Watch It! That Biscuit Might Bite

Booby-Trap Food
Doctors say urban Indians are flocking to clinics and hospitals with a large number of suspected food allergies.

Common causes of allergies
Tea, coffee, chocolate, colas, alcohol, sugar, sweets, cereals, meats, eggs, fish, dust, cosmetics, chicken, tobacco, milk, cheese, butter, smoked/salted/pickled foods, sea foods, chemical additives, preservatives and flavouring.

• Allergy to wheat is the most common among adult urban Indians
• In children, milk, eggs and peanuts generally cause allergies.
• The anti-allergy drug  market has doubled in size from 10 years ago.
• Changing food habits and lifestyle are the main culprits.

Cures And Prevention

• Be alert to symptoms like headache, dizziness, nervousness, sneezing, eczema, hay fever, indigestion, constipation, diarrhoea, stuffy or runny nose, shortness of breath
• Immediately avoid food that caused a previous allergic reaction; get tested
• Immunotherapy (which prepares the body to not react adversely to certain foods) may be needed
• Natural remedies such as yoga, exercise and lowering stress are seen as a way to avoid allergic reactions
• Build general health and resistance through exercise and dietary supplements

***

In January 2010, Sanjana took an allergy test—the most comprehensive of the few tests she has taken so far. It showed she is allergic to a large number of items, including dog dander, various plants, mushroom, cocoa, whole-wheat bread, even broccoli. Doctors are now helping wean her back to a normal diet, including food that’s not home-cooked, through immunotherapy, which introduces small, incremental doses of allergy-causing substances until the system learns to tolerate them.

Extreme though it is, Sanjana’s isn’t an isolated case. Urban Indians are flocking to clinics and hospitals with a large number of suspected food allergies. As many  sufferers are beginning to realise, potential allergens lie hidden in a vast variety of common eatables. That’s why patients are getting doctors’ instructions to not consume processed foods, or foods that are “complex” (such as pizza), food items constituted from so many ingredients that if an allergy  were to occur in an eater, it would be impossible to pinpoint the cause.

Take 13-year-old Prateek Nag, whose parents are struggling to identify the reason for his allergic reaction. His symptoms first broke out seven months ago—again, after eating out. At first, his mother Madhu concluded the allergic reaction was due to the roast meat he had consumed. Not eating any stopped his bumpy rashes from appearing, but then they unexpectedly returned. “Now, I’m beginning to think that hot and cold weather also affects him, as does dust. And maybe other roasted foods such as peanuts. Driving up to the hills for a recent vacation, he was ill all the way up, but recovered on the way down. We were quite perplexed,” she says.

Dr S. Chatterjee, a senior consultant in internal medicine at Indraprastha Apollo Hospitals, says allergies to food are a rising trend, but can’t say if urban Indians are showing more than normal food allergies—there are no studies to go by. His estimate of the incidence of allergies in the country is in the range 2 to 14 per cent among children and adults (men and women are equally prone to getting food allergies). What’s clear is that in urban areas, people are noticing allergic reactions much more, he says. “This could be because earlier they were not reporting such symptoms to doctors,” says Dr Chatterjee.

Numbers are certainly tough to come by. One indication of the rise of allergies among Indians is the size of the anti-allergy drug market, which was estimated at Rs 600 crore to Rs 800 crore ten years ago—it’s nearly double at present. Estimates vary, but approximately 25 per cent of the Indian population has some kind of allergy, ranging from asthma to skin and food or drug allergies—that’s around 250 million people. Doctors estimate that more Indians suffer from allergies than from cardiac problems. Worldwide, 40 per cent of the population is understood to have some kind of allergy, according to the World Allergy Organisation.

Whatever the numbers, Dr Chatterjee, for one, has been recommending the “gluten hypersensitivity” test more often of late. This test identifies allergic reactions to gluten, a compound found in wheat and several other grains. According to several doctors Outlook spoke to, allergy to wheat is the most common among adult urban Indians. In children, milk, eggs and peanuts generally cause allergies.

There’s another reason for allergies on the rise—a change in lifestyle, which has led to greater use of allergy-causing elements. For instance, carpeting, on which dust mites thrive, can cause allergies; so can the greater use of processed foods and changing food habits. It isn’t that imported foods cause allergies. Dr Sanjay Khanna, a consultant in gastroenterology at  the Dr B.L. Kapur Hospital in Delhi, explains how it works: “If a person is allergic to some food item, he will show the same allergic reaction and symptoms, regardless of where the food came from—India or abroad.”

Even if their reactions are not as severe as Sanjana’s, or as confusing as the young Prateek’s, still, lifestyle adjustments have to be made the minute food allergies are discovered. Take Manpreet Brar, 32, a technology consultant at Sapient who works out of Gurgaon. About seven years ago, he discovered he is allergic to cashewnuts— one was enough to cause reddish spots on his face and neck. “I know my allergy isn’t as bad as many people’s, but it was quite painful,” he says. “At times, I eat a biscuit or a chocolate, only to realise it contained cashew. My nose will swell up and the spots reappear.” Manpreet never visited a doctor for his allergy—once he knew the cause, he simply eliminated it from his diet.

Whatever the cause, Indians are struggling with cures ranging from yoga to allopathic treatments to natural remedies. Pankaj Mahajan, 37, general manager, corporate strategy, with HCL Technologies, is allergic to cold air, changing temperatures and dust. This is India’s most common allergy and growing the fastest as well. Mahajan has had three surgeries since his nasal polyps were discovered at age 12. None of them worked, and he has spent a large part of his life with a runny nose. “I’ve probably met every doctor in town by now. I’ve tried every cure,” says Mahajan. Things eased up somewhat about two years ago, when he underwent six months of immunotherapy, though he still cannot eat or drink anything cold or sweet.

Sunny Sandhu, a medical doctor who began a naturopathy-oriented practice a decade ago, says lifestyle-related allergies are more prevalent in India now than a few years ago. “The body gets mixed signals constantly due to people spending late nights up and sleeping through the daylight. Allergies are but a natural consequence of such a lifestyle,” he says. Skin allergies, he says, are tackled the natural way—by regular sun exposure and changes in diet (“No colas and candies please,” he tells patients). He also spreads awareness about the lack of labelling information on packaged, processed foods. “It could be that people are allergic to one or more of the contents in such foods, but never realise it because in India, food labels rarely have allergy warnings,” he says.

It’s hardly surprising then that many more urban Indians are reporting what they think is an allergy to doctors. Often, what’s causing the allergy is commonly found, such as vinegar in Raghav Suri’s case. The 32-year-old executive discovered he was allergic in 1996, after his general physician got him to “categorise food intake and observe”. Those who have an allergy know they must keep to untreated, natural foods as much as possible. That makes sense. Allergy tests are expensive, ranging from Rs 4,000-Rs 20,000 a pop. Given the absence of allergy specialists in the country (though the Medical Council of India has a course on allergy, it hasn’t had many takers), a stiff dose of caution remains the best prescription.