Diet and Health Guidelines for Food Allergies and Food Intolerances

1. Diet and Health Guidelines for Food Allergies and Food Intolerances Presented by Janice Hermann, PhD, RD/LD OCES Adult and Older Adult Nutrition Specialist

2. Who Has Food Allergies • 3-5% of young children are diagnosed with a food allergy • Most childhood food allergies appear early in life and are usually outgrown • 1-2% of the adult population have a food allergy

3. Who Has Food Allergies • Although anyone can develop a food allergy, the ability to become allergic tends to be inherited • Many people who have food allergies also have asthma, or show sensitivities to inhaled allergens such as dust, pollen and animal dander

4. What Is A Food Allergy • A food allergy is an adverse reaction to a food or food component that involves the immune system • A food allergen is the part of a food to which a person is allergic • Often an incompletely digested protein

5. What Happens With A Food Allergy • When someone eats a food they are allergic to, the food allergen stimulates the immune system to release antibodies • The antibodies cause body cells to release other substances, which cause allergic reactions

6. Food Allergy Symptoms • Allergic reactions can be immediate or delayed • Allergic reactions to foods usually occur within minutes to 24 hours after eating an offending food • In very sensitive people, even touching or inhaling the offending food may produce an allergic reaction

7. Food Allergy Symptoms • Food allergy reactions vary from person to person, as well as within the same person • The same food can produce totally different symptoms in different people, as well as varying symptoms within the same person

8. Food Allergy Symptoms • Food allergy symptoms usually fall into three areas: • Skin Reactions • Nose, Throat and Lung Reactions • Stomach and Intestinal Reactions

9. Skin Reactions • Types of reactions • Swelling of lips, mouth, tongue, face or throat • Hives • Rashes • Itching • Skin redness • With oral allergy syndrome • Hives, swelling and itching confined to the mouth and throat and usually result after consumption of raw fruits and vegetables

10. Nose, Throat and Lung Reactions • Types of reactions • Sneezing • Nasal congestion • Runny nose • Chronic cough • Shortness of breath or other breathing difficulties such as asthma

11. Stomach and Intestinal Reactions • Types of reactions • Nausea • Abdominal pain and bloating • Vomiting • Diarrhea • Cramping • Gas

12. Severe Allergy Reactions • Most food allergic reactions are mild, but a small number of food-allergic individuals have severe reactions that can be life-threatening • Anaphylaxis is rare, but can be a possibly fatal food allergy reaction

13. Anaphylaxis • Different parts of the body may experience food allergy reactions at the same time • Reactions can progress rapidly and may include: Itching Breathing difficulties Hives Lowered blood pressure Sweating Unconsciousness Throat swelling Even death

14. Have A Plan • People who have severe allergic reactions need to recognize early symptoms and have a plan for handling emergency situations • May carry epinephrine for self-injection and warning medical alter bracelets or necklaces in case they become unconscious

15. Importance of Diagnosis • Properly diagnosing food allergies is important • Proper diagnosis can help avoid unnecessary dietary restrictions • Parents may limit their children’s food intakes unnecessarily unless properly diagnosed • Proper diagnosis can also help avoid accidental exposure to allergens

16. Proper Diagnosis • Diagnosis requires a thorough medical history, physical examination, and laboratory tests • Having symptoms is not a diagnosis • Symptoms exactly like those of an allergy many not be caused by one

17. Proper Diagnosis • Methods for diagnosis • Skin-prick test • Antibody blood testing • Oral Food Challenges • Elimination Diets

18. RAST or ELISA • Radioallergosorbent test (RAST) or enzyme-linked immunosorbent assay (ELISA) are reliable skin-prick testing and antibody blood testing for diagnosing allergies

19. Proper Diagnosis • Food changes and elimination tests should be conducted only under medical supervision

20. Unreliable Methods • Two unreliable methods for diagnosing food allergies are cytotoxic testing and symptom provocation testing, where a dose of the food extract is placed under the tongue or injected

21. Most Common Food Allergies • Food allergies can occur to almost any food, but most allergic reactions are caused by a limited number of foods milk shellfish eggs soy wheat peanuts fish tree nuts like walnuts

22. Living With A Food Allergy • The only proven treatment for a food allergy is to avoid the offending food • An elimination diet must be carefully developed and be personalized to take into account the ability of an individual to tolerate an allergic food

23. Living With A Food Allergy • Using an elimination diet for 1-2 years may promote outgrowing a food allergy • Some food allergies, particularly to peanuts, nuts, fish and shellfish can last a lifetime

24. Living With A Food Allergy • No drugs are available to treat food allergies • Allergy shots, which are useful in desensitizing some people to pollen and other environmental allergens, are not recommended to treat food allergies and may be dangerous

25. Living With A Food Allergy • People with food allergies need to learn about food composition and how to read labels • Many foods may contain the allergen • Many terms used to describe food components

26. Milk Allergy • Milk and milk products are a common ingredient in many foods so food labels need to be checked carefully

27. Milk Allergy • Foods containing milk or milk products • Milk • Acidophilus, buttermilk, chocolate milk, evaporated milk, condensed milk, sweetened condensed milk, malted milk, • *Goat’s milk protein similar to cow’s milk protein, may cause similar symptoms, not a recommended substitute • Cheese • Ice cream • Sherbet • Yogurt • Custard • Pudding • Eggnog

28. Milk Allergy • Foods containing milk or milk products • Cream, half & half cream, light cream, whipping cream • Sour cream, sour cream solids, sour cream dressing • Butter, butter oil, butter fat, artificial butter flavor • Nougat • Mellorine • Curds • Semi-sweet chocolate, milk chocolate • Caramel, creamed, carob candies

29. Milk Allergy • Terms for milk products • Casein • Rennet casein • Amoniumcaseinate • Calcium caseinate • Magnesium caseinate • Potassium caseinate • Sodium caseinate • Casein hydrolysate • Milk protein hydrolysates • Protein hydrolysate

30. Milk Allergy • Terms for milk products • Lactose • Lactablumin • Lactalbumin phosphate • Lactoglobulin • Lactulose • Milk protein • Whey • Whey protein concentrate • Whey protein hydrolysate • Sweet whey • Delactosed whey

31. Milk Allergy • Ingredients potentially containing milk or milk products • Caramel flavoring • Bavarian cream flavoring • Coconut cream flavoring • Brown sugar flavoring • Butter flavoring • Natural flavoring • Simplesse®

32. Egg Allergy • Eggs and egg proteins are common ingredient in many foods so food labels need to be checked carefully • Because flu vaccines are prepared using egg embryos, people with egg allergies need to check with their physicians before being vaccinated

33. Egg Allergy • Eggs or foods containing egg products • Eggs, egg white, egg yolk • Dried eggs, frozen eggs, powdered eggs, egg solids • Egg substitutes • Imitation egg product • Béarnaise sauce • Hollandaise sauce • Eggnog • Mayonnaise • Meringue • Simplesse®

34. Egg Allergy • Terms for egg or egg products • Albumin • Apovitellin • Avidin • Egg lecithin • Flavoprotein • Globulin • Livetin • Lysozyme • Ovalbumin, conalbumin • Ovomucin

35. Wheat Allergy • Wheat is a common ingredient in many foods so food labels need to be checked carefully

36. Wheat Allergy • Wheat or wheat products • Atta wheat flour • Bal ahar • Bread flour • Bulgur • Cake flour • Cereal extract • Courscous • Cracked wheat • Durum • Durum flour

37. Wheat Allergy • Wheat or wheat products • Enriched flour • Farina • High protein flour • Kamut flour • Laubina • Lechealim • Malted cereals • Minchin • Multi grain breads • Multi grain flours

38. Wheat Allergy • Wheat or wheat products • Puffed wheat • Red wheat flakes • Rolled wheat • Semolina • Shredded wheat • Soft wheat flour • Spelt • SuperArmine • Triticale • Vital gluten

39. Wheat Allergy • Wheat or wheat products • Vitalia macaroni • Wheat protein powder • Wheat bran • Wheat germ • Wheat gluten • Wheat meal • Wheat pasta • Wheat protein • Wheat starch • Wheat tempeh

40. Wheat Allergy • Wheat or wheat products • White flour • Whole wheat berries • Whole wheat flour • Winter wheat flour

41. Wheat Allergy • Ingredients potentially made from wheat • Hydrolyzed vegetable protein • Vegetable starch • Starch • Gelatinized starch • Modified starch • Modified food starch • Vegetable gum

42. Peanut Allergy • Some people with peanut allergies have severe reactions, including anaphylaxis, to the smallest quantities of peanuts • Although peanut allergy is not ordinarily associated with other nut allergies, people may be advised to avoid all nuts due to potential cross-contamination

43. Peanut Allergy • Peanuts, peanut products, foods containing peanuts • Beer nuts • Eggrolls • Ground nuts • High protein food • Hydrolyzed plant protein • Hydrolyzed vegetable protein • Marzipan • Mixed nuts • Nougat

44. Peanut Allergy • Peanuts or peanut products • Peanuts • Peanut flour • Peanut soup • Peanut butter • Peanut oil • Peanut flakes

45. Peanut Allergy • Products that may contain peanuts • Pie crusts • Cheese cake crusts • Chocolate candy • Ice cream • Baked goods • Sauces • Chili • Candy

46. Other Types Of Food Reactions • Some people have adverse reactions to foods that do not involve the immune system • These are referred to as "food intolerances“ they are not food allergies

47. Causes of Food Intolerances • Food intolerances may be caused by: • Enzyme deficiencies • Reactions to chemicals in foods • Sulfur • Digestive diseases

48. Metabolic Intolerances • A metabolic intolerance is when the body cannot adequately digest a portion or component of a food • For example lactose intolerance and gluten intolerance

49. Lactose Intolerance • People with lactose intolerance cannot digest (breakdown) lactose in milk • Lactose is a disaccharide (sugar) in milk • Lactose is digested by the enzyme lactase into two monosaccharides, glucose and galactose, which can be absorbed by the small intestine

50. Lactose Intolerance • If there is not enough lactase, the lactose is goes undigested the intact lactose moves into the large intestine and is fermented by normal bacteria found in the large intestine • The amount of lactase produced tends to decrease in adulthood • Incidence of lactose intolerance varies for different populations.