Transcript Celiac Disease

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
 In most cases, such foreign material is
absorbed and incorporated into the human
body without difficulty.

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.
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.
Immune
Response
Histamine
Reaction
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
Histamine
Common Food Allergies
Eight foods account for
90% of all reactions
● Peanuts
● Tree nuts
● Wheat
● Soy
● Milk
● Eggs
● Fish
● Shellfish
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.
Allergy Testing

Skin Prick Test

Allergen-specific serum
IgE (sIgE)

Atopy Patch Test

Oral Food Challenges

Food Elimination Diet
Food 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
www.foodallergy.org
Symptoms:
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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
What is anaphylaxis?
Most severe allergic reaction
●
40-50% of people diagnosed with
food allergies are judged to have a high risk
of anaphylaxis
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Involves multiple systems at the same time
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Potentially fatal, especially if medication is
not given promptly – at first signs
What is anaphylaxis? (cont’d.)
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Can occur within minutes of exposure
●
Peanut/Tree nut allergies in combination
with asthma is the highest risk
death can occur within as few as 6 minutes
– 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 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
Food Allergy Facts
What the experts say . . .
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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 . . . .
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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
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Food Allergy Facts
What the experts say . . .
● No Cure
Strict avoidance is the only
way to prevent allergic
reactions.
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.
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Lack of evidence that delaying introduction of
solids beyond 6 months of age (including
highly allergenic foods) prevents the
development of food allergies.
Prevention (cont’d)
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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)
Hydrolyzed Michigan WIC
Authorized Formulas
Product
Good Start Nourish
Extent of Hydrolyzed Protein
Partially hydrolyzed whey protein
Indication
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
January, 2013
Summary of
Recommendations
• Avoidance diets
• Breastfeeding
• Selection of infant
formula
• Introduction of
complementary foods
http://www.jaci-inpractice.org/article/S22132198(12)00014-1/fulltext#sec1.1
Can Children Outgrow Food Allergies?
 Yes:
– Cow’s milk, soy, eggs, wheat
 NO:
– Peanut, tree nuts,
fish, and crustacean shellfish
Implications for WIC Professionals
Client-centered counseling
Assist families with food allergies in
making changes that improve quality
of life and promote nutritional wellbeing while avoiding offending foods.
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.
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Implications for WIC Professionals
(Cont’d)
Based on the needs and interests of the WIC client:
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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.
Managing Food Allergies
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Food allergen avoidance is the safest method
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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
The Food Allergen Labeling and Consumer
Protection Act (FALCA)
The Food Allergen Labeling and Consumer
Protection Act (FALCA)
Effective January 1, 2006
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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
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 or seafood : tuna, salmon, shrimp, lobster
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)”
Consumers
MUST continue
to read all food
Ingredients must
be listed if carefully!
they are present in any amount,
labels
even in colors, flavors, or spice blends.
Additionally, manufacturers must list :
 specific nut : almond, walnut, cashew
 or seafood : tuna, salmon, shrimp, lobster
Standard Label
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
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
“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.org
[email protected]
How to read a label for:
Wheat-Free Diet
Egg-Free Diet
Shellfish-Free Diet
Tree Nut-Free Diet
www.foodallergy.org
[email protected]
Pediatric Nutrition Care Manual
Pediatric Nutrition Care Manual
Pediatric Nutrition Care Manual
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 Vickerstaff Joneja Ph.D, RD
https://www.eatright.org/shop/product.aspx?id=6442472295
Thank You!
Questions
???