Food Allergies
Paediatric Dietetic Department 2014
Aims Of The Session
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Increase awareness of
 Common types of food allergy
 Symptoms of food allergy
 Practical considerations for
management of food allergy in schools
Food Allergy
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6-8% of children have a proven food allergy
Food allergies occur when the body’s immune
system perceives a food protein to be harmful &
acts against it
As a result of this action, chemicals are released
(e.g. histamine) and it is these chemicals which
cause symptoms
There is no cure for food allergy, complete and strict
avoidance of the food is the only way to prevent a
reaction
NICE guidelines, 2011
www.bda.uk.com/foodfacts/allergy
Types of Reaction
IgE
Non-IgE
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Quick ‘Acute’ onset
Anaphylaxis
Well-defined mechanism
Fairly easy to diagnose
Validated tests
-Specific serum IgE assays
-Skin Prick Tests
-+/- supervised Challenges
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Mild to moderate
‘Delayed’ onset
Mechanisms unclear
Harder to diagnose
No validated tests
- Elimination diet with planned
challenge
NICE Guidelines 2011
Possible Food Allergy Symptoms
IgE mediated
Symptoms
Non IgE mediated
symptoms
The skin
Acute Pruritus
Pruritis
Erythema
Erythema
Acute angioedema (most
commonly in the lips and face,
and around the eyes)
Significant atopic eczema
Urticaria
Possible Food Allergy Symptoms
IgE mediated
symptoms
Non-IgE mediated
symptoms
Gastrointestinal system
Colicky abdominal pain
Abdominal discomfort
Vomiting
Gastro-oesophageal reflux disease
Diarrhoea
Loose or frequent stools,
constipation, blood or mucus in
stools
Food refusal or aversion
Perianal redness
Faltering growth
Possible Food Allergy Symptoms
IgE mediated Symptoms
Respiratory System (usually in combination with one
or more of the previous symptoms and signs)
Upper respiratory tract symptoms (nasal itching,
sneezing, rhinorrhoea or congestion [with or without
conjunctivitis])
Lower respiratory tract symptoms (cough, chest tightness, wheezing or
shortness of breath)
Life Threatening Anaphylaxis
Symptoms
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All of the symptoms of IgE mediated reaction
Difficulty breathing
Swelling around tongue / throat
Redness of skin
Collapse
→Adrenaline auto injector
Note, not all children with a food allergy will
experience anaphylactic symptoms
Which foods are involved?
For children the most common food allergies are:
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Cows milk Protein
Eggs
Peanuts
Tree nuts
Fish
Shellfish
Cow’s Milk
Allergy (CMA)
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Occurs when the body’s immune system
reacts to proteins found in milk
Up to 7% of children have a CMA and
usually presents in infancy
Most children will outgrow it (average age 5
years for IgE mediated and majority by age
3 years for uncomplicated non-IgE mediated
allergy)
BMJ 2013;347:f5424
Cows Milk Containing Foods:
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Cows milk
Butter
Yoghurt
Cheese
Margarine
Ice cream
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Cream
Milk powder
Breads containing
milk such as pancake,
wheaten, soda
Cakes, buns, biscuits,
chocolate
Processed foods
Egg Allergy
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Egg allergy can be:
– - mild i.e. can tolerate well cooked egg
- severe i.e. can’t tolerate any form of egg
~50% of children with egg allergy can eat well
cooked egg e.g. cakes and biscuits
Children who are allergic to loosely cooked or raw
egg, the reactions are often severe
~50% of children grow out of an egg allergy in
about the first 5-7 years of life, but in the rest it is
likely to persist
www.anaphylaxis.org.uk
WELL COOKED EGG
LOOSELY COOKED
EGG
RAW EGG
Cakes, biscuits
Meringues
Fresh mousse
Dried egg pasta
Lemon curd
Fresh Mayonnaise
Prepared meat dishes
and sausages containing
egg
Scrambled, boiled,
poached or fried egg
Some ice-creams,
(especially fresh and
deluxe types) and sorbets
Egg glaze on pastry
Quiche
Royal Icing
Gravy granules (if they
contain egg)
Omelette
Horseradish, tartar sauce
Pancakes and scotch
pancakes (shop bought)
Egg custard
Some cheeses
Egg in batter
Raw egg in cake mix
Breadcrumbs
Inside a Cadbury's cream
egg
Homemade pancakes
Nut Allergy
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Unlike milk or egg allergies, children are unlikely to
grow out of a nut allergy (about 1 in 5 will grow out
of it)
Most first allergic reactions take place when child
is between 14 months and 2 years old
The nut allergy may become less severe with age,
but in 20%, it can become worse with time
www.allergyuk.org/peanut-and-tree-nutallergy
Peanuts
PEANUTS
Arachis hypogaea
Groundnuts
Beer nuts
Goober nut/pea
Cacahuete
Mandelonas
Chinese nuts
Monkey nuts
Earthnuts
Tree Nuts
TREE NUTS
Almond
Macadamia
Brazil
Pecan
Cashew
Pistachio
Hazelnut
Walnut
Food Labelling
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Children with a nut allergy are advised to
avoid all nuts including foods which:
– -‘may contain traces of nuts’ or
– -‘made in a factory which handles nuts’
– unless individual medical/dietetic advice has
been given to family
Food Labelling
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Current allergen labelling rules will be
changing on 13 December 2014.
Many businesses are already starting to
make changes to how they label allergens
on their products.
Under the new rules, allergens will be
emphasised on the label.
Other Considerations
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Trips - careful forward planning
Cookery - check ingredients and provide
alternatives if necessary
Treat days - supply any special snacks or
"birthday treats" in a labelled tin
No sharing snacks – remind children each
to eat their own snack
Other Considerations
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School meals & Packed lunch – ‘free-from’
status (e.g. milk, eggs and nuts)
Activities e.g. arts and crafts - glues,
paints, and old food cartons that may
include food allergens
Cross contamination – take extra care with
hand washing especially after lunch/snacks
Pets – bird seed, other pet foods
Food Allergy Resources
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www.food.gov.uk/allergy
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Allergy UK www.foodallergyuk.org
The Anaphylaxis Campaign www.anaphylaxis.org.uk
The British Dietetic Association www.bda.uk.com
National Institute of Clinical Excellence, 2011
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Thank you for listening!
Any questions?