7-day diet record indicated that she had a rather erratic pattern of eating. She would not eat breakfast because she woke every morning with a stomach ache. Lunch was often French fries and after school she would consume ice cream and soft drinks with her friends. Potato chips, milk, and Ritz cheese crackers appeared frequently in her diet. She rejected fruits and vegetables because she felt that they caused stomach ache. She would not touch meat in any form because she “can`t bear the thought of the animals being killed”.

Susan was accompanied by her mother, Pam, who was anxious about Susan`s stomach aches, but strangely did not seem concerned about Susan`s pattern of eating. As the interview progressed, it became clear that Pam disliked cooking and had suffered anorexia nervosa in the past. She had another daughter, older than Susan, who also seemed to exist largely on convenience foods. The suspicion that the older daughter was also experiencing anorexia nervosa was raised.

Because of Susan’s gastrointestinal symptoms, it seemed that a limited time trial on a diet designed to manage irritable bowel syndrome and avoidance of the foods suspected to be allergenic for her, would help. Detailed information was supplied to both mother and daughter for avoiding “reactive foods” and replacing them with nutritionally equivalent alternative foods. Susan listened attentively to the list of foods to avoid but became restless and bored when the discussion turned to details of which foods to substitute to obtain balanced nutrition, and how to cook and plan her meals.

The outcome was almost predictable. When Susan and her mother returned for the standard four-week follow-up, Susan had lost weight and her diet record showed that she had indeed carefully avoided the restricted foods but had replaced them with nothing at all. Her mother complained that she did not know what to feed Susan. Although Susan seemed happy with the restricted diet and said that her stomach aches had improved, she complained of feeling exhausted. Pam reported that Susan often could not get out of bed to go to school in the mornings.

Although these cases are rather more extreme than most of those seen in the Clinic, they do illustrate a very noticeable difference in attitude amongst teenage boys and girls, which often continues into adulthood:

• Males tend to deny and sometimes actively defy any restrictions on their life-style that foods may impose
• Females tend to actively welcome the idea of restricting their food intake

In both cases, however, the physical distress seems to be an acceptable price to pay, at least in the short term:

• In males as a consequence of their defiance
• In females as a consequence of their apparent compliance

When prescribed an alternate diet that excludes their “antagonistic foods” and provides complete nutrition from alternate sources, the response from young males and females often differs:

• Males are very anxious that their new diets should provide nutrients for increasing muscle mass and often weight gain
• Females are anxious to limit their dietary intake to achieve weight loss, or at least, not incur any gain in weight

 

SUMMARY

1. Atopic boys tend to outnumber girls by almost two to one in the under 7 year-old age group.

2. Differences in attitude to food restrictions between boys and girls does not become apparent until adolescence. Prior to this, the response to food restrictions often reflects that of the parents.
3. In both genders there is some degree of resistance to diet and life-style changes. In both genders peer acceptance strongly influences attitude.

4. Girls tend to accept food restrictions more readily than boys. There is possibly more acceptance among girls because of a peer-endorsed tendency to restrict food intake to reduce weight.

REFERENCES

Bahna,S.L. and Heiner,D.C. Allergies to milk. Grune and Stratton, New York 1980 Bock,S.A. Natural history of severe reactions to foods in young children. J.Pediatr. 1985 107:676-680 Bock,S.A. Prospective appraisal of complaints of adverse reactions to foods in children during the first 3 years of life. Pediatrics 1987 79 :683-688

David,T.J. Food intolerance: History, prevalence and natural history. In: Food and Food Additive Intolerance in Childhood . Blackwell Scientific Publications, Oxford 1993 12-15

Gallagher,J.S., Riehm,J.G., Valanis,B. and Bernstein,I.L. Cross sectional survey of the incidence of adverse food symptoms in adults. J.Allergy Clin.Immunol. 1983 71 :113

Kajosaari,M. Food allergy in Finnish children aged 1 to 6 years. Acta Paediatr.Scand 1982 71 :815-819

Lessof, M.H. (Chair). Food Intolerance and Food Aversion. Joint Report of the Royal College of Physicians and the British Nutrition Foundation. J.Roy.Coll.Physicians of London 1984 18 (2):83-122

Metcalfe,D.D. Food hypersensitivity. J.Allergy Clin.Immunol. 1984 73 :749-762

Parker,S.L., Sussman,G.L. and Krondl,M. Dietary aspects of adverse reactions to foods in adults. CMAJ 1988 139:71–718