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.
Food is first encountered by the infant through mothers 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. Oral Immunological Tolerance
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. Food Allergy – Definition When the bodys 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.
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 ImmuneResponse Histamine Reaction Histamine
Common Food Allergies Peanuts Tree nuts Wheat Soy Milk Eggs Fish Shellfish Eight foods account for 90% of all reactions
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. Risk for Developing Allergies
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 w ww.foodallergy.org
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 Symptoms:
What is anaphylaxis? Most severe allergic reaction 40-50% of people diagnosed with food allergies are judged to have a high risk of anaphylaxis Involves multiple systems at the same time Potentially fatal, especially if medication is not given promptly – at first signs
What is anaphylaxis? (contd.) Can occur within minutes of exposure death can occur within as few as 6 minutes Peanut/Tree nut allergies in combination with asthma is the highest risk – 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 Bock, et. al J Allergy Clinical Immunol 2001
Food Allergy Facts What the experts say... 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.... My tongue (or mouth) itches My tongue is hot or burning My mouth feels funny Theres 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
Food Allergy Facts What the experts say... No Cure No Cure Strict avoidance is the only way to prevent allergic reactions.
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. Lack of evidence that delaying introduction of solids beyond 6 months of age (including highly allergenic foods) prevents the development of food allergies.Prevention
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 cows 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) Prevention (contd)
Hydrolyzed Michigan WIC Authorized Formulas ProductExtent of Hydrolyzed ProteinIndication Good Start Nourish Partially hydrolyzed whey protein Reflux and spitting up Nutramigen with Enflora LGG Extensively hydrolyzed casein (protein) Cows milk allergy Nutramigen Extensively hydrolyzed casein (protein) Cows 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
Summary of Recommendations Avoidance diets Breastfeeding Selection of infant formula Introduction of complementary foods 2198(12) /fulltext#sec1.1 January, 2013
Can Children Outgrow Food Allergies? Yes: –Cows milk, soy, eggs, wheat NO: –Peanut, tree nuts, fish, and crustacean shellfish
Client-centered counseling Assist families with food allergies in making changes that improve quality of life and promote nutritional well- being while avoiding offending foods. Implications for WIC Professionals
Facilitate and encourage ongoing follow-up with the health care provider for optimal management of the clients 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. Implications for WIC Professionals Based on the needs and interests of the WIC client:
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 clients health care provider. Implications for WIC Professionals (Contd) Based on the needs and interests of the WIC client:
avoidance Food allergen avoidance is the safest method 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 Managing Food Allergies
The Food Allergen Labeling and Consumer Protection Act (FALCA)
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 or seafood : tuna, salmon, shrimp, lobster Effective January 1, 2006
The Food Allergen Labeling and Consumer Protection Act (FALCA) 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 or seafood : tuna, salmon, shrimp, lobster Effective January 1, 2006 Consumers MUST continue to read all food labels carefully!
Warning Labels May also say……. manufactured in a facility that also processes peanuts
How to read a label for: Milk-Free Diet Soy-Free Diet Peanut-Free Diet
How to read a label for: Wheat-Free Diet Egg-Free Diet Shellfish-Free Diet Tree Nut-Free Diet
Pediatric Nutrition Care Manual
Comprehensive Guide 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= Features: