Transcript Dietary Guidelines for Food Allergies and Food Intolerances

Diet and Health Guidelines for Food
Allergies and Food Intolerances
Presented by
Janice Hermann, PhD, RD/LD
OCES Adult and Older Adult Nutrition Specialist
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
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
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
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
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
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
Food Allergy Symptoms
 Food allergy symptoms usually fall into three
areas:
 Skin Reactions
 Nose, Throat and Lung Reactions
 Stomach and Intestinal Reactions
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
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
Stomach and Intestinal Reactions
 Types of reactions
 Nausea
 Abdominal pain and bloating
 Vomiting
 Diarrhea
 Cramping
 Gas
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
Anaphylaxis
 Different parts of the body may experience
food allergy reactions at the same time
 Reactions can progress rapidly and may
include:
Itching
Hives
Sweating
Throat swelling
Breathing difficulties
Lowered blood pressure
Unconsciousness
Even death
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
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
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
Proper Diagnosis
 Methods for diagnosis
 Skin-prick test
 Antibody blood testing
 Oral Food Challenges
 Elimination Diets
RAST or ELISA
 Radioallergosorbent test (RAST) or enzyme-
linked immunosorbent assay (ELISA) are
reliable skin-prick testing and antibody blood
testing for diagnosing allergies
Proper Diagnosis
 Food changes and elimination tests should be
conducted only under medical supervision
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
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
eggs
wheat
fish
shellfish
soy
peanuts
tree nuts like walnuts
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
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
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
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
Milk Allergy
 Milk and milk products are a common
ingredient in many foods so food labels need
to be checked carefully
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
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
Milk Allergy
 Terms for milk products
 Casein
 Rennet casein
 Amonium caseinate
 Calcium caseinate
 Magnesium caseinate
 Potassium caseinate
 Sodium caseinate
 Casein hydrolysate
 Milk protein hydrolysates
 Protein hydrolysate
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
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®
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
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®
Egg Allergy
 Terms for egg or egg products
 Albumin
 Apovitellin
 Avidin
 Egg lecithin
 Flavoprotein
 Globulin
 Livetin
 Lysozyme
 Ovalbumin, conalbumin
 Ovomucin
Wheat Allergy
 Wheat is a common ingredient in many foods
so food labels need to be checked carefully
Wheat Allergy
 Wheat or wheat products
 Atta wheat flour
 Bal ahar
 Bread flour
 Bulgur
 Cake flour
 Cereal extract
 Courscous
 Cracked wheat
 Durum
 Durum flour
Wheat Allergy
 Wheat or wheat products
 Enriched flour
 Farina
 High protein flour
 Kamut flour
 Laubina
 Leche alim
 Malted cereals
 Minchin
 Multi grain breads
 Multi grain flours
Wheat Allergy
 Wheat or wheat products
 Puffed wheat
 Red wheat flakes
 Rolled wheat
 Semolina
 Shredded wheat
 Soft wheat flour
 Spelt
 SuperArmine
 Triticale
 Vital gluten
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
Wheat Allergy
 Wheat or wheat products
 White flour
 Whole wheat berries
 Whole wheat flour
 Winter wheat flour
Wheat Allergy
 Ingredients potentially made from wheat
 Hydrolyzed vegetable protein
 Vegetable starch
 Starch
 Gelatinized starch
 Modified starch
 Modified food starch
 Vegetable gum
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
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
Peanut Allergy
 Peanuts or peanut products
 Peanuts
 Peanut flour
 Peanut soup
 Peanut butter
 Peanut oil
 Peanut flakes
Peanut Allergy
 Products that may contain peanuts
 Pie crusts
 Cheese cake crusts
 Chocolate candy
 Ice cream
 Baked goods
 Sauces
 Chili
 Candy
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
Causes of Food Intolerances
 Food intolerances may be caused by:
 Enzyme deficiencies
 Reactions to chemicals in foods
 Sulfur
 Digestive diseases
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
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
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.
Symptoms Of Lactose Intolerance
 Symptoms include cramps, bloating,
intestinal gas, diarrhea and nausea
 Severity of symptoms varies with the
amount of lactose consumed and degree of
intolerance
 Symptoms appear from 15 minutes to
several hours after eating foods or
beverages containing lactose
Is Lactose Intolerance A Milk Allergy?
 A milk allergy is an allergic reaction to the
protein components in milk, not the lactose in
milk
 People with milk allergy usually must avoid all
milk products. People with lactose intolerance
can use certain dairy products that are low in
lactose
How Much Lactose
 Amount of lactose allowed depends on the
degree of lactose tolerance
 Many can tolerate 6 grams lactose (1/2 C milk)
 Many can tolerate fermented products such as
yogurt and acidophilus milk
 Hard cheeses and cottage cheese may be tolerated
because most of the lactose is removed with whey
How Much Lactose
 Many foods contain small amounts of lactose,
for example breads, dry cereals, cold cuts,
cream soups, salad dressings, candy, cookies,
drink mixes, and sugar substitutes
 Most people can handle the small amount of
lactose in these foods
How Much Lactose
 Very sensitive people need to check food
labels carefully for:
 Milk
 Whey
 Lactose
 Nonfat milk solids
 Dry milk solids
 Curds
Cheese
 Margarine
 Sweet or sour cream
Lactobacilus
 Many people can use commercially prepared
milk products that have been treated with an
enzyme (lactobacilus) that breaks down
lactose
 Alternatively, people can take enzyme tables
with meals or add enzyme drops to their milk
 Example: Lact-aid, Dairy-ease, Lactinex
Gluten Intolerance
 Gluten is a protein found in wheat, rye, and
barley or derivatives of these grains such as
malt
 Some individuals cannot tolerate the gliadin
fraction in gluten
Gluten Intolerance
 Gluten intolerance is also referred to as celiac
disease, celiac-sprue, nontropical sprue or
gluten sensitive enteropathy
 Individuals do not outgrow gluten intolerance
Symptoms Of Gluten Intolerance
 As a result of gliadin intolerance the
intestinal lining is flattened which results in
reduced food absorption, diarrhea,
steatorrhea (fat in the stool), bloating, loss
of appetite, muscle wasting, weight loss and
can lead to progressive malnutrition
Symptoms Of Gluten Intolerance
 Lactose intolerance may temporarily occur
secondarily to gluten intolerance
 However, lactose containing foods can be
returned to the diet within a short time
Gluten Intolerance
 Gluten containing grains
 Wheat
 Rye
 Barley
 Oats
 Although oats is gluten-free, the use of oats is
controversial due to contamination with wheat
during processing
 A limited intake of oats (40 to 60 g/day) is
currently considered acceptable
Gluten Intolerance
 Non-gluten containing grains
 Tapioca
 Corn flour
 Corn starch
 Rice flours
 Potato starch
 Potato flour
 Soy flour
Gluten-Free Flour Substitute
 Gluten-free flour mix
Rice flour
6 cups
Potato starch 2 cups
Tapioca flour
1 cup
Food Additive Intolerances
 Although most individuals consume a wide
variety of food additives each day, only a
small number have been associated with
intolerances to food additives
Yellow No. 5 or Tartrazine Sensitivity
 Yellow No. 5 is a food color additive
 Although rare, yellow dye No. 5 may cause
hives in some individuals
 Whenever Yellow No. 5 is added to a food, it
should be listed on the product food label
Carmine Sensitivity
 Carmine is an extract of the cochineal insect
used as a bright red dye in a number of
products
 Occasional reactions to carmine used as a
food coloring have been reported
 If carmine is added to a food it should be
listed on the product food label
Monosodium glutamate (MSG)
 MSG is a flavor enhancer
 MSG is the sodium salt of glutamic acid, an
amino acid found naturally in all protein
 A few people report mild and short-lived
reactions after eating MSG
 If MSG is added to a food it is listed on the
label as monosodium glutamate
Sulfites
 Sulfites are used to preserve color of foods
and inhibit microorganism growth
 Some people develop shortness of breath or
fatal shock shortly after exposure to sulfites
 Sulfites can produce severe asthma attacks in
sulfite-sensitive asthmatics
Sulfites
 FDA banned the use of sulfites on fresh fruits
and vegetables (except potatoes) intended to
be sold to consumers raw
 Sulfites added to all packaged and processed
foods must be listed on the product label
Aspartame
 Some people have complained of adverse
reactions to aspartame
 However, in clinical studies aspartame has not
shown allergic reactions
 FDA concluded there is no evidence of a
cause and effect between aspartame and
sensitivities reported