ADVANCED DIPLOMA IN PRINCIPLES OF NUTRITION

@ShawPhotoTomCourse Educators: Thomas Woods, William Eames

BY AMANDA BRODERICK BSc ANutR

BSC HONS Sports Biomedicine and Nutrition

BY AMANDA BRODERICK LESSON: 6

Course Educator:

Amanda Broderick Course Educator

B.A. (Hons.)

Special Diets Semester :

Practical Lesson 6Food Allergies and Intolerances

@ShawNutritionA amandabroderick@shawacademy.com

Practical Lesson 6 Learning Outcomes

Peanut Allergy

Soya Allergy

Wheat Exclusion

Egg Allergy

Fish and Shellfish Allergy

Fruit and Veg Allergy

Food Labelling

Most serious form of food allergy to emerge in recent years

Sensitivity can be extreme Minute amounts of the allergen can trigger a

rapid and severe IgE-mediated response Can cause acute oro-pharyngeal swelling and

systemic circulatory effects which can result in asphyxiation and fatal anaphylaxis

Peanut and nut exclusion

4 in 5 children will go on to have nut allergy as an adult

Symptoms; Skin reactions, such as hives, redness or

swelling Itching or tingling in or around the mouth and

throat Digestive problems, such as diarrhoea, stomach

cramps, nausea or vomiting Tightening of the throat Shortness of breath or wheezing Runny nose

Treatment: antihistamine or adrenaline

Peanut and nut exclusion

Peanut grows from the ground - often called groundnut

Avoid its inhalation

Avoid absorption through skin

Complete avoidance of nuts is essential - usually allergic to more than

one type of nut

Risk of inadvertent exposure is high - important to carry and know how

to administer adrenaline

Under new EU law both refined and unrefined peanut oil have to be

declared on food labels

Eating out and takeaways-sometimes peanuts used as cheap alternative

to ground almond

Peanut butter is “secret ingredient” in some dishes

Airborne contamination: some people can react to airborne particles on

aeroplanes

Foreign travel: not all foods are prepared in the same way in different

countries so important not to presume something is nut free

Management of peanut and nut allergy

Treatment: complete avoidance!

Soya bean: legume and its derivatives used widely e.g. binder in the form of flour or a meat extender or meat replacement

Common in children known to have a cow’s milk allergy

As much as 60% of manufactured foods contain soya: Soya beans Soya flour Soya protein/gum/starch Texturised (or hydrolysed) vegetable protein Soya sauces Soya flavourings Soya lecithin

Level of tolerance needs to be established on an individual basis under medical supervision

Soya Allergy

Symptoms associated with

soya allergy include

anaphylaxis, eczema, rhinitis,

conjunctivitis and

bronchospasm (after

inhalation of soya bean dust),

angioedema, abdominal pain,

laryngeal oedema, respiratory

complaints and urticarial,

infantile colitis and food

protein-enterocolitis

syndrome

Soya Allergy

Common sources:

Vegetarian foods

Meat and fish products

Ready meals

Oriental foods and sauces

Bread

Cakes and biscuits

Desserts

Snack foods and confectionery

Many hidden sources- important to

read food labels carefully

Terms that indicate the presence of soya

•Soya protein isolate•Soya shortening•Soya protein•Soya albumin•Soya bean•Soya flavouring•Soya flour•Soya gum•Soya lecithin (E322)•Soya milk•Soya nuts•Soya oil•Soya starch

Guidance for Soya Avoidance

May provoke either IgE-mediated severed allergic reaction or non-IgE mediated chronic diffuse gastrointestinal symptoms

IgE-mediated wheat allergy: may require total wheat exclusion

Not all reactions to wheat are true allergies

Partial exclusion may be sufficient in some non-IgE-mediated food allergy or non-allergic forms of wheat hypersensitivity

The threshold of sensitivity varies and some people obtain symptom relief by simply reducing wheat intake

Wheat Allergy

The most common reactions are:

• Immediate type allergy to wheat• Delayed allergy reactions to wheat• Delayed type allergy to gluten, known as

Coeliac Disease• Intolerance to wheat

Wheat Allergy

1) Immediate Type Caused by an IgE reaction to a protein in wheat grain Most common in infants Usually resolve within first few years of life

Symptoms: Rhinitis, asthma, urticarial, angioedema, conjunctivitis Loose faeces, abdominal pain, worsening of eczema

2) Delayed allergic reaction significant worsening of symptoms usually within 24-

48 hours

3) Coeliac disease lifelong intolerance to gliadin (part of gluten protein in

grains) cause an immune reaction resulting in damage to the

small intestine The antibodies which are involved are a different class

to the IgE antibody that causes classical food allergy

Allergy to Wheat - 4 types

In all 3, wheat

should be

eliminated

from the diet

4) Wheat intolerance is different - poorly defined set of symptoms Varies considerably in individuals Symptoms: abdominal discomfort, nausea,

tiredness, bloating and altered bowel habits

NOT an immune reaction - not life threatening like wheat allergy

People with wheat intolerance will still experience adverse symptoms from gluten free products, as the remaining part of the wheat will be affecting them

may, or may not, be able to eat rye, barley and oats

may be able to reintroduce wheat back into the diet after a period of elimination

Sensitivity to wheat (and gluten) can also produce symptoms in some individuals which means they have to avoid these substances

Wheat Intolerance

Breads and baked foods Cereals Flour and pasta Meat and fish Vegetable products Sauces and condiments Beverages Confectionery Medication Durum wheat, spelt (triticum spelta), kamut (triticum poloncium) Couscous Bran, wheat bran, wheat germ, wheat gluten Farina Rusk Semolina, durum wheat semolina Flour, wholewheat flour, wheat flour, wheat starch Starch, modified starch, hydrolised starch, food starch, edible starch Vegetable starch, vegetable gum, vegetable protein Cereal filler, cereal binder, cereal protein. This is not an extensive list of sources - it is a guide

Sources of Wheat in the Diet

Common in infancy Can cause acute IgE-mediated reactions In most cases egg allergy will resolve by 5 years Egg and egg derivatives include: Fresh egg Dried egg Egg yolk Egg white (or egg albumen) Egg lecithin. Lecithin used in food manufacture is

more likely to be derived from soya than egg, but if this is not specified, the origin needs to be checked with the manufacturer. Most patients with an egg allergy will be able to tolerate egg lecithin, but reactions in the past have been reported.

Egg Allergy

Eggs are also a major component of foods such as: Meringue Quiche-type flans Egg custards Scotch egg Mayonnaise and dips Yorkshire pudding, batters and pancakes Cakes Quorn products (these contain rehydrated egg white)

However egg can also be a less obvious ingredient of foods such as pasta, biscuits, ice-cream, egg glazes, sweets and desserts. Since acute reactions to egg can result from ingestion of trace amounts, it is vital that all food labels are carefully scrutinised for its presence

Since 70% of egg proteins are denatured with heat, children are often able to tolerate egg cooked in a food product e.g. sponge cake

Egg Allergy

Fish and shellfish can provoke severe IgE-mediated allergic or pharmacologically mediated reactions

It is therefore important to distinguish between those induced by fish allergy and those induced by non-allergic reactions such as histamine poisoning

Adverse reactions to fish/shellfish are common a frequent cause of several types of symptoms, which may begin with oral allergy syndrome and end in anaphylaxis

These reactions are frequently related to asthmatic symptoms

Fish and Shellfish

Exclusion

Shellfish (crustaceans) include prawns/ shrimps, crayfish, crabs and lobsters

Molluscs, on the other hand, include bivalves (clams, oysters, mussels and scallops), snails, octopus, squid, and cuttlefish

High level of cross-reactivity is seen between shellfish and mollusc

Individuals with a fish allergy are often allergic to more than one type of fish or shellfish, but an IgE-mediated allergy to one type of fish does not necessarily indicate that all fish must be avoided.

Fish and Shellfish

Exclusion

Fish and Shellfish

Exclusion

Less obvious sources of fish/shellfish can

include:

• Ingredients such as fish

stock/puree/bouillon

• Worcester sauce (which contains anchovies)

• Food served at buffets and banquets where

the contents of soups, hors d’oevres, vol-au-

vents, sauces etc may not be present

• Oriental (especially Thai) dishes which often

contain seafood as an ingredient or fish

stock or sauce.

• Fish oil supplements

• Health food preparations such as green

lipped mussel extract (particularly cheaper,

less purified products)

• Aspic (can be derived from fish bones)

• Caviar

Relatively uncommon Symptoms develop within minutes of exposure but

occasionally can take 1-2 hours

Most common: Apple, pear, cherry, peach, plum Cucumber, melon, watermelon, zucchini, pumpkin Kiwi fruit- may cause more severe reaction than other

fruits

Fruit allergy usually due to proteins- prolifins

More common in older children and young adults

Legumes: peanut, soybean, fresh or dried bean seeds, pea, green beans and lentils

Most people allergic to one will not be allergic to another type

Allergy to Fruit and Veg

Chemical which occurs naturally in

certain foods

Also a chemical released in the

body as part of an allergic reaction-

causing typical itching, sneezing,

wheezing and swelling allergy

symptoms

Enzyme (diamine oxidase) breaks

down histamines from food

Some people have low levels of this

enzyme

When they eat too much histamine

containing food they develop

symptoms such as headaches,

rashes, itching, diarrhoea,

vomiting, abdominal pain:

histamine intolerance

Foods that are particularly high in histamine and

other vasoactive amines include:

Champagne, wine, beer, cider and other fermented

drinks and spirits

Sauerkraut and other pickled foods

Vinegar and foods containing it such as dressings,

pickles, mayonnaise, ketchup, mustard

Tofu and soya sauce

Parmesan cheese and other cheeses

Sausages and other processed meats (ham, salami,

gammon, bacon)

Mushrooms and quorn

Tinned and smoked fish (tuna, salmon, herring) and

crustaceans

Prepared salads

Tinned vegetables

Dried fruit, seeds, nuts

Yeast extract, yeast

Chocolate, cocoa, cola

Histamines

Bananas

Tomatoes

Strawberries

Nuts

Peanuts

Shellfish

Egg white

Chocolate

Pumpkin

Spinach

Aubergines

Avocado

Papayas

Kiwi

Pineapple

Mango

Raspberry

Tangerines

Grapefruits

Red prunes

Pea spices

Foods Sources of Histamine

Some components in a form that is not always obvious to the consumer e.g. “caseinates” or lactoglobulin are milk derivatives

Not always easy to identify allergen in food Food origin of other ingredients may not be declared e.g. additive lecithin could be derived from

soya or egg

EC directive 2003 ensures the following are on labels: Cereals containing gluten Crustaceans Eggs Peanuts Soya beans Milk Nuts Celery Mustard Sesame seeds Sulphur dioxide and sulphites at concentrations>10mg/kg or 10mg/l expressed as SO2

Food Labelling

In Conclusion

90% of all food allergic responses are related to:

1. Milk2. Eggs3. Peanuts4. Tree nuts (e.g. walnuts, almonds,

cashews, pistachios, pecans)5. Wheat6. Soy7. Fish8. Shellfish Allergen diagnosis tests should always

be done under medical supervision

Try attend all of the sessions live and see your knowledge grow

Lesson 7 will cover Treating Nutritional Deficiencies

Recordings are uploaded within 24 hours of the completion of each live session

Further reading links are available if you wish to learn more

Next Steps

Further Learning

To expand upon the subjects covered in todays lesson:

• Basic nutrition- Diploma in Nutrition

• Weight loss- Ultimate weight Loss Programme

Advanced Course Resources

• Free Short Videos• Topical Items that Pop Up Frequently• Easy way of communicating that free content is

available without spamming you!!!!

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Further Reading

1) Manual of Dietetic Practice, 4th edition, edited by Briony Thomas and Jacki Bishop

2) http://www.ncbi.nlm.nih.gov/pubmed/21236480

3) http://www.foodallergy.org/document.doc?id=194

4) http://www.who.int/mediacentre/factsheets/fs297/en/

5) http://www.cancerresearchuk.org/cancer-info/cancerstats/world/cancer-worldwide-

the-global-picture