Presentation on theme: "Presented by: Nelda Mercer, MS, RD, FADA March 14, 2013"— Presentation transcript:
1Presented by: Nelda Mercer, MS, RD, FADA March 14, 2013 Food AllergiesThank you, Diane, for that introduction andfor 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 theNutrition 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, FADAMarch 14, 2013
2Background – Normal Immune System Prevent diseaseexternal agents: viruses, bacteria, and toxinsinternal agents: cancer cellsMount Powerful defense against “invader”All Food is foreign to the bodyIn most cases, such foreign material is absorbed and incorporated into the human body without difficulty.I’d like to start by explaining briefly on howa “healthy” immune system works.Normally our immune system is designedto prevent disease from:external agents: viruses, bacteria, and toxinsinternal agents: cancer cellsIt Recognizes the “invader” as foreign to the bodyand mounts a powerful defense against it.If you stop to think about it, All Food is foreign to the bodyAs 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 incorporatedinto the human body without difficulty.
3Oral Immunological Tolerance Food is first encountered by the infant through mother’s breastmilkContains molecules of food from her dietTolerance 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 infantthrough mother’s breastmilk -click -the breastmilk contains molecules of foodfrom the mother’s diet-click –And…This leads to:Normal Tolerance that is developed through the process of low-dose, continuous exposurethat is optimal for the developmentof immunological tolerance.
4Food 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 personwho has been sensitized to it.The National Institute of Allergy and Infectious Disease defines a “Food Allergy” as an adverse health effectarising 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.ClickSo…… 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.
5ImmuneResponseHistamine ReactionThis is a snapshot of what is happening during anallergic 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 defenseby releasing chemicals such as Histamine that is responsible forcausing 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 asa “mild” reaction, - or they could cause a cascade of eventsthat 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 sensitizationRe-exposure to food, allergen sIgE identifies it and quickly initiates the release of chemicalsHistamine
6Common Food Allergies Eight foods account for 90% of all reactions PeanutsTree nutsWheatSoyMilkEggsFishShellfishThe 8 foods that account for 90% of all allergic reactions are listed on the slide.And, I’m sure that these come as no surpriseto you all, working with WIC children.
7Risk 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 allergiesBoyce, 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 diseaseare 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. The most common kind of rhinitis is allergic rhinitis, which is usually triggered by airborne allergens such as pollen and dander. Allergic rhinitis may cause additional symptoms, such as sneezing and nasal itching, coughing, headache, fatigue, malaise, and cognitive impairment. The allergens may also affect the eyes, causing watery, reddened or itchy eyes and puffiness around the eyes.
8Allergy Testing Skin Prick Test Allergen-specific serum IgE (sIgE) Atopy Patch TestOral Food ChallengesFood Elimination DietAlong with a detailed history of the disorder, such as symptoms, timing, common triggers and associations,there are several types of tests that health care providersmay use in diagnosing food allergies.Diagnosing food allergies is difficult because the detection of allergen-specific serum sIgE does not necessarilyindicate a clinical allergy.Often, more than one type of test is requiredto confirm a diagnosis.The double-blind, placebo controlled, food challengeis considered the gold standard in testing for food allergies.
9Food Allergy Facts What the experts say . . . . Doubling of food allergy over the past 10 years, particularly peanut allergy.~15 million Americans affected1 in 13 childrenOnset at any ageLatest statistics show a continual increase in food allergies - doubling over the past 10 yearswith peanut allergy as the leading cause.It is estimated thatApproximately 15 million Americans are affectedIncluding an alarming - 1 in 13 children.
10Symptoms: Urticeria – hives Pruritus – itching of skin, eyes, ears, mouthAngioedema – swelling of deeper tissues especially the mouth and faceWheezingCoughNauseaVomitingHypotensionAnaphylaxisSymptoms 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 ofrespiratory, gastrointestinal, and cardiovascular systems –leading to the severe, life- threatening reactioncalled anaphylaxis.
11What is anaphylaxis? Most severe allergic reaction 40-50% of people diagnosed with food allergies are judged to have a high risk of anaphylaxisInvolves multiple systems at the same timePotentially fatal, especially if medication is not given promptly – at first signsit is estimated that 40-50% of people diagnosed with food allergies may have high risk of anaphylaxisWhich involves multiple systems at the same timeand is potentially fatal, especially if medication is not given promptly
12What is anaphylaxis? (cont’d.) Can occur within minutes of exposure death can occur within as few as 6 minutesPeanut/Tree nut allergies in combination with asthma is the highest riskmilk, egg, fish, and crustacean fishPattern can vary among individualsthese symptoms can occur within minutes of exposure and rapidly progress in severity –death can occur within as few as 6 minutesPeanut 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 fishPattern can vary among individuals – as well as symptoms
13Symptoms of Anaphylaxis Tingling sensation in the mouthSwelling of the tongue and throatDifficulty breathingHivesVomitingAbdominal crampsDiarrheaDrop in blood pressureLoss of consciousnessDeath – in rare casesThere 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 rapidlyleading to a sudden drop in blood pressure,loss of consciousness andis some cases death.
14Food 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 annuallyreactions caused most often outside the home and by products believed to be safeAsthma increases risk of fatal reactionAdolescents and young adults are at the highest riskOutside the hospital setting – food allergy is the leading cause of serious allergic reaction –Anaphylactic reactions account for:over 30,000 Emergency Room visits per yearand approximately 175 deaths annuallyIt’s important to note that serious allergic reactions occur most often outside the home and by products believed to be safeAs I mentioned before, Asthma increases risk of fatal reaction - andAdolescents and young adults are at the highest riskBock, et. al J Allergy Clinical Immunol 2001
15Food Allergy Facts What the experts say . . . Sensitivity to the allergen can varyFor some, a speck of allergen can have the same effect as eating a large quantityFor some, skin contact with the allergen is enough to cause a reactionFor some, inhalation of the allergen can cause discomfortSensitivity is truly ‘unknown’Affected systems can vary between individuals AND reactionsSensitivity to the allergen can vary widely among individuals.For some, a speck of allergen can have the same effectas eating a large quantityFor some, skin contact with the allergen is enough to cause a reactionBy 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………….>
16Allergic Reaction: What a Child Might Say or Do My tongue (or mouth) itchesMy tongue is hot or burningMy mouth feels funnyThere’s something stuck in my throatIt feels like there are bugs in my earsThis food is too spicyPut their hands in their mouthsPull or scratch at their tonguesDroolHoarse cry or voiceSlur wordsBecome unusually clingyFor example a child may say:My tongue (or mouth) itches ………and put their hands in their mouthsMy tongue is hot or burning…………and pull or scratch at their tonguesMy mouth feels funny………………………and have excessive droolingThere’s something stuck in my throat……and have a hoarse cry or voiceIt feels like there are bugs in my ears………and start to slur their wordsThis food is too spicy………………and become unusually clingy or whiney
17Food Allergy Facts What the experts say . . . No CureStrict avoidance is the only way to prevent allergic reactions.There is NO CURE for food allergiesStrict avoidance is the only way to prevent allergic reactions.
18PreventionInsufficient 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.
19Prevention (cont’d)Protective role of breastfeeding in preventing food allergies needs further studySome 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 NutritionThe 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.
20Hydrolyzed Michigan WIC Authorized Formulas ProductExtent of Hydrolyzed ProteinIndicationGood Start NourishPartially hydrolyzed whey proteinReflux and spitting upNutramigen with Enflora LGGExtensively hydrolyzed casein (protein)Cow’s milk allergyNutramigenSimilac Expert Care AlimentumHydrolyzed casein with free amino acidsHypoallergenicElecare Infant/Elecare Jr100% free amino acidsEO28 SplashHypoallergenic, cow and soy milk allergy, multiple food protein intoleranceNeocate Infant/Neocate JuniorPediasure Peptide 1.0/1.5 ¹Hydrolyzed whey – dominant proteinMalabsorption and maldigestionPeptamen Jr 1.0/1.5 ²Hydrolyzed – 100% whey proteinMalabsorption¹ Contains milk and soy ingredients² Not appropriate for individuals with cow's milk allergyHere 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
21Summary of Recommendations January, 2013Summary of RecommendationsAvoidance dietsBreastfeedingSelection of infant formulaIntroduction of complementary foodsIf 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 slidesand a PDF of this article is also available in the resource materials section of this webcast.
22Can Children Outgrow Food Allergies? Yes:Cow’s milk, soy, eggs, wheatNO:Peanut, tree nuts, fish, and crustacean shellfishFor many individuals, food allergies appear withinthe first 2 years of life.Children often outgrow allergies tocow’s milk, soy, egg, and wheat quickly;but are less likely to outgrow allergies topeanut, 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 wheathas been outgrown ……..so the diet can be normalized.Adults may have food allergies continuing from childhoodor may develop sensitivity to food allergensencountered after childhood,which usually continues through life.
23Implications for WIC Professionals Client-centered counselingAssist 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 qualifiedto assist families with food allergiesin making changes that improve their quality-of-life and promote nutritional well-beingwhile giving them the tools they need to avoid offending foods.
24Implications 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 andcontinue 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.
25Implications 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 totheir 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 consideredto 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 openbetween you and the client’s health care provideris very important in establishing and coordinatingyour client’s care.
26Managing Food Allergies Food allergen avoidance is the safest methodWork closely with health care provider to determine the foods to be avoidedAvoid cross-reactive foods similar foods within a food groupall shellfish are closely relatedtree nuts: almonds, cashews, and walnutsAs I stated before: AVOIDANCE of food allergens is the only safe method– however –One needs to also consider avoiding cross-reactive foodsThese 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 fishBy 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.2In 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):
27The Food Allergen Labeling and Consumer Protection Act (FALCA) Now we are going to move on to food labeling.This slide is a screen shot ofFDA’s Food Allergen Labeling and Consumer Protection Act of 2004That you can access online.
28The Food Allergen Labeling and Consumer Protection Act (FALCA) Effective January 1, 2006Mandates 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…..” – orA 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, cashewor seafood : tuna, salmon, shrimp, lobsterAs 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 listor 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.” – orA parenthetical statement in the list of ingredientsFor 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 lobsterNow……Although the Food Allergen Labeling and Consumer Protection Act has made label reading easier for the millions of Americans living with food allergies.Click……..
29The Food Allergen Labeling and Consumer Protection Act (FALCA) Consumers MUST continue to read all food labels carefully!Effective January 1, 2006Mandates 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” – orA 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, cashewor seafood : tuna, salmon, shrimp, lobsterConsumers MUST continue to read all food labels carefully.
30Standard Label Let’s take a look at a few labels. This one, for example, has numerous ingredientsthat could potentially be a problemfor an individual with any ofthe common food allergies.Specific allergens identifiedon 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.”
32Warning LabelsThis warning label specifies that the products:“contain wheat, soy, egg, and milk ingredients andmay contain traces of peanuts and tree nuts.The “may contain” statement is voluntary.Many manufactures include this statementwhen 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”
33This product also carries the “contains” statement stating: “may contain traces of milk, egg, and soy”in addition to the wheat ingredients listed.
34www.fda.gov/ ForConsumers/ConsumerUpdates I am now going to briefly highlight someeducational resource material that you have access toand 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 Labelis a very basic 2 page handout produced by FDA for consumers, explaining the food labeling law andhow to read the label.
35Many of you are probably familiar with the Nibbles for Health, Nutrition Newsletters for parents of Young Childrenproduced 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 allergyand still eat healthfully.
36Milk-Free Diet Soy-Free Diet Peanut-Free Diet How to read a label for: The Food Allergy & Anaphylaxis Networkhas a handout educating consumerson how to read food labels forall of the common food allergies:The first page is titled –How to read a food label for a:Milk-free dietSoy-free dietPeanut-free diet
37Wheat-Free Diet Egg-Free Diet Shellfish-Free Diet Tree Nut-Free Diet How to read a label for:Wheat-Free DietEgg-Free DietShellfish-Free DietTree Nut-Free DietAnd the second page is for a:Wheat-free dietEgg-free dietShellfish-free dietAnd -Tree nut-free diet
38Pediatric 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.
39Pediatric Nutrition Care Manual I am going to quickly show you the first page of the remainder of the specific food allergen handouts:That include:PeanutFishShellfishEgg
40Pediatric Nutrition Care Manual Followed by:SoyWheatTree nutAnd a handout for multiple food allergies.
41Comprehensive Guide Features: The science behind food allergies and food intolerancesThe role of elimination diets and challenge protocols in identifying food sensitivitiesSymptoms, diagnosis and management of 24 foods and food componentsI’d like to close by letting you know about a referenceI found very helpful in preparing this presentation.The Health Professional’s Guide to Food Allergies and IntolerancesAuthored by:Janice Vickerstaff Joneja (Ho nay ha) Ph.D, RDThis 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 intolerancesThe role of elimination diets and challenge protocols in identifying food sensitivities ……….. and also included are:Symptoms, diagnosis, and managementdof 24 foods and food componentsYou can purchase this book online at eatright.orgJanice Vickerstaff Joneja Ph.D, RDhttps://www.eatright.org/shop/product.aspx?id=
42Thank You!Questions ???I want to sincerely thank you all for your attentionand now,I am happy to entertain any questions at this time.