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 ID: 920778
Download Presentation The PPT/PDF document "Food Allergies Presented by:" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Food Allergies
Presented by:
Nelda Mercer, MS, RD, FADA
March 14, 2013
Slide2Background –
Normal Immune System
Prevent disease
external agents: viruses, bacteria, and toxins internal agents: cancer cellsMount 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.
Slide3Food is first encountered by the infant through mother’s
breastmilk
Contains molecules of food from her dietTolerance is developed through the process of low-dose, continuous exposure that is optimal for the development of immunological tolerance.
Oral Immunological Tolerance
Slide4Food 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.
Slide5IgE
-mediated
– food allergen first enters the body immune system produces allergen-specific
IgE antibodies (sIgE) immunological sensitization Re-exposure to food, allergen sIgE identifies it and quickly initiates the release of chemicals
Immune
Response
Histamine Reaction
Histamine
Slide6Common Food Allergies
Peanuts
Tree nuts
Wheat SoyMilkEggsFish Shellfish
Eight foods account for 90% of all reactions
Slide7“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
Slide8Allergy Testing
Skin Prick Test
Allergen-specific serum
IgE (sIgE)Atopy Patch TestOral Food ChallengesFood Elimination Diet
Slide9Food Allergy Facts
What 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
w
ww.foodallergy.org
Slide10Urticeria
– hives
Pruritus – itching of skin, eyes, ears, mouthAngioedema – swelling of deeper tissues especially the mouth and faceWheezing
Cough
Nausea
Vomiting
Hypotension
Anaphylaxis
Symptoms:
Slide11What 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 timePotentially fatal, especially if medication is not given promptly – at first signs
Slide12What is anaphylaxis?
(cont’d.)
Can occur within minutes of exposure
death can occur within as few as 6 minutesPeanut/Tree nut allergies in combination with asthma is the highest riskmilk, egg, fish, and crustacean fish
Pattern can vary among individuals
Slide13Symptoms of Anaphylaxis
Tingling sensation in the mouth
Swelling of the tongue and throat
Difficulty breathingHivesVomitingAbdominal cramps
Diarrhea
Drop in blood pressure
Loss of consciousness
Death
– in rare cases
Slide14Food Allergy Facts
What 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
Slide15Food Allergy Facts
What the experts say . . .
Sensitivity to the allergen can vary
For some, a speck of allergen can have the same effect as eating a large quantityFor some, skin contact with the allergen is enough to cause a reactionFor some, inhalation of the allergen can cause discomfortSensitivity is truly ‘unknown’
Affected systems can vary between individuals AND reactions
Slide16Allergic Reaction:
What a Child Might Say or Do
Say . . . .
My tongue (or mouth) itchesMy tongue is hot or burningMy mouth feels funnyThere’s something stuck in my throatIt feels like there are bugs in my earsThis 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
Slide17Food Allergy Facts
What the experts say . . .
No Cure
Strict avoidance is the only way to prevent allergic reactions.
Slide18Insufficient 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
Slide19Protective 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)
Slide20Hydrolyzed 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
Slide21Summary 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
Slide22Can Children Outgrow Food Allergies?
Yes:
Cow’s milk, soy, eggs, wheat
NO:Peanut, tree nuts, fish, and crustacean shellfish
Slide23Client-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
Slide24Facilitate 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:
Slide25Monitor 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:
Slide26Food allergen
avoidance
is the safest method
Work closely with health care provider to determine the foods to be avoidedAvoid cross-reactive foods similar foods within a food groupall shellfish are closely relatedtree nuts: almonds, cashews, and walnuts
Managing Food Allergies
Slide27The Food Allergen Labeling and Consumer Protection Act (FALCA)
Slide28The 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
Slide29The 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!
Slide30Standard Label
Slide31“Contains” Statements
Slide32Warning Labels
May also
say…….
“manufactured in a facility that also processes peanuts”
Slide33Slide34www.fda.gov/
ForConsumers
/
ConsumerUpdates
Slide35Slide36How to read a label for:
Milk-Free Diet
Soy-Free Diet
Peanut-Free Dietwww.foodallergy.org
faan@foodallergy.org
Slide37How to read a label for:
Wheat-Free Diet
Egg-Free Diet
Shellfish-Free DietTree Nut-Free Diet
www.foodallergy.org
faan@foodallergy.org
Slide38Pediatric Nutrition Care Manual
Slide39Pediatric Nutrition Care Manual
Slide40Pediatric Nutrition Care Manual
Slide41Comprehensive 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:
Slide42Thank You!
Questions
???