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 bodyIn most cases, such foreign material is

absorbed and incorporated into the human body without difficulty.

● 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.

Oral Immunological Tolerance

● 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.

Food Allergy – Definition

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.

1. IgE-mediated – food allergen first enters the body immune system produces allergen-specific IgE antibodies (sIgE) immunological sensitization

2. Re-exposure to food, allergen sIgE identifies it and quickly initiates the release of chemicals

Immune Response

Histamine Reaction

Histamine

Common Food Allergies

● Peanuts● Tree nuts● Wheat ● Soy● Milk● Eggs● Fish ● Shellfish

Eight foods account for 90% of all reactions

“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 .

Risk for Developing Allergies

Allergy Testing

Skin Prick Test

Allergen-specific serum

IgE (sIgE)

Atopy Patch Test

Oral Food Challenges

Food Elimination Diet

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

● 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

Symptoms:

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

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

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

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.orgBock, et. al J Allergy Clinical Immunol 2001

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

Allergic Reaction:What a Child Might Say or Do

Say . . . . 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

Do . . . . Put their hands in their

mouths Pull or scratch at their

tongues Drool Hoarse cry or voice

Slur words

Become unusually clingy

Food Allergy FactsWhat the experts say . . .

● No Cure Strict avoidance is the only

way to prevent allergic reactions.

● 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.

Prevention

● 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)

Prevention (cont’d)

Hydrolyzed Michigan WIC Authorized Formulas

Product Extent of Hydrolyzed Protein Indication

Good Start Nourish Partially hydrolyzed whey protein Reflux and spitting up

Nutramigen with Enflora LGG Extensively hydrolyzed casein (protein) Cow’s milk allergy

Nutramigen Extensively hydrolyzed casein (protein) Cow’s milk allergy

Similac Expert Care Alimentum

Hydrolyzed casein with free amino acids Hypoallergenic

Elecare Infant/Elecare Jr 100% free amino acids Hypoallergenic

EO28 Splash 100% free amino acids Hypoallergenic, cow and soy

milk allergy, multiple food protein intolerance

Neocate Infant/Neocate Junior 100% free amino acids Hypoallergenic

Pediasure Peptide 1.0/1.5 ¹ Hydrolyzed whey – dominant protein Malabsorption and maldigestion

Peptamen Jr 1.0/1.5 ² Hydrolyzed – 100% whey protein Malabsorption

¹ Contains milk and soy ingredients

² Not appropriate for individuals with cow's milk allergy

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

January, 2013

Can Children Outgrow Food Allergies?

Yes:– Cow’s milk, soy, eggs, wheat

NO:– Peanut, tree nuts,

fish, and crustacean shellfish

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.

Implications for WIC Professionals

● 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.

Implications for WIC Professionals

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.

Implications for WIC Professionals (Cont’d)

Based on the needs and interests of the WIC client:

● 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

Managing Food Allergies

The Food Allergen Labeling and Consumer Protection Act (FALCA)

The Food Allergen Labeling and Consumer Protection Act (FALCA)

● 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

Effective January 1, 2006

The Food Allergen Labeling and Consumer Protection Act (FALCA)

● 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

Effective January 1, 2006

Consumers MUST continue to read all food labels carefully!

Sta

nd

ard

Lab

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CULTURED NONFAT MILK, SODIUM, DIACETATE, ONION POWDER, DISTILLED MONOGLYCERIDES, MOLASSES, WHEAT STARCH, GARLIC, YELLOW CORN FLOUR, COLOR ADDED, TRISODIUM PHOSPHATE, WHEY, CALCIUM CARBONATE,DISODIUM GUANYLATE, DISODIUM INOSINATE, MONOCALCIUM PHOSPHATE, SODIUM ACID PYROPHOPHATE, SOY SAUCE (WHEAT, SOYBEANS, SALT, MALTODEXTRIN, CARAMEL COLOR), TAMARIND EXTRACT, SESAME SEED, ALMOND FOUR, PEANUT FLOUR, FRESHNESS PERSERVED BY BHT

INGREDIENTS: ENRICHED FLOUR (WHEAT FLOUR, MALTED BARLEY FLOUR, NIACIN, IRON, THIAMIN MONONITRATE, RIBOFLAVIN, FOLIC ACID), DEGERMED YELLOW CORN MEAL, WHOLE WHEAT, VEGETABLE OIL (SOYBEAN, RIC BRAN AND/OR CANOLA), ENRICHED FLOUR BLEACHED (WHEAT FLOUR, NIACIN,IRON,THIAMIN MONONITRATE, RIBOFLAVIN, FOLIC ACID), PARTIALLY HYDOGENATED SOYBEAN OIL, SUGAR, SALT, CONTAINS 2% OR LESS OF: MONOSODIUM GLUTAMATE, MALTODEXTRIN, RYE FLOUR, YEAST, GARLIC POWDER, CORN SYRUP, SOLIDS, HIGH FRUTOSE CORN SYRUP,MARGARINE(PARTIALLY HYDROGENATED SOYBEAN OIL, SALT, MONO AND DIGLYCERIDES, SOY LECITHIN, WHEY, BETA CAROTENE, VITAMIN A PALMITATE, NATURAL FLAVOR), MALT, BAKING SODA, BARLEY MALT EXTRACT,CORN SYRUP,NATURAL AND ARTIFICIAL FLAVOR, MALT, SYRUP, SPICES, SOY LECITHIN

“Contains” Statements

Warning Labels

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

www.fda.gov/ ForConsumers/ConsumerUpdates

How to read a label for:

Milk-Free Diet

Soy-Free Diet

Peanut-Free Diet

www.foodallergy.orgfaan@foodallergy.org

How to read a label for:

Wheat-Free Diet

Egg-Free Diet

Shellfish-Free Diet

Tree Nut-Free Diet

www.foodallergy.orgfaan@foodallergy.org

Pediatric Nutrition Care Manual

Pediatric Nutrition Care Manual

Pediatric Nutrition Care Manual

Comprehensive Guide

• 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 Vickerstaff Joneja Ph.D, RD https://www.eatright.org/shop/product.aspx?id=6442472295

Features:

Thank You!

Questions???