Post on 24-Feb-2016
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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.