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.