Food Allergies: Chapter 4 PDF

Chapter 4: NUTR470 Prof. Reema Tayyem Objectives Recognize the symptoms linked with food allergies Recognize the symptoms and the effects of food intolerances Understand the importance of food preparation, knowledge of ingredients and labelling foods Understand what to do in an...

Chapter 4: NUTR470 Prof. Reema Tayyem Objectives Recognize the symptoms linked with food allergies Recognize the symptoms and the effects of food intolerances Understand the importance of food preparation, knowledge of ingredients and labelling foods Understand what to do in an emergency.  Adverse Food Reactions Old classification?? Adverse food reactions Food hypersensitivity Food intolerance Adverse food reactions are the result of: 1. Food hypersensitivity (adverse immunologic responses) 2. Food intolerance (adverse physiologic responses). 3 Adverse Reactions to Food e g PKU Elsevier items and derived items © 2012, 2008, 2007 by 4 Saunders, an imprint of Food Intolerance Lactose intolerance Lactase enzymedeficiency Glucose 6 phosphate dehydrogenase??? PKU Galactosemia we will have in Galactose in the blood normallyits not present cuz most dificulttoavoid is found in all food galactose 5  CausesNADPT to NADPHto so ifno NADPH 4202level which oxidation causeRBClysis 1202EftH2O 02 Fava beans Definition New definition  important to know irrespective mean inthehospitalmedicalsettings milkallergyin eEod E.fi m ymoresever itYI.net Bloodvessels waterincellsofBv acute suddensymptoms takestimeto appear lifethreatening Defining Food Allergy “An adverse health effect arising from a specific immune response that occurs reproducibly upon exposure to a given food” https://www.youtube.com/watch?v=OCMNXUBHDb8 https://www.youtube.com/watch?v=AKVjKC3u9hk&t=107s  Food Allergy Occurs when the immune system reacts to a substance (allergens) that is usually harmless, because the immune system mistakenly assumes it is harmful. Sensitization: exposure to an antigen or allergen that results in the development of hypersensitivity. time with 15-Sep-24 ofallergensothat it can toterateit 13 bodytosmallamounts desensitizationexpose thereforedoesnt become allergenic sensetizing  Food Allergy Young infants are more susceptible to food allergic reactions, because: -Immunological immaturity -Immaturity of the goto proteins can escape blood directly gastrointestinal tract. - Immense quantities of ingested proteins. 14  Food Allergy has a good response in the body Newborns lack IgA and IgM in exocrine secretions, and salivary secretory IgA is absent at birth and remains low during the early months of life. In genetically predisposed infants, these antigens may stimulate excessive production of IgE antibodies or other abnormal immune responses. 15 © Miqdady, M.D.  Food Allergy IgE-mediated mechanisms are the most well characterized forms of hypersensitivity response, usually occurs immediately or within 2 hours, they can be life threatening. Allergen with IgE (specific) attaches to a mast cell, causing the release of different chemical mediators (histamine, serotonin, kinins, etc) https://www.youtube.com/watch?v=-xhGwLGnYKY 16 takenotesfromdania  IgE-Mediated Anaphylaxis Rapid onset, can be fatal Food allergy is #1 cause of anaphylaxis in emergency department Commonly implicated foods: Peanut, tree nut, seafood In young children: cow’s milk and egg Milder reactions Hives (urticaria), swelling Oral allergy syndrome (OAS)/ Pollen Food Syndrome foodalone pollenalone nothing togetherallergy Oral Immunotherapy: also known as oral desensitization Can promote tolerance by gradually introducing small volumes of baked milk or egg  Oral allergy syndrome/ Pollen Food Syndrome Oral allergy syndrome, is caused by cross-reacting allergens found in both pollen and raw fruits, vegetables, or some tree nuts. The immune system recognizes the pollen and similar proteins in the food and directs an allergic response to it.  Unlike simple food Hypersensitivity reaction allergy, OAS requires to plant-based foods, prior sensitization to a manifesting most cross-reacting inhalant commonly with pruritus allergen rather than (itching) of the lips, direct sensitization to a tongue, and mouth. specific food protein. Diagnosis of IgE FA  Earlyallergen introductioncan LEAP benefit baby Beforetheyused to sayafterIyronly Learning Early About Peanut Allergy (LEAP) study transformed the guidance that pediatricians and allergists/immunologists give to parents about when to introduce peanut foods to children at high risk for food allergies. After4 6MO Early consumption of peanut resulted in a 70-80% relative risk reduction of peanut allergy. This lead to recommendations by an expert panel to encourage early introduction of peanut in infants at moderate risk of developing peanut allergy.  The potential for prevention of other food allergens via early life exposure is less clear. There may be some evidence that early egg introduction prevents egg allergy, but to date there are no current recommendations or guidelines for purposeful early introduction of egg in infancy. Data on milk is limited, but does suggest that delaying introduction may be associated with higher risk of milk allergy. Consequences of FA non IGE mediated allergies  mainly in 87h Cell-Mediated Allergic Proctocolitis Symptoms: blood in stool during infancy Usually occurs in first weeks/months of life In response to milk and/or soy proteins in infant formula or passed through breastmilk Treatment: Maternal diet: restrict cow’s milk Amino Acid based formula  smallintestine Food Protein-Induced Enterocolitis Syndrome (FPIES) < 12 months of age at initial diagnosis Profuse repetitive vomiting, 1–3 hours after ingestion of offending food Diarrhea, 2–10 hours after ingestion ACUTE: Dehydration  lethargy  shock FOODS IMPLICATED: MILK, SOY, RICE but any food can cause a reaction except fruits cuz it doesnt have protein In 60–90% of affected children, FPIES is outgrown in the first 5 years of life, but in some cases can persist into adolescent and adult years. https://www.youtube.com/watch?v=uEnvlDJ1_Sg  eosinophils esophagus Eosinophilic Esophagitis (EoE) Symptoms are patient dependent and can differ based on age organic Infants and Toddlers: FTT, reflux, irritability, vomiting School age: abdominal pain, reflux Adolescents/Adults: Dysphagia and food foodaccumulateabove eachother impaction, reflux Treatment options: Swallowed topical steroid Dietary antigen elimination continuous inflamation can turn to cancer  Food Allergy Management cesein protein Strict Avoidance itdairydoesnt yep haveceseinits okaytoeat The top 8: dairy, egg, wheat, soy, nuts, peanut, fish, shell fish To espeggwhitecuzof albumin Cross-Contact Cross-contact occurs when an allergen- containing food comes in contact with a “safe” food, such as Latex with Cross reactivity with: banana, avocado, kiwi, peach, nectarine, fig, melon, potato, grape, cherry, tomato, celery, carrots, apple, and pear. Latix withsafefoods Memorize them well very  Education Label reading, food preparation, school Clinical Reaction History The medical history is useful in diagnosing food allergy in acute events (e.g., systemic anaphylaxis following the ingestion of peanuts).  the formdepende on the baby's condition both considered as hypoallergenicforms  YlthaigtestvesYstemto Tying.tl state almost plateau Proiseasy flags TAG should be in hospital in eachstep the amount of milk Slightly results are nonsignificant Summary  Food Allergy: Rx Children foods to be avoided Milk milk, dried milk solids, whey, casein, lactalbumin, casein, caseinate, cheese, butter, or curds. Eggs albumin, egg yolk, mayonnaise, egg solids, avidin, globulin, ovo-something 15-Sep-24 50  Food Allergy: Rx Children Peanuts peanut oil or flour, high protein food, plant (vegetable) protein, mixed nuts Soy soy-something, soybean-something, plant (vegetable) protein 15-Sep-24 51  Food Allergy: Rx Children Wheat mightIntaminant cuz protein some flour, cereal, gluten, bread, bulgar, ? starch 15-Sep-24 52 Other Allergens: To EAT or To AVOID? CORN ALLERGY? > corn syrup, corn oil, HFCS? EAT SOY ALLERGY > soybean oil, soy lecithin? EAT PEANUT ALLERGY? > peanut oil? EAT SESAME ALLERGY? > Sesame oil? AVOID TREE NUT ALLERGY? > Nut derived oils? AVOID TREE NUT ALLERGY? > Coconut? EAT Food Allergy Management The registered dietitian plays a critical role in food allergy management, providing education on food avoidance, suggesting alternatives to the avoided foods, providing recipes and meal plans where necessary, evaluating compliance, and ensuring adequacy and enjoyment of the diet.  Label Reading Food Allergen Labeling and Consumer Protection Act (FALCPA) Products containing one of the “TOP 8” food allergens must use disclose the allergen, using its “common name” Ex: Albumin = Egg, Casein = Milk Allergen must be disclosed even if it is a MINOR ingredient (Public Law 108-282, Title II)  Nutritional Consequences of Food Allergy Macronutrient deficiency Protein - energy Micronutrient deficiency Calcium, vitamin D (diary) B vitamins (wheat)  Food Allergy: Rx Pitfalls Sharing utensils in preparing food Manufacturing 2 different foods using the same equipment ( same machine used to make almond and peanut butter) ( same oil used to fry potato and fish) Inaccurate labeling: emulsifier instead of egg white Not listed because it is low % One product is used to make a second product, listed as mayonnaise not egg 15-Sep-24 59  Food Allergy: Rx Parents and caregivers of children with IgE-mediated food allergies should be instructed in the care of allergic Rx in case of accidental ingestions & they should have injectable epinephrine (EpiPen) available at all times. 15-Sep-24 60  Food Allergy: Rx Implementation of strict allergen avoidance leads to development of clinical tolerance. Virtually all young infants experiencing diarrhea in response to cow's milk (or soy protein) lose their sensitivity in 1 to 3 years. After 1 year of antigen avoidance, one-third of patients lose their immediate hypersensitivity Rx. 15-Sep-24 61  Food Allergy: Rx Infants lose their food sensitivity more consistently than older children. Most children (about 85%) lose their sensitivity to most allergenic foods (egg, milk, wheat, soya) within the first 3-5 years of life food-specific IgE concentrations generally fall with tolerance. Even children with multiple, severe allergies usually achieve tolerance however adults with food allergy can have long-lived sensitivity https://www.youtube.com/watch?v=_jX99_R2TXg 15-Sep-24 62  In contrast to egg, milk, wheat, soya allergy, adults with food allergy may have long-lived sensitivity. Sensitivity to peanut, tree nuts, and seafood is rarely lost. The concept that peanut and tree nut allergy is permanent derives partly from the observation that it is an allergy that affects adults; However, it has become apparent that about 20% of peanut-allergic children under age 2 years, and about 9% of those with tree nut allergy, may achieve tolerance by school age. What is tolerance?  Food Allergy: Rx Food challenge After resolution of symptoms One food at a time Careful observation Start with small amount(1/10) inc. slowly Most reactions within 2 hr, non IgE may be >24hr. https://www.youtube.com/watch?v=9p VNFWi0XvU&t=124s 15-Sep-24 64  Food Allergy: Rx Infants who are < 2 yr and experience mild reactions may be rechallenged every 4-6 mo to ascertain whether symptoms persist. Older patients may be rechallenged every 1-2 yrs (depending on how difficult to avoid the food in question). Sensitivity to certain kinds of food antigen can be life long (e.g., peanuts, tree nuts, and seafood) rechallenging should be undertaken no sooner than every 5 yrs. 15-Sep-24 65  Food Allergy: Rx In certain disorders, such as celiac disease or dermatitis, restricted diets should be continued indefinitely. Clinical reactivity to a food appears to be highly specific, and rarely are children sensitive to more than one or two foods. 15-Sep-24 66  Babies at high risk for Introduce allergenic foods peanut allergy should be such as peanut starting as introduced to peanut early as 4-6 months of age. starting between 4-6 months of age. All babies should be There is no conclusive introduced to peanut evidence that breastfeeding starting in their first year of alone can prevent food life, regardless of food allergies, but breastfeeding allergy risk may help prevent eczema.  she skipped this said its repeated no conclusions can be made about the role of any duration of breastfeeding in either preventing or delaying the onset of specific food allergies. However, there is evidence that exclusive breastfeeding for the first 3 to 4 months decreases the cumulative incidence of eczema in the first 2 years of life. "There is lack of evidence that partially or extensively hydrolyzed formula prevents atopic disease in infants and children, even in those at high risk for allergic disease."  There is a difference between food allergy and intolerances We should perform the appropriate food allergy management, after critical diagnosis, doing oral food challenges, and food allergen Take avoidance. home We should take care of the nutritional risks associated with removing common allergens messages from the diet. We should introduce peanut in infants at risk of peanut allergy.