Weekly outline

  • Section 1. Course Objectives

    Welcome – To proceed though the course use the Navigation bar on the left. Click on  “Section 1” to start. 

    Introduction

    According to the U.S. Food and Drug Administration each year Food Allergy Categories millions of Americans have allergic reactions to food. Although most food allergies cause relatively mild and minor symptoms, some food allergies can cause severe reactions, and may even be life-threatening.

    There is no cure for food allergies. Strict avoidance of food allergens and early recognition and management of allergic reactions to food are important measures to prevent serious health consequences.

    The dietitian plays a critical role in empowering those under their care to manage food allergy and may play an integral role in supporting the physician in the diagnostic process. The Dietitian serves as a coach and a guide to the client offering support with change and helping to bridge the gap between old habits and foods into different habits and foods that help support the client with where they are in their health and life at the time.

    Course Objectives

    After completing this course, nutrition professionals should be able to:

    1. Identify the two categories of food allergy immune system changes
    2. Distinguish food allergy from adverse food reactions
    3. Identify the main food allergens and their prevalence
    4. Understand food allergy symptoms, diagnosis, and testing
    5. Explain the Food Allergen Labeling and Consumer Protection Act (FALCPA)
    6. Discuss the identification and avoidance of the most common food allergies
    7. Identify the treatment for Anaphylaxis

     

    Course Completion Requirements

    To complete this course you must read the course content and successfully complete the Mastery Test in Section 9.

  • Section 2. Food Allergy Categories

    Section Summary

    The following topics are included in this section:

    • Food allergy categories
    • Food allergy and food intolerance differences

      

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    Food Allergy Categories

    The National Institute of Health reports that a food allergy is an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food.  Food allergens are the parts of food or ingredients within food (usually proteins) that are recognized by immune cells. When an immune cell binds to a food allergen, a reaction occurs that causes the symptoms of food allergy.1

    Most food allergens cause reactions even after they have been cooked or digested. Some allergens, most often from fruits and vegetables, cause allergic reactions only when eaten raw. Food oils, such as soy, corn, peanut, and sesame, may or may not be allergenic (causing allergy), depending on how they are processed. “Allergy” and “allergic disease” refer to conditions that involve changes to your immune system. These immune system changes fall into two categories:

    1. Immunoglobulin E (IgE) mediated - the symptoms are the result of interaction between the allergen and a type of antibody known as IgE, which is thought to play a major role in allergic reactions

    2. Non-IgE-mediated - the symptoms are the result of interaction of the allergen with the immune system, but the interaction does not involve an IgE antibody

    If a person is sensitized to a food allergen, it means that their body has made a specific IgE (sIgE) antibody to that food allergen, but they may or may not have symptoms of food allergy.

    If a person can consistently tolerate a food that once caused them to have an allergic reaction, they have outgrown the food allergy.2

    Food Allergy and Food Intolerance Differences

    Food allergy is sometimes confused with food intolerance. Food intolerances are adverse health effects caused by foods. They do not involve the immune system. For example, if a person is lactose intolerant, they are missing the enzyme that breaks down lactose, a sugar found in milk.3

    Lactose Intolerance

    Lactose is a sugar found in milk and most milk products. Lactose is an enzyme in the lining of the gut that breaks down or digests lactose. Lactose intolerance occurs when lactase is missing. Instead of the enzyme breaking down the sugar, bacteria in the gut break it down, which forms gas, which in turn causes symptoms of bloating, abdominal pain, and sometimes diarrhea.

    Lactose intolerance is uncommon in babies and young children under the age of 5 years. Because lactase levels decline as people get older, lactose intolerance becomes more common with age. Lactose intolerance also varies widely based on racial and ethnic background.

    A healthcare professional can use laboratory tests to find out whether the person’s body can digest lactose.

    Food Additives

    Another type of food intolerance is a reaction to certain products that are added to food to enhance taste, add color, or protect against the growth of microbes. Compounds such as monosodium glutamate (MSG) and sulfites are tied to reactions that can be confused with food allergy.

    MSG is a flavor enhancer. When taken in large amounts, it can cause some of the following:

    • Flushing
    • Sensations of warmth
    • Headache
    • Chest discomfort

    These passing reactions occur rapidly after eating large amounts of food to which MSG has been added. Sulfites are found in food for several reasons:

    • They have been added to increase crispness or prevent mold growth.
    • They occur naturally in the food.
    • They have been generated during the winemaking process.
    • Sulfites can cause breathing problems in people with asthma.

    The FDA has banned sulfites as spray-on preservatives for fresh fruits and vegetables. When sulfites are present in foods, they are listed on ingredient labels.

    Gluten Intolerance

    Gluten is a part of wheat, barley, and rye. Gluten intolerance is associated with celiac disease, also called gluten-sensitive enteropathy. This disease develops when the immune system responds abnormally to gluten. This abnormal response does not involve IgE antibody and is not considered a food allergy.

    Food Poisoning

    Some of the symptoms of food allergy, such as abdominal cramping, are common to food poisoning. However, food poisoning is caused by microbes, such as bacteria, and bacterial products, such as toxins, that can contaminate meats and dairy products.

    Histamine Toxicity

    Fish, such as tuna and mackerel that are not refrigerated properly and become contaminated by bacteria, may contain very high levels of histamine. A person who eats such fish may show symptoms that are similar to food allergy. However, this reaction is not a true allergic reaction. Instead, the reaction is called histamine toxicity or scombroid food poisoning.

    Other Conditions

    Several other conditions, such as ulcers and cancers of the gastrointestinal (GI) tract, cause some of the same symptoms as food allergy. These symptoms, which include vomiting, diarrhea, and cramping abdominal pain, become worse when you eat.

     

  • Section 3. Prevalence of Food Allergies

    Section Summary

    The following topics are included in this section:

    • Food allergies prevalence
    • Common food allergies in infants, children, and adults
    • Food allergies among children
    • Food allergy within families

     

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    Food Allergies Prevalence

    According to the U.S. Centers for Disease Control and Prevention, food allergies affect about two per­cent of adults and four to six per­cent of children in the United States, and the number of young people with food allergies has increased over the last decade, according to a recent report by the Centers for Dis­ease Control and Prevention (CDC). Children with food allergies are more likely to have asthma, eczema, and other types of allergies.4

    Food allergies can range from merely irritating to life-threatening. Approximately 30,000 Americans go to the emergency room each year to get treated for severe food allergies, according to the U.S. Food and Drug Administration. It is estimated that 150 to 200 Americans die each year because of allergic reactions to food.5

    Researchers are trying to discover why food allergies are on the rise in developed countries worldwide, and to learn more about the impact of the disease in developing nations. More than 17 million Europeans have a food allergy, and hospital admissions for severe reactions in children have risen seven-fold over the past decade, according to the European Academy of Allergy and Clinical Immunology (EAACI).6

    Common Food Allergies in Infants, Children, and Adults

    The National Institute of Allergy and Infectious Diseases found that in infants and children, the most common foods that cause allergic reactions are the following:7

    • Egg
    • Milk
    • Peanut
    • Tree nuts such as walnuts
    • Soy (primarily in infants)
    • Wheat

    In adults, the most common foods that cause allergic reactions are the following:

    • Shellfish such as shrimp, crayfish, lobster, and crab
    • Peanut
    • Tree nuts
    • Fish such as salmon

    Food allergies generally develop early in life but can develop at any age. Children usually outgrow their egg, milk, and soy allergies, but people who develop allergies as adults usually have their allergies for life. Children generally do not outgrow their allergy to peanut.

    Foods that are eaten routinely increase the likelihood that a person will develop allergies to that food. In Japan, for example, rice allergy is more frequent than in the United States, and in Scandinavia, codfish allergy is more common than in the United States.

    Food Allergies among Children

    According to a study released in 2013 by the Centers for Disease Control and Prevention, food allergies among children increased approximately 50% between 1997 and 2011.

    Food allergies are a growing food safety and public health concern that affect an estimated 4%–6% of children in the United States. Children with food allergies are two to four times more likely to have asthma or other allergic conditions than those without food allergies.8

    The prevalence of food allergies among children increased 18% during 1997–2007, and allergic reactions to foods have become the most common cause of anaphylaxis in community health settings.

    • In 2006, about 88% of schools had one or more students with a food allergy.

    • Studies show that 16%–18% of children with food allergies have had a reaction from accidentally eating food allergens while at school. In addition, 25% of the severe and potentially life-threatening reactions (anaphylaxis) reported at schools happened in children with no previous diagnosis of food allergy.

    Although the number of children with food allergies in any one school or ECE program may seem small, allergic reactions can be life-threatening and have far-reaching effects on children and their families, as well as on the schools or ECE programs they attend.  The CDC recommends that staff who works in schools and early care and education (ECE) programs should develop plans for how they will respond effectively to children with food allergies.

    The CDC’s guidelines, Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs, were developed in response to Section 112 of the FDA Food Safety Modernization Act, which was enacted in 2011. This act is designed to improve food safety in the United States by shifting the focus from response to prevention. Until now, no national guidelines had been developed to help schools and ECE programs address the needs of the growing numbers of children with food allergies. However, 14 states and many school districts have formal policies or guidelines to improve the management of food allergies in schools.

    Many schools and ECE programs have implemented some of the steps needed to manage food allergies effectively. Yet systematic planning for managing the risk of food allergies and responding to food allergy emergencies in schools and ECE programs remain incomplete and in American College of Allergy, Asthma, and Immunology consistent.

    Food Allergy within Families

    According the American College of Allergy, Asthma, and Immunology, if both parents have allergies, the children have about a 75 percent chance of being allergic. If one of the parents is allergic, or if a relative from either side has allergies, there is 30-40 percent chance of having some form of allergy. If neither parent has allergy, the chance is only 10-15 percent. 

    The amounts of a food or a kind of food eaten, and how often it’s eaten, it may be important as to why a person has become food allergic.9

     

  • Section 4. Food Allergy Symptoms, Diagnosis, and Testing

    Section Summary

    The following topics are included in this section:

    • Food allergy symptoms
    • Diagnosis and the role of the Dietitian
    • Types of allergy testing

     

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    Food Allergy Symptoms

    Food allergy reactions can cause a variety of symptoms that range from mild to severe, including anaphylaxis, a serious reaction that is rapid in onset and may cause death. These reactions can be the result of the immune system producing an antibody, Immunoglobulin E (or IgE) to a certain food, or the result of a non-IgE reaction, which is cell-mediated. Some examples of non-IgE reactions include milk or soy intolerances, celiac disease, Food Protein Induced Enterocolitis (FPIES), and eosinophilic disorders.

    The American College of Allergy, Asthma, and Immunology reports that virtually any food can cause an adverse reaction, though eight foods (egg, milk, peanut, tree nuts, fish, shellfish, wheat, and soy) account for approximately 90 percent of all reactions.10

    The National Institute of Allergy and Infectious Diseases recommends that a healthcare professional should consider the diagnosis of food allergy if the person is experiencing anaphylaxis, a severe allergic reaction to food that involves more than one body system (for example, skin and respiratory tract and/or gastrointestinal (GI) tract) or if the person is experiencing a combination of symptoms within minutes to hours after eating food and/or after eating a specific food on more than one occasion.11

    Symptoms can involve the skin, gastrointestinal, cardiovascular, and/or respiratory tracts. Mild symptoms can include an itchy mouth, isolated hives, or mild nausea or discomfort. More severe food allergy symptoms include:

    • Vomiting
    • Stomach cramps
    • Indigestion
    • Diarrhea
    • Hives all over the body 
    • Shortness of breath
    • Wheezing
    • Repetitive cough
    • Tight, hoarse throat; trouble swallowing
    • Swelling of the tongue and/or lips
    • Weak pulse
    • Pale or blue coloring of skin
    • Dizziness or confusion

    The following chart summarizes the symptoms of allergic reactions caused by food.


    Symptoms of a food allergy typically occur within the first few minutes following ingestion of the food allergen, though in some cases, the reaction may be delayed by 4 to 6 hours, or even longer if the reaction is not IgE-mediated (i.e., FPIES).

    Certain symptoms can point to a particular type of reaction –  symptoms such as itchy mouth and throat that could signal Oral Allergy Syndrome (OAS), which occurs in individuals who have hay fever and eat certain raw fruits or vegetables that cross-react with pollens.

    Delayed (two to eight hours) allergic reactions to certain foods such as milk and soy among infants and young children could be related to FPIES, a reaction typically characterized by vomiting and diarrhea. 

    Some mild food related symptoms may be caused by food intolerance rather than an allergic reaction. If you have a reaction to what you believe is a food, consult with your allergist for a diagnosis and to determine a treatment and management plan. 

    Diagnosis and the Role of the Dietitian                          

    The Dietitian has a critical role in both diagnosing a suspected food allergy and supporting and helping patients manage a food allergy reports The International Food Information Council (IFIC) Foundation.

    The first step in the diagnosis of a suspected food allergy is a series of questions to identify suspected foods and determine what further tests should be done to verify food allergy.12

    National Institute of Allergy and Infectious Diseases recommends the following list of questions.

    1. Does anyone in the family have allergies? If so, who has allergies and to what are they allergic?
    2. What are the typical symptoms of the reaction and what is the order in which the symptoms occur?
    3. Did the reaction cause any breathing, skin and/or digestive symptoms?
    4. What was the length of time between consumption of the suspected food and the first sign of reaction?
    5. How much food was eaten to trigger the reaction?
    6. Does a similar reaction occur each time the food is eaten?
    7. Were any prescription medications or over-the-counter drugs taken at the time of the reaction?
    8. Have there been any recent changes in living situation, for example new pets, remodeling, move to a new home, etc.?
    9. How was the reaction treated? How long did it take to resume your normal activities?

    If a food allergy is suspected the patient should be referred to the primary care physician or a board-certified allergist.  The dietician’s role is to support the physician and allergist during the diagnostic procedure by helping the patient to complete a food diary and to assist with the supervised diets and tests.

    Types of Allergy Testing

    Allergy TestSkin tests often are used to diagnose allergies. These tests involve little discomfort and take about 30 minutes to perform. An allergist/immunologist interprets the results of the test in conjunction with the patient's history and uses these results to determine the best course of treatment. Treatment may include medications and allergy shots (immunotherapy).

       

    There are two types of skin tests:

    1. Prick tests - involve placing small drops of common allergens on the skin (usually on the forearms or back) and then lightly pricking the skin through the drop with a small needle.
    2. Intradermal (i.e., under the skin) tests - involve injecting a small amount of allergen into the outer layer of skin. When a patient is allergic to a substance, redness, itching, and swelling develop at the site of the test within 20 minutes. After the test, a mild cortisone cream may be applied to reduce itching.

    Patch tests can be used to diagnose contact dermatitis. In this test, the allergist/immunologist places a small amount of allergen on the skin (usually on the back), covers the area with a bandage, and checks for a reaction after 48-72 hours. Patients who are allergic to the substance develop a rash, or even blisters, on the skin.

    Certain medications (e.g., antihistamines, antidepressants) and skin conditions (e.g., eczema) can interfere with allergy skin tests. Patients who must continue to take these medications and patients who have a severe skin condition may require a blood test to diagnose allergies. Allergy blood tests involve taking a blood sample, adding an allergen to the sample, and measuring the amount of immunoglobulin E (IgE) antibodies produced in response to the allergen.

     Types of allergy blood tests include the following:

    • Enzyme-linked immunosorbent assay (ELISA)
    • In vitro basophil histamine release assay
    • Radioallergosorbent test (RAST)

    Allergy blood tests, which are less sensitive and more expensive than skin tests, are usually reserved for rare cases when allergy skin tests may not be accurate (e.g., when the patient has sensitive skin that reacts to a saline prick test or has a skin condition, such as hives or eczema, that prevents an adequate field for skin tests).

    In addition to allergy skin tests and allergy blood tests, patients with a suspected food allergy may undergo food allergy tests. Food allergy testing often begins with keeping a food diary, which is a detailed list of all foods, the date and time they were eaten, and any symptoms that occurred.

    When a single food allergy is suspected, the patient may be advised to eliminate the food from the diet and then, if symptoms are relieved, add the food back to the diet to determine if an allergic reaction occurs. This allergy test is not used in patients with a history of severe allergic reaction (anaphylaxis).

    If the results of these food allergy tests are inconclusive, the allergist/immunologist may perform a "blinded" food allergy test and/or a challenge test. These tests usually are performed in a physician's office or in the hospital, and they are closely supervised. They involve feeding the patient either the suspected food, or a neutral food (called a placebo), and then monitoring the patient for an allergic reaction. Neither the patient nor the physician knows whether the suspected food or the placebo is being given to the patient. The results of these allergy tests are very reliable.13

  • Section 5. Common Food Allergies

    Section Summary

    The following topics are included in this section:

    • Food Allergen Labeling and Consumer Protection Act (FALCPA)
    • Most common food allergens

        


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    Food Allergen Labeling and Consumer Protection Act (FALCPA)

    While more than 160 foods can cause allergic reactions in people with food allergies, the Food Allergen Labeling and Consumer Protection Act (FALCPA), identifies the eight most common allergenic foods. These foods account for 90 percent of food allergic reactions, and are the food sources from which many other ingredients are derived.14

    The eight foods identified by the law are:

    1. Milk
    2. Eggs
    3. Fish (e.g., bass, flounder, cod)
    4. Crustacean shellfish (e.g. crab, lobster, shrimp)
    5. Tree nuts (e.g., almonds, walnuts, pecans)
    6. Peanuts
    7. Wheat
    8. Soybeans

    These eight foods, and any ingredient that contains protein derived from one or more of them, are designated as “major food allergens” by FALCPA.

    FDA Facts

    The Food Allergen Labeling and Consumer Protection Act (FALCPA), which took effect January 1, 2006, mandates that the labels of foods containing major food allergens (milk, eggs, fish, crustacean shellfish, peanuts, tree nuts, wheat and soy) declare the allergen in plain language, either in the ingredient list or the following notice: 

    • The word “Contains” followed by the name of the major food allergen – for example, “Contains milk, wheat” – or

    • A parenthetical statement in the list of ingredients – for example, “albumin (egg)”

      

    Such ingredients must be listed if they are present in any amount, even in colors, flavors, or spice blends. Additionally, manufacturers must list the specific nut (e.g., almond, walnut, cashew) or seafood (e.g., tuna, salmon, shrimp, lobster) that is used.

    All product labels should be read carefully before purchasing and consuming any item. Ingredients in packaged food products may change without warning, so check ingredient statements carefully every time you shop. If you have questions, call the manufacturer.

    As of this time, the use of advisory labels (such as “May Contain”) on packaged foods is voluntary, and there are no guidelines for their use. However, the FDA has begun to develop a long-term strategy to help manufacturers use these statements in a clear and consistent manner, so that consumers with food allergies and their caregivers can be informed as to the potential presence of the eight major allergens.

    Food Allergen “Advisory” Labeling

    FALCPA’s labeling requirements do not apply to the potential or unintentional presence of major food allergens in foods resulting from "cross-contact" situations during manufacturing, e.g., because of shared equipment or processing lines. In the context of food allergens, "cross-contact" occurs when a residue or trace amount of an allergenic food becomes incorporated into another food not intended to contain it. FDA guidance for the food industry states that food allergen advisory statements, e.g., "may contain [allergen]" or "produced in a facility that also uses [allergen]" should not be used as a substitute for adhering to current good manufacturing practices and must be truthful and not misleading. FDA is considering ways to best manage the use of these types of statements by manufacturers to better inform consumers.15

    Most Common Food Allergens

    The most common food allergens are the proteins in cow’s milk, eggs, peanuts, wheat, soy, fish, shellfish and tree nuts. In some food groups, especially tree nuts and seafood, an allergy to one member of a food family may result in the person being allergic to other members of the same group. This is known as cross-reactivity. Cross-reactivity for other food families is not common.

    #1.  Peanut Allergy

    Peanut Butter JarPeanut allergy is one of the most common food allergies. Peanuts can cause a severe, potentially fatal, allergic reaction (anaphylaxis).16

    Peanuts are not the same as tree nuts (almonds, cashews, walnuts, etc.), which grow on trees. Peanuts grow underground and are part of a different plant family, the legumes. Other examples of legumes include beans, peas, lentils and soybeans. If a person is allergic to peanuts, they do not have a greater chance of being allergic to another legume (including soy) than they would to any other food.

    Trace amounts of peanut can cause an allergic reaction. Casual contact with peanuts, such as touching peanuts or peanut butter residue, is less likely to trigger a severe reaction. Casual contact becomes a concern if the area that comes into contact with peanuts then comes into contact with the eyes, nose or mouth (for example, a child with peanut allergy gets peanut butter on her fingers, and then rubs her eyes).

     Avoiding Peanuts

     Avoid foods that contain peanuts or any of these ingredients:

    Peanut a2

    The following list highlights examples of where peanuts have been unexpectedly found (e.g., on a food label for a specific product, in a restaurant meal, in creative cookery). This list does not imply that peanuts are always present in these foods; it is intended to serve as a reminder to always read the food label. Peanut is sometimes found in the following:

    Peanut e

     #2. Tree Nut Allergies

    Tree Nut AllergyTree nut allergy is one of the most common food allergies in children and adults. Tree nuts can cause a severe, potentially fatal, allergic reaction (anaphylaxis).17                           

    An allergy to tree nuts tends to be lifelong; recent studies have shown that approximately 9 percent of children with a tree nut allergy eventually outgrow their allergy. Younger siblings of children who are allergic to tree nuts may be at increased risk for allergy to tree nuts.

    Tree nuts include, but are not limited to, walnut, almond, hazelnut, cashew, pistachio, and Brazil nuts. These are not to be confused or grouped together with peanut, which is a legume, or seeds, such as sunflower or sesame.

    A person with an allergy to one type of tree nut has a higher chance of being allergic to other types. Therefore, many experts advise patients with allergy to tree nuts to avoid all nuts. Patients may also be advised to also avoid peanuts because of the higher likelihood of cross-contact with tree nuts during manufacturing and processing.

    Avoiding Tree Nuts

    Avoid foods that contain tree nuts or any of these ingredients:

    Tree Nut 1

    Tree nuts are sometimes found in the following:

    Tree Nut 2

    Some Unexpected Sources of Tree Nuts

    Tree nut proteins may be found in cereals, crackers, cookies, candy, chocolates, energy bars, flavored coffee, frozen desserts, marinades, barbeque sauces and some cold cuts, such as mortadella. Some alcoholic beverages may contain nut flavoring and should be avoided. These beverages are not currently regulated by FALCPA.

     

    #3. Milk Allergy

    Milk Poured

    Allergy to cow’s milk is the most common food allergy in infants and young children. Symptoms of a milk allergy reaction can range from mild, such as hives, to severe, such as anaphylaxis. To prevent a reaction, strict avoidance of cow’s milk and cow’s milk products is essential. Always read ingredient labels to identify cow’s milk ingredients.18

    Nearly all infants who develop an allergy to milk do so in their first year of life. Most children eventually outgrow a milk allergy. The allergy is most likely to persist in children who have high levels of cow’s milk antibodies in their blood.

    Sensitivity to cow’s milk varies from person to person. Some people have a severe reaction after ingesting a tiny amount of milk. Others have only a mild reaction after ingesting a moderate amount of milk. Reactions to milk can be severe and life-threatening (read more about anaphylaxis).

    Differences between Milk Allergy and Lactose Intolerance

    Milk allergy should not be confused with lactose intolerance. A food allergy is an overreaction of the immune system to a specific food protein. When the food protein is ingested, in can trigger an allergic reaction that may include a range of symptoms from mild symptoms (rashes, hives, itching, swelling, etc.) to severe symptoms (trouble breathing, wheezing, loss of consciousness, etc.). A food allergy can be potentially fatal.

    Unlike food allergies, food intolerances do not involve the immune system.  People who are lactose intolerant are missing the enzyme lactase, which breaks down lactose, a sugar found in milk and dairy products. As a result, lactose-intolerant patients are unable to digest these foods, and may experience symptoms such as nausea, cramps, gas, bloating and diarrhea. While lactose intolerance can cause great discomfort, it is not life-threatening.

    Avoiding Milk

    Food products may change without warning, so check ingredient statements carefully each time.

    Avoid foods that contain milk or any of these ingredients:

    Milk 1

    Milk is sometimes found in the following:

    Milk 2

    Some Unexpected Sources of Milk

    The following list highlights examples of where milk has been unexpectedly found (e.g., on a food label for a specific product, in a restaurant meal, in creative cookery). This list does not imply that milk is always present in these foods.

    Milk 3

    #4. Egg Allergy

    EggsEgg allergy is one of the most common food allergies in children, second only to milk allergy. Symptoms of an egg allergy reaction can range from mild, such as hives, to severe, such as anaphylaxis. Most children eventually outgrow an allergy to egg.19                

    While the whites of an egg contain the allergenic proteins, patients with an egg allergy must avoid all eggs completely. This is because it is impossible to separate the egg white completely from the yolk, causing a cross-contact issue.

    Egg Allergy and Vaccines

    Some vaccines contain egg protein. The recommendations of the American Academy of Pediatrics (AAP) acknowledge that the MMR vaccine (measles-mumps-rubella) can be safely administered to all patients with egg allergy. These recommendations have been based, in part, on scientific evidence that supports the routine use of one-dose administration of the MMR vaccine to patients with an egg allergy. This includes those patients with a history of severe, generalized anaphylactic reactions to egg.

    Influenza vaccines usually contain a small amount of egg protein. If a child is allergic to eggs, speak to the doctor before administering a flu shot.

    Avoiding Eggs

    Avoid foods that contain eggs or any of these ingredients:

    Eggs 1

    Eggs are sometimes found in the following:

    Eggs 2

    Some Unexpected Sources of Egg

    The following list highlights examples of where eggs have been unexpectedly found (e.g., on a food label for a specific product, in a restaurant meal, in creative cookery). This list does not imply that eggs are always present in these foods.

    • Eggs have been used to create the foam or topping on specialty coffee drinks and are used in some bar drinks.
    • Some commercial brands of egg substitutes contain egg whites.
    • Most commercially processed cooked pastas (including those used in prepared foods such as soup) contain egg or are processed on equipment shared with egg-containing pastas. Boxed, dry pastas are usually egg-free, but may be processed on equipment that is also used for egg-containing products. Fresh pasta is sometimes egg-free, too.
    • Egg wash is sometimes used on pretzels before they are dipped in salt.

      

    #5. Wheat Allergy

    WheatWheat allergy is most common in children, and is usually outgrown before reaching adulthood, often by age three. Symptoms of a wheat allergy reaction can range from mild, such as hives, to severe, such as anaphylaxis.20               

    A wheat allergy can present a challenge for the diet as well as for baking, because wheat is the nation’s predominant grain product. Someone on a wheat-restricted diet can eat a wide variety of foods, but the grain source must be something other than wheat. In planning a wheat-free diet, look for alternate grains such as amaranth, barley, corn, oat, quinoa, rice, rye, and tapioca. When baking with wheat-free flours, a combination of flours usually works best.

    Differences between Wheat Allergy and Celiac Disease or Gluten Intolerance

    A wheat allergy should not be confused with “gluten intolerance” or celiac disease. A food allergy is an overreaction of the immune system to a specific food protein. When the food protein is ingested, in can trigger an allergic reaction that may include a range of symptoms from mild symptoms (rashes, hives, itching, swelling, etc.) to severe symptoms (trouble breathing, wheezing, loss of consciousness, etc.). A food allergy can be potentially fatal.

    Celiac disease (also known as celiac sprue), which affects the small intestine, is caused by an abnormal immune reaction to gluten. Usually diagnosed by a gastroenterologist, it is a digestive disease that can cause serious complications, including malnutrition and intestinal damage, if left untreated. Individuals with celiac disease must avoid gluten, found in wheat, rye, barley and sometimes oats.

    People who are allergic to wheat often may tolerate other grains. However, about 20 percent of children with wheat allergy also are allergic to other grains. Be sure to ask your doctor whether foods containing barley, rye, or oats are safe for you or your child to eat.

    Avoiding Wheat

    Avoid foods that contain wheat or any of these ingredients:

     Wheat 1

    Wheat is sometimes found in the following:

    • Glucose syrup
    • Surimi
    • Soy sauce
    • Starch (gelatinized starch, modified starch, modified food starch, vegetable starch)

     

    Some Unexpected Sources of Wheat

    Always read ingredient labels carefully. Wheat has been found in some brands of ice cream, marinara sauce, play dough, potato chips, rice cakes, turkey patties and hot dogs.

    Wheat also may be found in ale, baking mixes, baked products, batter-fried foods, beer, breaded foods, breakfast cereals, candy, crackers, processed meats, salad dressings, sauces, soups, soy sauce, and surimi. Some types of imitation crabmeat contain wheat.

     

    #6. Soy Allergy

    LegumesSoybean allergy is one of the more common food allergies, especially among babies and children. Approximately 0.4 percent of children are allergic to soy.  Studies indicate that an allergy to soy generally occurs early in childhood and often is outgrown by age three. Research indicates that the majority of children with soy allergy will outgrow the allergy by the age of 10.21

    Allergic reactions to soy are typically mild; however, although rare, severe reactions can occur (read more about anaphylaxis). To prevent a reaction, strict avoidance of soy and soy products is essential.

    Soybeans are a member of the legume family, which include plant species that bear seed pods that split upon ripening. Some examples of other legumes include beans, peas, lentils and peanut. People with a soy allergy are not necessarily allergic to other legumes. If you are allergic to soy, you do not have a greater chance of being allergic to another legume (including peanut) than you would to any other food.

    In the United States, soybeans are widely used in processed food products. Soybeans alone are not a major food in the diet, but because soy is used in so many products, eliminating all those foods can result in an unbalanced diet.

    Avoiding Soy

    Avoid foods that contain soy or any of these ingredients:

    Soy 1

    Soy is sometimes found in the following:

    • Asian cuisine
    • Vegetable gum
    • Vegetable starch
    • Vegetable broth

    Some Unexpected Sources of Soy

    Soybeans and soy products are found in many foods, including baked goods, canned tuna and meat, cereals, cookies, crackers, high-protein energy bars and snacks, infant formulas, low-fat peanut butter, processed meats, sauces, and canned broths and soups.

    Asian cuisines are considered high-risk for people with soy allergy due to the common use of soy as an ingredient and the possibility of cross-contact, even if a soy-free item is ordered.

       

    #7. Fish Allergy

    Salmon AllergyFinned fish can cause severe allergic reactions (such as anaphylaxis). Approximately 40 percent of people with fish allergy experienced their first allergic reaction as adults.

    Salmon, tuna and halibut are the most common kinds of finned fish to which people are allergic.  More than half of all people who are allergic to one type of fish also are allergic to other fish, so allergists often advise their fish-allergic patients to avoid all fish. If you are allergic to a specific type of fish but want to have other fish in your diet, talk to your doctor about the possibility of allergy testing for specific fish.

    Finned fish and shellfish do not come from related families of foods, so being allergic to one does not necessarily mean that you must avoid both.

    Avoiding Fish 

    It has been estimated that there are upwards of 20,000 species of fish. Although this is not an exhaustive list, allergic reactions have been commonly reported to:

    Fish 1

    Some Unexpected Sources of Fish

    The following list highlights examples of where fish has been unexpectedly found (e.g., on a food label for a specific product, in a restaurant meal, in creative cookery).

    • Caesar salad and Caesar dressing
    • Worcestershire sauce
    • Bouillabaisse
    • Imitation or artificial fish or shellfish (surimi, also known as “sea legs” or “sea sticks,” is one example)
    • Meatloaf
    • Barbecue sauce
    • Caponata, a Sicilian eggplant relish

        

    #8. Shellfish

    ShrimpShellfish can cause severe allergic reactions (such as anaphylaxis). This allergy usually is lifelong. Approximately 60 percent of people with shellfish allergy experienced their first allergic reaction as adults. Shrimp, crab and lobster cause most shellfish allergies. Finned fish and shellfish do not come from related families of foods, so being allergic to one does not necessarily mean that you must avoid both.22

    There are two kinds of shellfish: crustacea (such as shrimp, crab and lobster) and mollusks (such as clams, mussels, oysters and scallops). Reactions to crustacean shellfish tend to be particularly severe. If you are allergic to one group of shellfish, you might be able to eat some varieties from the other group. However, since most people who are allergic to one kind of shellfish usually are allergic to other types, allergists usually advise their patients to avoid all varieties. If you have been diagnosed with a shellfish allergy, do not eat any shellfish without first consulting your doctor.

    To prevent a reaction, strict avoidance of shellfish and shellfish products is essential. Always read ingredient labels to identify shellfish ingredients. In addition, avoid touching shellfish, going to the fish market, and being in an area where shellfish are being cooked (the protein in the steam may present a risk).

    Avoiding Shellfish

    Avoid foods that contain shellfish or any of these ingredients:

    • Barnacle
    • Crab
    • Crawfish (crawdad, crayfish, ecrevisse)
    • Krill
    • Lobster (langouste, langoustine, Moreton bay bugs, scampi, tomalley)
    • Prawns
    • Shrimp (crevette, scampi)

    It is important to note that mollusks are not considered major allergens under FALCPA and may not be fully disclosed on a product label.

    Shellfish are sometimes found in the following:

    • Bouillabaisse
    • Cuttlefish ink
    • Glucosamine
    • Fish stock
    • Seafood flavoring (e.g., crab or clam extract)
    • Surimi

       

    #9. Other Allergens

    Although the list below is by no means exhaustive, allergic reactions have been reported to corn, gelatin, meat (beef, chicken, mutton, and pork), seeds (sesame, sunflower, and poppy being the most common), and spices such as caraway, coriander, garlic, and mustard.         

    Allergic reactions to fresh fruits and vegetables, such as apple, carrot, peach, plum, tomato and banana, to name a few, are often diagnosed as Oral Allergy Syndrome.

    Corn Allergy

    Allergic reactions to corn are rare and a relatively small number of case reports can be found in medical literature. However, the reports do indicate that reactions to corn can be severe. Reactions to corn can occur from both raw and cooked corn. Individuals who are allergic to corn should receive individualized expert guidance from their allergists.

    Meat Allergy

    Allergies to meats, such as beef, chicken, mutton or pork, are also rare.  A person who is allergic to one type of meat may not need to avoid other types of meat. Heating and cooking meat can reduce the allergenicity of product.

    Gelatin Allergy

    Gelatin is a protein that is formed when skin or connective tissue is boiled. Although rare, allergic reactions to gelatin have been reported.

    Many vaccines contain porcine gelatin as a stabilizer. Allergy to gelatin is a common cause of an allergic reaction to vaccines. Individuals who have experienced symptoms of an allergic reaction after consuming gelatin should discuss this with their health care provider before getting vaccinated. If a severe allergy to gelatin is known, vaccines that contain gelatin as a component should be avoided.

    Seed Allergy

    Allergic reactions to seeds can be severe. Sesame, sunflower, and poppy seeds have been known to cause anaphylaxis.

    The estimated prevalence of seed allergy is not known. In a study published in 2010, however, researchers at New York’s Mount Sinai School of Medicine concluded that 0.1 percent of the general population may have a sesame allergy, based on a national survey that focused primarily on the prevalence of peanut and tree nut allergy.

    Seeds are often used in bakery and bread products, and extracts of some seeds have been found in hair care products.

    Some seed oils are highly refined, a process that removes the proteins from the oil. However, as not all seed oils are highly refined, individuals with a seed allergy should be careful when eating foods prepared with seed oils.

    Spice Allergy

    Allergies to spices, such as coriander, garlic, and mustard, are rare and are usually mild, although severe reactions to spices have been reported. Some spices cross-react with mugwort and birch pollen, so patients who are sensitive to these environmental allergens are at a higher risk for developing an allergy to spice.

     

  • Section 6. Managing Food Allergies

    Section Summary

    The following topics are included in this section:

    • Managing food allergies
    • Treating Anaphylaxis
    • Pregnancy guidelines
    • Outgrowing food allergies

      

    Divider 1

      

    Managing Food Allergies

    There is currently no cure for food allergy, but there are many promising treatments under investigation. Avoidance, education and preparedness are the keys to managing food allergy.

    While exposure to airborne food allergens (e.g., from cooking vapors) usually does not result in anaphylaxis, it can cause a runny nose and itchy eyes similar to a reaction from coming in contact with pollen. However, eating even a small amount of the food, such as that left on cooking utensils or from a food processing facility, can cause a life-threatening reaction. This is why reading the ingredients on food labels and asking questions about prepared foods are an essential part of avoidance plans.

    The American Academy of Allergy, Asthma & Immunology recommends that people with food allergy should always carry auto-injectable epinephrine to be used in the event of an anaphylactic reaction. Symptoms of anaphylaxis may include difficulty breathing, dizziness or loss of consciousness. If any of these symptoms are present in the context of eating, use the epinephrine auto-injector and immediately call 911. Don’t wait to see if the symptoms go away or get better on their own.23

    Healthy tips include:

    • Always ask about ingredients when eating at restaurants or when eating foods prepared by family or friends.

    • Carefully read food labels. The United States and many other countries require that major food allergens are to be listed in common language (milk, egg, fish, shellfish, tree nuts, wheat, peanuts and soybeans).

    • Carry and know how to use auto-injectable epinephrine and antihistamines to treat emergency reactions. Teach family members and other people close how to use epinephrine and consider wearing an ID bracelet that describes the allergy. If a reaction occurs, have someone take the person to the emergency room, even if symptoms subside. Afterwards, get follow-up care from an allergist.

    Treating Anaphylaxis

    The symptoms of anaphylaxis vary and can be difficult to recognize.

    Anaphylaxis

    If a person is experiencing any one of the following three conditions, they may be experiencing an anaphylactic episode:

    • Symptoms appear within minutes to several hours and involve skin, mucosal tissue (moist lining of the body cavities, such as the nose, mouth, and GI tract), or both. Experience trouble breathing or a drop in blood pressure (pale, weak pulse, confusion, loss of consciousness).

    • Two or more of the following symptoms that occur within minutes to several hours after exposure to a suspected allergenic food: Hives, itchiness, or redness all over the body and swelling of the lips, tongue, or the back of the throat.

    • Trouble breathing

    • Drop in blood pressure.

    • GI symptoms such as abdominal cramps or vomiting.

    An anaphylactic reaction can occur as a:

    • Single reaction that occurs immediately after exposure to the allergenic food and gets better with or without treatment within the first minutes to hours. Symptoms do not recur later in relation to that episode.

    • Two reactions. The first reaction includes an initial set of symptoms that seem to improve and go away but then reappear. The second reaction can occur between 8 and 72 hours after the first reaction as a single long-lasting reaction that continues for hours or days following the initial reaction.

    Diseases such as asthma, chronic lung disease, and cardiovascular disease may increase the risk of death from anaphylaxis. Medications such as those that treat high blood pressure also may affect symptom severity and response to treatment.

    The National Institute of Allergy and Infectious Diseases, recommends treating anaphylaxis immediately after symptoms begin with an intramuscular (IM) injection of Epinephrine. After epinephrine has been given, the patient may be placed in a reclining position to help restore normal blood low.

    Epinephrine should be given immediately to treat anaphylaxis. Delays in giving epinephrine to patients can result in rapid decline and death within 30 to 60 minutes. Epinephrine acts immediately, but it may be necessary to give repeat doses.

    The Guidelines set by the National Institute of Allergy and Infectious Diseases (NIAID) recommends that a healthcare professional diagnosing a patient with anaphylaxis should understand the following:24

    1. Signs and symptoms of anaphylaxis
    2. Timing of symptoms in relation to exposure to the allergenic food
    3. Conditions such as asthma that may be associated with food allergy and how these conditions may affect treatment
    4. The limited value of laboratory tests during an anaphylactic episode

    Pregnancy Guidelines

    Breastfeeding

    The National Institute of Allergy and Infectious Diseases recommends that a mother not restrict her diet during pregnancy or when breastfeeding as a way to prevent food allergy from developing in her child. There is no evidence to suggest that restricting a mother’s diet while she is pregnant or breastfeeding prevents the development of food allergy in her child.25

    Additional recommendations during pregnancy are as follows:

    • A mother should exclusively breastfeed her infant until age 4 to 6 months, unless breastfeeding is not advised for medical reasons. There is no strong evidence that breastfeeding increases the likelihood that an infant will develop food allergy.

    • They do not recommend giving an infant at risk for food allergy soy milk formula instead of cow’s milk formula to prevent food allergy from developing. There is neither long-term harm nor significant benefit in giving an infant soy milk formula.

    •  Do not delay introducing solid foods, including potentially allergenic foods, to an infant beyond 4 to 6 months of age. There is no evidence that supports delaying the introduction of solid foods to an infant beyond 4 to 6 months of age to prevent allergic diseases from developing. This includes giving an infant a food containing milk, eggs, peanut, tree nuts, soy, or wheat.

    Outgrowing Food Allergies

    Most children eventually outgrow milk, egg, soy, and wheat allergy. Fewer children outgrow peanut and tree nuts allergy. Outgrowing a childhood allergy may occur as late as the teenage years.

    For many children, sIgE antibodies can be detected within the first 2 years of life. A child with a high initial level of sIgE, along with clinical symptoms of food allergy, is less likely to outgrow the allergy. A decrease in sIgE antibodies is often associated with outgrowing the allergy.

    Food allergy also can begin in adulthood. Late-developing food allergy tends to persist.

     
  • Section 7. Case Studies

    Section Summary

    The following case studies are included in this section:

    • Case Study #1: Nichole K. - Broad Range of Allergies
    • Case Study #2: Lindsay M. - Celiac Disease
    • Case Study #3: Deb J. - IBS

     

    Divider 1  

    Food Allergy Case Studies

    The Dietitian serves as a coach and a guide to the client offering support with change and helping to bridge the gap between old habits and foods into different habits and foods that help support the client with where they are in their health and life at the time.

    Making changes is overwhelming and difficult for some clients. With the knowledge of the registered dietitian, the client is guided toward change using foods that may be similar to what they are used to. The dietitian can also offer the client a list of items that would be fitting for the client’s needs based on their likes, dislikes and demographic area (what’s available to the client).

     

    Case Study #1: Nichole K. - Broad Range of Allergies

    Nichole K is a 14 year old female. She began experiencing blotchy, itchy skin, abdominal distention and swelling of skin on some areas of the body. She had a difficult time connecting which substances gave her the discomfort.

    After an Allergist did a series of prick skin tests and skin grafts, she was told that she was allergic to oats, beef, shellfish and hops.  Her family decided to seek the help of a dietitian that met with Nichole once a week for four months.

    It just so happens that her family prepared brats on a regular basis using beer. Her mother would prepare her oatmeal on most mornings and her family enjoyed seafood several times a week. Since she was exposed to these items on a regular basis, it was difficult to see what would be causing her discomfort.

    Nichole decided to eliminate the offending food items all together as the reaction she had from those items was so uncomfortable she did not want to test out her tolerance levels right away.  After replacing the items above, her conditions improved. She was also experiencing asthma and that too improved.

    Nichole continues to watch for these interactions when she is out with friends or in other social settings where others are unaware of her allergies. She is able to identify more clearly if she has an allergic reaction to an item. On occasion, this continues to happen due to servers not knowing what is in a product, mislabeling on packaged items, and from cross contamination in restaurants.

     

    Case Study #2: Lindsay M. - Celiac Disease

    Lindsay M. is a 24 year old female. She had been experiencing painful bouts of cramping followed by diarrhea alternating with constipation.  She went to see an Allergist and Gastroentologist and after a complete exam, was diagnosed as having celiac disease, an allergy to eggs and intolerance to lactose. After discovering this information, she sought out the services of a dietitian to help her manage her condition.

    Lindsay was very overweight. She had been exercising and struggling with times of binging and purging through exercise.

    Her new diet consisted of 35gms of fiber coming from lots of fruits and vegetables, oats and rice. She began using soy milk and other dairy alternatives. Because managing celiac disease can be challenging and overwhelming, she began making her own sauces to put on rice pasta and potatoes giving her complete control with ingredients. She ate very consistently for about four weeks and experienced much relief. She had regular and normal bowel movements, very little gas and bloating and decreased pain and tenderness in her abdomen.

    Lindsay also started to exercise more regularly. She started walking, then taking some aerobics classes, followed by the addition of a weight routine and then running.

    After four-weeks of consistency, Lindsay decided to experiment with the occasional wheat product, such as a large soft pretzel or regular pizza crust. She found that she was uncomfortable after eating those items, but nothing like the pain she experienced before.

    As with most food allergies or intolerances, we all seem to have our own level of tolerance. The tolerance level can change, but generally people decide how much pain they want to endure in order to add things back into their diet.

     

    Case Study #3: Deb J. - IBS

    At 53 years old, Deb J. sought out the services of a registered dietitian.  Her goals at the time were to lose weight and become more conditioned. She was battling the same 30 pounds for a span of about 30 years. She had complained of constant pain and bloat in her abdomen. Her physician had said she had a slight case of Irritable Bowl Syndrome (IBS).  Since IBS is such a broadly defined condition, it was necessary to start by incorporating some basic diet and lifestyle changes.

    Since Deb’s diet needed tweaking and there were no big dietary changes the first appointment was for an hour with a weekly session that ranged from 30 – 60 minutes, depending on the complexity and the questions or challenges from the client. With the help of a dietitian, Deb kept a general food log guide to track what was causing the irritation.

    Deb’s usual daily diet that was causing her IBS consisted of:

    • Breakfast - Lucky Charms or a Slim Fast or nothing, then coffee at work and all morning.
    • Lunch -  A frozen entrée of some sort and maybe a piece of fruit
    • Afternoon snack - Something from the vending machines, Doritos, pretzels or cookies. or if there was some candy at work then that would be the choice of the day 
    • Dinner - More red meat than chicken, turkey or fish, usually prepared with oils or butters and coupled by mashed potatoes made with dairy, a glass of milk and on occasion, a veggie.
    • Evening snack - Usually ice cream or cookies

     

    She started to decrease the total fat and more specifically the saturated fat in her diet.  She went from 65 – 90 grams of fat each day to an average of 35 – 40 grams of fat per day. She increased her intake of omega-3 fatty acids through the addition of fish in her diet about twice a week as well as the addition of a flax seed supplement. This client was using a flax seed supplement in the form of a gel capsules by Barleans. She started with 3 capsules a day and eventually increased up to 9 capsules a day. This helped her with the inflammation. She is currently on 3 – 6 day depending on her own level of comfort. She would take more on days she exercised more heavily and less on days that she wasn’t as physically active.

    She increased her fiber intake from about 15gms gradually to 35gms a day because her satiety levels were poor. She was bloated and would experience bouts of hypoglycemia. Increasing her fiber intake helped level out her blood sugar levels. She was struggling with being hungry often before starting to clean her diet up. Since she wasn’t taking in much fiber before, she needed to slowly get her level up.

    Deb worked on developing some different stress relievers. She started incorporating more exercise and stretching and became more involved in leisure activities such as knitting and gardening. She increased her exercise in the morning to 15 –30 minutes of walking before work.   She walked away from her desk while at work and would go into the bathroom and do 10 deep breathes and ‘squats”. She said this technique helped her calm down and just felt good to her body.

    After working with these changes for several months, she was feeling better than she had. However, she still didn’t feel great. She could definitely target that when she would have the occasional high fat food or entrée that she would experience bouts of diarrhea as well as abdominal cramping

    At her 3-month follow-up, Deb decided she wanted to see what more she could do to help herself. At the suggestion of the dietitian, she decided to eliminate dairy and wheat products from her diet. The dietitian helped her develop a working plan with specific foods and plenty of variety to deal with this change.

    Her new typical daily menu now consisted of:

    • Breakfast – Oatmeal, buckwheat or brown rice cereal with soy or rice milk
    • Lunch -Large salad with chicken or tuna and rice crackers
    • Afternoon snack – Fruit and 6 almonds
    • Dinner – shrimp, chicken, or turkey in the form of a stir-fry or baked with a vegetable and sometimes rice or potato

     

    Deb had a difficult time at first, just because everything was new and she was so used to preparing specific things for her husband, so there were some emotional issues involved as well.

    She was able to experiment with adding a dairy serving every now and again to see how her body would respond. She loves yogurt and cottage cheese, and was anxious to experiment with these items.  At times her body can handle them and at other times rejects them and she will have cramping and diarrhea followed by headaches and fatigue.

    This final change in her diet seemed to have made the most change in how she felt. Deb has been able to maintain this way of living now for the past 5 years. She ended up taking classes to become a Master Gardener.  The program opened her world up to more social events with people who had similar passions. She also started volunteering at a Stray Cat Home. This is a place that takes baby, stray or abandoned kittens and gets them used to living with humans. She loves it!

  • Section 8. Glossary

    The following glossary was published by the National Institute of Allergy and Infectious Diseases in the Guidelines for the Diagnosis and Management of Food Allergy in the United States.26

      

    Allergen-specific immunotherapy is a type of treatment in which a patient  is given increasing doses of an allergen—for example, milk, egg, or peanut allergen—with the goal of inducing immune tolerance (the ability of the immune system to ignore the presence of one or more food protein allergens while remaining responsive to unrelated proteins).

                  

    Allergic contact dermatitis (ACD) is a form of eczema caused by an allergic reaction to food additives or molecules that occur naturally in foods such as mango. The allergic reaction involves immune cells but not IgE antibodies. Symptoms include itching, redness, swelling, and small raised areas on the skin that may or may not contain luid.

        

    Allergic proctocolitis (AP) is a disorder that occurs in infants who seem healthy but have visible specks or streaks of blood mixed with mucus in their stool. Because there are no laboratory tests to diagnose food-induced AP, a healthcare professional must rely on a medical history showing that certain foods cause symptoms to occur. Many infants have AP while being breast-fed, probably because the mother’s milk contains food proteins from her diet that cause an allergic reaction in the infant.

        

    Anaphylaxis is a serious allergic reaction that involves more than one body system (for example, skin and respiratory tract and/or gastrointestinal tract), begins very rapidly, and may cause death.

     

    Angioedema is swelling due to luid collecting under the skin, in the abdominal organs, or in the upper airway (nose, back of the throat, voicebox). It often occurs with hives and, if caused by food, is typically IgE-mediated. When the upper airway is involved, swelling in the voicebox is an emergency requiring immediate medical attention. Acute angioedema is a common feature of anaphylaxis.

     

    Contact urticaria (hives) occurs when the skin comes in contact with an allergen. The hives can be local or widespread. They are caused by antibodies interacting with allergen proteins or from the direct release of histamine, a molecule involved in allergy.

     

    Corticosteroids are a class of drugs similar to the natural hormone cortisone. These drugs are used to treat inlammatory diseases, such as allergies and asthma.

     

    Cross-reactive foods are foods that are seen as similar to allergenic foods by the immune system. An antibody that reacts with the allergenic food also reacts with the cross-reactive food. For example, a person who is allergic to shrimp also may be allergic to lobster, because shrimp and lobster are closely related foods. In this case, lobster would be a cross-reactive food.

     

    Eczema (atopic dermatitis, atopic eczema) is a disease of the skin. Symptoms include scaly, itchy rashes and blistering, weeping, or peeling of the skin. The causes of the disease are unclear. There may be a problem in the skin’s ability to maintain an effective barrier against environmental factors, such as irritants, microbes, and allergens. A person who has a biological parent or sibling with a history of allergy and eczema is at risk for developing food allergy.

     

    Enterocolitis is an inflammation of the colon and small intestine.

     

    Enteropathy is a disease of the intestine.

     

    Eosinophilic esophagitis (EoE) is a disorder associated with food allergy, but how it is related is unclear. It occurs when types of immune cells called eosinophils collect in the esophagus. Both IgE- and non-IgE-mediated mechanisms appear to be involved in EoE.

        

    Epinephrine (adrenaline) is a hormone that increases heart rate, tightens the blood vessels, and opens the airways. Epinephrine is the best treatment for anaphylaxis.

     

    Exercise-induced anaphylaxis is a type of severe, whole-body allergic reaction that occurs during physical activity. Food is the trigger in about one-third of patients who have experienced exercise-induced anaphylaxis. This reaction is likely to recur in patients.

     

    Food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated disorder that usually occurs in young infants. Symptoms include chronic vomiting, diarrhea, and failure to gain weight or height. When the allergenic food is removed from the infant’s diet, symptoms disappear. Milk and soy protein are the most common causes, but some studies report reactions to rice, oat, or other cereal grains. A similar condition also has been reported in adults, most often related to eating crustacean shellfish.

     

    Immunotherapy with cross-reactive allergens is a type of treatment in which a patient is given increasing doses of an allergen to induce tolerance to a similar allergen that is causing a reaction.

     

    Noncontact food allergy develops as a result of the food allergen being ingested. Specific IgE antibodies to the food are only made after eating the food, not after simply touching the food.

     

    Systemic contact dermatitis is a rare disorder with symptoms that include eczema, fever, headache, and stuffy nose. To develop systemic contact dermatitis, a person first develops specific IgE antibodies to the allergen through contact with the skin. If the person subsequently swallows the allergen or is exposed to it though a skin cut or puncture, symptoms develop.

  • Section 9. Mastery Test & Certificate

    A 80% is required to pass the exam. There are 16 questions.

    After passing the course - Your certificate will be emailed to you and you can reprint your certificate at any time from the Certificate List on the right hand side bar.

    If you are a Florida Dietitian make sure that you have entered your Florida License number in your Profile. We will report your credits through CE Broker for the State of Florida.

  • Section 10. Additional Resources

    The Academy of Nutrition and Dietetics

    120 South Riverside Plaza, Suite 2000

    Chicago, IL 60606-6995

    (312) 899-0040

    http://www.eatright.org

     

    American Academy of Allergy, Asthma & Immunology (AAAAI)

    555 East Wells Street, Suite 1100

    Milwaukee, WI 53202-3823

    Phone:  (414) 272-6071

    http://www.aaaai.org/

     

    Food Allergy Research and Education

    7925 Jones Branch Dr., Suite 1100

    McLean, VA 22102

    Phone: (800) 929-4040

    http://www.foodallergy.org

  • Section 11. References

    1. National Institute of Allergy and Infectious Diseases, Guidelines for the Diagnosis and Management of Food Allergy in the United States [Website] Accessed February 15, 2014;  http://www.niaid.nih.gov/topics/foodAllergy/clinical/Documents/FAguidelinesPatient.pdf
    2. National Institute of Allergy and Infectious Diseases, Guidelines for the Diagnosis and Management of Food Allergy in the United States [Website] Accessed February 15, 2014;  http://www.niaid.nih.gov/topics/foodAllergy/clinical/Documents/FAguidelinesPatient
    3. National Institute of Allergy and Infectious Diseases, Is it Food Allergy or Food Intolerance? [Website] Accessed February 11, 2014; http://www.niaid.nih.gov/topics/foodAllergy/understanding/Pages/foodIntolerance.aspx
    4. U.S. Food and Drug Administration,  Food Allergies: Reducing the Risks [Website] Accessed February 2, 2014; http://google2.fda.gov/search?q=cache:tlHkYmaudLwJ:www.fda.gov/forconsumers/consumerupdates/ucm089307.htm+food+allergy+prevalence&client=FDAgov&site=FDAgov&lr=&proxystylesheet=FDAgov&output=xml_no_dtd&access=p&ie=UTF-8&oe=ISO-8859-1
    5. U.S. Food and Drug Administration, Food Allergies: What You Need to Know [Website] Accessed February 18, 2014; http://www.fda.gov/food/resourcesforyou/consumers/ucm079311.htm
    6. Food Allergy Research & Education, Inc., Facts and Statistics [Website] Accessed February 11, 2014; http://www.foodallergy.org/facts-and-stats
    7. National Institute of Allergy and Infectious Diseases, Is it Food Allergy or Food Intolerance? [Website] Accessed February 11, 2014; http://www.niaid.nih.gov/topics/foodAllergy/understanding/Pages/foodAllergy8Allergens.aspx
    8. Centers for Disease Control and Prevention, Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Program  [Website] Accessed February 15, 2014;  http://www.cdc.gov/healthyyouth/foodallergies/pdf/13_243135_A_Food_Allergy_Web_508.pdf
    9. American College of Allergy, Asthma, and Immunology, Common Food Allergies in Infants, Children, and Adults [Website] Accessed February 17, 2014; http://www.acaai.org/allergist/allergies/Types/food-allergies/Pages/default.aspx
    10. American College of Allergy, Asthma, and Immunology, Common Food Allergies in Infants, Children, and Adults [Website] Accessed February 17, 2014; http://www.acaai.org/allergist/allergies/Types/food-allergies/Pages/food-allergy-symptoms.aspx
    11. National Institute of Allergy and Infectious Diseases, Guidelines for the Diagnosis and Management of Food Allergy in the United States [Website] Accessed February 15, 2014; http://www.niaid.nih.gov/topics/foodAllergy/clinical/Documents/FAguidelinesPatient
    12. National Institute of Allergy and Infectious Diseases, Guidelines for the Diagnosis and Management of Food Allergy in the United States [Website] Accessed February 15, 2014; http://www.niaid.nih.gov/topics/foodAllergy/clinical/Documents/FAguidelinesPatient
    13. National Institute of Allergy and Infectious Diseases, Guidelines for the Diagnosis and Management of Food Allergy in the United States [Website] Accessed February 15, 2014; http://www.niaid.nih.gov/topics/foodAllergy/clinical/Documents/FAguidelinesPatient
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