Food Allergies – What Are They?
Health, Safety & Nutrition Food Allergies © Metro Child Care Resource & Referral 2008 copyright
1
As You Begin This self‐study should take you about two hours to complete. Within this course you will read and react to the course content, as well as visit an array of websites that will further your knowledge of food allergies, allergens, symptoms, and how to care for a child with food allergies. The exploration of the additional information we provide is an important part of the course, one which allows you to decide how far you would like to pursue the topics presented. We are enthusiastic about ensuring your learning experience is inspiring and valuable. If you have any questions or comments regarding the study materials please do not hesitate to contact us at
[email protected] or call us at (503) 489 2599. We also encourage the use of our student‐to‐student discussion forum, as well as our student‐to‐instructor discussion forum. To access these forums please visit http://207.5.88.94/blog/forums/.
© Metro Child Care Resource & Referral 2008 copyright
2
How the Self‐Study Is Organized The first section of this self study presents the basic overview of food allergies. This segment discusses how food allergies affect the body, the symptoms they can cause, and how they are commonly treated. The second section of this study introduces the food allergy pyramid, and the most common eight allergen food groups. This segment also discusses awareness and prevention of food allergies. The third section of the study is designed as a guide to nutritional management, food substitutions, and how to maintain a successful, allergen free, nutrition program. This section will also cover the modes of preventing food allergy accidents while maintaining nutritional integrity within your child’s diet.
© Metro Child Care Resource & Referral 2008 copyright
3
Learning Outcomes for Sections 1 & 2 By studying these sections you should be able to: Explain the difference between food allergies and food intolerance Identify symptoms related to specific food allergy reactions Define an emergency treatment plan if necessary Choose food substitutions that are nutritionally sound Create a plan for safe food shopping
© Metro Child Care Resource & Referral 2008 copyright
4
Learning Outcomes for Section 3 By studying this section you should be able to: Develop an allergy free nutrition plan Explain to prospective clients how you identify food allergy symptoms, and how you create and maintain a safe, nutritional environment for children and families as endorsed by such organizations as US Department of Health and Human Services, the American Academy of Pediatrics, and the Asthma & Allergy Foundation of America. Decide which foods can be substituted in place of an allergen, and identify ways to promote healthy eating patterns in the diets of children with specific food allergies.
© Metro Child Care Resource & Referral 2008 copyright
5
Food Allergies – What Are They? Section One A food allergy is an immune system response to a food that the body mistakenly believes is harmful. Once the immune system decides that a particular food is harmful, it creates specific antibodies to it.
Thus, the next time the individual eats that food, the immune system releases massive amounts of chemicals, including histamine, in order to protect the body. The histamine creates an allergic reaction that can attack the respiratory system, gastrointestinal tract, skin, or cardiovascular system, as well as various other parts of the body. An estimated 150 Americans die each year from severe allergic reactions to food. It is critical for people who have food allergies to identify them, avoid those foods that cause allergic reactions, and understand the complexities of their allergy. © Metro Child Care Resource & Referral 2008 copyright
6
How Do Food Allergies Affect the Body? In food allergies, two parts of the immune response are involved. One is the inherited ability to produce an antibody called immunoglobulin E (IgE) that circulates in the blood. The other is the production of Mast cells in all body tissues, commonly with more strength in areas that are typical sites of allergic reactions. When Mast cells come in contact with a protein that it identifies as harmful to the body (an allergen) releases chemicals including histamines, which causes the allergic reaction. They typical sites of allergic reactions include, but are not limited to: the nose, lungs, skin, and gastrointestinal tract. Individuals most likely to develop food allergies generally have family backgrounds in which allergies such as hay fever, asthma, or eczema are common.
© Metro Child Care Resource & Referral 2008 copyright
7
How Does It Affect the Body? It is important to know the difference between food allergies and food intolerances. A food intolerance is a metabolic disorder that does not involve the immune system. A food allergy is an immune system reaction to foods the body identifies as dangerous. People with food intolerances will not develop a rash, shortness of breath, or other symptoms associated with allergies. An intolerance to specific foods can be identified by gas, indigestion, bloating, diarrhea, and cramping, often present shortly after eating a particular food (such as dairy or wheat). Lactose intolerance is the most common food intolerance in the United States, affecting as many as 30% of adult Americans.
© Metro Child Care Resource & Referral 2008 copyright
8
Symptoms and Treatments The symptoms of food allergies are varied, as is the seriousness of the reaction. If the mast cells release their chemicals in the nose and throat, the reaction may be an itching tongue and mouth, a swelling of the tissue in the area, trouble breathing or swallowing, and the possibility of anaphylaxis. Anaphylaxis is a sudden, severe, potentially fatal, systemic allergic reaction that can involve various areas of the body such as the skin, respiratory tract, gastrointestinal tract, and cardiovascular system. Anaphylactic shock is the most severe type of anaphylaxis, and can lead to death in a matter of minutes if not treated immediately.
© Metro Child Care Resource & Referral 2008 copyright
9
Symptoms and Treatments About 30 out of 100,000 people suffer with anaphylaxis reactions, and individuals with asthma, eczema, or hay fever are at greater risk for experiencing anaphylaxis. Those with the known risk of more severe reactions treat their symptoms with Epinephrine, which is an adrenaline treatment. Children with food allergies that will cause anaphylaxis are generally prescribed an EPIPENJR® or Twinject®, which is a single dosage of Epinephrine that must be administered as soon as an anaphylactic reaction begins.
Visit the site below http://www.ccdsmetro.org/PDF%20Files/Food%20A llerty%20link%203anaphylaxis.pdf © Metro Child Care Resource & Referral 2008 copyright AND consult with your child's pediatrician.
10
Food Allergy Facts & Statistics Food Allergy is a growing public health concern in the U.S. There is no cure for food allergies.
Food Allergies and Food Intolerance is NOT the same thing.
Eight foods account for 90% of all food‐allergic reactions in the U.S. (e.g., milk, eggs, peanuts, tree nuts, wheat, soy, fish and shellfish
Peanut allergy doubled in children over a five‐ year period (1997‐2002)
Over 12 Million Americans have food allergies (3 Million of which are children)
Strict avoidance of food allergens and early recognition & management help prevent serious health consequences
Research suggests that food‐related anaphylaxis might be under diagnosed
A 2007 study has shown that milk allergy may persist longer in life than previously thought
Early administration of epinephrine is crucial to successful treatment of anaphylactic reactions
© Metro Child Care Resource & Referral 2008 copyright
11
Practical Application & Reflection Take some time before moving on to the next section to: Think about the specific foods in your child’s diet. Is there one specific item that might be a problem? NOTES: Visit the Food Allergy facts & statistics chart on page 11 of this course. Locate the box that tells you what percent of which food groups make up food allergies. Analyze your food purchasing, consumption, and reactions to those foods. Note any habits that need to change. Perhaps you’ll want to print out the chart to save as a reference. NOTES: Reflect on your trips to the grocery store and decide on one or more food safety related improvements you can make.
© Metro Child Care Resource & Referral 2008 copyright
12
Food Allergy Pyramid Section Two
© Metro Child Care Resource & Referral 2008 copyright
13
Food Allergy Pyramid Section Two If you believe your child is sensitive to cow’s milk it is best to avoid all sources of it, including Whey and Casein. Read all food labels, and for helpful tips visit: http://www.foodallergies.about.com/od/signsandsymptoms/Reading_Labels.htm
Know the hidden sources. Grains & Nuts are difficult to detect, so know how to find the ingredients hiding in your child’s diet. Nightshades include, but are not limited to: cayenne, eggplant, tobacco, peppers, paprika, tomatoes and potatoes. for complete signs, symptoms, and treatments available visit: http://www.webmd.com/allergies/foods‐allergy‐intolerance
© Metro Child Care Resource & Referral 2008 copyright
14
Milk & Dairy Allergies Many people find that they are sensitive to dairy products, experiencing a host of symptoms including gas, diarrhea, skin rashes, and fatigue when they consume milk and other dairy products. Yet it may be difficult to determine that these reactions are caused by the consumption of dairy, because adverse reactions may occur hours or even days after the consumption of dairy. If there is an adverse reaction that is believed to be caused by dairy, a safe way to check if that is the allergen is to eliminate dairy from the diet. It is important to note, however, that consideration must be given to the nutritional balance of this new diet. This topic will be covered in more detail © Metro Child Care Resource & in the coming section. Referral 2008 copyright
15
Milk & Dairy Allergies Infants’ immune systems are not fully developed and the early introduction of foods like formulas or milk can cause serious problems because the infant's system is incapable of handling the molecules in the food that are toxic to his or her body. Cow’s milk is the most common cause of food allergy in infants and young children. However, 90% of infants allergic to milk and 50 % those allergic to eggs outgrow their clinical reactivity by the age of three. Therefore, diagnosis should be re‐evaluated yearly. NOTE: Breastfeeding is always the best nutritional choice when possible. © Metro Child Care Resource & Referral 2008 copyright
16
Egg Allergy & Flu Shots Egg allergies are most often seen in children and usually disappear by the time the child reaches the age of five. The symptoms of an egg allergy can cause sickness within minutes of consumption, or up to several hours after the fact. The allergic reaction will usually consist of the skin breaking out into a rash, hives, vomiting, cramps, nausea or swollen nasal passages. Visit http://foodallergies.about.com for more information. Influenza Vaccine and Egg Allergies In 2008, the Advisory Committee on Immunization Practices (http://www.ccdsmetro.org/PDF%20Files/Food%20Allerty%20link% 20one%20egg%20n%20flu.pdf ) recommended that all
children get flu shots except infants younger than 6 months and those with serious egg allergies. © Metro Child Care Resource & Referral 2008 copyright
17
Nut Allergies Individuals with nut allergies generally are allergic to all types of nuts, including tree nuts such as cashews, walnuts, pecans, almonds, chestnuts, pistachios, hazelnuts, beechnuts, pine nuts, hickory and gingko nuts. Peanuts are oftentimes an allergen to those with nut allergies, even though they are technically a legume‐not a nut. Symptoms of an allergic reaction to nuts include swelling, hives, wheezing, a runny nose, gastro‐ intestinal problems and trouble breathing, and possibly anaphylaxis. For more information please visit: http://www.common‐food‐allergies.net
© Metro Child Care Resource & Referral 2008 copyright
18
Wheat Allergy The FDA requires food manufacturers clearly label the presence of wheat in all products containing it. For those with wheat allergies it is important to be aware of the wide range of foods wheat is used in. Foods that are especially likely to contain wheat: All baked goods (including bread and pizza crusts), unless prepared with wheat‐free flours Pasta, whether egg‐free or not, unless made with wheat‐free flour Some baking powders Most batter‐fried foods Flour‐thickened sauces, casseroles, and gravies Canned soup and chili Cereal (both hot and cold) Salad dressings, barbecue sauce, soy sauce and other condiments Beer © Metro Child Care Resource & Candy (especially with nougat) Referral 2008 copyright Sausage, meatloaf, and other dishes where breadcrumbs are used as a filler
19
Fish & Shellfish Pollock, salmon, cod, tuna, snapper, eel, and tilapia are among the fish that commonly trigger a fish allergy. There is high allergic cross‐reactivity among different types of fish, meaning that people with allergies to one type of fish are likely to have (or develop) allergies to others, because of the protein par albumin that is present in many fish. Reactions to fish allergies are usually very serious and include: swelling of the face/throat, dizziness, difficulty thinking, intense sense of fear, tightness of the chest, and vomiting or diarrhea, and possibly anaphylaxis.
© Metro Child Care Resource & Referral 2008 copyright
20
Soy Allergy Soy allergies are most common in infants. The average age at which the allergy manifests is 3 months old but the majority outgrow it by the age of two. There are many allergic reactions to soy. They may include acne, eczema,swelling, itching, nasal congestion, shortness of breath, asthma, canker sores, blisters, hives, weakness, nausea, or diarrhea. For helpful links visit: http://www.webmd.com/allergies/guide/soy‐allergy
© Metro Child Care Resource & Referral 2008 copyright
21
Soy Allergy Soy, like wheat, is extremely commonly occurring, in a vast array of foods. Some of the foods that contain soy are: miso, soy sauce, Worcestershire sauce, tamari, tempeh, vegetable broth, some cereals, some infant formulas, baked goods, and all soy milks/soy cheeses/soy dairy substitutes.
© Metro Child Care Resource & Referral 2008 copyright
22
Cross‐Contact Information Care must be taken in the kitchen to avoid contact between ingredients that are allergens, and those that are not. Crosscontact can occur in a number of ways, such as cutting an allergen on a cutting board with a non allergen. Be sure to wash your hands, utensils, and all food preparation areas with a mild cleaning solution as to avoid any contact with suspect foods.
© Metro Child Care Resource & Referral 2008 copyright
23
When Can Children Be Allergy Tested? Allergy testing can be done at almost any age. Age is not a barrier to skin testing; positive results can be obtained at any age, however, it is believed that skin testing is not as accurate in children under age 12 months. Blood allergy tests (RAST, CAP‐RAST, ImmunoCap) can also be done in younger children, but they require a large blood sample. If you want to have your small child blood tested it is best to confer with your doctor about what possible allergies you are most concerned about.
Not all children need allergy testing. You might try keeping a food journal & a simple avoidance of common things that trigger allergies at first. Always check with your pediatrician before changing your child's diet. © Metro Child Care Resource & Referral 2008 copyright
24
Can Food Allergies Be Prevented? Breastfeeding exclusively for the first six months of your baby’s life, and continued breastfeeding until your child is at least 12 months old greatly reduces the chances of food allergies. Avoiding peanuts and tree nuts (e.g., walnuts, almonds, cashews, pistachios, and pecans) while breastfeeding also reduces the risk of food allergies in your child. If solid foods are not introduced to infants until they are at least six months old, and at that point only rice cereal is introduced, the risk is again lower. © Metro Child Care Resource & Referral 2008 copyright
25
Can Food Allergies Be Prevented? Avoid feeding milk and dairy products until your child is 12 months old. Avoid introducing eggs until he/she is 2‐ years old. Read ALL product labels. Avoid peanuts, tree nuts, and fish until he/she is 3‐years old. Label clothing or other items belonging to the child with a food allergy. © Metro Child Care Resource & Referral 2008 copyright
26
Practical Application & Reflection Take some time before moving on to the next section to: Visit the link http://www.ccdsmetro.org/PDF%20Files/Food%20Allergies%20ana%20e mergency%20plan.pdf and study the “anaphylaxis emergency action plan”.
Choose one item from the emergency action plan and determine how you might implement this policy. Explain why you feel the way you do. Reflect on whether you want to share or implement this practice, or share the information with others. Feel free to modify or disregarded what does not fit your needs, or is not applicable. © Metro Child Care Resource & Referral 2008 copyright
27
Nutritional Management Section Three As mentioned previously, elimination diets should be undertaken with caution, especially if a significant number of foods or food groups are avoided, because of the chance of inadequate caloric intake and failure to thrive. With these issues in mind, it is important to identify exactly which foods need to be eliminated and to consider nutritional issues of a diet composed of the allowed foods over the long term. The nutritional management of food allergies in infants and children requires education about dietary avoidance and consideration for nutritional deficiencies that may result. The pediatrician plays a central role in identifying children with food allergy and for continued monitoring of food‐allergic patients for © Metro Child Care Resource & growth and development. Referral 2008 copyright
28
Nutritional Food Substitutes Milk and Dairy
Soy, rice, oat, almond milk Lactose‐free milk Soy cheese and yogurts Water and/or 100% fruit juice in recipes Soy based sour cream Goat or sheep milk based products
Egg (substitutes for baking)
1 tsp. baking powder, 1 T. liquid, 1 T. vinegar 1 tsp. yeast dissolved in 1/4 cup warm water 1 1/2 T. water, 1 1/2 T. oil, 1 tsp. baking powder 1 packet gelatin, 2 T. warm water. Do not mix until ready to use. Flat pastas are usually egg free (ALWAYS READ LABELS FIRST) © Metro Child Care Resource & Referral 2008 copyright
29
Nutritional Food Substitutes Peanuts and/or Tree Nuts Almonds, cashews or tahini (if not allergic to tree nuts) Peanut butter (is usually ok if you’re allergic to tree nuts as they are legumes) http://www.peanutfreeplanet.com for additional sources
Wheat Corn, arrowroot, tapioca, and potato flours Corn starch is good for thickening soups, sauces, and gravies White or brown rice flour Corn flour Corn meal Amaranth, quinoa, sorghum, teff, and buckwheat flour © Metro Child Care Resource & Referral 2008 copyright 30 Rice or oatmeal infant cereals
Nutritional Food Substitutes Fish and/or shellfish Flaxseed oil mixed with yogurt or cereal
Soy You will need to read the labels on all processed foods, as soy is found in almost all foods that have been processed. Any dairy product Tamari sauce Goat or Sheep milk products Seitan products
© Metro Child Care Resource & Referral 2008 copyright
31
Reflection Take some time before moving on to the next section to: Think about your next grocery shopping trip and the types of “high risk” foods that you will be purchasing Choose one item from the emergency action plan online and determine how you might implement this policy. Explain why you feel the way you do. Reflect on whether you want to share this practice or wisdom with others, want to see it modified or disregarded. You can also share your thoughts with others by posting on our weblog. You’ll find the link on your self study account login page.
© Metro Child Care Resource & Referral 2008 copyright
32
Links Centers for Disease Control: http://www.cdc.gov/HealthyYouth/foodallergies/ http://pediatrics.aappublications.org/cgi/content/full/111/6/S2/1645#SEC4
Recipes: www.southernmamas.com l www.kidswithfoodallergies.org/recipes.html http://www.eatingwithfoodallergies.com/ http://foodallergies.about.com/od/livingwithfoodallergies/tp/foodsubstitue s.htm
American College of Allergy, Asthma & Immunology
© Metro Child Care Resource & Referral 2008 copyright
33
Glossary
Allergen – A food or beverage that creates an immune response and sets symptoms in motion. Anaphylaxis – A serious allergic reaction that is rapid in onset and may cause death Cross Contact – Allowing utensils, dishes or food preparation materials to touch a known allergen or a surface in which a allergen was present Epinephrine – Prescription adrenaline, injected once allergic reactions occur. © Metro Child Care Resource & Referral 2008 copyright
34
Glossary Histamine – Protein molecule created in blood when a person ingests an allergen. Food Allergy – Occurs when the body's immune system mistakenly attacks a food protein. Food Intolerance – A metabolic disorder; it doesn’t involve the immune system. Food
Substitution – The substitution of a food or beverage that is known to cause allergic reaction for another food that does NOT. (i.e., Rice milk © Metro Child Care Resource & Referral 2008 copyright 35 substituted for Cow’s milk)
References Ulene, Art. (1998). How to Outsmart Your Allergies. California; HealthPOINTS. http://www.kidshealth.org/kid/health_problems/index.html http://www.webmd.com/allergies/guide/ http://www.foodallergy.org/ http://www.allergy.mcg.edu http://www.aaaai.org http://www.healthsystem.virginia.edu/UVAHealth/peds_allergy/ http://foodallergies.about.com http://www.babyandkidallergies.com
© Metro Child Care Resource & Referral 2008 copyright
36
