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Food Allergies

Food Allergies . Presented by: Nelda Mercer, MS, RD, FADA March 14, 2013. Background – Normal Immune System . Prevent disease external agents: viruses, bacteria, and toxins internal agents: cancer cells Mount Powerful defense against “invader” All Food is foreign to the body

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Food Allergies

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  1. Food Allergies Presented by: Nelda Mercer, MS, RD, FADA March 14, 2013

  2. Background – Normal Immune System • Prevent disease • external agents: viruses, bacteria, and toxins • internal agents: cancer cells • Mount Powerful defense against “invader” • All Food is foreign to the body • In most cases, such foreign material is absorbed and incorporated into the human body without difficulty.

  3. Oral Immunological Tolerance • Food is first encountered by the infant through mother’s breastmilk • Contains molecules of food from her diet • Tolerance is developed through the process of low-dose, continuous exposure that is optimal for the development of immunological tolerance.

  4. Food Allergy – Definition • Food allergies are adverse health effects arising from a specific immune response that occurs reproducibly on exposure to a given food. Boyce, J. et al. Guidelines for the diagnosis and management of food allergy in the United States: Report of the NIAID-Sponsored Expert Panel. Journal of Allergy and Clinical Immunology. 2010; 126(6):S1-S58. When the body’s immune system mistakenly believes a harmless substance is harmful to the body. It tries to protect the body by releasing IgE antibodies (histamines) to attack the substance.

  5. Immune Response • IgE-mediated – food allergen first enters the body immune system produces allergen-specific IgE antibodies (sIgE) immunological sensitization • Re-exposure to food, allergen sIgEidentifies it and quickly initiates the release of chemicals Histamine Reaction • Histamine

  6. Common Food Allergies Eight foods account for 90% of all reactions • Peanuts • Tree nuts • Wheat • Soy • Milk • Eggs • Fish • Shellfish

  7. Risk for Developing Allergies “At Risk” • Individuals with a biological parent or sibling with existing, or history of, allergic rhinitis, asthma, or atopic dermatitis. “High Risk” • Individuals with preexisting severe allergic disease and/or family history of food allergies Boyce, J. et al. Guidelines for the diagnosis and management of food allergy in the United States: Report of the NIAID-Sponsored Expert Panel. Journal of Allergy and Clinical Immunology. 2010; 126(6):S1-S58.

  8. Allergy Testing • Skin Prick Test • Allergen-specific serum IgE (sIgE) • Atopy Patch Test • Oral Food Challenges • Food Elimination Diet

  9. Food Allergy FactsWhat the experts say . . . . • Doubling of food allergy over the past 10 years, particularly peanut allergy. • ~15 million Americans affected • 1 in 13 children • Onset at any age www.foodallergy.org

  10. Symptoms: • Urticeria– hives • Pruritus– itching of skin, eyes, ears, mouth • Angioedema–swelling of deeper tissues especially the mouth and face • Wheezing • Cough • Nausea • Vomiting • Hypotension • Anaphylaxis

  11. What is anaphylaxis? Most severe allergic reaction • 40-50% of people diagnosed with food allergies are judged to have a high risk of anaphylaxis • Involves multiple systems at the same time • Potentially fatal, especially if medication is not given promptly – at first signs

  12. What is anaphylaxis? (cont’d.) • Can occur within minutes of exposure death can occur within as few as 6 minutes • Peanut/Tree nut allergies in combination with asthma is the highest risk • milk, egg, fish, and crustacean fish • Pattern can vary among individuals

  13. Symptoms of Anaphylaxis • Tingling sensation in the mouth • Swelling of the tongue and throat • Difficulty breathing • Hives • Vomiting • Abdominal cramps • Diarrhea • Drop in blood pressure • Loss of consciousness • Death – in rare cases

  14. Food Allergy FactsWhat the experts say . . . . • Food allergy is the leading cause of serious allergic reaction (anaphylaxis) outside the hospital setting. • over 30,000 ER visits per year • ~ 175 deaths annually • reactions caused most often outside the home and by products believed to be safe • Asthma increases risk of fatal reaction • Adolescents and young adults are at the highest risk www.foodallergy.org Bock, et. al J Allergy Clinical Immunol 2001

  15. Food Allergy FactsWhat the experts say . . . • Sensitivity to the allergen can vary • For some, a speck of allergen can have the same effect as eating a large quantity • For some, skin contact with the allergen is enough to cause a reaction • For some, inhalation of the allergen can cause discomfort • Sensitivity is truly ‘unknown’ • Affected systems can vary between individuals AND reactions

  16. Allergic Reaction:What a Child Might Say or Do Say . . . . Do . . . . Put their hands in their mouths Pull or scratch at their tongues Drool Hoarse cry or voice Slur words Become unusually clingy • My tongue (or mouth) itches • My tongue is hot or burning • My mouth feels funny • There’s something stuck in my throat • It feels like there are bugs in my ears • This food is too spicy

  17. Food Allergy FactsWhat the experts say . . . • No Cure Strict avoidance is the only way to prevent allergic reactions.

  18. Prevention • Insufficient evidence to conclude that restricting highly allergenic foods in the maternal diet during pregnancy or lactation prevents the development of food allergies in the offspring. • Lack of evidence that delaying introduction of solids beyond 6 months of age (including highly allergenic foods) prevents the development of food allergies.

  19. Prevention (cont’d) • Protective role of breastfeeding in preventing food allergies needs further study • Some evidence suggests that breastfeeding for at least 4 months may decrease likelihood of cow’s milk allergy in the first 2 years of life. • No convincing evidence for the use of soy formula as a strategy for preventing the development of food allergies in at-risk infants, therefore, not recommended. • For infants who are partially breastfed or formula fed, partially hydrolyzed formulas may be considered a strategy for preventing the development of food allergies in at-risk infants. Greer, F. et al. American Academy of Pediatrics Committee on Nutrition. Pediatrics. 2008; 121(1)

  20. Hydrolyzed Michigan WIC Authorized Formulas

  21. January, 2013 • Summary of Recommendations • Avoidance diets • Breastfeeding • Selection of infant formula • Introduction of complementary foods http://www.jaci-inpractice.org/article/S2213-2198(12)00014-1/fulltext#sec1.1

  22. Can Children Outgrow Food Allergies? • Yes: • Cow’s milk, soy, eggs, wheat • NO: • Peanut, tree nuts, fish, and crustacean shellfish

  23. Implications for WIC Professionals Client-centered counseling Assist families with food allergies in making changes that improve quality of life and promote nutritional well-being while avoiding offending foods.

  24. Implications for WIC Professionals Based on the needs and interests of the WIC client: • Facilitate and encourage ongoing follow-up with the health care provider for optimal management of the client’s condition. • Promote exclusive breastfeeding until 6 months of age and continue through the first year. • Provide hypoallergenic formula for clients with appropriate medical documentation, as needed. • Tailor food packages to substitute or remove offending foods.

  25. Implications for WIC Professionals • (Cont’d) Based on the needs and interests of the WIC client: • Monitor weight status and growth patterns of clients. • Educate clients about reading food labels and identifying offending foods and ingredients. • Educate clients on planning meals and snacks outside the home. • Refer clients to their health care provider for a re-challenge of offending foods, as appropriate. • Establish/maintain communication with client’s health care provider.

  26. Managing Food Allergies • Food allergen avoidance is the safest method • Work closely with health care provider to determine the foods to be avoided • Avoid cross-reactive foods similar foods within a food group • all shellfish are closely related • tree nuts: almonds, cashews, and walnuts

  27. The Food Allergen Labeling and Consumer Protection Act (FALCA)

  28. The Food Allergen Labeling and Consumer Protection Act (FALCA) Effective January 1, 2006 • Mandates that food labels show major food allergens (milk, eggs, fish, crustacean shellfish, peanuts, tree nuts, wheat, and soy) and declare the allergen in plain language, either in the ingredient list . . . . . . or via: • “Contains” followed by the name of the major food allergen • “Contains milk, wheat…..” – or • A parenthetical statement in the list of ingredients • “albumin (egg)” • Ingredients must be listed if they are present in any amount, even in colors, flavors, or spice blends. • Additionally, manufacturers must list : • specific nut : almond, walnut, cashew • or seafood : tuna, salmon, shrimp, lobster

  29. The Food Allergen Labeling and Consumer Protection Act (FALCA) Consumers MUST continue to read all food labels carefully! Effective January 1, 2006 • Mandates that food labels show major food allergens (milk, eggs, fish, crustacean shellfish, peanuts, tree nuts, wheat, and soy) and declare the allergen in plain language, either in the ingredient list . . . . . . or via: • “Contains” followed by the name of the major food allergen • “Contains milk, wheat” – or • A parenthetical statement in the list of ingredients • “albumin (egg)” • Ingredients must be listed if they are present in any amount, even in colors, flavors, or spice blends. • Additionally, manufacturers must list : • specific nut : almond, walnut, cashew • or seafood : tuna, salmon, shrimp, lobster

  30. Standard Label

  31. “Contains” Statements

  32. Warning Labels May also say……. “manufactured in a facility that also processes peanuts”

  33. www.fda.gov/ ForConsumers/ConsumerUpdates

  34. How to read a label for: Milk-Free Diet Soy-Free Diet Peanut-Free Diet www.foodallergy.org faan@foodallergy.org

  35. How to read a label for: Wheat-Free Diet Egg-Free Diet Shellfish-Free Diet Tree Nut-Free Diet www.foodallergy.org faan@foodallergy.org

  36. Pediatric Nutrition Care Manual

  37. Pediatric Nutrition Care Manual

  38. Pediatric Nutrition Care Manual

  39. Comprehensive Guide Features: • The science behind food allergies and food intolerances • The role of elimination diets and challenge protocols in identifying food sensitivities • Symptoms, diagnosis and management of 24 foods and food components Janice VickerstaffJonejaPh.D, RD https://www.eatright.org/shop/product.aspx?id=6442472295

  40. Thank You! Questions ???

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