Food Allergy Awareness

Dana MageeARAMARK Dietetic Intern

May 3, 2013

Overview

• What is a food allergy?

• Top 8 food allergies

• Lactose intolerance

• Celiac Disease

• Food labeling

• How to stay safe

Application to the Nutrition Links Program• Paperwork includes a question about food

allergies

• Label reading to keep food demonstrations safe to those with allergies

• How to recognize a reaction in class and what to do

• Underdiagnosed in this population may encourage to see their doctor

Food Allergy Experiences in Nutrition Links?

Food Allergies

• Affects about 15 million Americans

• 1 in every 13 school age children

• CDC found 18% increase between 1997-2007

• Other diseases affecting immune system have been increasing

Adverse Food Reaction

Adverse Food Reaction

Food Allergies: adverse immune reaction

to food protein with a range of symptoms and potentially anaphylaxis

Food Intolerances: adverse reaction to food

that does not involve immune system but the

digestion of the food

Top Eight Food Allergens

These 8 make

up 90% of all

food allergies!

What causes a food allergy?• Our immune system responsible for fighting off

illnesses

• When exposed to something foreign (germ) our body recognizes it as dangerous and fights it off and creates antibodies to remember it

• Abnormal response to food- can be any food

Signs and symptoms of a food allergy• Hives, eczema, red around eyes, itchy ears/

mouth, runny nose, cough

• Nausea, vomiting, diarrhea, stomach pain

• Anaphylaxis: breathing and circulation problems – Teen and young adults at highest risk

– Asthma increases risk

Anaphylaxis• Anaphylaxis: breathing and circulation problems – LIFE THREATENING

– Swelling of lips, throat, tongue

– Trouble swallowing

– Turning blue

– Drop in blood pressure

– Chest pain/ weakness

– Loss of consciousness

Anaphylaxis – Described by a child• “This food is too spicy”

• “My tongue is burning”

• “It feels like something’s poking my tongue”

• “My mouth itches”

• “There’s a frog in my throat”

• “My tongue feels heavy”

Treatment of Anaphylaxis• Epinephrine prescribed by

physician in auto- inject pen

• Always go to the emergency room

• 25% of people have a second reaction called biphastic anaphylaxis

• Doctor may treat with steroids in ER

Diagnosis of Food Allergies• Board certified allergist

• Don’t self diagnose

• Skin prick test

• Blood test

• Oral food challenge

• Elimination diet

Peanut Allergy• One of the most common, tripled from

1997- 2008

• 20% can outgrow this allergy

• Having sibling with allergy increases risk

• Can cause anaphylaxis

• Treat by avoiding peanuts and peanut products

Peanut Allergy

• Even a small amount ingested can trigger life threatening response

• Touching peanuts can cause a reaction if then touch eyes/nose/mouth

• 25-40% also have tree nut allergy– Often manufactured on same equipment so

best to avoid

Tree Nut Allergy• Can cause anaphylaxis

• Walnuts, almonds, hazelnuts, cashews, pistachios, brazil nuts etc.

• 9% children will grow out of it

• Siblings at greater risk

• Coconut: fruit vs. nut- must be cleared by allergist

• Careful of shampoos, lotions, and soaps

Finned Fish Allergy• Can cause anaphylaxis

• 40% people have first reaction as an adult

• Lifelong allergy

• 20,000 fish species: salmon, tuna, halibut most common

• Shellfish are separate allergy

Shellfish Allergy• Can cause anaphylaxis

• 60% experience first reaction as adults

• Most common: shrimp, crab, lobster- crustaceans

• Mollusk family: clams, mussels, oysters, scallops– May be less severe- one or both families

• Can be airborne: avoid seafood restaurants, fish market, cooking fish (steam)

Soy Allergy

• Most common in babies and 0.4% of children

• Usually outgrown by age 3-10

• Mild reaction but chance of anaphylaxis

• In many processed foods

Egg Allergy

• Second most common in children

• Symptoms of hives to anaphylaxis

• Most outgrow it

• It is the egg white, whole egg must be avoided

• Vaccines, MMR is safe, flu shot may not be

Cow’s Milk Allergy • Most common food allergy in infants and children

• Hives to anaphylaxis

• 2.5% under three have this allergy, most outgrow it

• Careful of kosher labeling of “D” or “pareve” may contain milk

• In cooking substitute milk with water or fruit juice in equal parts

Milk protein allergy vs. lactose intolerance• Milk protein allergy– Body starts an attack

– Can lead to life threatening anaphylaxis

• Lactose intolerance: – “milk sugar” is not

properly digested

– Not life threatening

Wheat Allergy

• Usually in children and outgrown by age 3

• Symptoms of hives to anaphylaxis

• Wheat free: amaranth, barley, corn, oat, quinoa, rice, rye, tapioca (may also be allergic to some of these)

Celiac Disease

• Genetic, exposure to gluten, environmental trigger, autoimmune response

• Gluten is the protein in wheat, rye, and barley

• Symptoms: bloating, gas, diarrhea, constipation, headaches, itchy skin, mouth sores, nausea, anemia, ADD, bone pain, depression, enamel effects, failure to thrive, fatigue, infertility

• Biopsy diagnosis, blood work

What is gluten free?

Celiac disease

• Doesn’t cause anaphylaxis

• Flattens the villi and elongates crypt cells

• Affects secretory, digestive, and absorptive ability

• Leads to micronutrient or macro nutrient deficiency

Celiac disease: Complications• GF foods may not be fortified

• Malabsorption: osteoporosis– Calcium, vitamin D

• Diarrhea: replete electrolytes and fluids

• Multivitamin

• Develop lactose intolerance

Gluten Free Diet• Even small amounts

can cause this reaction

• Cross contamination is a huge concern!

• Substitutions for wheat flour:

• Rice flour, potato starch flour, soy flour, corn flour

Food labeling• Food Allergen Labeling and Consumer

Protection Act (FALCPA)-2006

• Any packaged food with peanuts, milk, eggs, crustacean shellfish, tree nuts, wheat, and soy must be listed on label

• “ Contains…”

• If in small amounts (food coloring, flavor, spices etc.)- in parentheses

Food labeling• Meat, poultry, eggs, alcohol not under this law

• Always check labels: manufacturers can change ingredients

• Any questions: call the manufacturer

• In process of “May contain…” labeling

Food Allergy Research and Education Tool

Food safety at home• Everyone learn to read food labels

• Wash hands before, during, after handling food

• Clean surfaces and preparation equipment with soap and water

• Avoid cross contamination with separate cutting boards, utensils, bowls etc.

Food safety at home

• Designate different shelves

• Control areas of house where food can be eaten

• If cooking two meal: cook allergen free first

• If suffer from airborne allergens allow 30 minutes after prep

Eating out safely• Ask allergist or friends with allergies for

suggestions

• Look at the menu ahead of time

• Call and speak with manager ask about ingredients, cross contamination

• Go at less busy times

• Bring chef card

• Bring emergency medications

Eating out safely• Sit away from the kitchen if have an airborne

allergy

• How is it prepared? Grill or fryers cross contamination

• Alert the waiter, ask for manager or chef

• Careful of desserts not made on site

• If uncomfortable with ability to eat safely DO NOT eat

• Order steamed veggies or baked potato

Babysitter Training• Set time for babysitter to come over while you are

there

• Make sure to explain all allergies and what to avoid

• Take time to answer any questions

• Address take out food

• Go over emergency allergy plan

Gluten Free Voluntary Labeling

Gluten Free Flour (1 lb.)vs. All Purpose Flour (5 lb.)

Where is the labeling?

References• Gupta R. Study: Food Allergies in Children Becoming More Common, Severe [Video]. PBS Newshour;

2011.

• Food Allergy Research & Education. Facts and Statistics. FARE. http://www.foodallergy.org/facts-and-stats. Updated 2013. Accessed May 3, 2013.

• U.s. Department of Health and Human Services. Food Safety. HealthyPeople.gov. http://healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=14. Updated April 10, 2013. Acessed May 3, 2013.

• The Ohio State University Extension. Cultural Diversity: Eating in America African American. The Ohio State University Extension. http://ohioline.osu.edu/hyg-fact/5000/pdf/5250.pdf. Published 2010. Accessed April 18, 2013.

• Philadelphia Department of Public Health. Overview of Chronic Disease and Healthy Eating and Active Living Indicators for Philadelphia Adults and Children. Philadelphia Department of Public Health. http://www.phila.gov/health/pdfs/Philadelphia_obesity%20and%20chronic%20disease%20health%20indicators_2010.pdf. Published May 5, 2011. Accessed May 3, 2013.

• Penn State Extension. 2012 EFNEP Fact Sheet. Penn State Extension. http://extension.psu.edu/health/nutrition-links/about/annual-reports/2012/nutrition-links-annual-report-2012-efnep.pdf/view. Updated 2013. Accessed May 3, 2013.

• City-data.com. Philadelphia County, Pennsylvania (PA) Religion Statistics Profile Philadelphia. City-Data.com. http://www.city-data.com/county/religion/Philadelphia-County-PA.html. Accessed April 18, 2013.