Food Allergies. Food Allergy statistics: True Prevalence of Food Allergy
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1 Food Allergies
2 Food Allergies Food Allergy statistics: 11 million Americans, including adults 6% of US children 2% of adults have shellfish allergy True Prevalence of Food Allergy Patient/Parent Self Report = 12-14% Based upon History & Testing = 3%
3 Food Allergies Common food allergens: Cow s milk Egg white Soy Peanut Tree nuts Shellfish Fish Wheat
4 Natural History of Food Allergy Dependent on allergen - Most children outgrow milk, egg, soy & wheat allergy - Less common to outgrow peanut or tree nuts - Seafood allergies often develop in adults & persist Age - Food allergy that starts in adults is unlikely to resolve
5 Food Allergies Symptoms of an allergic reaction: Skin Gastrointestinal Respiratory Neurological
6 Anaphylaxis (or a severe allergic reaction) Skin: hives Gastrointestinal: vomiting diarrhea, abdominal pain Respiratory: wheezing, cough chest tightness throat tightening Neurological: anxiety sense of doom
7 Food Allergies Diagnosis: Medical history type of reaction can vary based on: Amount ingested Type of food Previous reactions Age of child timing treatment Physical exam
8 Food Allergies Treatment: Education, education, education Anaphylaxis Specific food avoidance/nutrition support Medications: injectable epinephrine Epi Pen Junior Auvi-Q Food allergy action plan Adjusting to daycare and/or school
9 Treatment of Reactions For reactions isolated to the skin Antihistamine (such as Benadryl, cetirizine or Zyrtec ) Close monitoring for additional symptoms For airway involvement, vomiting, or other symptoms of a severe reaction (anaphylaxis) Injectable epinephrine Delayed epi administration is a risk factor for death After epinephrine use, seek immediate care (911) Late phase reactions occur up to 20% of the time Important to have 2 epinephrine devices available At least 4 hrs of observation recommended in emergency department *Jarvinen, JACI 2008
10 Food Allergies Treatment (con t): Ongoing care by Primary Care Annual visits to allergy: Monitor growth, food exposures, reactions Education Repeat testing Evaluate for food challenge
11 Management in Schools* 25% of anaphylaxis occurs in schools in child without previous diagnosis Unassigned Epi should be considered Emergency action plans: Provider Parent School Health School Staff Antihistamines: adjunctive therapy not to treat anaphylaxis Epinephrine safe: when in doubt, inject. Medical alert ID (young children) *Clinical Report Management of Food Allergy in the School Setting, AAP 2010
12 Management in Schools* Peanut butter vapors protein Foods can be vaporized through heating respiratory symptoms Cleaning in classroom: soap/water; NOT antibacterial gels standard cleaning & lack of visible contamination should suffice Care not to ostracize/physically separate FA child *Clinical Report Management of Food Allergy in the School Setting, AAP 2010
13 Management in Schools* Reducing risk of accidental exposure: No food sharing Education of parents/staff (injectable epi use, when to call EMS) Plans for field trips Label-reading No eating on school bus Harassment/bullying *Clinical Report Management of Food Allergy in the School Setting, AAP 2010
14 Impact on Quality of Life Children & caregivers with significant anxiety due to risk 50% alter social activities & 10% homeschooled due to food allergy 1 60% food prep altered Children s self report of quality of life similar to Type I diabetes 2 1 Bollinger, Annals of Allergy Avery, Pediatric Allergy 2003
15 Food Allergies Additional Facts: Only 20% of fatal reactions had experienced a prior severe reaction* Patients ill prepared for reaction* < 20% have injectable epinephrine available < 20% pediatricians know how to administer epinephrine correctly* * Dr. Hugh Sampson, oral presentation, Wisconsin Allergy Society Meeting, October 2006
16 Online Resources Food Allergy & Anaphylaxis Network (FAAN) American Academy of Allergy Asthma & Immunology (AAAAI) Guidelines for the Diagnosis & Management of Food Allergy in the US: Report of the NIAID-Sponsored Expert Panel. Dec Clinical Report Management of Food Allergy in the School Setting. AAP. 2010
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