Food Allergies Paediatric Dietetic Department 2014

Food Allergies Paediatric Dietetic Department 2014

Aims Of The SessionAims Of The Session

Increase awareness ofCommon types of food allergySymptoms of food allergy Practical considerations for

management of food allergy in schools

Food Allergy Food Allergy 6-8% of children have a proven food allergy Food allergies occur when the body’s immune

system perceives a food protein to be harmful & acts against it

As a result of this action, chemicals are released (e.g. histamine) and it is these chemicals which cause symptoms

There is no cure for food allergy, complete and strict avoidance of the food is the only way to prevent a reaction

NICE guidelines, 2011

www.bda.uk.com/foodfacts/allergy

Types of ReactionIgE Non-IgE

Types of ReactionIgE Non-IgE

Quick ‘Acute’ onset Anaphylaxis Well-defined mechanism Fairly easy to diagnose Validated tests-Specific serum IgE assays

-Skin Prick Tests

-+/- supervised Challenges

Mild to moderate ‘Delayed’ onset

Mechanisms unclear Harder to diagnose No validated tests

- Elimination diet with planned challenge

NICE Guidelines 2011

Possible Food Allergy SymptomsPossible Food Allergy Symptoms

IgE mediated Symptoms

Non IgE mediated symptoms

The skin

Acute Pruritus Pruritis

Erythema Erythema

Acute angioedema (most commonly in the lips and face, and around the eyes)

Significant atopic eczema

Urticaria

Possible Food Allergy SymptomsPossible Food Allergy Symptoms

IgE mediated symptoms

Non-IgE mediated symptoms

Gastrointestinal system

Colicky abdominal pain Abdominal discomfort

Vomiting Gastro-oesophageal reflux disease

Diarrhoea Loose or frequent stools, constipation, blood or mucus in stools

Food refusal or aversion

Perianal redness

Faltering growth

Possible Food Allergy Symptoms

Possible Food Allergy Symptoms IgE mediated Symptoms

Respiratory System (usually in combination with one or more of the previous symptoms and signs)

Upper respiratory tract symptoms (nasal itching, sneezing, rhinorrhoea or congestion [with or without conjunctivitis])

Lower respiratory tract symptoms (cough, chest tightness, wheezing or shortness of breath)

Life Threatening Anaphylaxis Symptoms

Life Threatening Anaphylaxis Symptoms

All of the symptoms of IgE mediated reaction Difficulty breathing Swelling around tongue / throat Redness of skin Collapse

→Adrenaline auto injector

Note, not all children with a food allergy will experience anaphylactic symptoms

Which foods are involved? Which foods are involved? For children the most common food allergies are:

Cows milk Protein Eggs Peanuts Tree nuts Fish Shellfish

Cow’s Milk Allergy (CMA)Cow’s Milk

Allergy (CMA) Occurs when the body’s immune system

reacts to proteins found in milk Up to 7% of children have a CMA and

usually presents in infancy Most children will outgrow it (average age 5

years for IgE mediated and majority by age 3 years for uncomplicated non-IgE mediated allergy)

BMJ 2013;347:f5424

Cows Milk Containing Foods: Cows Milk Containing Foods:

Cows milk Butter Yoghurt Cheese Margarine Ice cream

Cream Milk powder Breads containing

milk such as pancake, wheaten, soda

Cakes, buns, biscuits, chocolate

Processed foods

Egg AllergyEgg Allergy Egg allergy can be:

– - mild i.e. can tolerate well cooked egg

- severe i.e. can’t tolerate any form of egg ~50% of children with egg allergy can eat well

cooked egg e.g. cakes and biscuits Children who are allergic to loosely cooked or raw

egg, the reactions are often severe ~50% of children grow out of an egg allergy in

about the first 5-7 years of life, but in the rest it is likely to persist

www.anaphylaxis.org.uk

WELL COOKED EGG LOOSELY COOKED

EGGRAW EGG

Cakes, biscuits Meringues Fresh mousse

Dried egg pasta Lemon curd Fresh Mayonnaise

Prepared meat dishes and sausages containing egg

Scrambled, boiled, poached or fried egg

Some ice-creams, (especially fresh and deluxe types) and sorbets

Egg glaze on pastry Quiche Royal Icing

Gravy granules (if they contain egg)

Omelette Horseradish, tartar sauce

Pancakes and scotch pancakes (shop bought)

Egg custard Some cheeses

Egg in batter Raw egg in cake mix

Breadcrumbs Inside a Cadbury's cream egg

Homemade pancakes

Nut AllergyNut Allergy

Unlike milk or egg allergies, children are unlikely to grow out of a nut allergy (about 1 in 5 will grow out of it)

Most first allergic reactions take place when child is between 14 months and 2 years old

The nut allergy may become less severe with age, but in 20%, it can become worse with time

www.allergyuk.org/peanut-and-tree-nutallergy

PeanutsPeanuts

PEANUTS

Arachis hypogaea Groundnuts

Beer nuts Goober nut/pea

Cacahuete Mandelonas

Chinese nuts Monkey nuts

Earthnuts

Tree NutsTree Nuts

TREE NUTS

Almond Macadamia

Brazil Pecan

Cashew Pistachio

Hazelnut Walnut

Food LabellingFood Labelling

Children with a nut allergy are advised to avoid all nuts including foods which: – -‘may contain traces of nuts’ or – -‘made in a factory which handles nuts’

– unless individual medical/dietetic advice has been given to family

Food LabellingFood Labelling

Current allergen labelling rules will be changing on 13 December 2014.

Many businesses are already starting to make changes to how they label allergens on their products.

Under the new rules, allergens will be emphasised on the label.

Other ConsiderationsOther Considerations

Trips - careful forward planning Cookery - check ingredients and provide

alternatives if necessary Treat days - supply any special snacks or

"birthday treats" in a labelled tin No sharing snacks – remind children each

to eat their own snack

Other ConsiderationsOther Considerations School meals & Packed lunch – ‘free-from’

status (e.g. milk, eggs and nuts) Activities e.g. arts and crafts - glues,

paints, and old food cartons that may include food allergens

Cross contamination – take extra care with hand washing especially after lunch/snacks

Pets – bird seed, other pet foods

Food Allergy ResourcesFood Allergy Resources

www.food.gov.uk/allergy Allergy UK www.foodallergyuk.org The Anaphylaxis Campaign www.anaphylaxis.org.uk The British Dietetic Association www.bda.uk.com National Institute of Clinical Excellence, 2011

Thank you for listening!

Any questions?