1. + Food Allergies in the United States Module 1

2. + Module Content  Definitions  Types and prevalence of food allergies in the United States  Types and prevalence of food allergies in foreign countries  Impact of food allergies

3. + Definitions Food “any substance—whether processed, semi-processed, or raw—that is intended for human consumption and includes drinks, chewing gum, food additives, and dietary supplements” “substances used only as drugs, tobacco products, and cosmetics (such as lip-care products) that may be ingested are not included” (Boyce et al., 2010, p. S8).

4. + Definitions Food allergy “an abnormal response to a food, triggered by the body’s immune system” “an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food”(Boyce et al., 2010, p. S8).

5. + Definitions Food allergens “those specific components of food or ingredients within food (typically proteins but sometimes also chemicals) that are recognized by allergen-specific immune cells and elicit specific immunologic reactions, resulting in characteristic symptoms” (Boyce et al., 2010, p. S8).

6. + Definitions Allergic response “a reproducible adverse reaction to a substance mediated by an immunological response. The substances provoking the reaction may have been ingested, injected, inhaled, or merely have come into contact with the skin or mucous membranes” (David, 2000, p. 34).

7. + Definitions Food intolerances non-immunologic adverse reactions Intolerance symptoms are usually caused by an inability to digest or metabolize a food, resulting in gas production, cramping, or diarrhea. Lactose intolerance (inability to digest milk sugar) is the most common type of food intolerance”(Boyce et al., 2010, p. S9).

8. + Definitions IgE (Immunoglobulin E) a unique class of immunoglobulin that mediates an immediate allergic reaction (Boyce et al., 2010). IgE is released from plasma cells in the mucosa of the GI (gastrointestinal) tract, respiratory tract, and tonsils when the immune system overreacts to an allergen, triggering the release of histamine, inflammation, and an allergic responses (Marieb & Hoehn, 2010).

9. + Types of adverse reaction to food (Boyce et al., 2010)

10. + Food Allergy Organizations Food Allergy Research & Education [FARE] is: a newly formed organization which combined two other groups, FAAN and FAI. FARE is “dedicated to food allergy research and education with the mission of ensuring the safety and inclusion of individuals with food allergies while relentlessly seeking a cure” (FARE, 2014).

11. + Big 8 Food Allergens in the United States In the U.S., 90% of food allergies are caused by eggs, milk, shellfish, wheat, peanut, fish, soy, and tree nuts (e.g., walnuts, cashews, almonds, pecans, pistachios, hazelnuts, macadamia nuts) (Sicherer, 2010). The estimated prevalence of allergies among the U.S. population (Boyce et al., 2010): Peanut: 0.6%-1.3% Tree nuts: 0.4%-0.6% Fish: 0.4% Crustacean shellfish (crab, crayfish, lobster, shrimp): 1.2% All seafood: 0.6% in children and 2.8% in adults Milk and egg: 1%-2% for young children and 0.2%-0.4% in the general population

12. + Big 8 Food Allergens in the United States Eggs Albumin Eggnog Lysozyme Mayonnaise Meringue Ovalbumin Surimi

13. + Big 8 Food Allergens in the United States Milk Butter Cream Cheese Lactose Pudding Yogurt Margarine Casein Whey

14. + Big 8 Food Allergens in the United States Shellfish Barnacle Crab Crawfish Krill Lobster Prawns Shrimp

15. + Big 8 Food Allergens in the United States Wheat Bread crumbs Flour Pasta Wheat germ oil

16. + Big 8 Food Allergens in the United States Peanut Peanut oil Peanut butter Peanut flour

17. + Big 8 Food Allergens in the United States Fish Anchovies Bass Catfish Cod Salmon

18. + Big 8 Food Allergens in the United States Soy Edamame Miso Soya Soybean Soy sauce Tofu

19. + Big 8 Food Allergens in the United States Treenut Almond Cashew Chestnut Coconut Pesto Walnut

20. + Food allergies among children In 2007 about three million children under the age of 18 (3.9%) were reported to have a food allergy (Branum, 2008). Reports of food allergies increased by 18% from 1997 to 2007 among children 18 years of age and younger (Branum, 2008). From 2004 to 2006, children 18 years of age and younger represented approximately 9,500 hospital discharges per year after a diagnosis related to a food allergy (Branum, 2008). It is more common for female than male adults to have food allergies, while male children typically have more food allergies than female children (Ben-Shoshan, Turnbull, & Clarke, 2012).

21. + Ethnic groups and children in the U.S.

22. + Emerging and less prevalent allergens The majority of studies have focused on the most common food allergens, even though more than 170 foods have been reported to cause IgE- mediated reactions (Boyce et al., 2010).

23. + Emerging and less prevalent allergens Examples of uncommon allergens (FARE, 2014): Corn: raw and cooked Meat: beef, mutton, chicken, and pork (heating and cooking meat may reduce the allergenicity) Gelatin: a protein formed when connective tissue or skin is boiled Seeds: sesame, poppy, or sunflower Spices: coriander, mustard, and garlic

24. + Types and prevalence of food allergies in foreign countries Common allergens in other countries and regions (Baumert, 2012) Canada: sesame, mollusks, mustard, sulfites, and gluten Europe: sesame, mollusks, sulfites, gluten, mustard, celery, and lupin (a type of legume used in flour form) Codex (South Africa): gluten and sulfites Hong Kong: sulfites and gluten Japan: milk, egg, peanuts, and wheat Australia/New Zealand: sesame, mollusks, sulfites, and gluten

25. + Impact of food allergies Hospitalization related to food allergies Average number of discharges per year

26. + Video Case Study Peanut Allergy Causes Parental Outrage

27. + SUMMARY Food allergy is “an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food” (Boyce et al., 2010, p. S8). Food allergies are common in U.S. and increased by 18% from 1997 to 2007 among children 18 years of age and younger (Branum, 2008). In the U.S., 90% of food allergies are caused by big 8 food allergens: eggs, milk, shellfish, wheat, peanuts, fish, soy, and tree nuts (Sicherer, 2010).