Q: My 12-year-old with legume allergies had only ever had mild reactions, then recently she had an accidental exposure to food containing soy flour and experienced anaphylaxis. Could this reaction have anything to do with hormonal changes, since she has only recently hit puberty?
Dr. Sharma: As your daughter’s case illustrates, food allergy reactions are unpredictable, and severe reactions can still occur even if all previous reactions have been mild.
There are several factors that might amplify the severity of a given food allergy reaction. These include: the amount of food allergen consumed; whether the allergic person recently exercised; taking certain medications; or consuming other foods or substances (for instance, alcohol) that might increase the risk of a severe reaction.
In addition, it has been noted that adolescent girls and women may have a heightened risk of severe reaction related to their menstrual cycle, specifically during the premenstrual or ovulatory phases. Presumably, hormonal changes associated with these phases of the menstrual cycle can alter the threshold for a reaction.
Aside from these factors, age is also important, in that severe reactions are more common in teens and young adults. This may be related to increased risk-taking, independence in decision-making, and peer pressure at this stage of life. I’d recommend the article “Food Allergy Meets the Teenage Brain” for more on the age considerations.
Dr. Sharma is an allergist, clinical researcher and assistant professor of pediatrics. He is Clinical Chief of the Division of Allergy and Immunology at Children’s National Health System in Washington, D.C. and Director of the Food Allergy Program. Questions submitted below will be considered for answer in the magazine.