Slide 1. Slide 2. Slide 3. Managing Food Allergies in Infants and Children. Objectives. Definitions. Laurie Slavin, MS, RD, LDN

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1 Slide 1 Managing Food Allergies in Infants and Children Laurie Slavin, MS, RD, LDN Slide 2 Objectives Define food allergy vs food intolerance. Discuss prevalence and contributing factors. Describe methods for diagnosing food allergies. Describe common symptoms of food allergies. Identify top eight food allergens. Discuss nutritional management of food allergies. Describe label reading for allergen identification. Discuss specialty formulas available. Discuss frequently associated conditions; celiac disease and lactose intolerance. Slide 3 Definitions Food allergy an adverse immune response that occurs reproducibly on exposure to a given food and is distinguished from other adverse reactions, such as food intolerance, pharmacological reactions, and toxin mediated reactions Immunological hypersensitivity another term for food allergy Food intolerance nonimmunological response after an ingested food

2 Slide 4 What are the facts and stats? Prevalence of food allergies and associated anaphylaxis appears on the rise. Cow s milk allergy estimated to affect 3.5% of infants and children. Food-specific IgE response identified in 3.9% of children in the United States.. Each year anaphylaxis caused by food has resulted in deaths. Eight foods account for 90% of all food allergic reactions. There is no cure for food allergies other than strict avoidance of the allergen. Slide 5 Diagnosing Food Allergies Skin Prick testing RAST testing Atopy Patch testing Elimination diet Cytotoxic testing Antigen Leukocyte Cellular Antibody Test (ALCAT) Applied Kinesiology testing The Vega test Slide 6 Possible Factors Affecting Prevalence Maternal Age Breastfeeding and delayed introduction of solids Maternal diet during pregnancy and lactation Exclusive breastfeeding Specialty formula use in infants Probiotics

3 Slide 7 Symptoms of a Food Allergy a tingling sensation in the mouth swelling of the tongue and the throat difficulty breathing hives, eczema vomiting, abdominal cramps, diarrhea drop in blood pressure, loss of consciousness, and even death symptoms typically appear within minutes to two hours after the person has eaten the food to which he or she is allergic Slide 8 Top 8 Food Allergens Milk Soy Egg Wheat Peanut Tree Nut Fish Shellfish Slide 9 Cow Milk Allergy Cow s milk allergy most common allergy diagnosed in infancy % of children will outgrow cow s milk allergy by age different proteins in milk that could induce a reaction. Cow s milk allergy is not lactose intolerance.

4 Slide 10 Symptoms Skin eczema, hives and swelling Gastrointestinal abdominal bloating, pain, gas, diarrhea, constipation, nausea, vomiting and occasional blood in stool Upper respiratory tract and asthma may worsen Inability to fall asleep, restless and disturbed sleep being investigated as possible symptoms Can cause anaphylaxis Slide 11 Label reading for a milk free diet Artificial butter flavor Butter (all types) Buttermilk Casein (all forms) Caseinates Cheese Cream Cottage cheese Curds Custard Ghee Half & half Lactalbumin (all forms) Lactoferrin Lactulose Milk (all forms) Nougat Pudding Sour cream Whey (all forms) Yogurt Slide 12 May contain milk protein Caramel and caramel flavoring Chocolate High protein flour Lactic acid starter culture Lactose Luncheon meat, hot dogs, sausages Margarine Non-dairy products

5 Slide 13 Concerns Adequate calcium in the diet Cross reaction with soy is common 40% chance Rice milk is common substitute (calcium fortified) Assess diet for adequate protein and micronutrients Slide 14 Soy Allergy Soybeans are legumes it is unnecessary to avoid all legumes with a soy allergy Symptoms of a soy allergy are similar to those for cow s milk allergy Anaphylaxis from soy is extremely rare Soy allergy is commonly outgrown Slide 15 Label reading for a soy free diet Tofu (all forms) Miso Okara (soy pulp) Sobee Supro Tamari Tempeh Yuba Soy milk Soy beverage Soy nuts Soy sauce Soy sprouts Soybean Soy flour Soy grits Soy albumin Soy protein Soy lecithin Texturized vegetable protein

6 Slide 16 May contain soy protein Emulsifiers Stabilizers Sprouts Hydrolyzed plant protein Hydrolyzed vegetable protein MSG Unspecified vegetable products, such as broths, gums, paste, protein, shortening or starch Slide 17 Concerns Nutrient deficiency is generally a concern with the elimination of soy Slide 18 Egg Allergy Egg allergy typically develops before age 2 and disappears by age 6. High risk of anaphylactic reaction in children under the age of 7. Many different types of protein in eggs. Cooking can denature some of these proteins so cooked eggs may be tolerated despite egg allergy diagnosis. Symptoms similar to milk allergy.

7 Slide 19 Label reading for an egg free diet Albumin Ovalbumin Globulin Ovomucin Ovomucoid Livetin Lysozyme Mayonnaise Simpless Egg (powder, white, yolk protein) Eggs of all bird species Frozen eggs Pasteurized eggs Egg Beaters Slide 20 Nonfood items that may contain egg Photographic film Printed natural fabrics Some fur garments Pet foods Some vaccines (MMR, Influenza vaccine, Yellow fever vaccine) Slide 21 Concerns Nutrients supplied by egg can easily be obtained in meat, fish and poultry products, legumes, whole grains and vegetables.

8 Slide 22 Wheat allergy Wheat is most common grain causing allergic reactions. Frequent wheat allergy symptoms are abdominal pain and loose stools occurring hours after eating wheat. Wheat allergy may also exacerbate asthma and eczema when undiagnosed. Anaphylaxis from wheat has been reported but is a very rare occurrence. Wheat allergy does not imply allergy to other grains. Slide 23 Label reading for a wheat free diet Bread (all types unless noted wheat free) Bran Bulgur Gluten High gluten flour High protein flour Graham flour Graham crackers Crackers (all types unless noted wheat free Cracker meal Durum Flour (all types unless noted wheat free Seitan Semolina Spelt Triticale Kamut Couscous Anything with wheat in the name Slide 24 May contain wheat Gelatinized starch HVP HPP Malt Starch and modified starch unless origin noted Vegetable gum Vegetable starch Soy sauce Postum Granola Granola bar Grain coffee substitute

9 Slide 25 Concerns Alternative choices to replace wheat include oats, rice, rye, barley, buckwheat, corn, amaranth and quinoa. Consider rice cakes and corn tortillas as a substitute for bread. Gluten free products will always meet the wheat free criteria. Slide 26 Peanut allergy Peanut allergy is the most frequently cited cause of anaphylaxis in children and young adults. Children are usually diagnosed with peanut allergy between 14 and 24 months. May not need to ingest peanut to have reaction; contact with skin may be enough. Children allergic to peanuts should avoid all nuts due to risk of identity confusion. 21% chance of outgrowing a peanut allergy Slide 27 Symptoms of peanut allergy Skin (hives, reddening, tissue swelling, especially the face) Respiratory tract (wheezing, noisy breathing, coughing, nasal congestion, throat tightening, asthma reaction) GI tract (vomiting, diarrhea, abdominal pain) Cardiovascular system (drop in blood pressure, irregular heart beat, anaphylaxis

10 Slide 28 Reading food labels for peanut free Peanut protein Hydrolyzed peanut protein Peanut oil Cold pressed peanut oil Peanut butter Peanut flour Mandalona nuts Artificial nuts Nu-nuts Beer nuts Mixed nuts Goober nuts Goober peas Slide 29 May contain peanut Marzipan Prepared and dried soups Chili Egg rolls Chinese and Thai dishes Satay sauces Baked goods Candies Chocolate ice cream Vegetable oil Hydrogenated vegetable oil Vegetable shortening Slide 30 Concerns A diet free of peanuts poses no risk of nutritional deficiency

11 Slide 31 Tree nut allergy All nuts should be avoided with a tree nut allergy. Tree nut allergies are frequently associated with anaphylactic reaction. Estimated that 9% of children will outgrow a tree nut allergy. No associated nutritional deficiencies with avoidance of tree nuts. Slide 32 Symptoms of tree nut allergy Contact dermatitis Oral allergy syndrome Tingling of lips Itching of the mouth, ears and eyes Conjunctivitis Throat tightening Hives Swelling Anaphylaxis GI symptoms Slide 33 Label reading for tree nut free diet Nuts of all types Nut butters of all types Nut pastes Nut oils Nut meal

12 Slide 34 May contain tree nuts Artificial nuts Nougat Nutella Gianduja Candy Flavored ice cream Cheese balls and cheese spreads Dessert toppings Slide 35 Fish and shellfish allergy Usual recommendation is to avoid only the fish that one has been diagnosed allergic to unless the allergy is noted as severe. If there is a risk of anaphylaxis then advised to avoid all fish and shellfish. Slide 36 Anaphylaxis Anaphylaxis is a serious allergic reaction that is rapid in onset and may cause death. Common signs of anaphylaxis: Skin: flushing, itching or hives Airway: swelling of the throat, difficulty talking or breathing GI tract: nausea, vomiting or diarrhea Heart: low blood pressure, increased pulse rate, reduced ability to pump blood

13 Slide 37 Standard emergency treatment Administer the epi-pen Transfer to the hospital In some reactions, the symptoms go away only to occur again 2-3 hours later. This reaction is called the biphasic reaction. Slide 38 Nutritional Management Elimination Diet Rotation Diet Elemental Diet Slide 39 Specialty Formulas Hydrolyzed Formulas: Alimentum Nutramigen Pregestimil Elemental Formulas: Neocate/EO28 Splash Elecare Nutramigen AA

14 Slide 40 Food Label Reading Food Allergy and Consumer Protection Act All foods regulated by the FDA must be labeled in a specific way to identify the top 8 allergens. Slide 41 Assuring Nutritional Adequacy Inappropriate/inaccurate diagnosis can unnecessarily restrict an infant s or child s diet and affect growth and development. Children with multiple food allergies often require specialty products in order to meet their nutritional needs. Need to be award of additives in vitamins and supplements. Slide 42 Frequently Associated Conditions Celiac Disease Lactose Intolerance

15 Slide 43 Thank You!