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Presented by: Nelda Mercer, MS, RD, FADA March 14, 2013

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1 Presented by: Nelda Mercer, MS, RD, FADA March 14, 2013
Food Allergies Thank you, Diane, for that introduction and for welcoming me to be part of this webcast. I am grateful to WIC for allowing me the opportunity to speak to you today on the three, timely changes to the Nutrition Risk Criteria that include: Food Allergies, Celiac Disease, and Lactose Intolerance. I feel that I learn so much by preparing these presentations . They say that if you really want to learn something – prepare to teach it. Well…..that certainly holds true for me –I often myself only a few small steps ahead of my audience! So without further ado - lets get started!……… Presented by: Nelda Mercer, MS, RD, FADA March 14, 2013

2 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. I’d like to start by explaining briefly on how a “healthy” immune system works. Normally our immune system is designed to prevent disease from: external agents: viruses, bacteria, and toxins internal agents: cancer cells It Recognizes the “invader” as foreign to the body and mounts a powerful defense against it. If you stop to think about it, All Food is foreign to the body As it is derived from plants, fungi, fish, poultry, and other animals which are unrelated to humans. However, in a healthy immune system, such foreign material is absorbed and incorporated into the human body without difficulty.

3 Oral Immunological Tolerance
Food is first encountered by the infant through mother’s 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. This is referred to “Normal Oral Tolerance” with the goal of achieving “Immunological Tolerance” The sequence of events would play out something like this: -click- Food is first encountered by the infant through mother’s breastmilk -click - the breastmilk contains molecules of food from the mother’s diet -click – And…This leads to: Normal Tolerance that is developed through the process of low-dose, continuous exposure that is optimal for the development of immunological tolerance.

4 Food Allergy – Definition
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. The term “food allergy is reserved for an immune system response that is triggered when a food is eaten by a person who has been sensitized to it. The National Institute of Allergy and Infectious Disease defines a “Food Allergy” as an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food. The key word here is “reproducibly” meaning that the same adverse health effect occurs again and again upon exposure; in other words it’s not just a one time event. I remember as a child breaking out in hives after eating strawberries. That was a one time event - I wasn’t having an allergic reaction; I think my body was just reacting to the quantity of strawberries I ate, rather than having been sensitized to strawberries. Click So…… to put it simply……. “When the body’s immune system mistakenly believes a harmless substance, is harmful to the body. It tries to protect the body by releasing IGE antibodies – which are histamines – to attach the substance. When the body’s 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.

5 Immune Response Histamine Reaction This is a snapshot of what is happening during an allergic immune response. As you can see, food allergy presents a different immunological profile - instead of developing immunological tolerance (as I previously described) the immune system in individuals with allergies mounts a non-protective resistance – the most common type involve immunoglobin E – (abbreviated IgE) which is a distinct class of antibodies that mediates an allergic reaction. hence they are referred to as IgE- mediated responses. When the food allergen first enters the body, the immune system produces “allergen-specific IgE antibodies abbreviated as sIgE – this process is called immunological sensitization. Following sensitization, whenever the same food molecules are encountered, the immune system mounts an allergic defense by releasing chemicals such as Histamine that is responsible for causing many of the symptoms of an allergic reaction. These symptoms can be immediate and often difficult to predict. They could be localized to a few cells, which would be classified as a “mild” reaction, - or they could cause a cascade of events that rapidly progress in severity…… as I will explain later. IgE-mediated – food allergen first enters the body immune system produces allergen-specific IgE antibodies (sIgE) immunological sensitization Re-exposure to food, allergen sIgE identifies it and quickly initiates the release of chemicals Histamine

6 Common Food Allergies Eight foods account for 90% of all reactions
Peanuts Tree nuts Wheat Soy Milk Eggs Fish Shellfish The 8 foods that account for 90% of all allergic reactions are listed on the slide. And, I’m sure that these come as no surprise to you all, working with WIC children.

7 Risk for Developing Allergies
“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. According to an expert panel sponsored by the National Institute of Allergy and Infectious Disease, Individuals with a family history of any allergic disease are susceptible to developing food allergies and are classified as either “at risk” or “high risk”. Individuals who are “at risk” are those with a biological parent or sibling with existing, or history of, allergic rhinitis, asthma, or atopic dermatitis. Individuals who are “high risk” are those with preexisting sever allergic disease and/or family history of food allergies. Rhinitis (pron.: /raɪˈnaɪtɪs/) is a medical term for irritation and inflammation of the mucous membrane inside the nose. Common symptoms of rhinitis are a stuffy nose, runny nose, and post-nasal drip.[1] The most common kind of rhinitis is allergic rhinitis,[2] which is usually triggered by airborne allergens such as pollen and dander.[3] Allergic rhinitis may cause additional symptoms, such as sneezing and nasal itching, coughing, headache,[4] fatigue, malaise, and cognitive impairment.[5][6][7] The allergens may also affect the eyes, causing watery, reddened or itchy eyes and puffiness around the eyes.[4]

8 Allergy Testing Skin Prick Test Allergen-specific serum IgE (sIgE)
Atopy Patch Test Oral Food Challenges Food Elimination Diet Along with a detailed history of the disorder, such as symptoms, timing, common triggers and associations, there are several types of tests that health care providers may use in diagnosing food allergies. Diagnosing food allergies is difficult because the detection of allergen-specific serum sIgE does not necessarily indicate a clinical allergy. Often, more than one type of test is required to confirm a diagnosis. The double-blind, placebo controlled, food challenge is considered the gold standard in testing for food allergies.

9 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 Latest statistics show a continual increase in food allergies - doubling over the past 10 years with peanut allergy as the leading cause. It is estimated that Approximately 15 million Americans are affected Including an alarming - 1 in 13 children.

10 Symptoms: 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 of allergic reactions are listed on this slide. As you can see, symptoms can range from mild – such as hives, itching of the skin, eyes, ears, and mouth - to more severe, involving swelling of deeper tissues of the mouth and face – to the involvement of respiratory, gastrointestinal, and cardiovascular systems – leading to the severe, life- threatening reaction called anaphylaxis.

11 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 it is estimated that 40-50% of people diagnosed with food allergies may have high risk of anaphylaxis Which involves multiple systems at the same time and is potentially fatal, especially if medication is not given promptly

12 What is anaphylaxis? (cont’d.)
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 these symptoms can occur within minutes of exposure and rapidly progress in severity – death can occur within as few as 6 minutes Peanut and Tree nut allergies in combination with asthma is the highest risk – However, it is not uncommon for anaphylaxis to occur in individuals who are also allergic to: milk, egg, fish, and crustacean fish Pattern can vary among individuals – as well as symptoms

13 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 There are a wide range of symptoms as you can see listed on this slide: These symptoms involve multiple body regulatory systems that can cause a cascading of events and progress very rapidly leading to a sudden drop in blood pressure, loss of consciousness and is some cases death.

14 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 Outside the hospital setting – food allergy is the leading cause of serious allergic reaction – Anaphylactic reactions account for: over 30,000 Emergency Room visits per year and approximately 175 deaths annually It’s important to note that serious allergic reactions occur most often outside the home and by products believed to be safe As I mentioned before, Asthma increases risk of fatal reaction - and Adolescents and young adults are at the highest risk Bock, et. al J Allergy Clinical Immunol 2001

15 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 Sensitivity to the allergen can vary widely among individuals. 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 By way of example: my daughter was allergic to milk as an infant But because she was exclusively breastfed, we did not know, until one day, by accident, she grabbed a small plastic creamer container at a restaurant and bit into it. The cream coming in contact with her mouth set off immediate Angioedema ( which as you saw in a prior slide is swelling of deeper tissues especially the mouth and face). ………… Fortunately, her reaction did not progress in severity, but It did scare me! ………Needless to say, since that episode, we were very careful to keep her away from any dairy foods. Fortunately, she began to outgrow her milk allergy starting at around years of age, and was able to tolerate milk by the time she was 5 or 6. and….For some, inhalation of the allergen can cause discomfort – this is why many schools have peanut-free lunch tables. So as you can see….. Sensitivity is truly ‘unknown’ and affected systems can also vary between individuals and reactions. – Next slide………….>

16 Allergic Reaction: What a Child Might Say or Do
My tongue (or mouth) itches My tongue is hot or burning My mouth feels funny There’s something stuck in my throat It feels like there are bugs in my ears This food is too spicy Put their hands in their mouths Pull or scratch at their tongues Drool Hoarse cry or voice Slur words Become unusually clingy For example a child may say: My tongue (or mouth) itches ………and put their hands in their mouths My tongue is hot or burning…………and pull or scratch at their tongues My mouth feels funny………………………and have excessive drooling There’s something stuck in my throat……and have a hoarse cry or voice It feels like there are bugs in my ears………and start to slur their words This food is too spicy………………and become unusually clingy or whiney

17 Food Allergy Facts What the experts say . . .
No Cure Strict avoidance is the only way to prevent allergic reactions. There is NO CURE for food allergies Strict avoidance is the only way to prevent allergic reactions.

18 Prevention 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. Currently, there is 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. As we all know, adequate nutrition intake during pregnancy and lactation is essential to achieve positive health outcomes. Therefore, unnecessary food avoidance can result in inadequate nutrition. And….. There is also a lack of evidence that delaying the introduction of solids beyond 6 months of age, (including highly allergenic foods), prevents the development of food allergies. – and as a matter of fact, there is some evidence to the contrary. Also, ….. As you well know,……if the introduction of developmentally appropriate solid food is delayed beyond 6 months of age, the consequences are - an increased risk for inadequate nutrient intake which may result in growth deficits, and feeding problems can also to occur.

19 Prevention (cont’d) Protective role of breastfeeding in preventing food allergies needs further study Some evidence suggests that breastfeeding for at least months may decrease likelihood of cow’s 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) Also, according to the American Academy of Pediatrics, Committee on Nutrition The protective role of breastfeeding in preventing food allergies needs further study -click- There is some evidence to suggests that breastfeeding for at least 4 months may decrease likelihood of cow’s milk allergy in the first years of life. -click - However, there is no convincing evidence for the use of soy formula as a strategy for preventing the development of food allergies in at-risk infants, therefore, this practice is not recommended. And - For infants who are partially breastfed or formula fed, partially hydrolyzed formulas may be considered a strategy for preventing the development of food allergies, but only in at-risk infants.

20 Hydrolyzed Michigan WIC Authorized Formulas
Product Extent of Hydrolyzed Protein Indication Good Start Nourish Partially hydrolyzed whey protein Reflux and spitting up Nutramigen with Enflora LGG Extensively hydrolyzed casein (protein) Cow’s milk allergy Nutramigen Similac Expert Care Alimentum Hydrolyzed casein with free amino acids Hypoallergenic Elecare Infant/Elecare Jr 100% free amino acids EO28 Splash Hypoallergenic, cow and soy milk allergy, multiple food protein intolerance Neocate Infant/Neocate Junior 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 Here is a list of the hydrolyzed formulas authorized for Michigan WIC clients: You may find it helpful to print this slide to keep as a reference. Note that Pedisure Peptide contains milk and soy ingredients and may not be appropriate for infants with either a milk or soy allergy. And – Peptamen Jr. is not appropriate for infants with cow’s milk allergy

21 Summary of Recommendations
January, 2013 Summary of Recommendations Avoidance diets Breastfeeding Selection of infant formula Introduction of complementary foods If you haven’t already read this article recently published in the Journal of Allergy and Clinical Immunology, I highly recommend that you do. It contains excellent summaries of current science, including controversial areas such as: maternal avoidance diet, use of partially hydrolyzed formulas, and timing of introduction of complementary foods. Having only received this reference a couple of days ago, (thank you, Kristen Hanulcik) it was reassuring to find that the recommendations by these authors are consistent with the information I have just presented. I have provided a link for you on this slides and a PDF of this article is also available in the resource materials section of this webcast.

22 Can Children Outgrow Food Allergies?
Yes: Cow’s milk, soy, eggs, wheat NO: Peanut, tree nuts, fish, and crustacean shellfish For many individuals, food allergies appear within the first 2 years of life. Children often outgrow allergies to cow’s milk, soy, egg, and wheat quickly; but are less likely to outgrow allergies to peanut, tree nuts, fish, and crustacean shellfish. If a child has had a recent allergic reaction, there is no reason to retest. Otherwise, annual testing may be considered to see if the allergy to cow’s milk, soy, egg, or wheat has been outgrown ……..so the diet can be normalized. Adults may have food allergies continuing from childhood or may develop sensitivity to food allergens encountered after childhood, which usually continues through life.

23 Implications for WIC Professionals
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. Now, I realize that as WIC professionals, you are masters of Client-centered counseling. As skilled professionals you are uniquely qualified to assist families with food allergies in making changes that improve their quality-of-life and promote nutritional well-being while giving them the tools they need to avoid offending foods.

24 Implications for WIC Professionals
Based on the needs and interests of the WIC client: Facilitate and encourage ongoing follow-up with the health care provider for optimal management of the client’s 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. So in the spirit of client-centered counseling and based on the client’s interest and needs you can empower your clients by: Facilitating and encouraging them to follow-up with their health care provider in order receive the best care in managing their condition. by…Championing the cause for promoting exclusive breastfeeding until 6 months of age and continue through the first year. If needed, provide hypoallergenic formula for clients with appropriate medical documentation. And it goes without saying, that tailoring the food package to substitute or remove offending foods is of upmost importance.

25 Implications for WIC Professionals
(Cont’d) 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 client’s health care provider. Certainly, monitoring weight status and growth patterns of clients is also very important. As well as: Educating clients about reading food labels so they can identify offending foods and ingredients. Educating clients on planning meals and snacks … particularly outside the home. and….It’s also important to refer clients to their health care provider for a re-challenge of offending foods, if you feel that’s appropriate Remember what I said a few slides earlier….. If a child has had a recent allergic reaction, there is no reason to retest. …………Otherwise, annual testing may be considered to see if the allergy ………to cow’s milk, soy, egg, or wheat has been outgrown….. so the diet can be normalized. And….last, but certainly NOT least….. Keeping those lines of communication open between you and the client’s health care provider is very important in establishing and coordinating your client’s care.

26 Managing Food Allergies
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 As I stated before: AVOIDANCE of food allergens is the only safe method – however – One needs to also consider avoiding cross-reactive foods These are foods that are similar within a food group: For example, if a child is allergic to shrimp he or she may also be allergic to other shell fish By the same token, if a child is allergic to one type of tree nut, other nuts may also present a problem. Also: Some research suggests, that an estimated 25-40% of people who have peanut allergy are also allergic to tree nuts.2 In addition, peanuts and tree nuts often come into contact with one another during the manufacturing and serving processes So, for these reasons, allergists usually tell their patients with peanut allergy to avoid tree nuts as well. Reference: 1 Sicherer SH, Munoz-Furlong A, Godbold JH, Sampson HA. US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up. J Allergy Clin Immunol 2010; 125(6): [LINK to ADVANCING A CURE>FARE Research Grants>Selected Completed Studies > Sicherer, Prevalence of Peanut and Tree Nut Allergy in the United States] 2 Ibid (same as previous reference); see also Sicherer SH, Munoz-Furlong A, Sampson HA. Prevalence of peanut and tree nut allergy in the United States determined by means of a random digit dial telephone survey: a 5-year follow-up study. J Allergy Clin Immunol 2003; 112(6):

27 The Food Allergen Labeling and Consumer Protection Act (FALCA)
Now we are going to move on to food labeling. This slide is a screen shot of FDA’s Food Allergen Labeling and Consumer Protection Act of 2004 That you can access online.

28 The Food Allergen Labeling and Consumer Protection Act (FALCA)
Effective January 1, 2006 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 As of January 1, 2006 the law mandated that……. All food labels show major food allergens - and declare the allergen in plain language, either in the ingredient list or via: one of these two “Contains” clauses: the word: “Contains” followed by the name of the major food allergen – for example “Contains milk, wheat, etc.” – or A parenthetical statement in the list of ingredients For example identifying the allergen (egg) in parenthesis - after the ingredient “albumin” Also……. Allergen Ingredients must be listed if they are present in any amount, even in colors, flavors, or spice blends. Additionally, manufacturers must list the specific: nut : for example: almond, walnut, cashew…………. or the specific seafood, for example : tuna, salmon, shrimp, or lobster Now……Although the Food Allergen Labeling and Consumer Protection Act has made label reading easier for the millions of Americans living with food allergies. Click……..

29 The Food Allergen Labeling and Consumer Protection Act (FALCA)
Consumers MUST continue to read all food labels carefully! Effective January 1, 2006 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 Consumers MUST continue to read all food labels carefully.

30 Standard Label Let’s take a look at a few labels.
This one, for example, has numerous ingredients that could potentially be a problem for an individual with any of the common food allergies. Specific allergens identified on this food label include: wheat, barley, soy, rye, milk, tree nuts, and peanut in various forms.

31 “Contains” Statements
This is an example of the “contains” clause: In addition to listing the specific allergen ingredients, it is followed by the “contains clause”: “Contains soy, almond, peanut, pecan, hazelnut, and walnut ingredients.”

32 Warning Labels This warning label specifies that the products: “contain wheat, soy, egg, and milk ingredients and may contain traces of peanuts and tree nuts. The “may contain” statement is voluntary. Many manufactures include this statement when there is a chance that a food allergen could be present. A manufacturer might use the same equipment to make different products. Even after cleaning this equipment, a small amount of an allergen (such as peanuts) that was used to make one product (such as cookies) may become part of another product (such as crackers). Some labels may also say that the products are “manufactured in a facility that also processes peanuts.” May also say……. “manufactured in a facility that also processes peanuts”

33 This product also carries the “contains” statement stating:
“may contain traces of milk, egg, and soy” in addition to the wheat ingredients listed.

34 www.fda.gov/ ForConsumers/ConsumerUpdates
I am now going to briefly highlight some educational resource material that you have access to and that you may find helpful for your clients. All of the materials that I will be showing you are available for you to download - either from the websites referenced on the slides or - on the materials resource section of this webcast. This first handout titled……. Have Food Allergies? Read the Label is a very basic 2 page handout produced by FDA for consumers, explaining the food labeling law and how to read the label.

35 Many of you are probably familiar with the
Nibbles for Health, Nutrition Newsletters for parents of Young Children produced by USDA. This is a particularly good handout that explains, in simple terms, what a food allergy is, what to do if a parent suspects a food allergy, how to manage food allergies and ………. how to help their child handle a food allergy and still eat healthfully.

36 Milk-Free Diet Soy-Free Diet Peanut-Free Diet How to read a label for:
The Food Allergy & Anaphylaxis Network has a handout educating consumers on how to read food labels for all of the common food allergies: The first page is titled – How to read a food label for a: Milk-free diet Soy-free diet Peanut-free diet

37 Wheat-Free Diet Egg-Free Diet Shellfish-Free Diet Tree Nut-Free Diet
How to read a label for: Wheat-Free Diet Egg-Free Diet Shellfish-Free Diet Tree Nut-Free Diet And the second page is for a: Wheat-free diet Egg-free diet Shellfish-free diet And - Tree nut-free diet

38 Pediatric Nutrition Care Manual
The Academy of Nutrition and Dietetics – Pediatric Nutrition Care Manual has comprehensive educational handouts for all 8 common food allergies: The handout starts out with a brief background and general explanation of the type of allergy. (click)……….. Followed by a list of recommend foods organized by food groups (click)…………. Then a fairly comprehensive list of foods that are “not recommended” (click)………….. Followed by a sample menu. (click)…………… now… It is important to note that these menus are generally designed for school-age children (in this case it is a 6 – 8 year old child), with instructions to consult with a registered dietitian to tailor the menu so that it is age- appropriate for food choices and portion size.

39 Pediatric Nutrition Care Manual
I am going to quickly show you the first page of the remainder of the specific food allergen handouts: That include: Peanut Fish Shellfish Egg

40 Pediatric Nutrition Care Manual
Followed by: Soy Wheat Tree nut And a handout for multiple food allergies.

41 Comprehensive Guide Features:
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 I’d like to close by letting you know about a reference I found very helpful in preparing this presentation. The Health Professional’s Guide to Food Allergies and Intolerances Authored by: Janice Vickerstaff Joneja (Ho nay ha) Ph.D, RD This comprehensive guide sheds light on the latest science behind food allergies and intolerances as well as practical suggestions for their management. The book Features: The science behind food allergies and food intolerances The role of elimination diets and challenge protocols in identifying food sensitivities ……….. and also included are: Symptoms, diagnosis, and management dof 24 foods and food components You can purchase this book online at eatright.org Janice Vickerstaff Joneja Ph.D, RD https://www.eatright.org/shop/product.aspx?id=

42 Thank You! Questions ??? I want to sincerely thank you all for your attention and now, I am happy to entertain any questions at this time.


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