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

 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.

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Food is first encountered by the infant through mother’s breastmilk
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Contains molecules of food from her diet
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Tolerance is developed through the process of low-dose, continuous exposure that is optimal for the development of immunological tolerance .

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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.
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.

Histamine
Reaction
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2.
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

Eight foods account for
90% of all reactions
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Peanuts
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Tree nuts
Wheat
Soy
Milk
Eggs
Fish
Shellfish

“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 .

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Skin Prick Test
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Allergen-specific serum
IgE (sIgE)
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Atopy Patch Test
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Oral Food Challenges
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Food Elimination Diet

What the experts say . . . .
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Doubling of food allergy over the past
10 years, particularly peanut allergy .
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~15 million Americans affected
 1 in 13 children
 Onset at any age w ww.foodallergy.org

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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

Most severe allergic reaction
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40-50% of people diagnosed with food allergies are judged to have a high risk of anaphylaxis
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Involves multiple systems at the same time
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Potentially fatal, especially if medication is not given promptly – at first signs

(cont’d.)
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Can occur within minutes of exposure death can occur within as few as 6 minutes
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Peanut/Tree nut allergies in combination with asthma is the highest risk
– milk, egg, fish, and crustacean fish
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Pattern can vary among individuals

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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

What the experts say . . . .
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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 www.foodallergy.org
Bock, et. al J Allergy Clinical Immunol 2001

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

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Say . . . .
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
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Do . . . .
Put their hands in their mouths
Pull or scratch at their tongues
Drool
Hoarse cry or voice
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Slur words
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Become unusually clingy

What the experts say . . .
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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.
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Lack of evidence that delaying introduction of solids beyond 6 months of age (including highly allergenic foods) prevents the development of food allergies.

(cont’d)
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Protective role of breastfeeding in preventing food allergies needs further study
– Some evidence suggests that breastfeeding for at least
4 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 )

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
Elecare Infant/Elecare Jr
Extensively hydrolyzed casein (protein) Cow’s milk allergy
Hydrolyzed casein with free amino acids
100% free amino acids
Hypoallergenic
Hypoallergenic
EO28 Splash 100% free amino acids
Hypoallergenic, cow and soy milk allergy, multiple food protein intolerance
Neocate Infant/Neocate Junior 100% free amino acids
Pediasure Peptide 1.0/1.5
¹ Hydrolyzed whey – dominant protein
Hypoallergenic
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

January, 2013
Summary of
Recommendations
• Avoidance diets
• Breastfeeding
• Selection of infant formula
• Introduction of complementary foods http://www.jaci-inpractice.org/article/S2213-
2198(12)00014-1/fulltext#sec1.1

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– Cow’s milk, soy, eggs, wheat
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– Peanut, tree nuts, fish, and crustacean shellfish

Assist families with food allergies in making changes that improve quality of life and promote nutritional wellbeing while avoiding offending foods.

Based on the needs and interests of the WIC client:
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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.

(Cont’d)
Based on the needs and interests of the WIC client:
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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.

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Food allergen avoidance is the safest method
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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

The Food Allergen Labeling and Consumer
Protection Act (FALCA)

The Food Allergen Labeling and Consumer
Protection Act (FALCA)
Effective January 1, 2006
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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)”
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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

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
•
 A parenthetical statement in the list of ingredients
•
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● even in colors, flavors, or spice blends.
Additionally, manufacturers must list :
 specific nut : almond, walnut, cashew
 or seafood : tuna, salmon, shrimp, lobster

INGREDIENTS: ENRICHED FLOUR (WHEAT FLOUR, MALTED BARLEY FLOUR, NIACIN,
IRON, THIAMIN MONONITRATE, RIBOFLAVIN, FOLIC ACID), DEGERMED YELLOW
CORN MEAL, WHOLE WHEAT, VEGETABLE OIL (SOYBEAN, RIC BRAN AND/OR
CANOLA), ENRICHED FLOUR BLEACHED (WHEAT FLOUR, NIACIN,IRON,THIAMIN
MONONITRATE, RIBOFLAVIN, FOLIC ACID), PARTIALLY HYDOGENATED SOYBEAN
OIL, SUGAR, SALT, CONTAINS 2% OR LESS OF: MONOSODIUM GLUTAMATE,
MALTODEXTRIN, RYE FLOUR, YEAST, GARLIC POWDER, CORN SYRUP, SOLIDS,
HIGH FRUTOSE CORN SYRUP,MARGARINE(PARTIALLY HYDROGENATED SOYBEAN
OIL, SALT, MONO AND DIGLYCERIDES, SOY LECITHIN, WHEY, BETA CAROTENE,
VITAMIN A PALMITATE, NATURAL FLAVOR), MALT, BAKING SODA, BARLEY MALT
EXTRACT,CORN SYRUP,NATURAL AND ARTIFICIAL FLAVOR, MALT, SYRUP, SPICES,
SOY LECITHIN
CULTURED NONFAT MILK, SODIUM, DIACETATE, ONION POWDER, DISTILLED
MONOGLYCERIDES, MOLASSES, WHEAT STARCH, GARLIC, YELLOW CORN FLOUR,
COLOR ADDED, TRISODIUM PHOSPHATE, WHEY, CALCIUM CARBONATE,DISODIUM
GUANYLATE, DISODIUM INOSINATE, MONOCALCIUM PHOSPHATE, SODIUM ACID
PYROPHOPHATE, SOY SAUCE (WHEAT, SOYBEANS, SALT, MALTODEXTRIN,
CARAMEL COLOR), TAMARIND EXTRACT, SESAME SEED, ALMOND FOUR, PEANUT
FLOUR, FRESHNESS PERSERVED BY BHT

May also say…….
“manufactured in a facility that also processes peanuts”

www.fda.gov/
ForConsumers/ConsumerUpdates

How to read a label for:
Milk-Free Diet
Soy-Free Diet
Peanut-Free Diet www.foodallergy.org
faan@foodallergy.org

How to read a label for:
Wheat-Free Diet
Egg-Free Diet
Shellfish-Free Diet
Tree Nut-Free Diet www.foodallergy.org
faan@foodallergy.org

Pediatric Nutrition Care Manual

Pediatric Nutrition Care Manual

Pediatric Nutrition Care Manual

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
Janice Vickerstaff Joneja Ph.D, RD https://www.eatright.org/shop/product.aspx?id=6442472295